§ 532. Supplemental and diagnostic breast examinations [For application of this section, see 84 Del. Laws, c. 121, § 5].
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/de/title-31/chapter-5-state-public-assistance-code/532A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)As used in this section:
(1)“Breast magnetic resonance imaging” or “breast MRI” means a diagnostic tool, including standard and abbreviated breast MRI, that uses radio waves and magnets to produce detailed images of structures within the breast. A breast MRI may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.
(2)“Breast ultrasound” means a noninvasive diagnostic tool that uses high-frequency sound waves and their echoes to produce detailed images of structures within the breast. A breast ultrasound may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.
(3)“Cost-sharing requirement” means a deductible, coinsurance, or copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense.
(4)“Diagnostic breast examination” means a medically-necessary and clinically-appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:
a. To evaluate an abnormality seen or suspected from a screening examination for breast cancer.
b. To evaluate an abnormality detected by another means of examination.
(5)“Mammogram” means a diagnostic or screening mammography exam using a low-dose X-ray to produce an image of the breast.
(6)“Supplemental breast screening examination” means a medically-necessary and clinically-appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:
a. To screen for breast cancer when there is no abnormality seen or suspected in the breast.
b. Based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.
(b)All carriers shall provide coverage for diagnostic breast examinations and supplemental breast screening examinations. The terms of such coverage, including cost-sharing requirements, shall be no less favorable than the cost-sharing requirements applicable to screening mammography for breast cancer.