Breast Imaging Coding for Medicare in 2018
- By John Verhovshek
- In CMS
- January 24, 2018
- Comments Off on 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.
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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?