Screening Mammography, Diagnostic Mammography, and Screening Mammography that Converts to Diagnostic Mammography

Special Billing Instructions When the Radiologist’s Interpretation of a Screening Mammogram Results in Additional Views:

• Both the screening mammography and the diagnostic mammography may be reimbursed by Medicare.
• The screening mammography should be billed with ICD-9-CM code V76.11 or V76.12.
• The diagnostic mammogram should be billed with one of the ICD-9-CM codes listed in the LCD under “ICD-9-CM Codes that Support Medical Necessity,” “For diagnostic mammography and screening mammography that converts to diagnostic mammography.” *
• The screening and diagnostic mammographies should be billed on the same claim. Attach the GG modifier to the diagnostic code to show that the test changed from a screening mammography to a diagnostic mammography.

* ICD-9-CM code V76.12 was removed from this list of covered ICD-9-CM codes. This ICD-9-CM code is only appropriate for use with a screening mammography.  

UnilateralScreening Mammography - (CPT codes 76092 and G0202)

Screening mammography CPT codes 76092 and G0202 should be reported whether the mammography is performed unilaterally or bilaterally.

Effective for services rendered on or after July 1, 2006, append CPT/HCPCS codes 76092 and G0202 with the modifier -52 (reduced services) when the mammogram is performed unilaterally.

Note: When modifier -52 is appended to the screening mammography codes 76092 and G0202, it is assumed that the service rendered was a unilateral mammography. The unilateral mammography will be reimbursed at 75 percent of the amount allowed for a bilateral mammography.

Reference: Empire Medicare Services LCD on Breast Imaging: “Mammography/Breast Echography (Sonography)/Breast MRI/Ductography” (New York #L3500 and New Jersey #L3477)

© All current procedural terminology (CPT) codes and descriptors copyrighted by the American Medical Association.