304.17-316 Coverage for mammograms.
(1)
(2)
(3)
(4)
The term "mammogram" shall mean an x-ray examination of the breast using
equipment dedicated specifically for mammography, including, but not limited to,
the x-ray tube, filter, compression device, screens, film, and cassettes, with two (2)
views of each breast and with an average radiation exposure at the current
recommended level as set forth in guidelines of the American College of Radiology.
(a) All insurers issuing individual health insurance policies in this
Commonwealth that provide coverage on an expense-incurred basis for
surgical services for a mastectomy and that are delivered, issued for delivery,
amended, or renewed on or after October 15, 1990, shall also provide
coverage for low-dose mammography screening for persons who have no sign
or symptom of breast cancer and when performed on dedicated equipment
which meets the guidelines established by the American College of Radiology
and upon self-referral or on referral by a health care practitioner acting within
the scope of the practitioner's licensure. The coverage shall make available
one (1) screening mammogram to persons age thirty-five (35) through thirtynine (39); one (1) mammogram every two (2) years for persons ages forty (40)
through forty-nine (49); and one (1) mammogram per year for a person fifty
(50) years of age and over and may be limited to a benefit of fifty dollars ()
per screening mammogram. Any deductibles and coinsurance factors shall be
no less favorable than for coverage for physical illness generally.
(b) All insurers issuing individual health insurance policies in this
Commonwealth that provide coverage on an expense-incurred basis for
surgical services for a mastectomy and that are delivered, issued for delivery,
amended, or renewed on or after July 14, 2000, shall also provide coverage for
mammograms, performed on dedicated equipment that meets the guidelines
established by the American College of Radiology, for any covered person,
regardless of age, who has been diagnosed with breast disease upon referral by
a health care practitioner acting within the scope of the practitioner's licensure.
The coverage provided under this paragraph shall be subject to the same
annual deductibles or coinsurance established for other coverages within the
policy.
The mammogram shall be performed by a Kentucky State Certified General
Certificate Radiographer or an American Registry of Radiologic Technology
Registered Radiographer, interpreted by a qualified radiologist, and performed
under the direction of a person licensed to practice medicine and certified by the
American Board of Radiology. Two (2) copies of the mammogram report shall be
sent to the health care practitioner who ordered it, one (1) copy of which shall be
given to the patient. In case of self-referral, one (1) copy of the mammogram report
shall be given to the patient upon request. The mammography film shall be retained
by the facility performing the examination in accordance with guidelines of the
American College of Radiology.
Effective July 15, 1990, any facility in which mammograms are performed for
reimbursement under this section, KRS 304.18-098, 304.32-1591, or 304.38-1935
shall meet current criteria of the American College of Radiology Mammography
Accreditation Program.
Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 18, sec. 1, effective July 14, 2000. -- Created
1990 Ky. Acts ch. 46, sec. 1, effective July 13, 1990.
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