| Effective Date:08/21/2003 |
Title:Breast Duct Lavage
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| Revision Date:02/05/2014
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Document:BI002:00
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| CPT Code(s):19499
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Public Statement
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Breast duct lavage is considered investigational. QualChoice does not cover breast duct lavage as a screening tool to detect women at high risk for breast cancer. This test has not established a valid role in detection, prevention or treatment of breast cancer. Investigational and experimental treatments are not covered benefits.
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Medical Statement
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The use of
cytological examination of breast fluid alone, whether by ductal lavage, fine
needle nipple aspiration, or the noninvasive HALO Breast Pap Test system, is
considered experimental and investigational and is not covered.
A national
Cancer Institute report updated in April 2013 states that use of ductal lavage
as a screening or diagnostic tool remains investigational, because ductal lavage
screening has not been compared to mammography and there is no evidence of
efficacy or mortality reduction.
The National
Comprehensive Cancer Network guideline on breast cancer screening and diagnosis
states that current evidence does not support the routine use of ductal lavage
as a screening modality for breast cancer.
Codes Used In This BI:
19499 Unlisted procedure, breast
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Limits
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Intentially left empty
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Reference
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1.
American
Society of Breast Surgeons. Ductal cell-based risk assessment statement. May
2007.
2.
National
Cancer Institute. Breast Cancer Screening PDQ. April 2013. Accessed on 19
December 2013 at:
http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/AllPages
3.
National
Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology.
Breast cancer screening and diagnosis. V1.2013.
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Application to Products
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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.
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Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
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