Breast Imaging Coding for Medicare in 2018

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  • January 24, 2018
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Breast Imaging Coding for Medicare in 2018

The Centers for Medicare & Medicaid Services (CMS) no longer requires use of dedicated G codes when reporting breast imaging services for Medicare beneficiaries, per MLN Matters Number: MM10181.
In 2017, the CPT® codebook deleted breast imaging codes 77051-77057 and replaced them with three new codes:

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 above codes (unlike their predecessors) includes computer-aided detection (CAD), when performed. CAD aids in the detection of breast cancer.
Medicare did not initially adopt the new CPT® codes. Instead, CMS required the use of dedicated G codes (G0202, G0204, G0206) throughout 2017 to describe breast imaging services for Medicare beneficiaries. Beginning Jan. 1, 2018, CMS has deleted the G codes, and instead allows reporting of CPT® codes 77065, 77066, 77067.

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering 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.

No Responses to “Breast Imaging Coding for Medicare in 2018”

  1. Kristine Wood says:

    Why is there no code for a screening mammogram, unilateral? This discriminates against breast cancer survivors. Insurance completely pays for screening mammograms, diagnostic depends on your deductible and if it’s been met. So, apparently after fighting breast cancer and surviving, we have less protection?