CPT code 77066 is for a diagnostic mammogram with computer-aided detection, used to evaluate breast abnormalities in a more detailed manner.
CPT code 77066 is used to describe a diagnostic mammography procedure that includes computer-aided detection (CAD) when performed. This code is specifically for a bilateral mammogram, meaning that both breasts are examined. Diagnostic mammography is typically conducted when there is a need to investigate suspicious breast changes, such as lumps or unusual findings from a screening mammogram. The inclusion of CAD technology assists radiologists by highlighting areas of concern that may require further analysis, enhancing the accuracy of the diagnosis.
When dealing with CPT codes 77065 and 77066, which pertain to diagnostic mammography, it is important to consider the appropriate use of modifiers to ensure accurate billing and reimbursement. Below is a list of potential modifiers that could be applied to these codes, along with the reasons for their use:
1. Modifier 26 (Professional Component):
Use this modifier when only the professional component of the service is being billed. This is applicable if the physician is providing the interpretation of the mammography but not the technical component.
2. Modifier TC (Technical Component):
This modifier is used when only the technical component of the service is being billed. It applies if the facility is providing the equipment, supplies, and technical staff for the mammography, but not the interpretation.
3. Modifier 52 (Reduced Services):
Apply this modifier if the service provided was less than what is typically required. For instance, if a complete diagnostic mammography was not performed due to patient limitations or other factors.
4. Modifier 76 (Repeat Procedure by Same Physician):
Use this modifier if the same physician needs to perform the diagnostic mammography more than once on the same day for the same patient, due to medical necessity.
5. Modifier 77 (Repeat Procedure by Another Physician):
This modifier is applicable if a different physician performs a repeat diagnostic mammography on the same day for the same patient.
6. Modifier 59 (Distinct Procedural Service):
This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if the mammography is performed in conjunction with other diagnostic procedures.
7. Modifier GG (Performance and Payment of a Screening Mammogram and Diagnostic Mammogram on the Same Patient, Same Day):
This modifier is used when both a screening and diagnostic mammogram are performed on the same patient on the same day.
8. Modifier GH (Diagnostic Mammogram Converted from Screening Mammogram on Same Day):
Apply this modifier when a screening mammogram is converted to a diagnostic mammogram on the same day due to findings that necessitate further diagnostic evaluation.
These modifiers help clarify the nature of the service provided and ensure that the billing accurately reflects the work performed, which is crucial for proper reimbursement and compliance with payer requirements.
CPT code 77066 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates and policies for this code can vary depending on the specific region and the Medicare Administrative Contractor (MAC) responsible for that area.
Each MAC may have slightly different guidelines and reimbursement rates, so it is essential for healthcare providers to verify the specific details with their local MAC to ensure accurate billing and reimbursement for CPT code 77066.
Discover the power of precision with MD Clarity's RevFind software. Our advanced tool meticulously analyzes your contracts to detect underpayments, pinpointing discrepancies down to the CPT code level, including 77066, and by individual payer. Ensure you're receiving the full reimbursement you deserve. Schedule a demo today to see how RevFind can enhance your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
