Screening mammograms are important for early detection of breast cancer, which can save lives. If you’re a radiologist, biller, or healthcare provider, you must understand the 77067 CPT code. This code is used to bill bilateral screening mammography with computer-aided detection (CAD), a method that helps detect abnormalities in breast images.
Getting the 77067 CPT code right means smoother insurance claims and ensures patients get the care they need on time.
What Exactly Is the 77067 CPT Code?
Put simply, CPT 77067 is used for a bilateral screening mammogram, meaning imaging of both breasts. What sets this code apart is that it includes the use of CAD — software that assists radiologists by highlighting suspicious areas on the mammograms. This extra set of “eyes” helps catch problems that might otherwise be missed.
The 77067 CPT code replaced older ones like G0202 and 77057 in 2017 to simplify the billing process.
When Should You Use the 77067 CPT Code?
The 77067 CPT code should only be used for screening mammograms in women who don’t have any symptoms no lumps, pain, or nipple discharge. If a patient is showing symptoms, diagnostic mammography codes should be used instead.
The screening involves taking two views per breast (typically a top-to-bottom and an angled view) and should include CAD. Most women over the age of 40 get this test every year as part of regular breast cancer screening.
Insurance companies generally cover this test fully as a preventive service, so patients usually don’t have to pay out-of-pocket.
What Should Be Documented for the 77067 CPT Code?
To avoid claim denials, your clinical report desires to without a doubt nation:
- Why the screening was executed (age, own family records, ordinary test-up, etc.)
- That the patient has no breast symptoms
- The imaging technique, confirming two views on both breasts
- Confirmation that CAD was used during interpretation
- Radiologist’s findings and any recommended follow-up
- The suitable ICD-10 analysis code — Z12.31 (screening for breast cancer)
Good documentation ensures that the 77067 CPT code is processed smoothly and helps insurance understand the medical necessity.
Helpful Modifiers to Know for 77067 CPT Code
Modifiers clarify specific billing situations related to the 77067 CPT code:
- -26: Professional component only (radiologist’s interpretation)
- -TC: Technical component only (equipment and technologist)
- -52: Reduced service (e.g., imaging only one breast instead of both)
- -GG: Screening converted to diagnostic on the same day
- -59: Distinct procedural service (used less often)
If you do a unilateral (one breast) screening, remember to add modifier -52 to both CPT 77067 and 77063 (if tomosynthesis is performed).
What About Insurance and Reimbursement for the 77067 CPT Code?
Medicare reimburses more or less $a hundred thirty five to $one hundred forty five for the global service below CPT 77067, even though amounts can vary with the aid of vicinity. Most private coverage plans observe similar regulations, masking the mammogram as a preventive carrier without a price to the patient.
Always use the right diagnosis code to avoid claim rejections when billing with 77067 CPT code. Some insurers may require proof of high risk, such as family history, for more frequent screenings.
Digital Breast Tomosynthesis (3D Mammography) and the 77067 CPT Code
With advances in breast imaging, 3-d mammography (known as tomosynthesis) is becoming greater common. When tomosynthesis is carried out with screening mammography, you furthermore mght invoice CPT code 77063 as an upload-on.
Key matters to preserve in mind:
- 77063 can never be billed alone — it must accompany 77067.
- If tomosynthesis is done on only one breast, add modifier -52 to both codes.
- For diagnostic mammograms, specific codes (77065, 77066) follow rather.
Common Mistakes to Avoid
- Use 77067 for patients who show symptoms.
- Bill 77063 without 77067.
- Forget modifier -52 for unilateral exams.
- Miss applying modifier -GG when a screening exam becomes diagnostic on the same day.
Quick Reference Table
| Feature Details | Details |
| CPT Code | 77067 |
| Procedure | Bilateral screening mammogram with CAD |
| Add-On Code | 77063 (for tomosynthesis) |
| ICD-10 Code | (screening for breast cancer) |
| Frequency | Usually once a year |
| Common Modifiers | -26, -TC, -52, -GG, -59 |
| Medicare Reimbursement | Around $135–$145 |
Conclusion
Understanding and correctly applying CPT code 77067 is important for healthcare carriers worried in breast most cancers screening. Accurate coding, thorough documentation, and proper use of modifiers make sure smooth compensation and compliance with payer requirements. As imaging technologies evolve, staying knowledgeable about related billing practices, which includes tomosynthesis upload-on codes, will help optimize patient care and practice sales. By following first-class practices, providers can make contributions to early detection efforts while keeping green and compliant billing workflows.