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365 days
Category Diagnostic Radiology
Subcategory Mammography
Voucher Type Single
Validity 365 days
3D Mammography Tomosynthesis Unilateral or Bilateral Screening or Diagnostic*
Diagnostic Radiology
Tier I
Terms & Conditions

This Voucher Includes a 3D Mammography with CAD (computer-aided detection) Unilateral or Bilateral Screening or Diagnostic. (Facility Or Provider Standard Protocol Applies) Any procedure being upgraded all terms & condition to the upgraded procedure do apply. If the value of the voucher is lower than the Tier purchased you are accepting the lesser value & lose any remaining balance. 

The CPT code,(s) provided are property of AMA and are to be used for reference purpose only. The may change at any given time without notice and THP is not responsible for accuracy. Multiple CPT codes listed may be irrelevant in some or all circumstances.

Exclusions And Special Instructions

Excludes Breast MRI, MRA Runoff, MR Arthrogram. Must Have A Valid Prescription/Order From A Licensed Physician. A 2D Mammography Prescription will cover a 2D & 3D Mammography. Must check availability and follow scheduling requirements of a participating THP Provider/Facility before purchase. TERMS USED BUT NOT DEFINED HEREIN SHALL HAVE THE RESPECTIVE MEANINGS GIVEN TO THEM IN THP'S TERMS & CONDITIONS FOUND ON

Related CPT Code
77067, 77066, 77065, 77063, 77051

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