Mammography Coding Changes for 2018
- By Renee Dustman
- In Billing
- March 6, 2018
- 5 Comments
Coding for screening mammography furnished to Medicare patients is changed in 2018 as the Centers for Medicare & Medicaid Services (CMS) 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 mammography provided to Medicare patients.
Screening Mammography
CMS now instructs providers to use CPT codes:
77067
Screening mammography, bilateral (2-view study of each breast), including CAD when performed
77066
Diagnostic mammography, including (CAD) when performed; bilateral
77065
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 in conjunction 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.
Sources:
CMS Manual System, Pub 100-04, Transmittal 3844, CR 10181, August 18, 2017; www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3844CP.pdf
MLN Matters MM10181 Revised, CR 10181, August 18, 2017; www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10181.pdf
Renee Dustman
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This information is very helpful!
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.
Having a debate with unilateral Tom 77063 screening and mod 52. Use 52 or not.
Having a debate with unilateral Tom. Screening and modifier 52. Use it or not?
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.