Breast Cancer Screening and Adjunct Imaging in Single Visit Offers Increased Convenience and Compliance

A recent study conducted by the National Cancer Institute estimates an additional 2,500 breast cancer deaths between 2020 and 2030 due to reduced screenings, delayed diagnoses, and decreased chemotherapy treatments during the COVID-19 pandemic.

Members trust you and look to you for education on what to do during this time. You can help reduce breast cancer deaths by:

• Providing the right education to our members on the risk factors of breast cancer and effectiveness of screenings
• Assessing, identifying, and evaluating potential Social Determinants of Health (SDOH) needs such as transportation needs/concerns when coordinating member care from Pre-screening, Scheduling, Screening, and Post-screening

Highmark provides the resources below to share the importance of prevention with our members and your staff. You can order printed copies to make available to members during office visits or for mailing to their homes.

• Breast Cancer Brochure
• Breast Cancer Screening Flyer (available in Spanish )
• Breast Cancer Screening Reminder Card
• Health Screening and Vaccination Tracker (available in Spanish )

You can order the resource here .

Why Scheduling In-Office Screenings Helps

Scheduling completed in your office not only ensures that the screening is scheduled, but also decreases the burden for the member in scheduling their screening. By completing the mammogram and tomosynthesis in your office, you offer the right set of circumstances to order necessary (adjunct) testing at their screening appointment. For instance, the diagnosis of dense breast tissue is common and has been often associated with an increased risk of breast cancer. Members with dense breasts may require additional imaging exams such as complete (asymptomatic) breast ultrasound². Member screening/testing compliance is elevated when convenience is at the core.

NOTE: Additional breast imaging exams may be considered diagnostic and therefore subject to individual policy benefits including deductibles, co-insurance, and/or co-pays. The clinical information provided is not intended to interfere with clinical or coding judgment.

Highmark Preventive Health Guidelines

We encourage you to consult our Preventive Health Guidelines when planning care for Highmark members. We thank you for your partnership in addressing their health care needs. To access the Preventive Health Guidelines, click here .

Please note that most, although not all, of our customer groups follow the Highmark Preventive Schedule. Therefore, not all Highmark members may have coverage for services on the preventive schedule. Additional breast imaging exams may be considered diagnostic and therefore subject to individual policy benefits including deductibles, co-insurance, and/or co-pays.

As always, we recommend verifying a member’s eligibility and benefits prior to providing services. You can verify a Highmark member’s coverage by using the Eligibility and Benefits transaction in NaviNet^®, performing an electronic HIPAA 270 Eligibility/Benefit Inquiry transaction, or by calling the Provider Service Center.

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References

1. Alagoz, O, Lowry KP, Kurian AW, et al. Impact of the COVID-19 Pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling. JNCI: Journal of the National Cancer Institute, 2021; 113(11): 1484-1494. https://doi.org/10.1093/jnci/djab097

2. Thigpen D, Kappler A, Brem R. The role of ultrasound in screening dense breasts—a review of the literature and practical solutions for implementation. Diagnostics. 2018; 8(1):20. https://doi.org/10.3390/diagnostics8010020