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

Important documents

• 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

• Mayo Clinic Health System Center for Breast Care
• Why MBI
• Facts about MBI