CMS Pub. 100-04, ch. 18, § 20.2

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

HCPCS

Code

Definition

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 assigned

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 (professional).

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 addition 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:

ICD-10

CM code Definitions

C43.52 Malignant melanoma of skin of breast

C43.59 Malignant melanoma of other part of trunk

C44.511 Basal cell carcinoma of skin of breast

C44.519 Basal cell carcinoma of skin of other part of trunk

C44.521 Squamous cell carcinoma of skin of breast

C44.529 Squamous cell carcinoma of skin of other part of trunk

C44.591 Other specified malignant neoplasm of skin of breast

C44.599 Other specified malignant neoplasm of skin of other part of trunk

C45.9 Mesothelioma, unspecified

C50.011 Malignant neoplasm of nipple and areola, right female breast

C50.012 Malignant neoplasm of nipple and areola, left female breast

C50.021 Malignant neoplasm of nipple and areola, right male breast

C50.022 Malignant neoplasm of nipple and areola, left male breast

C50.111 Malignant neoplasm of central portion of right female breast

C50.112 Malignant neoplasm of central portion of left female breast

C50.121 Malignant neoplasm of central portion of right male breast

C50.122 Malignant neoplasm of central portion of left male breast

C50.211 Malignant neoplasm of upper-inner quadrant of right female breast

C50.212 Malignant neoplasm of upper-inner quadrant of left female breast

C50.221 Malignant neoplasm of upper-inner quadrant of right male breast

C50.222 Malignant neoplasm of upper-inner quadrant of left male breast

C50.311 Malignant neoplasm of lower-inner quadrant of right female breast

C50.312 Malignant neoplasm of lower-inner quadrant of left female breast

C50.321 Malignant neoplasm of lower-inner quadrant of right male breast

C50.322 Malignant neoplasm of lower-inner quadrant of left male breast

C50.411 Malignant neoplasm of upper-outer quadrant of right female breast

C50.412 Malignant neoplasm of upper-outer quadrant of left female breast

C50.421 Malignant neoplasm of upper-outer quadrant of right male breast

C50.422 Malignant neoplasm of upper-outer quadrant of left male breast

C50.511 Malignant neoplasm of lower-outer quadrant of right female breast

C50.512 Malignant neoplasm of lower-outer quadrant of left female breast

C50.521 Malignant neoplasm of lower-outer quadrant of right male breast

C50.522 Malignant neoplasm of lower-outer quadrant of left male breast

C50.611 Malignant neoplasm of axillary tail of right female breast

C50.612 Malignant neoplasm of axillary tail of left female breast

C50.621 Malignant neoplasm of axillary tail of right male breast

C50.622 Malignant neoplasm of axillary tail of left male breast

C50.811 Malignant neoplasm of overlapping sites of right female breast

C50.812 Malignant neoplasm of overlapping sites of left female breast

C50.821 Malignant neoplasm of overlapping sites of right male breast

C50.822 Malignant neoplasm of overlapping sites of left male breast

C56.1 Malignant neoplasm of right ovary

C56.2 Malignant neoplasm of left ovary

C77.3 Secondary and unspecified malignant neoplasm of axilla and upper limb lymph

nodes

C78.01 Secondary malignant neoplasm of right lung

C78.02 Secondary malignant neoplasm of left lung

C78.1 Secondary malignant neoplasm of mediastinum

C78.2 Secondary malignant neoplasm of pleura

C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct

C79.2 Secondary malignant neoplasm of skin

C79.31 Secondary malignant neoplasm of brain

C79.32 Secondary malignant neoplasm of cerebral meninges

C79.40 Secondary malignant neoplasm of unspecified part of nervous system

C79.49 Secondary malignant neoplasm of other parts of nervous system

C79.51 Secondary malignant neoplasm of bone

C79.52 Secondary malignant neoplasm of bone marrow

C79.61 Secondary malignant neoplasm of right ovary

C79.62 Secondary malignant neoplasm of left ovary

C79.81 Secondary malignant neoplasm of breast

C80.0 Disseminated malignant neoplasm, unspecified

C80.1 Malignant (primary) neoplasm, unspecified

C84.7A Anaplastic large cell lymphoma, ALK-negative, breast

D03.52 Melanoma in situ of breast (skin) (soft tissue)

D03.59 Melanoma in situ of other part of trunk

D04.5 Carcinoma in situ of skin of trunk

D05.01 Lobular carcinoma in situ of right breast

D05.02 Lobular carcinoma in situ of left breast

D05.11 Intraductal carcinoma in situ of right breast

D05.12 Intraductal carcinoma in situ of left breast

D05.81 Other specified type of carcinoma in situ of right breast

D05.82 Other specified type of carcinoma in situ of left breast

D22.5 Melanocytic nevi of trunk

D23.5 Other benign neoplasm of skin of trunk

D24.1 Benign neoplasm of right breast

D24.2 Benign neoplasm of left breast

D48.5 Neoplasm of uncertain behavior of skin

D48.61 Neoplasm of uncertain behavior of right breast

D48.62 Neoplasm of uncertain behavior of left breast

D49.1 Neoplasm of unspecified behavior of respiratory system

D49.6 Neoplasm of unspecified behavior of brain

D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of

nervous system

I80.8 Phlebitis and thrombophlebitis of other sites

M70.80 Other soft tissue disorders related to use, overuse and pressure of unspecified

site

M70.88 Other soft tissue disorders related to use, overuse and pressure other site

M70.89 Other soft tissue disorders related to use, overuse and pressure multiple sites

M79.5 Residual foreign body in soft tissue

M79.81 Nontraumatic hematoma of soft tissue

M79.89 Other specified soft tissue disorders

N60.01 Solitary cyst of right breast

N60.02 Solitary cyst of left breast

N60.11 Diffuse cystic mastopathy of right breast

N60.12 Diffuse cystic mastopathy of left breast

N60.21 Fibroadenosis of right breast

N60.22 Fibroadenosis of left breast

N60.31 Fibrosclerosis of right breast

N60.32 Fibrosclerosis of left breast

N60.41 Mammary duct ectasia of right breast

N60.42 Mammary duct ectasia of left breast

N60.81 Other benign mammary dysplasias of right breast

N60.82 Other benign mammary dysplasias of left breast

N61.0 Mastitis without abscess

N61.1 Abscess of the breast and nipple

N61.21 Granulomatous mastitis, right breast

N61.22 Granulomatous mastitis, left breast

N61.23 Granulomatous mastitis, bilateral breast

N62 Hypertrophy of breast

N63.11 Unspecified lump in right breast, upper outer quadrant

N63.12 Unspecified lump in right breast, upper inner quadrant

N63.13 Unspecified lump in right breast, lower outer quadrant

N63.14 Unspecified lump in right breast, lower inner quadrant

N63.15 Unspecified lump in right breast, overlapping quadrants

N63.21 Unspecified lump in the left breast, upper outer quadrant

N63.22 Unspecified lump in left breast, upper inner quadrant

N63.23 Unspecified lump in left breast, lower outer quadrant

N63.24 Unspecified lump in left breast, lower inner quadrant

N63.25 Unspecified lump in left breast, overlapping quadrants

N63.31 Unspecified lump in axillary tail of the right breast

N63.32 Unspecified lump in axillary tail of the left breast

N63.41 Unspecified lump in right breast, subareolar

N63.42 Unspecified lump in left breast, subareolar

N64.0 Fissure and fistula of nipple

N64.1 Fat necrosis of breast

N64.2 Atrophy of breast

N64.3 Galactorrhea not associated with childbirth

N64.4 Mastodynia

N64.51 Induration of breast

N64.52 Nipple discharge

N64.53 Retraction of nipple

N64.59 Other signs and symptoms in breast

N64.81 Ptosis of breast

N64.82 Hypoplasia of breast

N64.89 Other specified disorders of breast

N64.9 Disorder of breast, unspecified

N65.0 Deformity of reconstructed breast

N65.1 Disproportion of reconstructed breast

R59.0 Localized enlarged lymph nodes

R59.1 Generalized enlarged lymph nodes

R59.9 Enlarged lymph nodes, unspecified

R92.0 Mammographic microcalcification found on diagnostic imaging of breast

R92.1 Mammographic calcification found on diagnostic imaging of breast

R92.2 Inconclusive mammogram

R92.30 Dense breasts, unspecified

R92.311 Mammographic fatty tissue density, right breast

R92.312 Mammographic fatty tissue density, left breast

R92.313 Mammographic fatty tissue density, bilateral breasts

R92.321 Mammographic fibroglandular density, right breast

R92.322 Mammographic fibroglandular density, left breast

R92.323 Mammographic fibroglandular density, bilateral breasts

R92.331 Mammographic heterogeneous density, right breast

R92.332 Mammographic heterogeneous density, left breast

R92.333 Mammographic heterogeneous density, bilateral breasts

R92.341 Mammographic extreme density, right breast

R92.342 Mammographic extreme density, left breast

R92.343 Mammographic extreme density, bilateral breasts

R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast

R93.9 Diagnostic imaging inconclusive due to excess body fat of patient

S20.01xA Contusion of right breast, initial encounter

S20.02xA Contusion of left breast, initial encounter

S21.011A Laceration without foreign body of right breast, initial encounter

S21.012A Laceration without foreign body of left breast, initial encounter

S21.021A Laceration with foreign body of right breast, initial encounter

S21.022A Laceration with foreign body of left breast, initial encounter

S21.031A Puncture wound without foreign body of right breast, initial encounter

S21.032A Puncture wound without foreign body of left breast, initial encounter

S21.041A Puncture wound with foreign body of right breast, initial encounter

S21.042A Puncture wound with foreign body of left breast, initial encounter

S21.051A Open bite of right breast, initial encounter

S21.052A Open bite of left breast, initial encounter

S28.211A Complete traumatic amputation of right breast, initial encounter

S28.212A Complete traumatic amputation of left breast, initial encounter

S28.221A Partial traumatic amputation of right breast, initial encounter

S28.222A Partial traumatic amputation of left breast, initial encounter

S29.091A Other injury of muscle and tendon of front wall of thorax, initial encounter

S29.099A Other injury of muscle and tendon of unspecified wall of thorax, initial

encounter

S29.8xxA Other specified injuries of thorax, initial encounter

S39.091A Other injury of muscle, fascia and tendon of abdomen, initial encounter

S39.81xA Other specified injuries of abdomen, initial encounter

T85.41xA Breakdown (mechanical) of breast prosthesis and implant, initial encounter

T85.42xA Displacement of breast prosthesis and implant, initial encounter

T85.43xA Leakage of breast prosthesis and implant, initial encounter

T85.44xA Capsular contracture of breast implant, initial encounter

T85.49xA Other mechanical complication of breast prosthesis and implant, initial

encounter

T85.79xA Infection and inflammatory reaction due to other internal prosthetic devices,

implants and grafts, initial encounter

Z03.89 Encounter for observation for other suspected diseases and conditions ruled out

Z08 Encounter for follow-up examination after completed treatment for malignant

neoplasm

Z77.123 Contact with and (suspected) exposure to radon and other naturally occurring

radiation

Z77.128 Contact with and (suspected) exposure to other hazards in the physical

environment

Z77.9 Other contact with and (suspected) exposures hazardous to health

Z85.3 Personal history of malignant neoplasm of breast

Z85.831 Personal history of malignant neoplasm of soft tissue

Z85.89 Personal history of malignant neoplasm of other organs and systems

Z86.000 Personal history of in-situ neoplasm of breast

Z91.89 Other specified personal risk factors, not elsewhere classified

Z92.89 Personal history of other medical treatment

Z98.82 Breast implant status

Z98.86 Personal history of breast implant removal