10- 144 C.M.R. ch. 707, § 4.0

Current through 2024-51, December 18, 2024

Section 144-707-4.0 - Covered Services

4.1.MBCHP will cover the following services when provided by a participating MBCHP Provider and determined to be medically necessary:

Physical examinations, which must include one or more of the following screening services: clinical breast exam, pelvic exam, and Pap test. Annual physical examinations are only covered when provided by a MBCHP Primary Care Provider;

Mammography (screening and diagnostic);

Breast diagnostic services (to include but may not be limited to diagnostic mammography, ultrasound, breast biopsies, and fine needle aspirations). Hospital charges for breast biopsies are not covered; however, physician charges are covered.

Effective date 7/25/2007

Cervical diagnostic services (to include but may not be limited to Colposcopy, cervical biopsy and Endocervical curettage)

Surgical consults for diagnosis of breast and cervical cancer;

Interpretation/translation services for MBCHP covered services;

Pathology charges for breast and cervical biopsies;

Anesthesia for breast biopsies (physician charges only, hospital charges are not covered).

4.2.Non-covered Services.All other services are not covered including, but not by way of limitation, the following:

Services not related to breast or cervical cancer screening or diagnosis;

Treatment procedures and/or services;

Services provided by non-participating providers;

Hospital charges for breast biopsies;

In-patient services

10- 144 C.M.R. ch. 707, § 4.0