§ 4095b.
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/vt/title-8/chapter-107/4095bA research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§ 4095b. Mammography and other breast imaging services
(a)(1) A health insurance plan shall provide coverage for screening mammography and for other medically necessary breast imaging services upon recommendation of a health care professional as needed to detect the presence of breast cancer and other abnormalities of the breast or breast tissue. In addition, a health insurance plan shall provide coverage for screening by ultrasound or another appropriate imaging service for a covered individual for whom the results of a screening mammogram were inconclusive or who has dense breast tissue, or both.
(2)Benefits provided shall cover the full cost of the mammography, ultrasound, and other breast imaging services and shall not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement or additional charge, except to the extent that such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.
(b)This section shall apply only to procedures conducted by test facilities accredited by the American College of Radiologists.
(c)As used in this section:
(1)“Mammography” means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and digital detector. The term includes breast tomosynthesis.
(2)“Other breast imaging services” means diagnostic mammography, ultrasound, and magnetic resonance imaging services that enable health care professionals to detect the presence or absence of breast cancer and other abnormalities affecting the breast or breast tissue.
(3)“Screening” includes the mammography or ultrasound test procedure and a qualified health care professional’s interpretation of the results of the procedure, including additional views and interpretation as needed. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)