Medicare Claims Processing Manual (Pub. 100-04), Ch. 18 § 20.4.2
A/B MAC (A) Requirements for Nondigital Screening Mammographies
20.4.2 - A/B MAC (A) Requirements for Nondigital Screening Mammographies
(Rev. 3844, Issued: 08-18-17, Effective: 01-01-18, Implementation: 01-02-18)
The A/B MAC (A) will consider the following when determining whether payment may be made:
•
Presence of revenue code 0403;
•
Presence of HCPCS code 77067* (G0206*);
•
Presence of high risk diagnosis code indicator where appropriate;
•
Date of last screening mammography; and
•
Age of beneficiary.
The A/B MACs (A) must accept revenue code 0403 for bill types 13X, 22X, 23X, 71X, 73X, or
85X.
* For claims with dates of service January 1, 2017 thru December 31, 2017 providers report
HCPCS code G0206. For claims with dates of service January 1, 2018 and later, providers report
CPT code 77067.