BCS: Breast Cancer Screening
Percentage with mammogram in last 27 months (biennial).
Measure description
Percentage with mammogram in last 27 months (biennial).
Eligible population
Women ages 50-74
Performance drivers
USPSTF + ACS aligned. Star measure for Medicare Advantage.
Documentation & PA strategy
PA typically not needed for screening mammogram (G0202 / 77067). Annual diagnostic mammo PA may apply.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure BCS measure?
Percentage with mammogram in last 27 months (biennial).
What drives performance on this measure?
USPSTF + ACS aligned. Star measure for Medicare Advantage.
How should clinicians document for this measure?
PA typically not needed for screening mammogram (G0202 / 77067). Annual diagnostic mammo PA may apply.
What is the eligible population?
Women ages 50-74
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