January 2007
Provider Types Affected
All physicians and providers who bill Medicare carriers, Fiscal Intermediaries (FI), or Part A/B Medicare Administrative Contractors (A/B MACs) for providing mammography services.
Provider Action Needed
As part of the annual HCPCS update, CMS has assigned new 2007 Current Procedural Terminology (CPT) mammography codes for screening and diagnostic mammography services. Effective January 1, 2007, these codes ((77051, 77052, 77055, 77056, and 77057) will replace the current CPT codes; however the CPT code descriptors for the services are unchanged.
Failure to submit the correct codes will cause your claims to be returned and not processed. Make sure that your billing staffs are aware of the CPT code changes.
Background
CR 5327, from which this article was taken, announces the assignment of new CPT codes for screening and diagnostic mammography services.
As part of the annual HCPCS update, CMS has assigned new 2007 CPT mammography codes for screening and diagnostic mammography services. Effective January 1, 2007, these codes ((77051, 77052, 77055, 77056, and 77057) will replace the current CPT codes; however the CPT code descriptors for the services are unchanged.
The following table displays the new (and old) replacement codes and their description.
| 2007 Screening and Diagnostic Mammography CPT Codes | ||
| New Code | Old Code | Description |
|---|---|---|
| 77051 | 76082 | Computer aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images, diagnostic mammography. (List separately in addition to code for primary procedure) |
| 77052 | 76083 | Computer aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images, screening mammography. (List separately in addition to code for primary procedure) |
| 77055 | 76090 | Diagnostic mammography, unilateral |
| 77056 | 76091 | Diagnostic mammography, bilateral |
| 77057 | 76092 | Screening mammography, bilateral (two view film study of each breast) |
Be advised that your carriers and FIs will return claims (with dates of service on or after January 1, 2007) that contain the old screening and diagnostic mammography codes. And also effective January 1, 2007, frequency standards for screening mammography will be applied to the new screening codes (77052 and 77057).
Additional Information
You can find more information about the new 2007 mammography CPT codes by going to CR5327, located at http://www.cms.hhs.gov/Transmittals/downloads/R1070CP.pdf on the CMS website.
There, as an attachment to that CR, you will find revised Chapter 18 (Preventive and Screening Services), Section 20 (Mammography Services) of the Medicare Claims Processing Manual (100-04),
If you have any questions, please contact your state's Provider Contact Center.
MLN Matters MM5327