BlueCross BlueShield of Tennessee Medical Policy Manual

Magnetic Resonance Imaging (MRI) of the Breast

DESCRIPTION

Magnetic resonance imaging (MRI) is a non-invasive test using a multiplanar imaging method based on an interaction between radiofrequency (RF) electromagnetic fields and certain nuclei in the body (usually hydrogen nuclei) after the body has been placed in a strong magnetic field. The magnetic resonance (MR) scanners and intravenous magnetic resonance contrast agents are used to create detailed pictures of areas inside the body.

These images are intended to differentiate between normal and diseased tissue. MRI of the breast has been investigated as a screening tool in specific higher risk subgroups of individuals. Specialized breast coils are used during the imaging of the breast. MRI of the breast may be performed bilaterally or unilaterally. MRI of the breast is not meant to replace mammography, percutaneous biopsy or ultrasound in the screening for breast cancer in the general population.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

High Risk Individuals are defined as individuals with a 20% or greater lifetime risk of developing breast cancer.  The modified Gail model risk assessment is accessible at http://www.cancer.gov/bcrisktool/.

BI-RADS™ Categories:

SOURCES

American College of Obstetricians and Gynecologists. (2015). Committee Opinion. Management of women with dense breasts diagnosed by mammography. Retrieved July 18, 2018 from https://www.acog.org.

American College of Radiology. (2017). ACR appropriateness criteria. Breast cancer screening. Retrieved July 18, 2018 from https://acsearch.acr.org/list.

eviCore healthcare. (2018, May). Breast imaging policy. Retrieved July 18, 2018 from www.evicore.com. (38 articles and/or guidelines reviewed)

eviCore healthcare. (2018, May). Oncology imaging policy. Breast cancer. Retrieved July 18, 2018 from www.evicore.com. (9 articles and/or guidelines reviewed)

Moy, L., Elias, K., Patel, V., Lee, J., Babb, J., Toth, H., & Mercado, C. (2009). Is breast MRI helpful in the evaluation of inconclusive mammographic findings? American Journal of Roentgenology, 193 (4), 986-993.

National Comprehensive Cancer Network. (2018, July). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/familial high-risk assessment: breast and ovarian. Version 1.2019. Retrieved July 18, 2018 from the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2018, March). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast Cancer, Version 1.2018. Retrieved July 18, 2018 from the National Comprehensive Cancer Network.

Peters, N.H., Borel Rinkes, I.H., Zuithoff, N.P., Mali, W.P., Moons, K.G., & Peeters, P.H. (2008). Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology, 246 (1), 116-124. Abstract retrieved July 18, 2018 from PubMed database.

U.S. Preventive Services Task Force. (2016). Breast cancer: screening. Retrieved July 18, 2018 from https://www.uspreventiveservicestaskforce.org.

ORIGINAL EFFECTIVE DATE:  8/1/2001

MOST RECENT REVIEW DATE:  5/31/2019  

ID_EC

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.