Coding guide Diagnostic/Screening mammogram CPT Code 77065, 77066 & 77067

Intro about Cpt code for Mammogram Diagnostic

Mammogram exam are performed as Screening or Diagnostic. The Screening mammogram, which is done at regular interval after crossing an age of 40, to check for any sign and symptoms, related to breast cancer. While the diagnostic Mammogram is done if there is, any diagnosis is present in breast like mass or lump or swelling etc which can lead to breast cancer.So, we are just here to learn more about diagnostic mammogram and what are CPT codes used for coding them. Cpt code for Mammogram Diagnostic is digital codes. Digital codes are G codes and are used for both screening and diagnostic mammogram. There are also numerical procedure codes for Mammogram, which are also used in coding. CPT code 77065, 77066 & 77067 are going to use for diagnostic and screening mammogram from 2018.

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Deleted Cpt code for Mammogram Digital in 2018

Below HCPCS & CPT codes have been deleted from 1st January 2018. All G codes used for mammogram has been deleted. 

Screening Mammogram CPT Code for bilateral – G0202
In addition, for unilateral Screening Mammogram -Go202-52
CAD (Computer Aided Detection) For Screening – 77052
Diagnostic Mammogram cpt code for bilateral – G0204
Diagnostic Mammogram cpt code for unilateral – Go206
CAD (Computer Aided Detection) for diagnostic – 77051

The above codes will be replaced with the new CPT code 77065, 77066 & 77067 in 2018 for diagnostic and screening mammogram procedures.

A screening mammography is a radiologic procedure furnished to a woman without signs or symptoms of breast disease, for the purpose of early detection breast cancer,and includes a physician’s interpretation of the results of the procedure. A screening mammogram does not require a physician’s referral, however, detection of a radiographic abnormality, may prompt the interpreting radiologist to order additional views on the same day.

When this is the case, the mammography is no longer considered to be a screening exam and should be reported as a diagnostic mammogram. Radiologists who order additional tests must refer back to the treating physician or qualified non-physician practitioner for his/her UPIN and report back to the treating physician the condition of the patient. No separate reimbursement will be made for additional views. The cost for additional views is included in the cost of the diagnostic mammography service. Screening mammogram(s) (digital and non-digital) for the
following indications are allowed:
• Asymptomatic women ages 40 and older are eligible for a screening mammography (digital and nondigital) performed after at least 11 months have passed following the month in which the last screening mammography was performed.
• Women between the ages of 35 and 39 are eligible to receive one baseline screening mammogram.
• Women with breast implants are eligible for screening mammography when the screening mammogram is performed within the aforementioned age and frequency limitations.
• Services will only be allowed if supplied by certified suppliers or FDA-certified mammography centers.

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Old deleted  Cpt codes for Diagnostic and Screening mammogram Numerical

Screening Mammogram CPT Code for bilateral  – 77057 
In addition, for unilateral Screening Mammogram -77057-52
CAD (Computer Aided Detection) – 77052
Diagnostic Mammogram cpt code for bilateral – 77056
Diagnostic Mammogram cpt code for unilateral – 77055
CAD (Computer Aided Detection) – 77051

New CPT code 77065, 77066 & 77067 for Diagnostic and Screening Mammography

From 1st January 2018, the below CPT code 77065, 77066 and 77067 will be used for coding diagnostic and screening mammogram for Medicare and Non-Medicare payers.

• 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
• 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
• 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

Do and don’t with 77065, 77066 & 77067 for Mammography Diagnostic

Do not code Procedure code 77065 along with 77066 it will be denied if any provider submits it for the same date of service.
Do not code Procedure code 77066 along with G0204 (deleted in 2018) it will be denied if any provider submits it for the same date of service.
Do not code Procedure code G0206 (deleted in 2018) along with 77066 or G0204 (deleted in 2018) it will be denied if any provider submits it for the same date of service.
Do code GG modifier with diagnostic Mammogram when performed with screening mammogram on the same date of service as.