HCPCS and Diagnosis Codes for Mammography Services

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 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