§ 23-79-140 - Mammograms. - Arkansas Statutes

23-79-140. Mammograms.

(a) (1) "Mammography" means radiography of the breast.

(2) "Screening mammography" is a radiologic procedure provided to a woman, who has no signs or symptoms of breast cancer, for the purpose of early detection of breast cancer. The procedure entails two (2) views of each breast and includes a physician's interpretation of the results of the procedure.

(3) "Diagnostic mammography" is a problem-solving radiologic procedure of higher intensity than screening mammography provided to women who are suspected to have breast pathology. Patients are usually referred for analysis of palpable abnormalities or for further evaluation of mammographically detected abnormalities. All images are immediately reviewed by the physician interpreting the study, and additional views are obtained as needed. A physical examination of the breast by the interpreting physician to correlate the radiologic findings is often performed as part of the study.

(b) Every accident and health insurance company, hospital service corporation, health maintenance organization, or other accident and health insurance provider in the State of Arkansas shall offer, after January 1, 1990, to each master group contract holder as an optional benefit, coverage for at least the following mammogram screening of occult breast cancer:

(1) A baseline mammogram for a woman covered by such a policy who is thirty-five (35) to forty (40) years of age;

(2) A mammogram for a woman covered by such a policy who is forty (40) to forty-nine (49) years of age, inclusive, every one (1) to two (2) years based on the recommendation of the woman's physician;

(3) A mammogram each year for a woman covered by such a policy who is at least fifty (50) years of age;

(4) Upon recommendation of a woman's physician, without regard to age, when the woman has had a prior history of breast cancer or when the woman's mother or sister has had a history of breast cancer; and

(5) Insurance coverage for screening mammograms will not prejudice coverage for diagnostic mammograms as recommended by the woman's physician.

(c) (1) The insurers shall pay not less than fifty dollars ($50.00) for each screening mammogram, which shall include payment for both the professional and technical components.

(2) In case of hospital out-patient screening mammography, and comparable situations, when there is a claim for professional sevices separate from the claim for technical services, the claim for the professional component will not be less than forty percent (40%) of the total fee.

(d) Furthermore, no insurer shall pay for mammographies performed in an unaccredited facility after January 1, 1990.