Breast Cancer Risk Assessment FAQ

How long will the risk assessment visit take?  

The risk assessment visit may take up to one hour. We ask you to arrive 15 minutes prior to your appointment to complete paperwork.

What do I need to bring with me to my appointment? 

You should bring your insurance card, a current list of medications and your completed family history form. Download Family Health History Form

Do I need a referral for this visit?  

No. This is an educational visit with a nurse that is billed to your insurance company without the need for a referral.

Will my insurance company pay for this visit? 

Every insurance plan is different. You should call your insurance company and ask if it is covered. The billing code for your visit will be 99214 with a diagnosis code of v16.3 (family history of breast cancer). If your insurance company declines the bill, the cost of the visit is $263.00.  In general, Medicare does not cover this type of visit. If you have Medicare, please let us know and we can discuss alternatives for you and your family.

What should I expect during my risk assessment visit?  

The risk assessment visit is a one-on-one meeting with a nurse practitioner who is specially trained to assess your risk for breast cancer. The hour-long appointment will begin with a thorough review of your family history and your personal risk factors for breast cancer. She will discuss recommendations for breast cancer screening and risk reducing strategies. If genetic testing is appropriate, the nurse practitioner will review all the benefits, risks, limitations, and implications of genetic testing prior to offering the test.

Can I have genetic testing at the time of my risk assessment visit?  

Yes. If appropriate, genetic testing can be done at the time of your risk assessment visit.

Can I have genetic testing without having a risk assessment visit?  

No. You must meet with the nurse practitioner before having your genetic test. Genetic testing is not like a regular blood test; it has serious implications not only for your own health, but the health of your family members as well.

Will my insurance pay for genetic testing?  

We will help you determine your benefits for genetic testing prior to starting your test.  We can submit your test, but delay starting it until your benefits are confirmed. You can still have your test on the day of your visit and we will determine your benefits without delaying your test.  Most insurance companies require that you meet certain criteria before they agree to pay for the test. You may want to call your insurance company prior to your visit to check your coverage for the test.

Will I face health insurance discrimination if I am found to have a genetic mutation?  

It is highly unlikely that you will face health insurance discrimination based on your genetic status.  There are both federal and state laws that protect you from discrimination.

Should I make an appointment if I have already had breast cancer?  

Yes. It is possible that you had a hereditary form of breast cancer and, therefore, you could be at increased risk for getting a second breast cancer or other cancers such as ovarian cancer.  If your breast cancer was hereditary, then other family members may be at increased risk too.  By understanding your risk, you can possibly help your family members better understand their risk.  If you have not been evaluated for hereditary breast cancer, or your evaluation was more than five years ago, you should consider having an evaluation.

Should I discuss this with my oncologist?  

Yes, you should discuss the value of risk assessment and genetic testing with your oncologist if you have one. A consultation note regarding your risk assessment visit will be sent to your oncologist after your appointment.