CPT 0634T: CT Breast With Contrast, Single Breast

CPT code 0634T represents a CT examination of a single breast performed using intravenous or intra-breast contrast material and may include 3D rendering. The code captures an advanced diagnostic breast imaging procedure used to evaluate focal findings, characterize lesions, or support surgical planning. As a distinct procedural code, 0634T matters nationally because it defines a standardized way to report contrast-enhanced breast CT imaging, supports billing and utilization tracking, and informs coverage and benefit design for advanced breast imaging services.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for contrast-enhanced breast CT, typical sites of service (outpatient imaging centers and hospital radiology departments), and common billing considerations. The publication summarizes available benchmarks and policy-relevant points where payers may differ in coverage or prior authorization requirements. It also outlines how the procedure is documented in claims and what stakeholders — including radiology practices, hospital billing departments, and payers — need to consider when coding and submitting services.

The content is intended to inform billing staff and policy analysts about the code’s clinical use, reporting expectations, and the payer landscape nationally. Data not available in the input will be identified as such in relevant sections.

Billing Code Overview

CPT code 0634T describes a computed tomography (CT) examination of a single breast performed with contrast material. The service includes advanced image processing and may include 3D rendering, though 3D rendering is not required for reporting the code.

Service type: Diagnostic imaging — CT breast with contrast

Typical site of service: Outpatient imaging center or hospital radiology department

Data not available in the input.

Clinical Context

A typical patient is a woman referred for evaluation of a suspicious focal breast abnormality after screening mammography or diagnostic mammogram and targeted ultrasound demonstrate an indeterminate mass or architectural distortion. The ordering physician (breast surgeon, breast imaging radiologist, or oncologist) requests a contrast-enhanced dedicated breast CT of a single breast to better delineate lesion extent, vascularity, and multifocality prior to biopsy or surgical planning. The clinical workflow includes patient history and consent, screening for contraindications to iodinated contrast (renal function review, allergy assessment), IV access placement, contrast administration, acquisition of multiplanar CT images of the affected breast, optional 3D rendering, radiologist interpretation (professional component), and technologist/room resources (technical component). Results are communicated to the referring provider and used to guide image-directed biopsy planning, preoperative mapping, or further staging. Typical site of service is an outpatient imaging center or hospital radiology department equipped for dedicated breast CT and contrast administration.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the radiologist interpretation separate from technical component.
`TC`

Taxonomy Code	Specialty	Notes
207RR0500X	Diagnostic Radiology	Performs and interprets dedicated breast CT and contrast studies.
207RC0000X	Radiology - Diagnostic	Alternative taxonomy for radiologists performing cross-sectional breast imaging.
207XS0117X	Breast Imaging	Subspecialty radiologist focused on breast imaging and image-guided procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N63`	Unspecified lump in breast	Common indication for targeted breast imaging including contrast-enhanced dedicated breast CT to characterize a palpable or imaging-detected mass.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of breast	Used when prior imaging is inconclusive and additional cross-sectional imaging is needed.
`C50.911`	Malignant neoplasm of unspecified site of right female breast	Used when staging or extent-of-disease assessment of a known breast cancer is required for surgical planning.
`C50.912`	Malignant neoplasm of unspecified site of left female breast	As above, for the left breast.
`N61`	Inflammatory disorders of breast	When inflammatory or infectious processes require imaging to evaluate abscess or complex fluid collections.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`77063`	Magnetic resonance imaging (MRI) of the breast (contrast-enhanced), unilateral	Alternative cross-sectional contrast-enhanced modality for problem solving or preoperative staging; may be ordered before or instead of dedicated breast CT.
`77061`	MRI of the breast, bilateral, without and with contrast	Bilateral MRI when more extensive assessment is needed; complements unilateral breast CT when multifocal disease is suspected.
`19083`	Image-guided biopsy, breast, with placement of breast localization device, when performed	Often performed after lesion characterization on breast CT to obtain tissue diagnosis and localize for surgery.
`77067`	Screening mammography, two-view study of each breast	Screening test that frequently triggers additional diagnostic imaging such as dedicated breast CT for equivocal findings.
`77055`	Diagnostic mammography; single view, unilateral	Prior diagnostic imaging that may precede dedicated breast CT for targeted evaluation of a single breast.

OpenPayer

Summary & Overview