Screening Mammography Coverage Update (IB 24-18)

Date: 06/06/24

Louisiana Healthcare Connections is sharing with providers an update to screening mammography coverage (IB 24-18).

Effective June 1, 2024, Louisiana Medicaid made revisions to the coverage of screening mammograms (CPT 77063 and 77067). Coverage is being extended to include beneficiaries age 30-39. The Medicaid Professional Services Provider Manual has been updated to reflect this change, and the fee-for-service (FFS) fee schedule will be updated on the Louisiana Medicaid website, https://www.lamedicaid.com.

Louisiana Medicaid allows payment for one screening mammogram (either film or digital) per calendar year for beneficiaries meeting one or more of the following criteria:

• Any woman age 30 or older with hereditary susceptibility from pathogenic mutation carrier status or prior chest wall radiation.
• Provider recommendation for any woman 35 years of age or older with a predicted lifetime risk greater than 20 percent.
• Any woman who is 35 through 39 years of age. Please note: Only one baseline mammogram is allowable between this age range for beneficiaries not meeting other criteria.
• Any woman who is 40 years of age or older.

Questions regarding this message and FFS claims are to be directed to Gainwell Technologies at  1-800- 473-2783 or 225-924-5040.

Providers with questions regarding claims can contact their Provider Representative or call Provider Services at 1-866-595-8133.