Breast Cancer Screening

Last update: Oct 1, 2020

Healthcare Effectiveness Data and Information Set (HEDIS®) measures can help enhance quality of care by identifying ways to support preventive care. By working with UnitedHealthcare on HEDIS® medical record collection, your efforts can have a direct impact on better patient outcomes – from improved medication adherence and closing clinical care gaps to deeper member engagement in their own well-being.

We realize some of you have questions on specific measures. To help you improve performance for the Breast Cancer Screening (BCS), we’ve shared measure information, tips, and recommendations.

BCS is defined as the percentage of female members, ages 50-74, who had a mammogram screening Oct. 1, two years prior to the measurement year, ­through Dec. 31 of the measurement year. Always include a date of service (year and month is acceptable) when documenting a mammogram reported by a member.

As an administrative measure, it’s important to submit the appropriate ICD-10 diagnosis code that reflects a member’s history of bilateral mastectomy, Z90.13. If a member is new to the care provider and the diagnosis is discovered during the history and physical, the code should be submitted with the initial visit claim. If a member isn’t new to the care provider, but the member’s chart has a documented history of the diagnosis, the ICD-10 diagnosis code should be submitted on any visit claim.