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UnitedHealthcareMedicaid · Coverage · Medical Policy · KS · Radiology, Oncology, General Practice +1 moreMedium impact

Breast Imaging for Screening and Diagnosing Cancer (for Kansas Only)

Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Oct 3, 2026

Summary

UnitedHealthcare Community Plan of Kansas (Medicaid) is revising its breast imaging medical policy effective December 1, 2026, to clarify that certain advanced imaging modalities (Magnetic Resonance Elastography of the Breast, Molecular Breast Imaging, Computed Tomography of the breast, and Computer-Aided Tactile Breast Imaging) remain unproven and not medically necessary for routine screening in normal or high-risk individuals. The policy updates terminology and removes outdated definitions but does not change coverage for conventional mammography.

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What to do

by Nov 30, 2026 · 5 steps
01Billing and clinical teams must review the updated policy and ensure claims submission workflows comply with the new coverage determinations.
02Billing staff must deny or reject claims for Magnetic Resonance Elastography of the Breast, Molecular Breast Imaging (breast-specific gamma imaging, scintimammography, Positron Emission Mammography), Computed Tomography of the breast, and Computer-Aided Tactile Breast Imaging when billed for routine screening in normal or high-risk individuals on Kansas Medicaid plans.
03Update internal policy documentation and billing system notes to reflect the revised terminology and exclusions.
04Educate ordering providers that these modalities remain non-covered for the specified indications.
05Refer to the Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual for medical necessity criteria if diagnostic (non-screening) use is claimed.
If missed: Failure to implement these changes will result in improper claim denials or payment of non-covered services, creating compliance risk.

Original notice

Breast Imaging for Screening and Diagnosing Cancer (for Kansas Only)
uhcprovider.com · Always check the source before changing claims.
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