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.

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.

Who Is Covered

All female Medicare beneficiaries aged 35 and older

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)

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

ICD-10-CM Codes

Z12.31

Frequency

   • Aged 35 through 39: One baseline

   • Aged 40 and older: Annually

Medicare Beneficiary Pays

Screening mammogram: You pay nothing for the screening test if the doctor or other qualified health care provider accepts assignment

Diagnostic mammogram: You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

   • Copayment waived

   • 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

References