Criteria
Coverage is subject to the specific terms of the member's benefit plan.
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 lavage for 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 Code
