Currently diagnostic mammogram 77066 and screening mammogram 77067 do not require a Prior Authorization (PA), however 77067 does have an age requirement (PA required for ages < 40 years old). Effective April 15, 2019 the age requirement will change for screening mammogram 77067. No PA will be required for ages 35 and older.
In addition, the PA requirement for G0279 Diagnostic digital breast tomosynthesis is changing. It will no longer require a PA effective April 15, 2019. It continues to not be a covered service for Medicaid per Diagnostic Guideline D6 and Guideline Note 173 of the OHP Prioritized List of Health Services.
Please call PacificSource with any questions regarding this notice.