CPT code 77067 is for a screening mammogram, including computer-aided detection, used to detect breast cancer in asymptomatic women.
CPT code 77067 is used to describe a screening mammography procedure that includes computer-aided detection (CAD). This code is specifically for a bilateral mammogram, meaning it examines both breasts. The purpose of this screening is to detect any signs of breast cancer or other abnormalities in women who do not have any symptoms. The inclusion of CAD means that a computer system assists radiologists by highlighting areas of concern on the mammogram images, potentially improving the accuracy of the screening.
When considering whether CPT codes 77066 and 77067 require any modifiers, it's important to understand the context in which these codes are used and the specific circumstances of the billing scenario. Here 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 if only the professional component of the mammography service is being billed. This is applicable when the radiologist is providing the interpretation of the mammogram but not the technical component.
2. Modifier TC (Technical Component):
- This modifier is used when only the technical component of the mammography service is being billed. It applies when the facility provides the equipment, supplies, and technical staff for the mammogram, but not the interpretation.
3. Modifier 52 (Reduced Services):
- Apply this modifier if the mammography service was partially reduced or not fully completed. This might occur if the procedure was started but not completed due to patient circumstances or other factors.
4. Modifier 76 (Repeat Procedure by Same Physician):
- Use this modifier if the same mammography procedure is repeated by the same physician on the same day. This indicates that the procedure was necessary to be performed again for the same patient.
5. Modifier 77 (Repeat Procedure by Another Physician):
- This modifier is applicable if the mammography procedure is repeated by a different physician on the same day. It signifies that the procedure was necessary to be performed again by another provider.
6. Modifier 59 (Distinct Procedural Service):
- Use this modifier to indicate that the mammography service was distinct or independent from other services performed on the same day. This is often used to avoid bundling issues and to clarify that the services are separate.
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. It helps differentiate the services for billing purposes.
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 require further investigation.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It's crucial to apply the appropriate modifiers based on the specific circumstances of each case to avoid claim denials or delays.
CPT code 77067 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates and coverage specifics for CPT 77067 can vary based on geographic location and other factors, which are determined by the respective Medicare Administrative Contractor (MAC) for each region.
Healthcare providers should consult their local MAC for detailed information on reimbursement rates and any specific billing requirements associated with CPT code 77067.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 77067. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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