88112 Insurance Policy Changes

Breast Ductal Lavage and Fiberoptic Ductoscopy (CPB 0517, reviewed 2026-08-05)

Aetna has clarified coverage for breast ductal lavage and fiberoptic ductoscopy procedures. Only specific medically necessary uses are covered: ductal lavage as an alternative to aspiration for non-lactational nipple discharge with low cellular yield, fiberoptic ductoscopy with cytology for intra-ductal lesions, and ductoscopy as a guide for known intra-ductal cancer resection. All screening, risk assessment, and other investigational uses are not covered. Billing teams must update denial protocols to reject claims for non-covered indications.