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Need CPT Code for Unilateral Screening Mammogram

  1. Default Need CPT Code for Unilateral Screening Mammogram
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    I am not sure if this is the correct forum to post this on, but thanks in advance for your help.

    Recently Medicare changed the rules for Breast Imaging/Mammography. According to article L26890, the new LCD for Breast Mammography, if a patient has a history of breast cancer, but the patient is clinically stable, which is a time frame of two years, we no longer do diagnostic breast imaging. The patient should get a routine screening mammogram.

    My question is what CPT code do we assign for a patient with a clinically stable history of breast cancer that has also had a mastectomy. We cannot find a code for screening mammography, unilateral only; all screening mammograms codes appear to be bilateral.

    You might also note that we are a small critical access hospital and therefore we do not use modifiers.

    Thanks again.


  2. #2
    Hope this helps, THIS IS ALL PER THE ACR

    First here is the website:

    The following Q&As address Medicare guidelines on the reporting of breast imaging procedures. Private payer guidelines may vary from Medicare guidelines and from payer to payer; therefore, please be sure to check with your private payers on their specific breast imaging guidelines.

    Q: How do you code for a unilateral screening mammogram in a patient who has had one of her breasts removed? The code descriptor for a screening mammogram specifies that it is a bilateral study.

    When a screening mammography study is ordered and performed on a patient who has only one breast, it is appropriate to report 77057 (Screening Mammography, bilateral [2-view] film study of each breast) or G0202 (Screening mammography, producing direct digital image, bilateral, all views). Because the CPT code descriptors for 77057 and G0202 state “bilateral,” it would be appropriate to use a 52 modifier (reduced level of service) to designate a screening procedure of only one breast. However, radiology practices should check with their local carrier and other third-party payers regarding the use of the 52 modifier in this situation, because some payers have stated that a 52 modifier is not necessary for reporting a unilateral screening mammogram.

    Good luck!
    Jessica O'Donnell CPC

  3. Default
    Thank you so much Jessica! That helped a lot! I hope this solves our issue. Again, thank you


  4. #4
    Anytime, I know what it feels like to be in desperate need of an answer!!

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