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Breast Cancer Awareness Month: Tips for Rescheduling Patients before January
Highmark·PA, NY, WV, DE, NJ · Radiology, General Surgery, Oncology +3 more·Provider Bulletin
Effective date
Sep 29, 2025
We identified it
Jul 28, 2026
Summary
This is a provider outreach bulletin from Highmark encouraging practices to reschedule patients who missed breast cancer screening appointments during October (Breast Cancer Awareness Month) to close HEDIS BCS-E measure gaps. The policy identifies specific mammogram CPT codes and mastectomy codes that count toward the screening measure for members ages 50-74, with measurement period Oct 1, 2023 through Dec 31, 2025.
Action Required
Before December 31, 2025: Front desk/scheduling staff should implement outreach protocols to contact patients with missed breast cancer screening appointments within 24-48 hours using multiple communication channels (phone, text, email). Billing team should ensure claims for mammograms (CPT 77061-77067) and mastectomy procedures (CPT 19180, 19200, 19220, 19240, 19303-19307) for members ages 50-74 are tracked and coded correctly to support HEDIS BCS-E gap closure. Verify that only screening, diagnostic, film, digital, or 3D mammograms count toward the measure—breast MRI, ultrasound, and biopsy do not. Access Highmark's HEDIS guide via Availity Essentials for detailed measurement specifications. Update patient outreach materials using Highmark's free resources (brochures, reminder cards, flyers) ordered via the Inventory Request Form. Failure to properly track and code these services will result in missed opportunities to close HEDIS gaps and may impact quality measure reporting.