Summary & Overview
CPT 0638T: Bilateral Breast CT, Without and With Contrast
CPT code 0638T represents a bilateral computed tomography (CT) examination of the breasts performed twice — first without intravenous contrast and then with contrast — and may include 3D rendering. This imaging procedure expands diagnostic options for breast evaluation by providing cross-sectional and contrast-enhanced information that can assist in characterizing lesions, guiding further workup, and supporting multidisciplinary care decisions. Nationally, adoption of dedicated breast CT techniques affects diagnostic imaging portfolios, capital planning, and payer coverage policy discussions.
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 breast CT, benchmarking and utilization considerations, and where coverage and coding clarity matter for billing and reimbursement workflows. The publication summarizes typical sites of service and service components, outlines common modifiers for billing workflows, and flags areas where payers commonly apply medical necessity or coverage criteria.
The report is intended for coding professionals, radiology administrators, and policy analysts seeking a national perspective on how CPT code 0638T fits into diagnostic imaging services, payer interactions, and operational planning. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 0638T describes a computed tomography (CT) examination of both breasts, performed first without contrast material and then with contrast material. The service may include three-dimensional (3D) rendering, though 3D rendering is not required for coding.
Service type: Diagnostic imaging — bilateral breast CT with and without contrast
Typical site of service: Outpatient imaging center or hospital radiology department, where CT imaging and contrast administration are routinely performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman referred for diagnostic breast imaging after an indeterminate mammogram or ultrasound, a palpable breast mass, asymmetric breast findings, or for preoperative local staging. The provider performs a bilateral computed tomography (CT) breast examination first without contrast and then with intravenous contrast to evaluate lesion extent, multifocal or multicentric disease, chest wall invasion, or regional nodal involvement. The workflow includes patient consent and screening for contrast allergy and renal function, IV placement, non-contrast CT acquisition of both breasts, administration of iodinated contrast with timed post-contrast acquisition, image reconstruction (including optional 3D rendering), radiologist interpretation, and documentation of findings and comparison to prior studies. Typical site of service is an outpatient radiology or imaging center, hospital outpatient department, or ambulatory surgery center when performed as part of preoperative staging. A realistic scenario: a 54-year-old female with a suspicious 2.5 cm left breast lesion on diagnostic mammography and ultrasound undergoes 0638T for detailed assessment of tumor extent and evaluation for additional ipsilateral or contralateral lesions prior to surgical planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the radiologist interpretation separate from technical imaging services billed by the facility. |
TC | Technical component | When only the technical portion (equipment, technologist) is billed by the imaging facility. |
52 | Reduced services | When the study is partially reduced in scope (limited acquisition) compared with full protocol. |
53 | Discontinued procedure | When the examination is started but halted due to patient intolerance or adverse event. |
76 | Duplicate procedure by same physician | When the same physician repeats the CT breast exam on the same date for the same patient. |
77 | Repeat procedure by another physician | When a second physician repeats the study on the same date. |
50 | Bilateral procedure (note: many imaging codes are inherently bilateral) | When payer requires explicit bilateral modifier for both-breast imaging despite code description covering both breasts. |
22 | Unusual procedural service | When work required is substantially greater than typical for this CT exam (documented justification). |
59 | Distinct procedural service | When this CT breast exam is a separate and distinct service from another procedure on the same day (supporting documentation required). |
RT | Right side | When reporting a side-specific service and the payer requires laterality reporting for this study. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RX0400X | Radiology | Diagnostic radiologists interpret cross-sectional breast CT and manage imaging protocols. |
| 207RH0000X | Diagnostic Radiology | Radiologists performing breast imaging and interventional procedures for preoperative planning. |
| 207K00000X | Nuclear Medicine | Occasionally involved when combined functional imaging is coordinated, though CT interpretation remains primary. |
| 261QM0800X | General Surgery | Breast surgeons order bilateral contrast-enhanced CT for staging and surgical planning. |
| 207L00000X | Vascular/Interventional Radiology | If additional image-guided biopsy or localization is planned in coordination with CT findings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.912 | Malignant neoplasm of unspecified site of left female breast | Used when breast cancer is present in the left breast and CT is performed for staging or surgical planning. |
C50.911 | Malignant neoplasm of unspecified site of right female breast | Used when breast cancer is present in the right breast and CT is performed for staging or surgical planning. |
N63 | Unspecified lump in breast | Common indication for advanced imaging when a palpable mass is identified and needs further characterization. |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Used when prior imaging is indeterminate and CT is ordered for problem-solving. |
R92.2 | Inconclusive mammogram | Indicates incomplete or inconclusive mammographic evaluation prompting additional imaging such as contrast-enhanced CT. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77063 | Magnetic resonance imaging (MRI) of the breast, including contrast when performed; unilateral or bilateral — with contrast | Alternative cross-sectional modality for high-resolution breast evaluation and preoperative staging; may be performed when MRI is indicated or when CT is contraindicated. |
19083 | Image-guided percutaneous needle biopsy, breast, including imaging guidance (e.g., stereotactic, CT), with placement of localization device when performed; first lesion | May be performed after 0638T if CT identifies a suspicious lesion requiring tissue diagnosis; CT guidance can be used for biopsy of lesions difficult to access by ultrasound or stereotactic techniques. |
76000 | Fluoroscopic guidance for needle placement (eg, biopsy, aspiration), imaging supervision and interpretation | May be used when image guidance is required for procedures planned based on CT breast findings. |
77046 | Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral | Often performed before or after CT breast examination as part of the diagnostic imaging workup and for mammographic correlation. |
76641 | Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed | Commonly performed adjunctively to characterize lesions seen on mammogram or CT and to guide ultrasound-directed biopsy. |