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Mammography Coding Changes for 2018

Mammography Coding Changes for 2018

Mammography coding for screening mammography furnished to Medicare patients is changed in 2018. The Centers for Medicare & Medicaid Services (CMS) now recognizes three CPT codes, added in 2017.

G Codes Out, CPT Codes In

Effective for services rendered on or after Jan. 1, 2018, you will no longer use HCPCS Level II codes G0202, G0204, and G0206 to report screening mammogram provided to Medicare patients.

Screening Mammography Coding

CMS now instructs providers to use CPT codes:
Screening mammography, bilateral (2-view study of each breast), including CAD when performed
Diagnostic mammography, including (CAD) when performed; bilateral
Diagnostic mammography, including CAD when performed; unilateral.
Code 77067 is now type of service code 4 Diagnostic radiology, but coinsurance and deductible will continue to be waived.

Screening Digital Breast Tomosynthesis

Also effective for claims with dates of service Jan. 1, 2018 and later, CPT code 77063 Screening digital breast tomosynthesis, bilateral must be billed with the primary service mammogram code 77067, or the claim will be denied. Watch the age and frequency edits, too.
Likewise, HCPCS Level II code G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral must be billed in conjunction with the primary service mammogram code 77065 or 77066.
All other coding guidelines remain the same.

Tools to Make Your OBGYN Coding Efficient

If you’d like to prove to your employer, you have sufficient experience and expertise in obstetrics gynecology (OBGYN) coding, it’s a good idea to obtain the Certified Obstetrics Gynecology Coder (COBGC™) credential.
To help you steer clear of compliance issues, be sure your mammography coding is as current as possible  by using the most up-to-date medical coding books.
To help with claims processing efficiency, you can quickly search across medical coding sets using a keyword or a code by using AAPC Coder, the fastest and most comprehensive code search engine on the planet and add much more.
CMS Manual System, Pub 100-04, Transmittal 3844, CR 10181, August 18, 2017
MLN MattersMM10181 Revised, CR 10181, August 18, 2017
Related: Coding for Mastectomy

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

16 Responses to “Mammography Coding Changes for 2018”

  1. V. Lucero says:

    This information is very helpful!

  2. Monica Hawkins says:

    question: Medicare Mammogram 77067. Our provider does mammogram here at his office. We have been billing TC modifier for doing the procedure mammogram and Radiology is bill for reading of mammogram with 26 modifier. Can we fill for the technical component and reading of radiology with Medicare? Radiologist is not part of our practices.
    Are we require to add FY modifier to mammogram or is the FY modifier only for X-Rays not mammogram?
    I just need like help where to find information.

  3. Lori says:

    Having a debate with unilateral Tom 77063 screening and mod 52. Use 52 or not.

  4. Lori L says:

    Having a debate with unilateral Tom. Screening and modifier 52. Use it or not?

  5. Denise Walsh says:

    If a screening mammography is done on one breast, do we append modifier 52 to CPT 77067? I’m finding conflicting information and our MAC doesn’t specify for Medicare.

  6. Elizabeth Hearne says:

    What about an order for Tomosynthesis? Are providers required to write in 3D mammography on their orders for payment?


    can we billed cpt code 76641 tc 50 with a dx code Z12.39

  8. jane yauney says:

    how do you code for implants? screening and diagnostic

  9. jane yauney says:

    what are the codes for mammograms on implants…..both screening and diagnostic?

  10. Nicole says:

    Do we still use these CPT codes if doctor does NOT use CAD?

  11. Jo says:

    I am receiving denials from WPS Medicare on G0279. The denial codes are c016 – claim lacks info needed and m20 missing/ incomplete/ invalid hcpcs.
    Here is how I am coding them 77067-59
    Can someone please tell me what I am missing?

  12. Tammy B says:

    I need a code for 3D Diagnostic bilat Mammogram. What CPT code do you recommend?

  13. jane yauney says:

    If a patient is scheduled for a RT screening mammo and a Lt diagnostic (in the case of a 6 mo fu) how are the patients billed? Both exams are done at the same time.

  14. Michael David says:

    Thanks for sharing information with us. My cousin has breast cancer this information will help her. Please share more information like this and spread cancer awareness. And I found this website they have authentic and latest information on each cancer.

  15. Katrena Harmon, CPC, CPMA says:

    I’m having a problem with cpt code 77067 (screening) that turns into cpt code 77065 (diagnostic with add’l views) and cpt code 77063 (3-D). We are billing these on the same bill. Is this not correct? Any suggestions?

  16. Joanne Johnson says:

    Hello, I billed a claim for cpt 77066 tc with dx code C50.919 denied by a HMO carrier stating: non-covered; Decision was based on (LMRP) patient is 75 years old, do I need a better dx code or medical records to show reason for TEST?