How To Bill Screening & Diagnostic Mammography | Codes & Guidelines (2022)
Screening mammography can be billed with CPT 77067, and diagnostic mammography with CPT 77065 and CPT 77066.
1. What Is Screening Mammography?
Screening mammography is a radiologic procedure for the detection of breast cancer in an early stage and is provided to asymptomatic women.
This procedure is used for women without any symptoms and includes the interpretation of the results by the health provider. This procedure will be covered without symptoms, signs, or a history of breast cancer.
Screening mammography procedures are covered without a referral or a doctor’s prescription. Payments are based on the age of the female patient and the statutory frequency parameter.
2. What Is CPT Code 77067?
CPT 77067 can be used for screening mammography. The provider does a routine screening by taking two X-rays of both of the patient’s breasts and uses software to identify potential abnormalities.
The CPT book describes CPT 77067 as follows: “Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.”
The 77067 CPT code screening mammography procedure starts with the technician placing both breasts between two plates before they press them together.
The plates use X-rays and expose the breast to radiation for imaging. Then, two pictures (two views) are taken from each breast.
The technician can use computer-aided detection (CAD) software to detect abnormalities and improve their analysis. The images sometimes need to be scanned into the computer for analysis.
The CAD technology detects minute details and can identify false findings. Finally, the provider reviews the marked CAD–detected abnormalities in the images on a computer screen.
2.3 Billing Guidelines
You can report CPT 77066 instead of CPT 77067 if this procedure is performed with a single view of each breast.
Append modifier 25 to CPT code 77067 if you report the interpretation of the technician or provider alone.
CPT 77067 can only be used as a diagnostic mammography procedure to identify diseases in patients without symptoms or signs.
3. What Is Diagnostic Mammography?
Diagnostic mammography is a radiologic procedure to detect breast cancer. This procedure is used for women with lumps or other symptoms that might indicate breast cancer.
4. What Is CPT Code 77065?
The 77065 CPT code diagnostic mammography can be billed if a provider performed X-ray imaging of the patient’s breast with suspected cancer or a lump.
The provider can use CAD software for diagnosing and identifying abnormalities.
TIP: You can find the complete billing guide for CPT code 77065 here.
4.3 Billing Guidelines
CPT code 77065 can only be used for diagnostic mammography on one breast. Use CPT 77066 if the procedure was performed on both breasts.
5. What Is CPT Code 77066?
The 77066 CPT code procedure for diagnostic mammography can be billed if a provider performs X-ray imaging services for a patient with suspected cancer in both breasts.
The provider uses CAD software to analyze and diagnose potential abnormalities in both breasts.
The CPT book describes CPT code 77066 as follows: “Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral.”
This diagnostic mammography procedure starts with the technician placing both breasts with suspected cancer or lumps under two plates before pressing them together.
Then, X-ray images are taken of both breasts, and the provider scans them, if necessary, to a computer with CAD software. This software helps the provider with analyzing and diagnosing the images for abnormalities.
5.3 Billing Guidelines
You can append modifier TC to the claim if you report only the technical component of CPT code 77066. Modifier 26 might be used for the professional component alone if the procedure was not a global service.