Follow-up MRI of BI-RADS 3 lesions is considered medically necessary every 6 months for up to two years.To follow up a probable benign lesion on MRI (BI-RADS 3 lesions) that was originally detected by MRI:.Phyllodes tumor (cystosarcoma phyllodes), indicated preoperatively to establish extent of disease, where diagnosis has been established by biopsy or.Screening for silent intra-capsular rupture more frequently than every 2 years is not considered medically necessary To detect intra-capsular (silent) rupture of silicone gel-filled breast implants.Have a lifetime risk of breast cancer of 20 to 25 % or more using standard risk assessment models (BRCAPRO, Claus model, Gail model, or Tyrer-Cuzick).First degree blood relative with BRCA1 or BRCA2 mutation and are untested or.Confirmed presence of BRCA1 or BRCA2 mutation (beginning age 25 years) or.Carry a genetic mutation in BARD1, RAD51C, or RAD51D (beginning at age 40) or.Carry a genetic mutation in ATM, CHEK2, or NBN (beginning at age 40) or.Carry a genetic mutation in CDH1 or NF1 (beginning at age 30) or.Carry a genetic mutation in Puetz-Jaeger syndrome (STK11/LKB1 gene variations) (beginning age 30 years) or.Carry a PALB2 mutation (beginning at age 30) or.Carry a genetic mutation in the TP53 gene (Li-Fraumeni syndrome) (screening beginning at age 20 years or age of earliest diagnosed breast cancer in the family for TP53) or.Carry or have a first-degree relative who carries a genetic mutation in PTEN gene (Cowden and Bannayan-Riley-Ruvalcaba syndromes) (screening beginning at age 30 for PTEN) or.As an adjunct to mammography for screening of women considered to be at high genetic risk of breast cancer because of any of the following (mammography must have been performed within the past year mammography not required for women under age 30 years):.Evaluation of inconclusive or conflicting findings on mammography or ultrasound that is not a discrete palpable mass.After breast conservation therapy in women who exhibit suspicious clinical or imaging findings that remain indeterminate after complete mammographic and sonographic evaluations or.Lesion characterization (nipple retraction, unilateral drainage from the nipple that is bloody or clear) when all other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer or.Adenocarcinoma in axillary lymph node without a breast primary site identified on mammogram/ultrasoundĬontralateral breast examination for members with any of the following:. ![]() Multifocal or multicentric breast cancer.To map the extent of primary tumors and identify multi-centric disease in persons with any of the following:.To localize the site of primary occult breast cancer in individuals with adenocarcinoma suggestive of breast cancer discovered as axillary node metastasis or distant metastasis without focal findings on physical examination or on mammography/ultrasonography or.To guide localization of breast lesions to perform needle biopsy when suspicious lesions exclusively detected by contrast-enhanced MRI can not be visualized with mammography or ultrasonography or.To detect the extent of residual cancer in the recently post-operative breast with positive pathological margins after incomplete lumpectomy when the member still desires breast conservation and local re-excision is planned or.To detect local tumor recurrence in individuals with breast cancer who have radiographically dense breasts or old scar tissue from previous breast surgery that compromises the ability of combined mammography and ultrasonography or.To detect suspected local tumor recurrence in members with breast cancer who have undergone mastectomy and breast reconstruction with an implant or.To detect implant rupture in symptomatic members or.To assess tumor location, size, and extent before and/or after neoadjuvant chemotherapy in persons with locally advanced breast cancer, for determination of eligibility for breast conservation therapy or. ![]()
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