For preventive care and services ordered as part of the exam to be covered as preventive, they must be coded by the provider as routine — without indication of injury or illness.
One per calendar year is covered as preventive. Additional screenings beyond one (1) per calendar year are covered as diagnostic unless otherwise specified.
The cancer screening benefit includes, but is not limited to:
*Additional mammograms are covered, if ordered by a provider, for any woman with a history of breast cancer or whose mother or sister has a prior history of breast cancer.
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