SCINTIMAMMOGRAPHY AND GAMMA IMAGING OF THE BREAST AND AXILLA

IV.86





IV.86 SCINTIMAMMOGRAPHY AND GAMMA IMAGING OF THE BREAST AND AXILLA


Description

Scintimammography, breast-specific gamma imaging (BSGI), and molecular breast imaging (MBI) use radiotracers with nuclear medicine imaging as a diagnostic tool for abnormalities of the breast. These tests are distinguished by the use of differing gamma camera technology, which may improve diagnostic performance for detecting small lesions. Breast-specific gamma imaging uses a single-head breast-specific gamma camera and a compression device; whereas MBI uses dual-head breast-specific gamma cameras that also produce breast compression. Preoperative lymphoscintigraphy and/or intraoperative hand-held gamma detection of sentinel lymph nodes is a method of identifying sentinel lymph nodes for a biopsy after radiotracer injection. Surgical removal of 1 or more sentinel lymph nodes is an alternative to full axillary lymph node dissection for staging, evaluation, and management of breast cancer.



Dates

  • Original Effective
    07-01-2026
  • Last Review
    03-09-2026
  • Next Review
    08-05-2026

Policy

I. Scintimammography, breast-specific gamma imaging, and molecular breast imaging are considered investigational in all applications, including but not limited to their use as an adjunct to mammography or in staging the axillary lymph nodes. 

II. Use of radiopharmaceutical administration and gamma detection (lymphoscintigraphy) for localization of sentinel lymph nodes in individuals with breast cancer may be considered medically necessary. 



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Procedure

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Diagnosis

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Codes

      
          Full Description
            Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging
      
          Full Description
            Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days
      
          Full Description
            Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical