CPT/HCPCS Codes for Screening Mammography
* 77052 (in conjunction with 77057): Computer-aided with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography. (List separately in addition to code for primary
procedure).
* 77057 (in conjunction with 77052): Screening mammography, bilateral (2-view film study of each breast) for computer-aided detection applied to a screening mammogram.
* G0202: Screening mammography, producing direct digital image, bilateral, all views.
Diagnostic mammography checks for breast cancer after the discovery of a lump or other sign or symptom of breast cancer. These signs may include pain, skin thickening, nipple discharge, or a change in breast size or shape. Diagnostic mammography is not a preventive service.
Screening Pelvic Exam
CPT code G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast examination
Report one of the following codes: V76.2, V76.47, V76.49, V15.89, V72.31
All female Medicare beneficiaries
• Annually if at high-risk for developing cervical or vaginal cancer, or childbearing age with abnormal Pap test within past 3 years
• Every 24 months for all other women
Prior to 01/01/11:
• Copayment/coinsurance applies
• Deductible waived
On or after 01/01/11:
• Copayment/coinsurance waived
• Deductible waived
Screening Mammography
CPT code 77052, 77057, G0202
covered DX – Report one of the following codes: V76.11 or V76.12
All female Medicare beneficiaries aged 35 and older
• Aged 35 through 39: One baseline
• Aged 40 and older: Annually
Prior to 01/01/11:
• Copayment/coinsurance applies
• Deductible waived
On or after 01/01/11:
• Copayment/coinsurance waived
• Deductible waived
Carrier and CWF Edits
The CWF will not edit for POS for screening mammography. Disable 76X1 edit. Add-on CAD Code 76083 must be billed in conjunction with screening mammography code 76092 or G0202 for claims with dates of service on or after January 1, 2004 throughnDecember 31, 2006. For claims with dates of service January 1, 2007 and later, add on CAD code 77052 must be billed in conjunction with screening mammography code 77057 or G0202. Use Type of Service “1”.
Add-on CAD Code 76082 must be billed in conjunction with diagnostic mammography code 76090, 76091, G0204, or G0206 for claims with dates of service on or after January 1, 2004 through December 31, 2006. For claims with dates of service January 1, 2007 and later, add- on CAD code 77051 must be billed in conjunction with diagnostic mammography codes 77055,77056, G0204 and G0206. Use Type of Service “4”.
Frequency edits apply to screening mammography with or without the CAD code. Screening and diagnostic mammographies (film and digital) are subject to the FDA certification. However, CAD equipment does not require FDA Certification.
Mammography related CAD equipment does not require FDA certification.
Mammography utilizes a direct x-ray of the breast. By contrast, the CAD process uses laser beam to scan the mammography film from a film (analog) mammography, converts it into digital data for the computer, and analyzes the video display for areas suspicious for cancer. The CAD process used with digital mammography analyzes the data from the mammography on a video display for suspicious areas. The patient is not required to be present for the CAD process.
Only one screening mammogram, either 77057* (76092*) or G0202, may be billed in a calendar year. Therefore, providers/suppliers must not submit claims reflecting both a film screening mammography (77057* (76092*)) and a digital screening mammography G0202. Also, they must not submit claims reflecting HCPCS codes 77055* (76090*) or 77056* (76091*) (diagnostic mammography-film) and G0204 or G0206 (diagnostic mammographydigital). Contractors deny the claim when both a film and digital screening or diagnostic mammography is reported. However, a screening and diagnostic mammography can be billed together.
* For claims with dates of service prior to January 1, 2007, providers report CPT codes 76090, 76091, and 76092. For claims with dates of service January 1, 2007 and later, providers report CPT codes 77055, 77056, and 77057 respectively.
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