§ 58-67-76. Coverage for mammograms and cervical cancer screening. - North Carolina Statutes

§ 58‑67‑76. Coverage for mammograms and cervical cancer screening.

(a)        Every health careplan written by a health maintenance organization and in force, issued,renewed, or amended on or after January 1, 1992, that is subject to thisArticle, shall provide coverage for examinations and laboratory tests for thescreening 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 plan shall apply to coverage forexaminations and laboratory tests for the screening for the early detection ofcervical cancer and low‑dose screening mammography.

(a1)      As used in thissection, "examinations and laboratory tests for the screening for the earlydetection of cervical cancer" means conventional PAP smear screening,liquid‑based cytology, and human papilloma virus (HPV) detection methodsfor women with equivocal findings on cervical cytologic analysis that aresubject to the approval of and have been approved by the United States Food andDrug 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 isdetermined to be at risk for breast cancer. For purposes of this subdivision, awoman is at risk for breast 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, the laboratoryfee, 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. 3; 2003‑186,s. 4.)