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Breast Cancer Care
Referral Information for non-Mayo Clinic Health System providers
A primary care provider must order the MBI. The referring provider is then notified when the MBI is scheduled.
Telephone and fax numbers
- Center for Breast Care — 608-392-9822
- Center for Breast Care referral questions — 608-392-6464 (Robin Manke)
- Patient Referral Services — 608-392-9816
- Patient Referral Services fax — 608-392-9814
- Patient Referral Form — Print, complete and fax to Patient Referral Services to refer a patient for an MBI
- MBI Information for Referring Providers
Prior authorization or pre-approval CPT codes
- 78800 (Radiopharmaceutical Localization of Tumor, Limited Area)
- A9500 (Supply of Radiopharmaceutical Imaging Agent - Technetium TC-99m Sestamibi, per Dose)
Communication with referring providers
- Referring providers receive MBI results by fax.
- If results are positive, the Radiology/Breast Imaging Department contacts the patient to offer and schedule additional diagnostic imaging.
- Any additional report(s) are faxed to the referring provider.
Relevant webpages to share with patients
Not all treatments, tests and services are available at all Mayo Clinic Health System locations. Check with your preferred location in advance.