CPT code 77063 describes bilateral digital breast tomosynthesis (3D mammography) for screening. It is often referred to as a 3D mammography, where the technician captures images of the breasts from different areas for evaluation.
Why is this important? Mammography plays a vital role in breast cancer screening and early diagnosis. Statistics reveal that every year, breast cancer accounts for over 30% of all new cancer cases in American women.
The radiology procedure involves imaging of both breasts and is usually performed in conjunction with 2D mammograms. These mammograms enable medical practitioners to observe and identify any abnormalities or medical complications in this region and perform the necessary interventions.
CPT Code 77063 – Description
According to the official AAPC description of CPT 77063:
It indicates the procedure in which the provider captures three-dimensional images of the breast using X-rays at various angles for a routine checkup.
Professionals use an advanced technique during the procedure called tomosynthesis. This technique creates multiple 1-mm-thin cross-sectional images of the breast tissue to form an accurate image, compared to conventional mammography, and assists the oncologist in checking for any abnormalities (like lumps) in the organ.
The accuracy of the procedure leads to early detection, allowing medical practitioners to intervene and prevent or treat cancerous cells.
Note: CPT 77063 is an add-on code and cannot be reported as a stand-alone procedure. It is billed with the primary screening mammography code, CPT code 77067.
Also, previously, the temporary HCPCS level II code G0202 was used as the primary mammography code for Medicare billing. However, on Jan 1, 2018, this code was deleted and replaced with 77067.
Appropriate Use Cases for CPT Code 77063
The following are some clinical scenarios where CPT code 77063 accurately applies.
Routine Annual Screening
Think of a 45-year-old asymptomatic woman who appears at the primary care provider’s (PCP’s) office. The medical practitioner orders the screening, and the patient undergoes her yearly mammogram with bilateral 3D tomosynthesis added for enhanced detection.
After the procedure is complete, the payer is billed CPT code 77067 for a bilateral 2D screening mammogram and 77063 for the additional bilateral tomosynthesis (3D mammography).
High-Risk Patient Screening
Imagine a 38-year-old female patient with a family history of breast cancer (mother was diagnosed with breast cancer at age 43). The patient arrives at the specialized diagnostic clinic and receives annual bilateral screening, including digital breast tomosynthesis.
The radiologist proceeds with the 3D imaging procedure after 2D mammography and sends the radiology report to the oncologist. Later on, the medical team justifies billing CPT code 77063 with 77067 as the patient is at higher risk, and 3D tomosynthesis will more accurately detect abnormality early on compared to standard imaging.
Dense Breast Tissue
Consider the case of a 50-year-old woman who visits the medical facility and shares her history with the oncologist. The patient has a prior mammogram, showing dense breasts, and is now returning for an annual screening.
The radiologist or primary care provider orders a 3D tomosynthesis to overcome tissue density limitations in 2D views. After the procedure, billing professionals use CPT codes 77063 and 77067 for accurate reimbursement. In the documents, they explain the procedure’s medical necessity, mentioning that 3D mammography aids tumor visibility in such cases.
Modifiers to Append with CPT Code 77063
For CPT code 77063, the following modifiers may be appended.
Modifier 26
Modifier 26 is used in medical billing when the provider bills the payer for the interpreting and reporting of the imaging study. In other words, it represents the professional component of a 3D mammography.
Modifier TC
Modifier TC, on the other hand, represents the technical component of breast tomosynthesis. Meaning that the radiology facility reports this modifier with code 77063 to bill for the equipment, technician’s services, and supplies.
Modifier 52
CPT code 77063 is inherently bilateral, meaning whether you image a single breast or both, 1 unit of 77063 will be reported. So, to alert the payer that only one breast was imaged, providers often use modifier 52, which indicates reduced service. Therefore, in this particular case, modifier 52 will explain the unilaterality of the procedure.
Reimbursement Guidelines for CPT Code 77063
Accurate reimbursement greatly relies on following the guidelines. Here is what medical billing teams and medical practitioners should ensure:
Provide Proof of Medical Necessity
Billers must provide the patient’s complete medical history, physician’s notes, and all other relevant documents to prove medical necessity for the procedure. You must also mention the appropriate ICD-10-CM codes on the claim form.
Be Wary of Coverage Limitation
Since CPT code 77063 is a screening 3D mammography code, it may only be covered by payers if the patient is high-risk, of a certain age (40 to 74), or has dense breast tissue. Generally, the procedure must be performed once every 12 months.
Meet Payer-Specific Requirements
Medicare covers the procedure (CPT code 77063), given all prerequisites are met. However, if the patient has a different coverage other than Medicare, the billing teams must meet the specific requirements accordingly.
Use the Right Modifier
Medical billing teams may have to append a modifier to specify the special circumstances surrounding the medical intervention. Using an incorrect modifier will lead to a claim denial and could also result in an audit of your radiology lab or medical facility.
Wrapping Up
To quickly recap everything we discussed above, we must repeat that CPT code 77063 covers 3D mammography or tomosynthesis. It applies to both breasts and helps medical practitioners obtain detailed images of the organ. Modifiers 26, TC, 52, or others may apply to the code, depending on the specific situation.
Moreover, medical billers should ensure they provide proof of medical necessity, consider coverage limitations, and meet payer-specific requirements. If your medical billing team still requires further guidance on this matter, our radiology billing services are available to guide you to faster reimbursements.
