Stick with G Codes for Medicare Mammography

Stick with G Codes for Medicare Mammography

The 2017 CPT® codebook introduced three new codes to describe mammography services;

  • 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 they 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 (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 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.

Source: Frequently Asked Questions for Mammography Services.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 474 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

One Response to “Stick with G Codes for Medicare Mammography”

  1. Lilianne Norman says:

    I am receiving multitudes of denials for the G codes for regular Medicare. The Medicare replacement plans are also being denied because they do not use the G code. This is like a catch 22 situation. The 77063 , 77062, 77061 are also being denied and they are coded correctly when they are documented as such. Is there something going on within the inner workings of the regular Medicare & the replacement plans? Is there some sort of verbiage within the Medicare policy that is wrong in disallowing the TOMO to be coded?

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