Does S8080 require prior authorization?

Yes, S8080 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for S8080?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S8080`, Scintimammography (radioimmunoscintigraphy of the breast), unilateral,

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; refer to the guidelines titled Medical Records Documentation Used for Reviews.

When deciding coverage, reference the member specific benefit plan document and any applicable federal or state mandates; in the event of a conflict, the member specific benefit plan document governs.

Coding clarification relevant to billing: Computer-aided detection (CAD) is included with the MRI breast CPT code 77048 and 77049 procedures. If CAD is performed with these codes, there is no additional reimbursement.

Parathyroid localization enhanced by dual-isotope subtraction and/or ultrasound with iPTH assay in US-guided FNA: documentation of ultrasound and iPTH aspirate results when performed to direct surgical approach.

Sentinel node procedures: documentation of preoperative lymphoscintigraphy (when performed), intraoperative lymphatic mapping technique, and definitive histopathology of sentinel node(s) (only individuals with histologically confirmed sentinel node metastases are selected for radical node dissection).

AdreView (iobenguane I-123) diagnostic standard: “The diagnosis was determined by histopathology or, when histopathology was unavailable, a composite of imaging, plasma/urine catecholamine and/or catecholamine metabolite measurements and clinical follow-up.” (implies need for histopathology or detailed composite diagnostic documentation).

Key Coverage Criteria

Magnetic Resonance Imaging (MRI) of the breast for individuals who are high risk for breast cancer as defined as having any of the following:
Prior thoracic radiation therapy between the ages 10 and 30 (screening starting at age 25 or 8 years after treatment, whichever is later)
Lifetime risk estimated at greater than or equal to 20% as defined by models that are largely dependent on family history (e.g., Gail, Claus, Tyrer-Cuzick or BRCAPRO)
Personal history of breast cancer (not treated with bilateral mastectomy)
Personal history with any of the following gene mutations/conditions: ATM (screening beginning at age 30)
Personal history with any of the following gene mutations/conditions: BARD1 (screening beginning at age 40)

5 Active Policies

EVICORE-HPLAN-HAP-390DB1C1AAAD, Health Alliance Plan Radiology Code List - Effective 08/01/2026

UHC-POL-breast-imaging-screening-diagnosing-cancer, Breast Imaging for Screening and Diagnosing Cancer

AETNA-CPB-0168, Tumor Scintigraphy

UMR-POL-UMR-breast-imaging-screening-diagnosing-cancer, Breast Imaging for Screening and Diagnosing Cancer

SUREST-POL-SUREST-breast-imaging-screening-diagnosing-cancer, Breast Imaging for Screening and Diagnosing Cancer

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S8080, Scintimammography (radioimmunoscintigraphy of the breast), unilateral,