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New Codes for Mammography

 

New Codes for Mammography

There are three New Codes for Mammography introduced in the 2017 CPT code book to better describe the types of mammography services that are now provided;

  • 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
  • 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

 

Unlike the codes these replaced (77051, 77052, 77055, 77056, and 77057), the new codes include computer-assisted detection (CAD), when performed:

Although the Centers for Medicare & Medicaid Services (CMS) intends to recognize the CPT® codes in 2018, mammography claims to Medicare in 2017 must continue to use dedicated G codes.

Specifically, CMS instructs: Mammography is described using the following codes:

 

  • G0202 Screening mammography, bilateral (a 2-view study of each breast), including computer- aided detection (CAD) when performed.
  • G0204 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral.
  • G0206 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.

 

Breast tomosynthesis is described using the following add-on codes:

 

  • 77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
  • G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206).

 

When breast tomosynthesis is furnished, practitioners should report one of the following G0202, G0204, or G0206 and one of G0279 or 77063.

For purposes of billing digital breast tomosynthesis, the appropriate, accompanying 2D image(s) may either be acquired or synthesized.

For example, a Medicare claim for a digital screening mammogram with CAD and tomosynthesis will need to include codes G0202 (mammogram and CAD) and 77063 (tomosynthesis). And a Medicare claim for a unilateral digital diagnostic mammogram with CAD and tomosynthesis would require codes G0206 (mammogram and CAD) and G0279 [Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)].

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