(A) As used in this section, "screening mammography" means a radiologic examination utilized to detect unsuspected breast cancer at an early stage in asymptomatic women and includes the x-ray examination of the breast using equipment that is dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, film, and cassettes, and that has an average radiation exposure delivery of less than one rad mid-breast. "Screening mammography" includes two views for each breast. The term also includes the professional interpretation of the film.
"Screening mammography" does not include diagnostic mammography.
(B) The medicaid program shall cover both of the following :
(1) Screening mammography to detect the presence of breast cancer in adult women;
(2) Cytologic screening for the presence of cervical cancer.
(C) The medicaid program's coverage of screening mammography pursuant to division (B)(1) of this section shall be provided in accordance with all of the following:
(1) If a woman is at least thirty-five years of age but under forty years of age, one screening mammography;
(2) If a woman is at least forty years of age but under fifty years of age, either of the following:
(a) One screening mammography every two years;
(b) If a licensed physician has determined that the woman has risk factors to breast cancer, one screening mammography every year.
(3) If a woman is at least fifty years of age but under sixty-five years of age, one screening mammography every year.
(D) The medicaid program's coverage of screening mammographies pursuant to division (B)(1) of this section shall be provided only for screening mammographies that are performed in a facility or mobile mammography screening unit that is accredited under the American college of radiology mammography accreditation program or in a hospital as defined in section 3727.01 of the Revised Code.
(E) The medicaid program's coverage of cytologic screenings pursuant to division (B)(2) of this section shall be provided only for cytologic screenings that are processed and interpreted in a laboratory certified by the college of American pathologists or in a hospital as defined in section 3727.01 of the Revised Code.
Renumbered from § 5111.024 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Effective Date: 11-24-1995Section: Previous 5164.01 5164.02 5164.03 5164.05 5164.06 5164.07 5164.08 5164.09 5164.15 5164.20 5164.25 5164.26 5164.30 5164.301 5164.31 Next
Last modified: October 10, 2016