Summary & Overview
CPT 0422T: Computer-Aided Tactile Breast Examination
CPT code 0422T denotes a computer-aided tactile examination of one or both breasts using a hand-held tactile sensing device that generates two- and three-dimensional images and a surface map of the breast and any lesions in real time. This technology-assisted physical exam supplements traditional breast evaluation by providing a digital surface map that can be reviewed by the provider and patient during the encounter. Nationally, the code matters for payers and providers assessing coverage policy for newer, device-driven breast assessment tools and for tracking utilization of advanced diagnostic adjuncts in breast clinics and imaging centers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical application and typical sites of service, plus discussion of coverage considerations and payer treatment in the marketplace. The publication also presents benchmarks and policy updates where available, clarifies common billing modifiers associated with device-based diagnostic services, and situates the code within clinical workflows for breast evaluation. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 0422T describes a computer-aided tactile examination of the breast in which the provider glides a hand-held tactile sensing device over the surface of the breast and under the arms. The device transmits data to a computer that converts the input into two- and three-dimensional images and displays a surface map of the breast and any lesions in real time on a monitor that can be viewed by both the provider and the patient.
Service type: Diagnostic imaging / tactile sensing examination with computer-assisted mapping
Typical site of service: Outpatient clinic or ambulatory imaging center, where a handheld tactile sensing device and real-time imaging monitor are available. If a provider and patient view the monitor during the encounter, the setting is most commonly an office-based breast imaging or specialty clinic.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman presents to a breast imaging clinic with a palpable focal area of concern in the upper outer quadrant of the right breast. She has no prior breast cancer history but reports a new persistent thickening noted on self-exam. After targeted physical examination and review of prior imaging, the provider offers a computer-aided tactile examination using a hand-held tactile sensing device to further characterize surface topography and localize any palpable lesion in real time.
The clinical workflow: the patient is positioned seated or supine in an outpatient breast imaging or specialty clinic. The provider gently glides the hand-held tactile sensing device over the breast surface and under the axilla while the device transmits data to a computer. Two- and three-dimensional images and a surface map of the breast and any lesions are generated and displayed on a monitor visible to both provider and patient. Findings are documented in the encounter note; abnormal or suspicious results prompt correlation with diagnostic mammography, targeted ultrasound, or referral for biopsy as appropriate. The service is billed using 0422T for one or both breasts as performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the tactile examination requires substantially greater effort, time, or technical difficulty beyond typical. |
23 | Unusual anesthesia | Use if the procedure is performed with anesthesia for extenuating circumstances. |
52 | Reduced services | Use when a partially reduced tactile exam is performed (less than full study). |
53 | Discontinued procedure | Use if the tactile exam is started but terminated for patient safety or intolerance before completion. |
62 | Two surgeons | Use when two surgeons of different specialties simultaneously perform aspects of the tactile exam (rare). |
80 | Assistant surgeon | Use when an assistant surgeon provided assistance during the procedure. |
82 | Assistant surgeon (when qualified resident not available) | Use when a qualified resident is unavailable and an assistant surgeon is required. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when the service is performed or personally provided by one of these clinicians eligible to bill under their scope. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Use only if anesthesia medical direction applies to the encounter. |
QX | CRNA service with medical direction by a physician | Use if CRNA provides anesthesia under physician direction during the encounter. |
QY | Medical direction of one certified registered nurse anesthetist (CRNA) | Use for documented medical direction of a CRNA. |
TG | Via interactive audio and video telecommunications systems (telehealth) | Use when the tactile device data are transmitted and interpreted in a real-time telehealth encounter supporting remote viewing. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207P00000X | Diagnostic Radiology | Radiologists frequently interpret imaging correlated with tactile exam findings. |
207RI0012X | Breast Surgery | Breast surgeons perform tactile examinations as part of evaluation and operative planning. |
207VP0005X | Obstetrics & Gynecology | OB/GYNs in clinics may perform or coordinate breast tactile evaluation in outpatient settings. |
363L00000X | Nurse Practitioner | NPs commonly perform point-of-care breast tactile assessments and device operation. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R19.0 | Intra-abdominal and pelvic swelling, mass and lump (Data not applicable) | Data not available in the input. |
R22.9 | Localized swelling, mass and lump, unspecified | Common presenting symptom prompting tactile examination of the breast. |
N63 | Unspecified lump in breast | Typical indication for performing a computer-aided tactile breast examination to characterize a palpable mass. |
N64.4 | Mastodynia | Breast pain may prompt tactile assessment when associated with a focal complaint. |
Z85.3 | Personal history of malignant neoplasm of breast | Surveillance in patients with prior breast cancer may include tactile device evaluation for recurrence. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77067 | Screening digital breast tomosynthesis, bilateral (3D mammography) | Often performed before or after tactile exam for structural correlation of abnormalities. |
76641 | Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete | Used for targeted evaluation of palpable findings detected or localized by the tactile device. |
19101 | Biopsy of breast, percutaneous, needle, single or multiple lesions; without imaging guidance | If tactile exam localizes a superficial lesion amenable to palpation-guided biopsy, this code may follow. |
19083 | Biopsy, needle core, breast, with imaging guidance (stereotactic) | Used when tactile findings correlate with imaging that requires image-guided core needle biopsy. |
99000 | Handling and/or conveyance of specimen for transfer from operating room to laboratory (historical/rare) | May be used in workflows that include immediate specimen handling after tactile-directed procedures. |