Wiki New mammogram code frusturation!!

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aandersoncpc

aandersoncpc

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Has anyone else figured out a good way to bill the new tomosynthesis code 77063 in addition to a 3D screening mammogram and actually get it paid?? Medicare will only pay it on a 2D mamm, and most commercial payers just won't pay it period, as it is still deemed investigational and experimental. Our normal screening mammograms consist of the regular screening G0202, computer aided detection 77052, and tomosynthesis 77063. Should we just stop billing the CAD portion to Medicare?
 
The problem you had was that CMS had 77052 as a column two edit to 77063 in the first quarter, V21.0, edits for 2015. They fixed this as of 04.01.2015 in the second quarter, V21.1, edits and made it retroactive to 01.01.2015. Medicare is now reimbursing for all three codes, however, for any claims where they denied the 77052 as bundled with 77063, you will need to submit again on your own.
 
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