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.
- 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 Authorizations or Pre-approvals (CPT Codes)
- 78800 (Radiopharmaceutical Localization of Tumor, Limited Area)
- A9500 (Supply of Radiopharmaceutical Imaging Agent - Technetium TC-99m Sestamibi, per Dose)
Communications 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 web pages (share with your patients)