Coverage Policies

Use the index below to search for coverage information on specific medical conditions.

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

High-Tech Imaging: High-Tech Imaging services are administered by National Imaging Associates, Inc. (NIA). For coverage information and authorizations, click here.

Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 04/17/2002 Title: Fiberoptic Ductoscopy
Revision Date: 03/21/2005 Document: BI098:00
CPT Code(s): None
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

Fiberoptic Ductoscopy, a procedure to allow a physician to view the inside of the ducts of the female breast, is not covered. There is, as yet, inadequate evidence to establish this procedure as a valuable, established step in the diagnosis and/or treatment of breast cancer.

Medical Statement

Fiberoptic ductoscopy is considered experimental and investigational and is not eligible for coverage.  [These procedures will be denied as a contract exclusion as experimental and investigational.]


Background

Fiberoptic ductoscopy (with the Acueity System [Acueity, Inc., Larkspur, CA]) is used for the detection, diagnosis, and treatment of breast cancer by enabling physicians to look through the nipple directly into the milk ducts where most cancers develop.    

 

The safety and effectiveness of the Acuity System for the detection, diagnosis and treatment of breast cancer has not been demonstrated by the publication of randomized well-controlled studies in the medical literature.  Fiberoptic ductoscopy is considered experimental and investigational.


Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.