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Understand Billing Changes for Preventive Mammography

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Coding changes for preventive mammography screenings took effect Jan. 1, 2020.

Requirements introduced by the Affordable Care Act (ACA) state that a mammogram screening is covered as preventive care, not diagnostic. 

As a result, we have removed diagnostic mammogram codes from our guidelines. Current mammogram screening codes are listed as Breast Cancer Screening. For more information on this change or to view other Preventive Care Services Guidelines, please visit the Clinical Guidelines section on our website. 

 Service & Description USPSTF, Bright Futures, HRSA or SACHDNC Recommendation CPT/HCPCS Codes Frequency & Criteria
Breast Cancer Screening The USPSTF recommends screening mammography for women, with or without clinical breast examination, every 2 years for women ages 50 to 74 years. 77055, 77056, 77057, 77061-77062, 77063*, 77067, 77051, 77052, G0202, G0204, G0206 *CPT 77063 is coverable when billed in conjunction with HCPCS G0202, and ICD-10 Z123.1 Women ages 50-74
1 time per benefit period