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Screening Mammography (NCD 220.4)

Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer death in women in the U. S. Every woman is at risk, and this risk increases with age. Breast cancer usually can be treated successfully when found early. Medicare covers screening mammograms and digital technologies to check for breast cancer before you or a doctor may be able to find it manually.

Update: Medicare now requires an add-on code when you furnish a mammography using 3-D mammography in conjunction with a 2-D digital mammography, effective January 1, 2015.

HCPCS/CPT Codes

77052 – Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation; screening mammography (List separately in addition to code for primary procedure)

77057 – Screening mammography, bilateral (2-view film study of each breast)

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~~Use 77063 as an add-on code to 77067 when tomosynthesis is used in addition to 2-D mammography)

G0202 – Screening mammography, producing direct 2-D digital image, bilateral, all views

77067 – Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

ICD-10-CM (ICD-9-CM) Codes

Report one of the following codes:

Z12.31 (V76.11 or V76.12)

Who Is Covered

All female Medicare beneficiaries aged 35 and older

Frequency

Aged 35 through 39: One baseline; or
Aged 40 and older: Annually (11 full months must have passed since the last screening)

Beneficiary Pays

You pay nothing for this screening if the doctor or other qualified health care provider accepts assignment.

Copayment/coinsurance waived
Deductible waived

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

Frequently Asked Questions (FAQs)

Am I at high risk for breast cancer?

Your risk of developing breast cancer increases if any of these are true:

You had breast cancer in the past.
You have a family history of breast cancer (like a mother, sister, daughter, or 2 or more close relatives who’ve had breast cancer).
You had your first baby after age 30.
You’ve never had a baby.

Other Notes

If billing a screening mammogram and a diagnostic mammogram on the same day, use modifier –GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to show a screening mammography turned into a diagnostic mammography.
Procedure codes G0202, G0204, and G0206 have an end date of December 31, 2017.