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Digital Mammograms

wjune66

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We recently added the equipment to perform Digital Mammograms to our office. We have noticed higher reimbursment from all payers with the exception of one. We contacted that payer and we were advised that there is an addtional code that we should be submitting to receive full reimbursement but she would not tell us what that is.

After reading many of the posts on this site I wonder if she is refering to the CAD code. We no longer have the equipment for the CAD but I just want to be sure that we aren't missing out on something.

Any help is greatly appreciated.
 

donnajrichmond

True Blue
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518
Location
Alexandria, LA
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We recently added the equipment to perform Digital Mammograms to our office. We have noticed higher reimbursment from all payers with the exception of one. We contacted that payer and we were advised that there is an addtional code that we should be submitting to receive full reimbursement but she would not tell us what that is.

After reading many of the posts on this site I wonder if she is refering to the CAD code. We no longer have the equipment for the CAD but I just want to be sure that we aren't missing out on something.

Any help is greatly appreciated.
Are you using the G codes?
 

wjune66

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Yes, we are using G0202. We only perform screening Mammograms in our office. We refer all diagnostic out.
 

donnajrichmond

True Blue
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518
Location
Alexandria, LA
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There are codes for additional procedures (such as CAD and digital breast tomosynthesis-DBT), but these are separate and wouldn't change the fee for the mammogram, which is what you were asking about.
There are a few payers who pay the same regardless of technique, and a few who do not recognize the G codes for digital.
So, unless this payer has a strange rule requiring something special, you probably got someone who doesn't know what she is talking about.

Have you checked the payer's website for their mammogram policy?
 
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