Mammography
Breast cancer screening and diagnostic evaluation — standard of care for women 40 and older.
What Does Mammography Show?
Screening mammography looks for early breast cancer before symptoms develop, detecting calcifications, masses, architectural distortion, and asymmetries. Diagnostic mammography is ordered for a specific clinical concern (palpable lump, nipple discharge, prior abnormal screening), allowing targeted additional views. 3D mammography (tomosynthesis) improves detection in dense breast tissue.
About Mammography
Mammography uses low-dose X-rays to image breast tissue, compressing the breast to improve image quality and reduce radiation dose. Digital mammography captures images electronically. 3D mammography (digital breast tomosynthesis, DBT) acquires images from multiple angles and reconstructs cross-sectional slices — significantly improving cancer detection in dense breast tissue by reducing the tissue overlap that conceals findings on 2D imaging.
When to Use Mammography — and When Not To
Choosing the right modality is one of the most impactful parts of the prior authorization process. Payers are more likely to approve a study when the chosen modality is clearly the most appropriate tool for the clinical question.
✓ Mammography is the right choice when…
- Breast cancer screening: standard of care for average-risk women, detecting calcifications, masses, and architectural distortion before symptoms develop.
- 3D mammography (tomosynthesis): improves cancer detection rate and reduces callback rates compared to 2D in dense breast tissue.
- Calcification characterisation: mammography is uniquely sensitive to microcalcifications, which may be the only sign of early DCIS.
⚠ Consider a different modality when…
- Dense breast tissue with inconclusive mammogram: supplemental MRI or ultrasound is recommended for high-risk women.
- High-risk screening (BRCA mutation, lifetime risk >20%): annual MRI breast is added to mammography.
- Characterising a palpable lump (initial): diagnostic mammogram plus ultrasound for full evaluation.
- Implant evaluation for rupture: MRI breast is the standard.
+ Technical strengths, limitations & patient preparation
Strengths
- Standard of care for breast cancer screening
- 3D tomosynthesis improves detection in dense tissue and reduces unnecessary callbacks
- Uniquely sensitive to microcalcifications (early DCIS)
- Widely available and relatively low cost
Limitations
- Lower sensitivity in dense breast tissue — supplemental MRI or ultrasound often recommended
- Cannot reliably distinguish benign from malignant lesions without biopsy
- False positives lead to callbacks and additional workup
📋 Patient Preparation
Avoid deodorant, powder, or lotion on the chest or underarms on exam day — these can appear as artefacts. Scheduling during the first half of the menstrual cycle reduces breast tenderness.
Common Indications
Clinical scenarios in which Mammography is typically ordered:
- Annual screening — women 40+ per ACR/SBI, or 50+ per USPSTF
- Palpable breast lump — diagnostic workup
- Nipple discharge evaluation
- Abnormal screening mammogram — callback for additional views
- Short-interval follow-up for BI-RADS 3 finding
- High-risk screening (BRCA mutation, strong family history) — may include supplemental MRI
- New breast asymmetry or skin change
Contrast Protocols
When to order each protocol for Mammography:
Prior Authorization Overview
✓ Key Approval Criteria
- Screening (77067): age-appropriate, documented as screening (not diagnostic) — typically no PA needed
- Diagnostic: document specific clinical indication (palpable lump, discharge, abnormal screening)
- Short-interval follow-up: reference prior BI-RADS assessment and recommended interval
- 3D (77063): check payer coverage — some require documentation of dense breast tissue
⚠ Common Denial Pitfalls
- Billing diagnostic codes for screening studies (different patient responsibility)
- Not documenting BI-RADS result from prior screening when requesting diagnostic follow-up
- Some payers require radiologist documentation of dense breast tissue for 3D tomosynthesis coverage
Coverage by Payer
Select your payer for specific prior authorization criteria and policy details.
Aetna
General guidance available
View general guidance →Cigna (eviCore)
General guidance available
View general guidance →UnitedHealthcare
General guidance available
View general guidance →Anthem BCBS (Carelon)
General guidance available
View general guidance →Humana
General guidance available
View general guidance →Frequently Asked Questions
Related Procedures
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