(Medicare Claims Processing Manual)

If the MQSA file appears to be in error, contact your regional office mammography coordinator. The coordinators will contact the FDA to research the apparent error.    20.2 - HCPCS and Diagnosis Codes for Mammography Services                                          (Rev. 12435, Issued:12- 28-23, Effective:01- 29-24, Implementation:01- 29-24)  The following HCPCS codes are used to bill for mammography services.   HCPCS Code  Definition  77065*  (G0206*)   Diagnostic mammography, including computer -aided detection (CAD) when performed; unilateral  77066*  (G0204*)  Diagnostic mammography, including computer -aided detection (CAD) when performed; bilateral  77067*  (G0202*)  Screening mammography, bilateral (2 -view study of each breast), including computer -aided detection (CAD) when performed    77063**  Screening Breast Tomosynthesis; bilateral (list separately in addition to code for primary procedure).   G0279**  Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to code for primary procedure)   *NOTE:   For claims with dates of service January 1, 2017 through December 31, 2017 providers report HCPCS codes G0202, G0204, and G0206.  For claims with dates of service on or after January 1, 2018 providers report CPT codes 77067, 77066, and 77065 respectively.  **NOTE:  HCPCS codes 77063 and G0279 are effective for claims with dates of service on or after January 1, 2015.  New Modifier  -GG:  Performance and payment of a screening mammography and diagnostic mammography on same patient same day -  This is billed with the Diagnostic Mammography code to show the test changed from a screening test to a diagnostic test.  A/B MACs (A) and (B) will pay both the screening and diagnostic mammography tests.  This modifier is for tracking purposes only.  This applies to claims with dates of service on or after January 1, 2002. A. Diagnosis for Services On or After Oct 1, 2015 The BBA of 1997 eliminated payment based on high- risk indicators.  However, to ensure proper coding, one of the following diagnosis codes should be reported on screening mammography claims as appropriate:  ICD- 10-CM Z12.31 -  Encounter for screening mammogram for malignant neoplasm of breast.  Beginning October 1, 2003, A/B MACs (B) are not permitted to plug the code for a screening mammography when the screening mammography claim has no diagnosis code.  Screening mammography claims with no diagnosis code must be returned as unprocessable for as signed claims.  For unassigned claims, deny the claim. In general, providers report diagnosis codes in accordance with the instructions in the appropriate ASC X12 837 claim technical report 3 (institutional or professional) and the paper claim form instructions found in chapters 25 (institutional) and 26 (prof essional).  In addition, for institutional claims, providers report diagnosis code Z12.31 (if ICD -10-CM is applicable) in Principal Diagnosis Code if the screening mammography is the only service reported on the claim.  If the claim contains other services in additi on to the screening mammography, these diagnostic code Z12.31 (ICD -10-CM)  are reported, as appropriate, in Other Diagnostic Codes.  NOTE:   Information regarding the form locator number that corresponds to the principal and other diagnosis codes is found in chapter 25.  A/B MACs (B) receive this diagnosis in field 21 and field 24E with the appropriate pointer code of Form CMS -1500 or in Loop 2300 of ASC - X12 837 professional claim format. ICD- 10-CM Codes for a diagnostic mammography: