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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/12/2024

 

To: All Medical Assistance Program Providers
​Date November 12, 2024
​Re:
 Confirmation of Coverage for Molecular Breast Imaging (MBI) and Magnetic Resonance Imaging per Public Act 103-0808

This notice confirms the Department of Healthcare and Family Services’ (HFS) coverage for molecular breast imaging (MBI) and magnetic resonance imaging (MRI). This coverage is required under Public Act 103-0808 and applies to the Medicaid fee-for-service program and managed care organizations (MCOs).

In accordance with the Act, HFS must ensure coverage for MBI and MRI of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue or when medically necessary as determined by a physician licensed to practice medicine in all of its branches, advanced practice registered nurse, or physician assistant.

HFS currently covers mammograms, MRIs, and MBIs as medically necessary. No coverage changes are necessary.

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

 

Kelly Cunningham, Administrator
Division of Medical Programs