Summary & Overview
CPT 0635T: CT Examination of Single Breast Without and With Contrast
CPT code 0635T denotes a CT examination of a single breast performed initially without contrast and subsequently with contrast, optionally including 3D rendering. This imaging procedure is part of advanced breast diagnostic and assessment workflows and matters nationally as facilities expand breast-specific imaging modalities to complement mammography and MRI. Payers commonly covering or adjudicating this service in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents clinically, typical sites of service, and how it fits into breast imaging care pathways. The publication presents benchmarks and coverage context where available, highlights relevant billing and documentation considerations, and summarizes the clinical context for when dual-phase breast CT may be used. Data not available in the input is noted when applicable. This summary is written for a national audience and is focused on clarifying the procedure, its service setting, and the payers assessed in the accompanying analysis.
Billing Code Overview
CPT code 0635T describes a computed tomography (CT) examination of a single breast performed first without contrast and then with contrast material. The service may include, but does not require, 3D rendering of the image data.
Service type: Breast CT imaging with and without contrast
Typical site of service: Outpatient radiology or imaging center, including hospital outpatient departments and freestanding CT suites.
Clinical & Coding Specifications
Clinical Context
A 52-year-old woman with a recent abnormal screening mammogram and persistent focal breast density is referred for further evaluation with breast CT (dedicated breast computed tomography). The imaging workflow includes pre-procedure patient consent and explanation, patient positioning prone on the dedicated breast CT scanner with the targeted single breast placed in the field of view, acquisition of a non-contrast CT series of the single breast, followed by intravenous administration of iodinated contrast and repeat CT acquisition of the same breast. Image post-processing may include multiplanar reformats and optional 3D rendering for lesion conspicuity. The examination is interpreted by a board-certified radiologist with breast imaging expertise; a radiology report documents technical parameters, comparison to prior studies, lesion characterization, and recommendations for further management (ultrasound, MRI, biopsy) as indicated. Typical site of service is an outpatient imaging center or hospital radiology department equipped with dedicated breast CT capability.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician interpretation separate from technical component |
TC | Technical component | Use when reporting only the equipment and technologist portion |
52 | Reduced services | Use when the CT acquisition is partially reduced in scope or duration |
53 | Discontinued procedure | Use when the exam is started but terminated for patient safety or intolerance |
76 | Data not available in the input. | Data not available in the input. |
77 | Data not available in the input. | Data not available in the input. |
62 | Two surgeons | Use when two surgeons share the procedure (rare for imaging-guided procedures) |
80 | Assistant surgeon | Use when an assistant surgeon performed a substantive portion (uncommon for imaging) |
22 | Increased procedural services | Use when documentation supports substantially greater effort or complexity |
26 | Data not available in the input. | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
261QM0800X | Diagnostic Radiology | Interpreting physician for breast CT studies |
261QR0400X | Radiology—Diagnostic Radiology | Alternate radiology taxonomy for hospital-based radiologists |
207RC0000X | Radiology Technician | Practitioners performing the technical component and acquisition |
363A00000X | Nurse Practitioner | May perform patient assessment and contrast screening |
2084P0800X | Radiation Oncologist | Consults when findings prompt multidisciplinary care |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Common indication for problem-solving breast CT after abnormal mammography |
N60.31 | Solitary cystic mastopathy of right breast | Benign breast findings that may be characterized on breast CT |
N63 | Unspecified lump in breast | Palpable mass prompting targeted breast CT evaluation |
C50.911 | Malignant neoplasm of unspecified site of right female breast | Staging or lesion characterization in known breast cancer may involve dedicated breast CT |
N64.89 | Other specified disorders of breast | Miscellaneous breast symptoms or findings evaluated with breast CT |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77063 | Screening digital breast tomosynthesis, unilateral or bilateral; single view per breast | Alternative advanced breast imaging modality used for problem solving prior to breast CT |
77061 | Diagnostic mammography, including CAD when performed; unilateral | Often performed before or after breast CT for correlative evaluation |
76641 | Ultrasound breast, unilateral, real time with image documentation | Frequently performed as an adjunct to evaluate lesions detected on breast CT and guide biopsy |
19083 | Biopsy, breast, percutaneous, with imaging guidance (e.g., stereotactic, ultrasound, MRI), first lesion | Performed if breast CT identifies a suspicious lesion requiring tissue diagnosis |
75563 | Magnetic resonance angiography, chest, for breast MRI protocols | Breast MRI may be performed as a complementary cross-sectional study when CT findings are indeterminate |