Screening Mammography CPT code 77057, 77055, 77056 , 77052

 Procedure  Code  Description Site of Service


77055 Mammography; unilateral Office/Freestanding (Global) 2.52 $90.23 Facility (Professional) 1.00 $35.80 Facility (Technical) 1.52 $54.42

77056 Mammography; bilateral Office/Freestanding (Global) 3.24 $116.01 Facility (Professional) 1.24 $44.40 Facility (Technical) 2.00 $71.61

77057 Screening mammography, bilateral (2-view film study of each breast) Office/Freestanding (Global) 2.31 $82.71 Facility (Professional) 1.00 $35.80 Facility (Technical) 1.31 $46.90


Screening Mammography

Medicare covers one screening mammogram for women aged 40 years or older once every 12 months. CPT code 77057 (screening mammography, bilateral [two view film study of each breast]) is reported if a standard screening mammogram is performed. Medicare also covers computer aided detection (CAD) technology when performed in addition to the standard mammography. This service is reported using CPT add-on code +77052 (computer-aided detection (computer algorithm analysis of digital image data for lesion detection); screening mammography) in addition to code 77057. The Medicare deductible is waived for this service but the patient is responsible for 20% of the Medicare approved amount.


In April 2001, Medicare began to cover and provide additional payment for the use of digital technology for screening and diagnostic mammography studies. HCPCS code G0202 (Screening mammography, producing direct digital image, bilateral, all views) was developed to be reported for a screening full-field digital (FFDM) mammogram. Diagnosis code(s) V76.11 (screening mammogram for high-risk patient) or V76.12 (other screening mammogram) should be linked to the appropriate CPT-4 mammography code reported. The Medicare deductible is waived for this service but the patient is responsible for 20% of the Medicare approved amount.


A diagnostic mammogram (when the patient has an illness, disease or symptoms indicating the need for a mammogram) is covered whenever it is medically necessary.

Computer-Aided Detection (CAD) Add-On Codes

Effective for services on or after January 1, 2002 thr ugh December 31, 2003, (or April 1, 2002 for hospitals subject to OPPS) a new Procedure code 76085, CAD conversion of standard film images to digital images has been established as an add-on code that can be billed only in conjunction with the primary service screening mammography code 76092. The definition of 76085 is: “Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, mammography (list separately in addition to code for primary procedure).”

NOTE: For claims with dates of service April 1, 2003 – December 31, 2003, code G0202 may be billed in conjunction with 76085.

Carriers and FIs make payment under the Medicare physician fee schedule. There is no Part B deductible. However, coinsurance is applicable.

For claims with dates of service April 1, 2005, and la er, hospitals bill for code 76082* (77051*) under the 13X bill type. The 14X bill type is no longer applicable. Appropriate TOBs for providers other than hospitals are 22X, 23X, and 85X.

Contractors must assure that claims containing code 76085 also contain HCPCS code 76092 or G0202. If not, FIs return claims to the provider with an explanation that payment for code 76085 cannot be made when billed alone. Carriers deny payment for 76085 when billed without 76092 or G0202.

NOTE: When screening CAD 76085 is billed in conjunction with a screening mammography (76092 or G0202) and the screening mammography (76092 or G0202) fails the age and frequency edits in CWF, both services will be rejected by CWF.

Effective with claims with dates of service January 1, 2004 thru December 31, 2006, HCPCS code 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),” can be billed in conjunction with the primary service mammography code 76092 or G0202.

Effective with claims with dates of service January 1, 2007 and later, HCPCS code 77052, which replaces code 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),” can be billed in conjunction with the primary service mammography code 77057 or G0202.

Contractors must assure that claims containing code 77052* (76083*) also contain HCPCS code 77057* (76092*) or G0202. FIs return claims containing code 77052* (76083*) that do not also contain HCPCS code 77057* (76092*) or G0202 with an explanation that payment for code 77052* (76083*) cannot be made when billed alone. Carriers deny payment for 77052* (76083*) when billed without 77057* (76092*) or G0202.

NOTE: When screening CAD 77052* (76083*) is billed in conjunction with a screening mammography (77057* (76092*) or G0202) and the screening mammography (77057* (76092*) or G0202) fails the age and frequency edits in CWF, both services will be rejected by CWF. *For claims with dates of service prior to January 1, 2007, providers report Procedure codes 76083 and 76092 or G0202. For claims with dates of service January 1, 2007 and later, providers report Procedure codes 77052 and 77057 or G0202, respectively.

Diagnostic Add-on Codes G0236 and 77051* (76082*) Effective for services on or after January 1, 2002 thru December 31, 2003, (or April 1, 2002 for hospital claims subject to OPPS), HCPCS code G0236 was established for diagnostic mammography CAD that can be billed only on the same claim with the primary service of either 76090 or 76091. The definition of G0236 is: “Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation.”

The code must be listed separately in addition to code for the primary procedure.

NOTE: For claims with dates of service April 1, 2003 - December 31, 2003, code G0204 and G0206 may be billed in conjunction with G0236.

For claims with dates of service April 1, 2005, and later, hospitals bill for code 76082* (77051*) under the 13X bill type. The 14X bill type is no longer applicable. Appropriate TOBs for providers other than hospitals are 22X, 23X, and 85X.

There are no frequency limitations on film or digital diagnostic tests or CAD-diagnostic tests. Contractors must assure that claims containing code G0236 also contain HCPCS code 76090, 76091, G0204, or G0206. If not, FIs return claims to the provider with an explanation that payment for code G0236 cannot be made when billed alone. Carriers deny payment for G0236 when billed without 76090, 76091, G0204, or G0206.

Effective with claims with dates of service January 1, 2004 thru December 31, 2006, HCPCS code 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  ddition to code for primary procedure),” can be billed in conjunction with the primary service mammography code 76090, 76091, G0204, or G0206.

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