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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 thirty-nine (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 ($50)
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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