Wiki New Tomosynthesis Codes

[neva]

I am having trouble getting paid for the G0202 and 77052 with Humana. I do not think we do 3-D on our screening mammograms. I was wondering if I had to use the new code 77063 with the G0202 for 2015.

 

[mderemer]

This needs to be appealed with your Representative. 77052 (screening ) is the CAD portion of the mammo and is a separate procedure and must be billed with G0202 as it is an add-on CPT to G0202/77057. CPT 77063 (screening 3D) is only for use if you are performing the new procedure Tomosynthesis, which is 3D imaging of the breast.
If you are doing a diagnostic mammo and tomosynthesis , the CPT for the tomo would be 77061 (one breast), 77062 (both breast). If the patient has Medicare, you would use G0279 (one or both breast). G0279 is on valid for a diagnostic mammo