December 14, 2017

New York Secures Breast Tomosynthesis Coverage

New York Gov. Andrew Cuomo signed AB 5677 into law on Nov. 29 mandating certain health insurance policies cover breast tomosynthesis.

The law goes into effect on January 28, 2018, 60 days after Cuomo’s approval. At that point, every health insurance policy that provides coverage in New York State for hospital, surgical or medical care shall provide the following coverage for mammography screening for occult breast cancer:

“(i) upon the recommendation of a physician, a mammogram, which may be provided by breast tomosynthesis, at any age for covered persons having a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram, which may be provided by breast tomosynthesis, for covered persons aged thirty-five through thirty-nine, inclusive; and
(iii) an annual mammogram, which may be provided by breast tomosynthesis, for covered persons aged forty and older.”

Mammography screening is defined as an X-ray examination of the breast using dedicated equipment, including X-ray tube, filter, compression device, screens, films and cassettes, with an average glandular radiation dose less than 0.5 rem per view per breast, provided that mammography screening shall also include breast tomosynthesis.