All policy statements below refer to performing magnetic resonance imaging (MRI) of the breast with contrast agents and a breast coil. An MRI of the breast without a breast coil, regardless of the clinical indication, is considered investigational. See additional comments in the Policy Guidelines section about the breast imaging team and the need for breast MRI centers to perform MRI-guided biopsy and localization.
Screening Uses
MRI of the breast may be considered medically necessary for individuals undergoing breast cancer screening with a high risk of breast cancer (for definitions on each of the risk levels, see the Policy Guidelines section).
MRI of the breast is considered investigational as a screening technique in average-risk individuals.
MRI of the breast is considered investigational as a screening technique for the detection of breast cancer when the sensitivity of mammography (ie, mammography using low-dose x-rays for imaging) is limited (ie, dense breasts, breast implants, scarring after breast cancer treatment).
Detection Uses
MRI of the breast may be considered medically necessary for detection of a suspected occult breast primary tumor in individuals with axillary nodal adenocarcinoma (ie, negative mammography and physical exam).
MRI of the breast may be considered medically necessary in individuals with a new diagnosis of breast cancer to evaluate the contralateral breast when clinical and mammographic findings are normal.
MRI of the breast is considered investigational for diagnosis of low-suspicion findings on conventional testing not indicated for immediate biopsy and referred for short-interval follow-up.
MRI of the breast is considered investigational for the diagnosis of a suspicious breast lesion in order to avoid biopsy.
Treatment-Related Uses
MRI of the breast may be considered medically necessary for preoperative tumor mapping of the involved (ipsilateral) breast to evaluate the presence of multicentric disease in individuals with clinically localized breast cancer who are candidates for breast conservation therapy (see the Policy Guidelines section).
MRI of the breast may be considered medically necessary for presurgical planning in individuals with locally advanced breast cancer (before and after completion of neoadjuvant chemotherapy) to permit tumor localization and characterization.
MRI of the breast may be considered medically necessary to determine the presence of pectoralis major muscle/chest wall invasion in individuals with posteriorly located tumors.
MRI of the breast may be considered medically necessary to evaluate a documented abnormality of the breast before obtaining an MRI-guided biopsy when there is documentation that other methods, such as palpation or ultrasound, are not able to localize the lesion for biopsy.
MRI of the breast is considered investigational to determine response during neoadjuvant chemotherapy in individuals with locally advanced breast cancer.
MRI of the breast is considered investigational for evaluation of residual tumor in individuals with positive margins after initial lumpectomy or breast conservation surgery.
