§ 58-51-57. Coverage for mammograms and cervical cancer screening. - North Carolina Statutes

§ 58‑51‑57. Coverage for mammograms and cervical cancer screening.

(a)        Every policy orcontract of accident or health insurance, and every preferred provider benefitplan under G.S. 58‑50‑56, that is issued, renewed, or amended on orafter January 1, 1992, shall provide coverage for examinations and laboratorytests for the screening for the early detection of cervical cancer and for low‑dosescreening mammography. The same deductibles, coinsurance, and other limitationsas apply to similar services covered under the policy, contract, or plan shallapply to coverage for examinations and laboratory tests for the screening forthe early detection of cervical cancer and low‑dose screeningmammography.

(a1)      As used in thissection, "examinations and laboratory tests for the screening for theearly detection of cervical cancer" means conventional PAP smearscreening, liquid‑based cytology, and human papilloma virus (HPV)detection methods for women with equivocal findings on cervical cytologicanalysis that are subject to the approval of and have been approved by theUnited States Food and Drug Administration.

(b)        As used in thissection, "low‑dose screening mammography" means a radiologicprocedure for the early detection of breast cancer provided to an asymptomaticwoman using equipment dedicated specifically for mammography, including aphysician's interpretation of the results of the procedure.

(c)        Coverage for low‑dosescreening mammography shall be provided as follows:

(1)        One or moremammograms a year, as recommended by a physician, for any woman who is at riskfor breast cancer. For purposes of this subdivision, a woman is at risk forbreast cancer if any one or more of the following is true:

a.         The woman has apersonal history of breast cancer;

b.         The woman has apersonal history of biopsy‑proven benign breast disease;

c.         The woman's mother,sister, or daughter has or has had breast cancer; or

d.         The woman has notgiven birth prior to the age of 30;

(2)        One baselinemammogram for any woman 35 through 39 years of age, inclusive;

(3)        A mammogram everyother year for any woman 40 through 49 years of age, inclusive, or morefrequently upon recommendation of a physician; and

(4)        A mammogram everyyear for any woman 50 years of age or older.

(d)        Reimbursement for amammogram authorized under this section shall be made only if the facility inwhich the mammogram was performed meets mammography accreditation standardsestablished by the North Carolina Medical Care Commission.

(e)        Coverage for thescreening for the early detection of cervical cancer shall be in accordancewith the most recently published American Cancer Society guidelines orguidelines adopted by the North Carolina Advisory Committee on CancerCoordination and Control. Coverage shall include the examination, thelaboratory fee, and the physician's interpretation of the laboratory results.Reimbursements for laboratory fees shall be made only if the laboratory meetsaccreditation standards adopted by the North Carolina Medical Care Commission. (1991, c. 490, s. 1; 1997‑519,s. 3.3; 2003‑186, s. 2.)