---
title: HB 928. Insurance; utilization review by an insurer shall not be required in the instance in which a physician has determined the existence of dense breast tissue and the medical necessity of a breast ultrasound; provide
collection: bills
id: 2025-2026/hb928
cite_as: HB 928, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/hb928
md_url: https://georgiacommons.org/bills/2025-2026/hb928.md
text_url: https://georgiacommons.org/bills/2025-2026/hb928/text
source_url: https://www.legis.ga.gov/legislation/72077
date: 2026-01-12
status: introduced
corpus_version: bills-2026-09-13
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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previous: https://georgiacommons.org/bills/2025-2026/hb927.md
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index: https://georgiacommons.org/bills/index.md
omitted: votes and history
omitted_chars: 129
omitted_url: https://georgiacommons.org/bills/2025-2026/hb928.md?full=1
bill_number: HB 928
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: House
bill_type: bill
status_date: 2025-04-04
last_action: House Second Readers
sponsors:
  - Inga Willis
  - Omari Crawford
  - Mekyah McQueen
  - Edna Jackson
  - Tanya Miller
text_version: Introduced
has_text: true
legiscan_url: https://legiscan.com/GA/bill/HB928/2025
upstream_id: 2020918
summaries_model: claude-sonnet-5
topic_tags:
  - breast cancer screening
  - health insurance coverage
  - dense breast tissue
  - utilization review
  - insurance regulation
---

# HB 928. Insurance; utilization review by an insurer shall not be required in the instance in which a physician has determined the existence of dense breast tissue and the medical necessity of a breast ultrasound; provide

## Text

House Bill 928
By: Representatives Willis of the 55th, Crawford of the 89th, McQueen of the 61st, Jackson
of the 165th, and Miller of the 62nd
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
insurance generally, so as to provide that utilization review by an insurer shall not be
required in the instance in which a physician has determined the existence of dense breast
tissue and the medical necessity of a breast ultrasound; to provide for a definition; to provide
for related matters; to provide for an effective date and applicability; to repeal conflicting
laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance
generally, is amended by revising Code Section 33-24-59.32, relating to cost-sharing
requirements for diagnostic and supplemental breast screening examinations, as follows:
"33-24-59.32.
(a) As used in this Code section, the term:
(1) 'Breast <del>magnetic resonance imaging' or 'breast</del> MRI' means a diagnostic and
screening tool, including standard and abbreviated breast MRI, that uses radio waves and
magnets to produce detailed images of structures within the breast.
(2) 'Breast ultrasound' means a noninvasive diagnostic and screening tool that uses
high-frequency sound waves and their echoes to produce detailed images of structures
within the breast.
(3) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any
maximum limitation on the application of such a deductible, coinsurance, copayment, or
similar out-of-pocket expense.
<ins>(4) 'Dense breast tissue' means heterogeneously or extremely dense breast tissue based
on nationally recognized guidelines or systems for breast imaging reporting of
mammography, including, but not limited to, the Breast Imaging Reporting and Data
System established by the American College of Radiology.
</ins> <del>(4)(5)</del> 'Diagnostic breast examination' means a medically necessary and clinically
appropriate examination of the breast, including such examination using breast MRI,
breast ultrasound, or mammogram, that is:
(A) Used to evaluate an abnormality seen or suspected from a screening examination
for breast cancer; or
(B) Used to evaluate an abnormality detected by another means of examination.
<del>(5)(6)</del> 'Health benefit policy' means any individual or group plan, policy, or contract for
<del>health care</del> <ins>healthcare</ins> services issued, delivered, issued for delivery, executed, or
renewed by an insurer in this state.
<del>(6)(7)</del> 'Insurer' means any person, corporation, or other entity authorized to provide
health benefit policies under this title.
<del>(7)(8)</del> 'Mammogram' means a diagnostic or screening mammography exam using a
low-dose X-ray to produce an image of the breast.
<del>(8)(9)</del> 'Supplemental breast screening examination' means a medically necessary and
clinically appropriate examination of the breast, including such examination using breast
MRI, breast ultrasound, or mammogram, that is:
(A) Used to screen for breast cancer when there is no abnormality seen or suspected
in the breast; or
(B) Based on personal or family medical history or additional factors that may increase
the individual's risk of breast cancer.
(b) A health benefit policy that provides coverage for diagnostic <ins>breast</ins> examinations <del>for
breast cancer</del> shall include provisions that ensure that the cost-sharing requirements
applicable to diagnostic <ins>breast examinations</ins> and supplemental breast screening
examinations are no less favorable than the cost-sharing requirements applicable to
screening mammography for breast cancer.
(c) Nothing in this Code section shall be construed to preclude existing utilization review
provided under Chapter 46 of this title, <ins>except that, if a supplemental breast screening
examination reveals the existence of dense breast tissue, following the patient notification
required in Code Section 31-1-17, the diagnosing physician may determine whether a
breast ultrasound is medically necessary, and such determination shall not be disputed
through utilization review or any other procedure by an insurer for purposes of denying
insurance coverage for such examinee.
</ins> (d) If under federal law application of subsection (b) of this Code section would result in
Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, such
cost-sharing requirement shall apply only for Health Savings Account qualified High
Deductible Health Plans with respect to the deductible of such plan after the enrollee has
satisfied the minimum deductible under Section 223 of the Internal Revenue Code, except
with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C)
of the Internal Revenue Code, in which case the requirements of subsection (b) of this
Code section shall apply regardless of whether the minimum deductible under Section 223
of the Internal Revenue Code has been satisfied.
(e) The Commissioner shall promulgate rules and regulations necessary to implement the
provisions of this Code section in accordance with current guidelines established by
professional medical organizations such as the National Comprehensive Cancer Network."
SECTION 2.
This Act shall become effective on July 1, 2025, and shall apply to all applicable policies,
contracts, and certificates executed, delivered, issued for delivery, or renewed in this state
on or after October 1, 2025.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.

## Summaries written by Georgia Commons

The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.

A Georgia House bill would stop insurers from second-guessing a doctor's decision to order a breast ultrasound after finding dense breast tissue, removing that decision from insurance company utilization review.

### Plain-language summary

Georgia law already requires health insurance policies to charge no more in cost-sharing (deductibles, copays, coinsurance) for diagnostic and supplemental breast exams than they charge for routine screening mammograms. This bill amends that law (O.C.G.A. § 33-24-59.32) to add a new protection: if a supplemental breast screening exam finds dense breast tissue, and the patient's doctor decides a follow-up breast ultrasound is medically necessary, an insurer cannot dispute that decision through utilization review or any other process to deny coverage.
The bill also adds a formal definition of 'dense breast tissue' based on nationally recognized breast imaging guidelines, such as the system used by the American College of Radiology, and makes small wording updates elsewhere in the definitions section. The changes would take effect July 1, 2025, and apply to insurance policies and contracts issued or renewed in Georgia on or after October 1, 2025.

### What it does

- Bars insurers from using utilization review (an insurer's process for checking if care is medically necessary) to dispute a doctor's finding that a breast ultrasound is medically necessary after dense breast tissue is found.
- Adds a formal legal definition of 'dense breast tissue' tied to recognized medical imaging classification systems like the American College of Radiology's system.
- Keeps the existing requirement that cost-sharing for diagnostic and supplemental breast exams be no less favorable than for routine screening mammograms.
- Ties the new utilization review exemption to the patient notification already required under a separate Georgia law (O.C.G.A. § 31-1-17).
- Sets the law to take effect July 1, 2025, applying to policies issued or renewed on or after October 1, 2025.

### Who it affects

Georgia patients who undergo breast cancer screening and are found to have dense breast tissue, the physicians who diagnose them and order follow-up ultrasounds, and health insurers that write individual or group health benefit policies in the state, who lose the ability to challenge these specific ultrasound orders through utilization review.

### Why it matters

Patients found to have dense breast tissue, which can hide tumors on a mammogram, would no longer risk having their doctor-ordered ultrasound denied or delayed by an insurer's internal review process, potentially speeding up follow-up care and reducing coverage disputes between doctors and insurance companies.

### Key provisions

- Section 1 revises O.C.G.A. § 33-24-59.32 to add a definition of 'dense breast tissue' based on nationally recognized breast imaging guidelines.
- Section 1 adds language to subsection (c) stating that if a screening reveals dense breast tissue, a physician's determination that a breast ultrasound is medically necessary cannot be disputed through utilization review or other insurer procedures for denying coverage.
- Section 1 keeps intact the existing rule that cost-sharing for diagnostic and supplemental breast exams must be no less favorable than for standard screening mammograms.
- Section 1 retains an exception allowing higher cost-sharing under Health Savings Account qualified high-deductible plans until the federal minimum deductible is met, except for preventive care.
- Section 2 sets the effective date as July 1, 2025, applying to policies executed, delivered, issued, or renewed on or after October 1, 2025.
- Section 3 repeals conflicting laws.

## Status

- Status: Introduced (2025-04-04)
- Last action: House Second Readers (2026-01-12)
- Sponsors: Inga Willis, Omari Crawford, Mekyah McQueen, Edna Jackson, Tanya Miller
- Official page: https://www.legis.ga.gov/legislation/72077

> The history, votes, and amendments (129 characters) are at https://georgiacommons.org/bills/2025-2026/hb928.md?full=1