Medicare Guidelines - Screening and Diagnostic Mammography CPT Code (77067, 77066 & 77065)

Screening and Diagnostic Mammography CPT Code:

• Effective 01/01/2018, Screening mammography CPT code G0202 & Diagnostic mammography CPT codes G0204, and G0206 were deleted.

• CPT codes G0202, G0204 & G0206 were replaced with 77067, 77066 & 77065 respectively.

• It is necessary to bill Screening digital breast tomosynthesis CPT 77063 in conjunction with Screening mammography CPT 77067, Diagnostic digital breast tomosynthesis bilateral CPT 77062 in conjunction with Diagnostic mammography CPT 77066 & Diagnostic digital breast tomosynthesis unilateral CPT 77061 in conjunction with Diagnostic mammography CPT 77065 to get these mammography CPTs paid.

• Effective 01/01/2018, CPT G0279 must be billed with CPT 77065 & 77066 for reimbursement.

Reimbursement Guidelines for Screening Mammography Code:

• Payment may not be made for screening mammography performed on a woman under age 35.
• Payment may be made for only one screening mammography performed on a woman over age 34 but under age 40.
• For an asymptomatic woman over age 39, payment may be made for screening mammography performed after at least 11 months have passed following the month in which the last screening mammography was performed.

Reimbursement Guidelines for Diagnostic Mammography Code:

• A patient has distinct signs and symptoms for which a mammogram is indicated.
• A patient has a history of breast cancer.
• A patient is asymptomatic but on the basis of the patient's history and other factors the physician considers significant, the physician's judgment is that a mammogram is appropriate.