by Jared Staheli
June 25th, 2015
The following HCPCS codes are used to bill for mammography services.
|Computer aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images, diagnostic mammography (list separately in addition to code for primary procedure). Code 76082 is effective January 1, 2004 thru December 31, 2006. Code 77051 is effective January 1, 2007.|
|77052* (76083*)||Computer aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images, screening mammography (list separately in addition to code for primary procedure). Code 76083 is effective January 1, 2004 thru December 31, 2006. Code 77052 is effective January 1, 2007.|
|77055* (76090*)||Diagnostic mammography, unilateral.|
|77056* (76091*)||Diagnostic mammography, bilateral.|
|77057* (76092*)||Screening mammography, bilateral (two view film study of each breast).|
|77063**||Screening Breast Tomosynthesis; bilateral (list separately in addition to code for primary procedure).|
|G0202||Screening mammography, producing direct 2-D digital image, bilateral, all views. Code is effective April 1, 2001. This code descriptor effective January 1, 2015.|
|G0204||Diagnostic mammography, direct 2-D digital image, bilateral, all views. Code is effective April 1, 2001. This code descriptor is effective January 1, 2015.|
|G0206||Diagnostic mammography, producing direct 2-D digital image, unilateral, all views. Code is effective April 1, 2001. This code descriptor is effective January 1, 2015.|
|G0279**||Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)|
*For claims with dates of service prior to January 1, 2007, providers report CPT codes 76082, 76083, 76090, 76091, and 76092. For claims with dates of service January 1, 2007 and later, providers report CPT codes 77051, 77052, 77055, 77056, and 77057 respectively.
New Modifier “-GG”: Performance and payment of a screening mammography and diagnostic mammography on same patient same day - This is billed with the Diagnostic Mammography code to show the test changed from a screening test to a diagnostic test. Contractors will pay both the screening and diagnostic mammography tests. This modifier is for tracking purposes only. This applies to claims with dates of service on or after January 1, 2002.
A. Diagnosis for Services On or After January 1, 1998
The BBA of 1997 eliminated payment based on high-risk indicators. However, to assure proper coding, one of the following diagnosis codes should be reported on screening mammography claims as appropriate:
V76.11 – “Special screening for malignant neoplasm, screening mammogram for high-risk patients” or;
V76.12 - “Special screening for malignant neoplasm, other screening mammography.”
Beginning October 1, 2003, A/B MACs are no longer permitted to plug the ICD-9-CM code for a screening mammography when the screening mammography claim has no diagnosis code. Screening mammography claims with no diagnosis code must be returned as unprocessable for assigned claims. For unassigned claims, deny the claim.
Providers report diagnosis code V76.11 or V76.12 in “Principal Diagnosis Code” if the screening mammography is the only services reported on the claim. If the claim contains other services in addition to the screening mammography, diagnostic codes V76.11 or V76.12 are reported, as appropriate, in “Other Diagnostic Codes.” NOTE: Information regarding the form locator number that corresponds to the principal and other diagnosis codes and a table to crosswalk the CMS-1450 form locator to the 837 transaction is found in chapter 25.
A/B MACs (B) receive this diagnosis in field 21 and field 24E with the appropriate pointer code of Form CMS-1500 or in Loop 2300 of ANSI- X12 837.
Diagnosis codes for a diagnostic mammography will vary according to diagnosis.
B. Diagnoses for Services October 1, 1997 Through December 31, 1997
On every screening mammography claim where the patient is not a high-risk individual, diagnosis code V76.12 is reported on the claim.
If the screening is for a high risk individual, the provider reports the principal diagnosis code as V76.11 - “Screening mammogram for high risk patient.”
In addition, for high-risk individuals, one of the following applicable diagnoses codes is reported as “Other Diagnoses codes”:
• V10.3 “Personal history - Malignant neoplasm female breast”;
• V16.3 “Family history - Malignant neoplasm breast”; or
• V15.89 “Other specified personal history representing hazards to health.”
The following chart indicates the ICD-9 diagnosis codes reported for each high-risk category:
|High Risk Category||Appropriate Diagnosis Code|
|A personal history of breast cancer||V10.3|
|A mother, sister, or daughter who has breast cancer||V16.3|
|Not given birth prior to age 30||V15.89|
|A personal history of biopsy-proven benign breast disease||V15.89|