CommercialCoverageMedium impact
Magnetic Resonance Imaging (MRI) of the Breast
Blue Cross & Blue Shield of Mississippi·MS · Radiology, Oncology, OB-GYN +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive new policy establishing medical necessity criteria for breast MRI coverage. It specifies when breast MRI is considered medically necessary (including BRCA mutations, high-risk screening, preoperative planning) versus not medically necessary (routine screening, avoiding biopsy). All network providers must have proper accreditation from IAC, ACR, or RadSite.
Action Required
Immediately: Billing team must verify all network providers performing breast MRI technical components have IAC, ACR, or RadSite accreditation. Update prior authorization workflows to check medical necessity criteria before scheduling breast MRI - verify patients meet specific criteria like BRCA mutations, high-risk factors, or diagnostic indications listed in policy. Educate providers on documentation requirements for covered versus non-covered breast MRI indications.