CDP: EWC Mammography Policy Clarification

Cancer Detection Programs: Every Woman Counts (CDP: EWC) providers are reminded that the mammography policy stated in Medi-Cal Updates also applies to CDP: EWC and that reimbursement of mammograms is restricted to recipients 40 years of age and older.

More than one screening mammogram (CPT-4 code 76092) performed by the same provider on the same woman within 365 days will not be reimbursed. In addition, all diagnostic mammograms (CPT-4 codes 76090 and 76091) require an ICD-9-CM code for reimbursement. For complete policy information, see the April 2007 Medi-Cal Update.

Because CDP: EWC claims are processed by Medi-Cal, the program must follow Medi-Cal policy for CPT-4 code reimbursement. Therefore, all mammography reimbursement policy stated in Medi-Cal Updates also applies to CDP: EWC with the exception of digital mammography which is not a covered benefit of CDP: EWC.