AR Code § 23-79-140 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 79 - Insurance Policies Generally|Subchapter 1 - General Provisions|§ 23-79-140. Mammograms — Breast ultrasounds — Definitions

 (a) As used in this section:  (1) “Breast ultrasound” means an imaging technique that uses harmless, high-frequency sound waves to produce detailed images of the breast in order to screen for and diagnose breast disease, such as cancer;  (2) “Diagnostic mammography” means a problem-solving radiologic procedure of higher intensity than screening mammography provided to women who are suspected to have breast pathology, usually characterized by the following medical events:  (A) Patients are usually referred for analysis of palpable abnormalities or for further evaluation of mammographically detected abnormalities;  (B) All images are reviewed by the physician interpreting the study, and additional views are obtained as needed; and  (C) A physical examination of the breast by the interpreting physician to correlate the radiologic findings is performed as part of the study when indicated;    (3) “Mammography” means radiography of the breast; and  (4)  (A) “Screening mammography”, including digital breast tomosynthesis, means a radiologic procedure provided to a woman, who has no signs or symptoms of breast cancer, for the purpose of early detection of breast cancer.  (B) The procedure entails at least two (2) views of each breast and includes a physician's interpretation of the results of the procedure.      (b)  (1) Every accident and health insurance company, hospital service corporation, health maintenance organization, or other accident and health insurance provider in the State of Arkansas shall offer as an essential health benefit, coverage for screening mammography and breast ultrasound for the diagnosis of breast disease such as cancer and the evaluation of dense breast tissue:  (A) A baseline mammogram for an insured woman who is thirty-five to forty (35-40) years of age;  (B) An annual mammogram for an insured woman who is forty (40) years of age or older;  (C) Upon recommendation of a woman's physician, without regard to age, when the woman has had a prior history of breast cancer, when the woman's mother or sister has had a history of breast cancer, positive genetic testing, or other risk factors; and  (D) A comprehensive ultrasound screening of an entire breast or breasts if a mammogram screening demonstrates heterogeneously dense or extremely dense breast tissue and the woman's primary healthcare provider or radiologist determines a comprehensive ultrasound screening is medically necessary.    (2) Insurance coverage for screening mammograms, including digital breast tomosynthesis, and breast ultrasounds shall not prejudice coverage for diagnostic mammograms or breast ultrasounds, as recommended by the woman's physician.  (3) A fully insured large group insurer that issues, renews, or extends a health benefit plan in this state shall also provide coverage for an optional screening mammography and breast ultrasound benefit as described under subdivision (b)(1) of this section.  (4) As used in this subsection, an accident and health insurance company, hospital service corporation, health maintenance organization, or other accident and health insurance provider does not include benefits under one (1) or more, or any combination thereof, of the following:  (A) Coverage only for accident or disability income insurance, or any combination thereof;  (B) Coverage issued as a supplement to liability insurance;  (C) Liability insurance, including general liability insurance and automobile liability insurance;  (D) Workers' compensation or similar insurance;  (E) Automobile medical payment insurance;  (F) Credit-only insurance;  (G) Limited-scope dental or vision benefits;  (H) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof;  (I) Coverage only for a specified disease or illness;  (J) Hospital indemnity or other fixed indemnity insurance; or  (K) Other similar insurance coverage, specified in rules, under which benefits for medical care are secondary or incidental to other insurance benefits.      (c) [Repealed.]  (d) Furthermore, no insurer shall pay for mammographies performed in an unaccredited facility after January 1, 1990.  (e)  (1) After January 1, 2014, an accident and health insurance company, hospital service corporation, health maintenance organization, or other accident and health insurance provider shall use the Healthcare Common Procedure Coding System G code for digital mammography services or the Current Procedural Terminology code as established for digital mammography and listed in the most recent annual edition of Current Procedural Terminology published by the American Medical Association.  (2) The codes used for digital mammography services described in subdivision (e)(1) of this section shall be reimbursed at a minimum of one and five-tenths (1.5) times the Medicare reimbursement rate.    (f)  (1) Benefits under this section are subject to any policy provisions that apply to other services covered by the policy, except that an insurance policy shall not impose a copayment or deductible for a screening mammogram.  (2) A breast ultrasound may be subject to any applicable copayment as required under a health benefit plan but shall not be subject to a deductible.