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

  • 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

The new code descriptors match exactly those of HCPCS codes G0206, G0204, and G0202, respectively, which were required for Medicare payers. But, due to technical issues, the Centers for Medicare & Medicaid Services (CMS) was unable to ready its systems to process claims using CPT® codes 77065, 77066, and 77067. Although CMS intends to recognize the CPT® codes in 2018, claims to Medicare in 2017 must continue to use G0206, G0204, and G0202.

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 … 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.

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

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About Has 460 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. Craig Plattner says:

    Thanks for the update on Medicare. If a non-Medicare payor does not use G Codes, but uses the full set of CPT Codes– my understanding would be that they would use CPT’s 77061/77062 for Digital Breast tomosynthesis without any add-on for diagnostic. Is that correct? Screening tomosynthesis would use the 77067 with the 77063 add-on.

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