Medicare_Claims_Processing_Manual / Chapter_18 / 20.6

Why This Topic Matters

Mammography claims can be processed differently depending on whether the imaging remains screening or becomes diagnostic, and the handling changes across time periods and claim types. Correctly identifying the applicable Medicare pathway affects claim submission, payment processing, and data collection.

Article Sections

1. Instructions When an Interpretation Results in Additional Films

   Overview of Medicare billing treatment when a screening mammography interpretation leads to additional imaging. The section is organized by date-of-service period and by carrier versus FI claim handling.

2. Claims With Dates of Service October 1, 1998 Through December 31, 2001

   Billing guidance for an earlier Medicare date range, including how claims are processed when additional films are performed and how related reporting elements are handled.

3. Claims With Dates of Service On or After January 1, 2002, (or On or After April 1, 2002 for Hospitals Subject to OPPS)

   Billing guidance for a later Medicare date range, including separate carrier and FI claim handling and the associated tracking requirements.

4. Carrier Claims

   Carrier-specific processing instructions for claims that include both screening and diagnostic mammography elements on the same day.

5. FI Claims

   Fiscal intermediary processing instructions for claims that include both screening and diagnostic mammography elements on the same day.