Feature | November 05, 2014

CMS Issues Ruling on 2015 Mammography Screening Reimbursement Rates

Separate codes created for screening mammography versus diagnostic mammography

November 5, 2014 — Hologic, Inc. announced that the Centers for Medicare and Medicaid Services (CMS) has released reimbursement rates for screening and diagnostic 3-D mammography. The action establishes national average payment rates for the Category I Current Procedural Terminology (CPT) code for 3-D screening mammography and creates a new add-on Healthcare Common Procedure Coding System (HCPCS) code for 3-D diagnostic mammography.

The Medicare payment rates will go into effect Jan. 1, 2015, and will allow providers in the United States to file reimbursement claims specific to screening and diagnostic 3-D mammography. The CMS Medicare Physician Fee Schedule Final Rule not only sets reimbursement rates for 3-D mammography, but also creates a pathway for private insurers to explore broader coverage and payment options. The rates are as follows:

  • 3-D screening mammography CPT code, 77063, assigned a payment rate of approximately $57. This is an add-on to the existing 2-D mammography screening code, G0202, with an assigned payment rate of approximately $135.
  • 3-D diagnostic mammography HCPCS code, G0279, assigned a payment rate of approximately $57 for either unilateral or bilateral images.  
    • This is an add-on to the existing 2-D mammography unilateral diagnostic code, G0206, with an assigned payment rate of approximately $130. 
    • This is an add-on to the existing 2-D mammography bilateral diagnostic code, G0204, with an assigned payment rate of approximately $165.

For more information www.hologic.com

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