The Women’s Preventive Services Guidelines have been updated to expand access to breast cancer screening and related services. The NYCDCC Welfare Fund provides preventive breast cancer screening through Independence Blue Cross (IBX).
The Fund’s coverage includes:
- Annual screening mammograms beginning at age 35.
- For women at average risk, annual mammography screening beginning no later than age 40 and continuing through at least age 74.
- When medically appropriate to complete the screening process, additional imaging—such as an ultrasound, magnetic resonance imaging (MRI), or additional mammography—and related pathology evaluations.
Qualifying preventive screening services are covered without member cost sharing when obtained from a participating provider and billed using the appropriate preventive diagnosis and procedure codes.
Cost sharing may apply when services are received from a non-participating provider, billed as diagnostic rather than preventive, exceed applicable frequency limits, or involve follow-up testing or treatment that does not qualify as preventive care.
Members should speak with their healthcare provider about the screening schedule appropriate for them based on their age, health history and individual risk factors. Before receiving services, members may also contact IBX at 1-833-242-3330 to confirm coverage and provider participation.
