Criteria
Breast Ductal Lavage
Breast ductal lavage may be considered medically necessary when non-lactational nipple discharge is too low to permit adequate cytological analysis.:
Breast ductal lavage in combination with ductoscopy for the evaluation of women with ipsilateral breast cancer is considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Breast ductal lavagefor the purpose of breast cancer screening, breast cancer risk-assessment and for all other indications is considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Fiberoptic Ductoscopy
Fiberoptic ductoscopy may be considered medically necessary:
- When combined with cytology testing for diagnosing intra-ductal lesions in women with non-lactational sporadic nipple discharge accompanied by documented positive cytology,or
- As a guide for resection of known breast intra ductal cancer.
Fiberoptic ductoscopy is considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature when used for breast cancer screening and all other indications.
Procedure Codes
