US · guidance
CMS Pub. 100-04, ch. 18, § 20.3.1.1
Outpatient Hospital Mammography Payment Table
Payment for screening mammography in the Hospital Outpatient Setting (Revenue code 403) is the
lesser of charge, or TC of MPFS for code 77067* (G0202*). Neither deductible nor a coinsurance
applies.
Payment for diagnostic mammography, bilateral in the Hospital Outpatient Setting (Revenue code
401) is the lesser of charge, or TC of MPFS for code 77066* (G0204*).
Payment for diagnostic mammography, unilateral in the Hospital Outpatient Setting (Revenue
code 401) is the lesser of charge, or TC of MPFS for code 77065* (G0206*). Deductible and
coinsurance apply.
Beginning January 1, 2005, Medicare Prescription Drug, Improvement, and Modernization Act
(MMA) of 2003, §644, Public Law 108-173 has changed the way Medicare pays for diagnostic
mammography. Medicare payment will be based on the MPFS. Payment will no longer be made
under the OPPS.
History
(Rev. 3844, Issued: 08-18-17, Effective: 01-01-18, Implementation: 01-02-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c691ab255875782562ce75e28e072babcaafad90c4036cd1ad8219a24bee7ffb
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