Do you know that breast cancer is the most common type of cancer in women in the USA? In fact, roughly 30% of all female cancer diagnoses are breast cancers. However, if detected early, they can be treated and fully cured. Screening mammography helps in their detection. However, billing these mammograms isn’t simple.
One type of screening mammography is billed via CPT code 77067. Many billers struggle with this code. That’s why we have created this detailed guide on what 77067 is and how you can bill it correctly and efficiently. So, let’s start.
CPT Code 77067 – Description
CPT code 77067 is defined as:
“Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.”
Let’s break that down. As hinted in the definition, 77067 is a radiology billing code. It is used for a routine preventive mammography. The word “bilateral” in the definition is important to note. It means that the imaging is performed on both breasts. So, modifier 50 isn’t required with this code.
Also, the “2-view” requirement means that the radiologist must capture at least 2 angles of each breast. Computer-aided detection (CAD) is optional. You can use this code with or without CAD.
The CAD is actually an FDA-approved software technology that scans the digitized mammogram and flags areas of concern, such as masses, calcifications, or architectural distortions.
One more thing to keep in mind about CPT code 77067 is that it is a screening code only. Meaning that it applies only to asymptomatic patients. If the patient already has symptoms of a disease, like cancer, other more relevant codes should be used.
Appropriate Use Cases for CPT Code 77067
Here are a couple of real-world scenarios in which CPT code 77067 can be used:
Scenario 1
Suppose a 50-year-old woman comes to a radiology practice to get her routine annual mammogram. This is because she has a family history of breast cancer. She currently has no symptoms, no breast pain, and no new lumps. So, the radiologist performs a standard bilateral two-view mammogram with CAD assistance. The images show that everything is normal and there are no suspicious findings in the breast tissue.
In this scenario, CPT code 77067 is the correct code to bill. The patient is asymptomatic, both breasts were imaged, and CAD was used during interpretation.
Scenario 2
For our second scenario, suppose a healthcare organization is running a preventive wellness initiative. The initiative invites all eligible female employees to get their annual breast cancer screening. An employee with no previous history of cancer or any current symptoms also participates. The facility performs a bilateral two-view screening mammogram with CAD. The radiologist provides a complete written interpretation.
Since in this scenario all the conditions of the definition are met, the billing department can use CPT code 77067 to bill the service.
Modifiers to Append with CPT Code 77067
The following are the most commonly used modifiers with CPT code 77067:
| Modifier | Name | When to Use |
|---|---|---|
| 26 | Professional Component | Used to bill the physician’s interpretation and written report only. |
| 52 | Reduced Services | Used when only one breast is imaged, the bilateral descriptor is not fully met, so reduced services must be documented. |
| TC | Technical Component | Used to bill the technical work only (equipment, imaging staff, supplies). |
Reimbursement Guidelines for CPT Code 77067
The following guidelines are essential to know before filing claims for CPT code 77067:
Screening vs. Diagnostic Distinction
This is one of the most common mistakes that billers make. As we have already explained, CPT 77067 is a preventive/screening code. The moment a patient with symptoms of breast cancer, like a lump, nipple discharge, or skin changes, visits, the encounter no longer qualifies as screening.
Using 77067 in these situations will result in a denial.
ICD-10 Diagnosis Codes that Support Medical Necessity
Like every other billing code, CPT code 77067 must also be supported by a valid ICD-10 code. In most cases, healthcare providers use Z12.31 as the ICD-10 code for screening mammography.
Medicare Frequency Requirements
To prevent any denials, you must be aware of the basic eligibility requirements and usage limitations. Here are the two most important points:
- Medicare covers one screening mammogram per 12-month period.
- Only female patients aged 40 or above are eligible.
Final Thoughts
Let’s wrap up this guide. CPT code 77067 is an important code in radiology. The screening mammography can prevent many patients from developing breast cancer. However, billing the procedure requires careful documentation and strict criteria. Before the conclusion, here are the key highlights of our guide:
- Code 77067 is used to bill a bilateral screening mammography.
- Computer-aided detection (CAD) is optional but bundled with 77067, so you don’t need to bill it separately.
- Only one screening test is allowed per year.
- Append necessary modifiers when required.
If your practice is seeing repeated denials for 77067 or any other imaging codes, it is better to get professional radiology billing services. Many companies like NeuraBill offer dedicated billing services at affordable rates.
