2015 Breast Imaging  Code Changes

January 12, 2015

Dear Clients and Friends,

In follow up to our November summary of the new CPT codes released for 2015, MSN feels it is important to provide some further specifics pertaining to the new breast imaging code changes.
Breast Tomosynthesis 

The Centers for Medicare and Medicaid Services (CMS) has released three new codes for breast tomosynthesis:

  •       77061 (New) Digital breast tomosynthesis; unilateral
  •       77062 (New) Digital breast tomosynthesis; bilateral
  •       77063 (New) Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
CMS intends to only recognize the screening add-on code, 77063, Screening digital breast tomosynthesis, bilateral, in conjunction with the digital screening mammography code, G0202. CMS considers the new diagnostic  CPT codes (77061 and 77062) not valid for Medicare purposes for 2015. CMS instead created a new add-on G-code (G0279) to be used with the existing digital diagnostic mammography codes (G0204 and G0206) to reflect the work of tomosynthesis when provided with diagnostic digital mammography.
Medicare will instruct its Medicare Administrative Contractors to pay for the combination of mammography and tomosynthesis using the existing
digital mammography G-codes for the mammogram and add-on codes for Digital Breast Tomosynthesis for 2015. Private payers are encouraged to also cover tomosynthesis by either paying under this same coding scheme or using all of the new CPT codes that were created and are available.
The new procedure codes for breast tomosynthesis are exempt from the Ordering of Diagnostic Tests Rule and do not require a separate order from the referring physician.  However, when breast tomosynthesis codes are used, the breast tomosynthesis procedure should be clearly documented in the report.  The breast tomosynthesis codes fall within the test design exception described in CMS Transmittal 1725.
Breast Ultrasound

The existing code for breast ultrasound (76645) has been deleted and two new codes have been introduced for limited and complete ultrasound:

76641 (New)Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete (consists of an ultrasound examination of all four quadrants of the breast and the retroareolar region.

 76642 (New) Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited (consists of a focused ultrasound of the breast limited to the assessment of one or more, but not all, of the elements listed in code 76641.)
Post Procedure Mammogram including Stereotactic Guidance
Post procedure mammogram including stereotactic guidance (e.g., 19081, 19082, 19281, 19282) should no longer be reported separately.
Biopsy Coding
When more than one biopsy or localization device placement is performed using the same imaging modality, use an add-on code whether the additional service(s) is on the same or contra-lateral breast. If additional biopsies or localization device placements are performed using different imaging modalities, report another primary code for each additional biopsy or localization device placement performed using a different image guidance modality.