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Preventive Services: Screening Mammography

By:  Find-A-Code
Published:  September 1st, 2017

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on a Screening Mammography: 

HCPCS/CPT Codes

77052 - Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure)
77057 - Screening mammography, bilateral (2-view study of each breast)
77063 - Screeningdigitalbreasttomosynthesis; bilateral (List separately in addition to code for primary procedure)
  • Use 77063 as an add-on code to G0202 when tomosynthesis is used in addition to 2-D mammography
G0202 - Screening mammography, producing direct digital image, bilateral, all views

ICD-10 Codes

Z12.31

Who Is Covered

All female Medicare beneficiaries aged 35 and older

Frequency

  • Aged 35 through 39: One baseline
  • Aged 40 and older: Annually

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

Other Notes

  • If billing a screening mammogram and a diagnostic mammogram on the same day, use modifier -GG to show a screening mammography turned into a diagnostic mammography.

Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.


References:

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