CommercialAdministrativeMedium impact
HEDIS Measure: Breast Cancer Screening (BCS)
Blue Cross Blue Shield of Rhode Island·RI · Radiology, OB-GYN, Family Medicine +1 more·Physician
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
BCBS Rhode Island has issued updated guidance on HEDIS Breast Cancer Screening measures for women ages 50-74, specifying acceptable mammography CPT and HCPCS codes and exclusion criteria for bilateral mastectomy patients. This appears to be quality reporting guidance rather than a billing policy change.
Action Required
Immediately: Review current mammography billing practices to ensure use of approved CPT codes (77055-77067) and HCPCS codes (G0202, G0204, G0206) for women ages 50-74. Verify billing system correctly excludes patients with bilateral mastectomy history (ICD-10 Z90.13) from breast cancer screening quality measures. Quality reporting team should update HEDIS measure tracking systems.