Coding of Screening Mammograms

VERMONT State of Vermont Department of Financial Regulation 89 Main Street Montpelier, VT 05620-3101 For consumer assistance: [Banking] 888-568-4547 [Insurance] 800-964-1784 [Securities] 877-550-3907 www.dfr.vermont.gov ## Vermont Department of Financial Regulation Division of Insurance Insurance Bulletin No.195 Coding of Screening Mammograms It has been brought to the Department's attention that a small number of callback Screening mammograms have been coded so as to result in a financial obligation for insureds. 8 V.S.A. § 4100a requires that: - (a) Insurers shall provide coverage for screening by mammography for the presence of occult breast cancer, as provided by this subchapter. Benefits provided shall cover the full cost of the mammography service and shall not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement or additional charge. - (d)(3) "Screening" includes the mammography test procedure and a qualified physician's interpretation of the results of the procedure, including additional views and interpretation as needed. The Department understands that insurers are working with their contracted providers to assure compliance with this requirement. The Department encourages such communication and cooperation. The collaborative efforts promote required compliance, which will help produce better health outcomes, and provide efficiencies for insurers and their contracted providers in meeting the statutory requirement. Dated: 10/4/17 Michael Pieciak Michael Pieciak, Commissioner  Banking 802-828-3307 Insurance 802-828-3301 Captive Insurance 802-828-3304 Securities 802-828-3420