Summary & Overview
CPT 0636T: Bilateral Breast CT Without Contrast
CPT code 0636T represents a bilateral breast computed tomography (CT) exam performed without intravenous contrast, with optional 3D rendering included in the service. Nationally, this code captures a specialized diagnostic imaging modality used for breast evaluation when CT without contrast is clinically indicated. It matters because it defines reporting for a specific bilateral non-contrast CT technique distinct from mammography, diagnostic ultrasound, and contrast-enhanced breast CT protocols.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, national billing considerations, and the payer landscape addressed. The publication summarizes typical service settings, common payer approaches, and the coding definition that determines when 0636T is applicable.
This report provides benchmarks and policy-relevant notes where available, clarifies what the code includes (bilateral exam, non-contrast, optional 3D rendering), and outlines the practical implications for billing and claims classification in outpatient imaging and hospital outpatient settings. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0636T describes a computed tomography (CT) examination of both breasts performed without contrast material. The service includes 3D rendering when performed, but 3D rendering is not required for reporting the code. This procedure is an imaging study intended to evaluate breast tissue using CT technology.
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Service type: Diagnostic imaging (bilateral breast CT without contrast)
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Typical site of service: Outpatient imaging center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman referred for screening or diagnostic breast imaging when mammography or ultrasound findings are inconclusive or when more detailed volumetric assessment is required. The patient arrives at an outpatient radiology clinic or hospital imaging center for a same-day appointment. After registration and verification of indications and prior imaging, the technologist reviews contraindications and explains the CT breast protocol: non-contrast, bilateral breast computed tomography with the patient positioned prone or supine as per scanner design. The procedure includes limited preparation, positioning of the breasts into the dedicated CT breast cradle or aperture, and acquisition of thin-slice non-contrast images; optional 3D reconstruction may be produced from the acquired dataset. The interpreting radiologist reviews the images, documents findings such as focal masses, architectural distortion, or calcifications, and issues a diagnostic report. Typical sites of service are outpatient imaging centers, hospital outpatient departments, and specialty breast imaging centers. Typical patient scenarios include problem-solving after equivocal mammography/ultrasound, preoperative local staging in certain patients, or evaluation of palpable lumps when mammography is limited by patient anatomy or prior surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation component separate from technical component. |
TC | Technical component | Use when billing only the facility/technical portion of the study. |
52 | Reduced services | Use when the study is partially reduced in scale or scope compared to the full service. |
53 | Discontinued procedure | Use when the CT breast exam is started but discontinued due to patient condition or other issues. |
76 | Data not provided in the input | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Radiology | Diagnostic radiologists commonly interpret breast CT. |
207RR0500X | Diagnostic Radiology-Radiation Oncology | Radiologists with advanced breast imaging practice may use this modality. |
363A00000X | General Surgery | Breast surgeons may request and review studies for surgical planning. |
207K00000X | Nuclear Medicine | In centers where multidisciplinary imaging is performed, nuclear medicine specialists may be involved in correlating studies. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Common indication for further imaging such as non-contrast breast CT to clarify findings. |
R92.0 | Mammographic microcalcifications | When calcifications are present on mammography, additional imaging including breast CT may be used for evaluation. |
N63 | Unspecified lump in breast | Palpable mass prompting cross-sectional imaging when mammography/ultrasound are inconclusive. |
C50.911 | Malignant neoplasm of unspecified site of right female breast | Preoperative staging or assessment of extent in confirmed malignancy. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Same clinical relevance for the contralateral breast. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77066 | Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | Often performed before or as the primary screening/diagnostic test; may precede breast CT when mammography is inconclusive. |
76641 | Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete | Frequently performed alongside mammography; used before or after breast CT for targeted evaluation of palpable findings. |
77067 | Screening mammography, bilateral (2-view study of each breast) | Routine screening exam that may lead to further problem-solving with breast CT if findings are suspicious or inconclusive. |
76091 | Computer-aided detection, screening mammography, with interpretation and report | May accompany mammography studies in the diagnostic workup leading to CT breast imaging. |
19301 | Mastectomy, simple, complete | Surgical procedures such as mastectomy may be planned with input from cross-sectional imaging including breast CT for extent of disease. |