CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Scintimammography and Gamma Imaging of the Breast and Axilla

Defines coverage stance for scintimammography, breast-specific gamma imaging (BSGI) and molecular breast imaging (MBI) for Blue Cross Blue Shield - Rhode Island members; distinguishes use for sentinel lymph node localization which is governed under a separate High-Tech Radiology policy.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyScintimammography and Gamma Imaging of the Breast and Axilla

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2019

Next Review Date

Key ActionVerify member-specific benefits and authorization rules with the provider call center or benefit booklet before ordering scintimammography/BSGI/MBI.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredCoverage stance

S8080Not-covered code

40 minImaging time

<15 mmSensitivity limit

2022-11-16Last review

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage criteria — scintimammography, BSGI, MBI

Not covered / Not medically necessary

Medicare Advantage Plans: Scintimammography, BSGI, and MBI are considered not covered in all applications (including adjunct to mammography or staging axillary lymph nodes) because evidence is insufficient to determine effects on health outcomes.

[[chunk 4]]

Commercial Products: Scintimammography, BSGI, and MBI are considered not medically necessary in all applications (including adjunct to mammography or staging axillary lymph nodes) because evidence is insufficient to determine effects on health outcomes.

[[chunk 5]]

This policy applies specifically to scintimammography, including Breast-Specific Gamma Imaging (BSGI) and Molecular Breast Imaging (MBI). It does not govern gamma detection following radiopharmaceutical administration for sentinel lymph node localization in patients with breast cancer; that use is addressed under the High-Tech Radiology policy.

This medical policy is provided for informational purposes and is not a guarantee of payment. Member benefits and eligibility are determined by the member's subscriber agreement, member certificate, or employer agreement, which supersede the provisions of this policy. For member-specific benefit information, contact the provider call center.

Use of scintimammography, BSGI, and MBI as an adjunct to mammography or for staging of the axillary lymph nodes is not covered for Medicare Advantage plans and not medically necessary for Commercial products. CPT/HCPCS code S8080 is explicitly listed as not covered / not medically necessary for these applications.

Indications considered (covered) — when imaging may be appropriate

Evaluation of indeterminate or suspicious breast lesions

Covered when the following diagnostic-context statement applies:

Diagnostic accuracy context: For individuals with indeterminate or suspicious breast lesions, diagnostic accuracy studies of scintimammography, BSGI, or MBI report negative predictive values ranging approximately 83%–94%; given biopsy is the criterion standard and the potential consequences of missed cancer, current evidence is insufficient to support replacing or routinely augmenting biopsy or diagnostic mammography with these modalities.

[[chunk 8]]

Not covered / not medically necessary applications

Scintimammography, Breast-Specific Gamma Imaging (BSGI), and Molecular Breast Imaging (MBI) are not covered / not medically necessary in all applications, including but not limited to use as an adjunct to mammography or for staging the axillary lymph nodes. The policy explicitly lists CPT/HCPCS S8080 as not covered / not medically necessary.

Coding — covered and not-covered procedure codes

Not covered / Not medically necessary CPT/HCPCS codesHCPCSNot Covered

S8080

Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical

Actions for providers — authorization, benefit verification, and denial risk

Prior Authorization

Not applicable

Denial Risk

Coverage — Medicare Advantage

For Medicare Advantage plans, scintimammography, breast-specific gamma imaging (BSGI), and molecular breast imaging (MBI) are considered not covered in all applications (including as an adjunct to mammography or for staging axillary lymph nodes) because evidence is insufficient to determine health outcome effects.

Denial Risk

Coverage — Commercial Products

For Commercial products, scintimammography, BSGI, and MBI are considered not medically necessary in all applications (including as an adjunct to mammography or for staging axillary lymph nodes) because evidence is insufficient to determine health outcome effects.

Background — technical and clinical context

Scintimammography is a nuclear medicine technique that uses injected radiopharmaceuticals to image the breast. Breast-Specific Gamma Imaging (BSGI) and Molecular Breast Imaging (MBI) refer to dedicated detector systems applied to scintimammography to improve breast imaging resolution compared with conventional planar cameras. Detector technologies differ (for example, cesium iodide or sodium iodide multi-crystal arrays for BSGI versus semiconductor detectors such as cadmium zinc telluride for MBI). Conventional scintimammography has relatively limited sensitivity for lesions smaller than about 15 mm, and MBI procedures typically require approximately 40 minutes of imaging time. Sentinel lymph node localization using radiotracers is not covered by this policy and is addressed under the High-Tech Radiology policy.

Definitions and scope

Scintimammography, BSGI, MBI — definitions

ScintimammographyNuclear medicine imaging of the breast after injection of a radiopharmaceutical (commonly technetium Tc99m sestamibi) with planar or dedicated breast imaging to detect tumors.

Breast‑Specific Gamma Imaging (BSGI)Breast‑specific gamma camera acquisition with dedicated detector arrays (e.g., cesium iodide or sodium iodide multi‑crystal arrays) positioned adjacent to the breast to increase resolution compared with conventional scintimammography.

Molecular Breast Imaging (MBI)A breast‑specific gamma imaging modality using semiconductor detectors (e.g., cadmium zinc telluride) and detector configurations that improve resolution; typical MBI exams take approximately 40 minutes.

Sentinel lymph node localization — policy governance

ScopeGamma detection following radiopharmaceutical administration for localization of sentinel lymph nodes in patients with breast cancer is governed by the High‑Tech Radiology policy (not by this scintimammography policy).