CMS Pub. 100-03, ch. 1, § 220.13

Percutaneous image-guided breast biopsy is a method of obtaining a breast biopsy through a percutaneous

incision by employing image guidance systems. Image guidance systems may be either ultrasound or

stereotactic.

The Breast Imaging Reporting and Data System (or BIRADS system) employed by the American College of

Radiology provides a standardized lexicon with which radiologists may report their interpretation of a

mammogram. The BIRADS grading of mammograms is as follows: Grade I-Negative, Grade II-Benign

finding, Grade III-Probably benign, Grade IV-Suspicious abnormality, and Grade V-Highly suggestive of

malignant neoplasm.

A. Non-Palpable Breast Lesions

Effective January 1, 2003, Medicare covers percutaneous image-guided breast biopsy using stereotactic or

ultrasound imaging for a radiographic abnormality that is non-palpable and is graded as a BIRADS III, IV,

or V.

B. Palpable Breast Lesions

Effective January 1, 2003, Medicare covers percutaneous image guided breast biopsy using stereotactic or

ultrasound imaging for palpable lesions that are difficult to biopsy using palpation alone. A/B MACs (A)

and (B) have the discretion to decide what types of palpable lesions are difficult to biopsy using palpation.