How To Use HCPCS Code C8905

HCPCS code C8905 describes a specific procedure known as magnetic resonance imaging (MRI) of the breast. This procedure involves the use of magnetic fields and radio waves to create detailed images of the breast tissue. The code specifies that the MRI is performed without contrast initially, followed by a second MRI with contrast. This code is used to identify and bill for this specific imaging procedure.

1. What is HCPCS C8905?

HCPCS code C8905 is used to identify the specific procedure of magnetic resonance imaging (MRI) of the breast. It indicates that the MRI is performed without contrast first, followed by a second MRI with contrast. This code is important for accurate billing and reimbursement purposes.

2. Official Description

The official description of HCPCS code C8905 is “Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral.” The short description is “Enteral supp not otherwise c.” These descriptions provide a clear understanding of the procedure being performed and the body part involved.

3. Procedure

1. The provider begins by preparing the patient for the MRI procedure.
2. The patient lies down on a table that slides into the MRI machine.
3. The machine uses a strong magnetic field and radio waves to create detailed images of the breast tissue.
4. The initial MRI is performed without the use of contrast agents.
5. After the initial scan, a contrast agent is administered to the patient.
6. A second MRI is then performed with the contrast agent to enhance the visibility of certain structures or abnormalities.
7. The images obtained from the MRI scans are analyzed by a radiologist to make a diagnosis or evaluate the breast tissue.

4. When to use HCPCS code C8905

HCPCS code C8905 should be used when performing a magnetic resonance imaging (MRI) of the breast. It is specifically used when the MRI is done without contrast initially, followed by a second MRI with contrast. This code should only be used for unilateral breast imaging, meaning it is performed on one breast.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C8905, healthcare providers need to ensure proper documentation of the procedure. This includes documenting the use of contrast agents, the specific breast being imaged (unilateral), and any relevant findings or abnormalities observed during the MRI. It is important to follow the specific billing guidelines provided by Medicare or other insurance carriers to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C8905 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996, indicating that it has been in use for a significant period of time. The code has a pricing indicator code of 57, which means it is priced by other carriers. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and other insurance carriers may provide coverage for HCPCS code C8905. However, it is important to check with the specific carrier to determine their coverage policies and requirements. The pricing indicator code and multiple pricing indicator code indicate how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code C8905 should be billed:

1. A 45-year-old female presents with a suspicious lump in her left breast. She undergoes an MRI of the left breast without contrast, followed by a second MRI with contrast to evaluate the abnormality.
2. A patient with a history of breast cancer undergoes routine surveillance imaging. She receives an MRI of the right breast without contrast, followed by a second MRI with contrast to monitor for any recurrence or new abnormalities.
3. A 30-year-old female with a family history of breast cancer undergoes a diagnostic MRI of the right breast without contrast, followed by a second MRI with contrast to assess her risk and screen for any abnormalities.
4. A patient presents with a palpable mass in her right breast. She undergoes an MRI of the right breast without contrast, followed by a second MRI with contrast to further evaluate the mass and determine the appropriate course of treatment.
5. A patient with a known breast abnormality undergoes an MRI of the left breast without contrast, followed by a second MRI with contrast to assess the extent of the abnormality and guide surgical planning.