How To Use HCPCS Code G0202

HCPCS code G0202 describes the procedure of screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. This code is used to identify and bill for the specific service provided by healthcare providers. In this article, we will explore the details of HCPCS code G0202, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0202?

HCPCS code G0202 is a specific code used to identify the procedure of screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. It is important to note that this code is only applicable for screening purposes and not for diagnostic mammography.

2. Official Description

The official description of HCPCS code G0202 is “Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.” The short description for this code is “Scr mammo bi incl cad.”

3. Procedure

  1. The healthcare provider performs a screening mammography on the patient.
  2. The mammography includes a 2-view study of each breast.
  3. If available, computer-aided detection (CAD) is utilized during the screening.
  4. The images obtained from the mammography are reviewed and analyzed for any abnormalities or signs of breast cancer.
  5. The results of the screening mammography are documented and communicated to the patient.

4. When to use HCPCS code G0202

HCPCS code G0202 should be used when a healthcare provider performs a screening mammography on a patient. It is important to note that this code is specifically for screening purposes and not for diagnostic mammography. The screening mammography is typically performed on patients who do not have any symptoms or signs of breast cancer but are undergoing routine screening as a preventive measure.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0202, healthcare providers need to ensure that the following documentation requirements are met:

  • Documentation of the screening mammography procedure performed
  • Documentation of the 2-view study of each breast
  • Documentation of the utilization of computer-aided detection (CAD), if applicable
  • Documentation of the results of the screening mammography

Providers should also follow the specific billing guidelines provided by the payer or insurance company to ensure accurate and timely reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code G0202 was added to the Healthcare Common Procedure Coding System on April 01, 2001. It has a pricing indicator code of 13, which means that the price for this service is established by 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. It is important to note that HCPCS code G0202 was terminated on December 31, 2017.

7. Medicare and Insurance Coverage

Medicare and other insurance companies may provide coverage for HCPCS code G0202. The specific coverage and reimbursement policies may vary, so it is important for healthcare providers to verify the coverage guidelines with the respective payer. The pricing indicator code for this code is 13, indicating that the price is established by carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0202 should be billed:

  1. A 45-year-old female patient visits her primary care physician for a routine check-up. As part of the preventive care, the physician orders a screening mammography. HCPCS code G0202 should be billed for this service.
  2. A 50-year-old female patient presents to a mammography center for her annual screening mammography. The procedure includes a 2-view study of each breast and utilizes computer-aided detection. HCPCS code G0202 should be billed for this service.
  3. A 55-year-old female patient with a family history of breast cancer undergoes a screening mammography at a specialized breast imaging center. The procedure includes a 2-view study of each breast. HCPCS code G0202 should be billed for this service.
  4. A 60-year-old female patient visits a mobile mammography unit for a screening mammography. The procedure includes a 2-view study of each breast. HCPCS code G0202 should be billed for this service.
  5. A 65-year-old female patient receives a reminder letter from her healthcare provider for her routine screening mammography. She schedules an appointment and undergoes the procedure, which includes a 2-view study of each breast. HCPCS code G0202 should be billed for this service.

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