Scintimammography and Gamma Imaging of the Breast and Axilla
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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.
No material clinical or coverage changes in this revision.
Coverage criteria — scintimammography, BSGI, MBI
Not covered / Not medically necessary
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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:
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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
| S8080 | Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical |
Actions for providers — authorization, benefit verification, and denial risk
Prior Authorization
Not applicable
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.
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.
Verify member benefits
Benefits may vary between groups and contracts. Providers should refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage determinations.
Not covered / Not medically necessary codes
CPT S8080 (Scintimammography, radioimmunoscintigraphy of the breast, unilateral, including supply of radiopharmaceutical) is considered not covered for Medicare Advantage and not medically necessary for Commercial products when used as an adjunct to mammography or for staging the axillary lymph nodes.
- S8080 Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical
Member-specific coverage and billing liability
Benefits and eligibility are determined by the member's subscriber agreement or employer agreement and those documents supersede this policy. For member-specific benefit information and eligibility, contact the provider call center. If services are determined to be not medically necessary or are non-covered benefits, providers may not charge the member unless the member was informed and provided written agreement in advance per the participation agreement.
- Contact provider call center for member-specific benefits and eligibility
- Providers may not bill members for non-covered services except when permitted by prior written agreement
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
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