New Mexico House Bill 27 applies to coverage issued or renewed on or after Jan. 1, 2024. This bill prohibits cost sharing on covered diagnostic and supplemental breast exams that are medically necessary and clinically appropriate.
Cost sharing for breast exams does not apply to the following exams:
- Diagnostic breast exams: medically necessary follow-up imaging used to take a closer look at an abnormality previously found or suspected in a routine screening or other exam. This includes diagnostic mammography and breast MRI/ultrasound.
- Supplemental breast exams: medically necessary screening imaging used before an abnormality is seen or suspected, when the member has risk factors for breast cancer, like a personal or family history of the disease. This includes breast MRI/ultrasound.
This bill applies to fully insured and IBAC health plans underwritten and/or administered by Blue Cross and Blue Shield of New Mexico.
Additional Information
Cost sharing will only be removed from services obtained from an in-network provider. Services obtained from an out-of-network provider may still have cost-sharing. Members on an HSA-eligible high-deductible health plan must meet their deductible before diagnostic and supplemental breast exams can be paid without cost sharing. Preventive screenings provided by an in-network provider are still covered without cost sharing before the deductible for HDHP plans.
Providers are reminded to check eligibility and benefits prior to administering services. If you have questions, please contact your Provider Representative using the Network Contact List.