Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast
MRI/Ductography

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Breast Imaging: Breast Echography
(Sonography)/Breast MRI/Ductography (L33585).  
  
 **Coding Information:**  
  
Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.  
  
For services requiring a referring/ordering physician, the name and UPIN or
NPI of the referring/ordering physician must be reported on the claim.  
  
A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.  
  
The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.  
  
 **  For claims submitted to the Part B MAC:**  
  
All services/procedures performed on the same day for the same beneficiary by
the physician/provider should be billed on the same claim.  
  
An evaluation and management (E&M) service or consultation by the radiologist
on the same day (or subsequent days) as a breast sonogram, MRI, or ductogram
or their components should not be separately coded or billed.  
  
For breast sonography, breast MRI, and ductogram, the NPI of the
treating/ordering physician or qualified non-physician practitioner is
required on the claim. Report this number in item 17a of the CMS-1500 form or
in the electronic equivalent.  
  
 **BREAST SONOGRAPHY**  
  
If performed bilaterally, a modifier 50 may be reported with CPT code 76641 or
76642.  
  
**BREAST MRI**  
  
Only CPT codes 77046, 77047, 77048, 77049 may be reported for any given date
of service.  
  
 **MAMMARY DUCTOGRAM OR GALACTOGRAM**  
  
Only CPT code 77053 or 77054 may be reported for any given date of service.  
  
Use CPT code 19030 for the injection of contrast.  
  
 **For claims submitted to the Part A MAC:**  
  
CPT code 19030 is a packaged service and is not separately payable.

**BREAST SONOGRAPHY**

  * For Part A billing of breast sonography, use the following:
  * CPT codes 76641 and 76642

**BREAST MRI**  
  
For Part A billing of breast MRI, use the following:

  * HCPCS code C8903, C8905, C8906, C8908
  * CPT codes 77046 and 77047

  **DUCTOGRAPHY**  
  
For Part A billing of ductography, use the following:

  * CPT codes 77053 or 77054

**Documentation Requirements:  
  
** The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the related LCD. (See
"Indications and Limitations of Coverage.") This documentation includes, but
is not limited to, relevant medical history, physical examination, and results
of pertinent diagnostic tests or procedures.  
  
A clear, clinical indication for the breast sonogram/breast MRI/ductogram must
be documented in the medical record, as well as in the referral order.  
  
The medical record must include a formal written report describing all the
views completed. The formal written report must include the reason for the
test, a description of the test, the interpretation and results of the test,
and the name of the physician to whom the report is being sent.  
  
Documentation must be available to Medicare upon request.