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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/23/14

Breast Cancer Screenings

​To: Enrolled Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Centers, Encounter Rate Clinics and Local Health Departments​
Date: October 23, 2014
​Re: Breast Cancer Screenings​

October is National Breast Cancer Awareness Month and Illinois Department of Healthcare and Family Services (HFS) would like to remind providers about covered clinical services and coverage of annual screening mammograms. Early detection is the key to cure or long term survival, thus it is important that all clients have timely access to services.

Clients should be educated about breast self awareness; practitioners should provide interval clinical breast exams; screening mammograms should be accessible and routinely offered; and high risk clients should be offered BRCA1/BRCA2 genetic testing and counseling.

HFS is aware that national professional organizations and societies are not at consensus regarding mammography screening recommendation intervals. Be advised, however, HFS will continue to pay for a baseline screening mammogram done between the patient’s 35th and 40th birthday, and annually thereafter as per current Illinois Insurance Code (215 ILCS 5/356g) and the Public Aid Code (305 ILCS 5/5-5). Providers are advised to use their professional judgment based on each patient’s individual history consistent with National Standards and state payment codes.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs