Breast MRI

What is it?

A breast MRI is an option to improve detection of abnormalities. It is important to know that Mammography is still the cornerstone of breast cancer screening and we are not suggesting you replace your mammogram. However, adding it on as supplemental screening increases detection. Mammography misses roughly 10–15% of breast cancers, and in women with dense breast tissue that number can be even higher. Breast MRI uses powerful magnets (no radiation) to create highly detailed images of breast tissue from a completely different angle. Studies consistently show that adding MRI to mammography catches significantly more cancers at an earlier, more treatable stage.

Who benefits most from supplemental MRI screening?

• Women with a lifetime breast cancer risk of 20% or higher

• Women with dense breast tissue (Categories C or D on your mammogram report)

• Women with a personal or strong family history of breast or ovarian cancer

• BRCA1/BRCA2 gene carriers.

However, we want to be completely transparent with you about costs before you decide:

Because supplemental breast MRI is recommended for higher-risk patients — not as universal screening for everyone — it does not fall under the "no cost-share" (no out-of-pocket cost) rules that apply to standard preventive screenings like your annual mammogram. This is true even when your insurance agrees the scan is medically necessary and covers it as a benefit.

Find out more

Coverage + Medical Necessity ≠ Zero Out-of-Pocket Cost.

Don't be caught off guard...

Even if your insurance approves the MRI as a covered, medically necessary procedure, you may still owe money depending on your specific plan — particularly if you have not yet met your annual deductible. Costs can range from $0 (if your deductible is fully met and your plan is generous) to $3,000 or more for a standard full MRI.

Call Your Insurance:

We strongly encourage you to call the member services number on the back of your insurance card and ask about CPT code 77049 (MRI breast, bilateral, with and without contrast, with computer-aided detection). Having that code ready when you call will help the insurance representative give you a much more accurate answer.

Ask:

• "Is CPT code 77049 a covered benefit under my plan?"

• "Has my deductible been met?"

• "What will my estimated out-of-pocket cost be for CPT code 77049?"

There are two options available at Northside Hospital:

OPTION 1: Full Diagnostic Breast MRI (with and without contrast) This is the comprehensive, guideline-standard breast MRI. What it includes:

• Highly detailed, thin-slice images of all breast tissue

• Before and after contrast imaging sequences

• Computer-aided detection (CAD)

• Radiologist interpretation with full written report

• Recommended by major medical organizations (ACR, ACS, NCCN) for high-risk screening

• Billed to insurance under CPT code 77049 Cost: Filed to your insurance. Depending on your plan, deductible status, and coverage rules, your out-of-pocket cost may range from $0 to $3,000 or more. We cannot predict your exact cost — please call your insurer in advance.

OPTION 2: Abbreviated ("Fast") Breast MRI — $395 flat fee.

This is a streamlined version of breast MRI that captures the most diagnostically valuable sequences in approximately 10–15 minutes. It still uses contrast dye but acquires fewer image series. What's different:

• Uses wider image slices (less anatomic detail than the full study)

• Focuses on the contrast-enhancement pattern most useful for cancer detection

• Takes significantly less time

• Does NOT have a standard insurance billing code — it is not filed to insurance

• Flat self-pay fee: $395 at Northside Hospital What stays the same:

• Still adds meaningful detection benefit over mammogram alone

• Still read and interpreted by a radiologist

• Still uses gadolinium contrast

• Still a far better picture than mammogram alone for dense or higher-risk tissue

Please let your provider know if you decide you would like to proceed with breast MRI and if so which one.