Screening Mammography - JE Part B

HCPCS/CPT Codes

• 77063 - Screening digital breast tomosynthesis; bilateral (List separately in addition to code for primary procedure) (Use this as an add-on code to G0202 when tomosynthesis is used in addition to 2-D mammography)
• 77067 - Screening mammography, bilateral (2-view film study of each breast) (Effective 01/01/18)
• G0202 - Screening mammography, producing direct 2-D digital image, bilateral, all views (Valid prior to 01/01/18)

Frequency

• Women aged 35 - 39: One baseline
• Women 40 and over: Annually

Diagnosis Code

Z12.31 - Encounter for screening mammogram for malignant neoplasm of breast

Coverage

All females aged 35 and older

Facilities

• Must be certified by Food and Drug Administration (FDA)
• Cannot release x-rays for interpretation to physicians not approved under certification number unless:
  • Patient requested transfer for second opinion
  • Patient moved to another part of country where next screening mammography will be performed

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - 77057 and G0202

Resources

• CMS Frequently Asked Questions
• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.3
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 20
• CMS Medicare Preventive Services
• CMS National Coverage Determination (NCD) 220.4