Summary & Overview
CPT 77049: Bilateral Breast MRI with and without Contrast
CPT code 77049 represents a bilateral breast magnetic resonance imaging (MRI) study performed with and without intravenous contrast, often producing three-dimensional images and optionally using real-time computer-aided detection. This advanced diagnostic imaging code is central to breast cancer detection, preoperative planning, and evaluation of complex breast conditions, making it clinically and financially significant across care settings nationwide. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for bilateral contrast-enhanced breast MRI, benchmarks related to utilization and payment (where available), and relevant policy updates affecting coverage and reimbursement. The publication explains typical service locations such as outpatient imaging centers and hospital outpatient departments, outlines common billing considerations, and highlights coverage patterns among major national payers. Data not provided in the input will be noted as unavailable where applicable.
Billing Code Overview
CPT code 77049 describes a bilateral breast magnetic resonance imaging (MRI) procedure performed with and without contrast, producing three-dimensional images. The provider applies an external magnetic field and radiofrequency waves to generate cross-sectional and volumetric breast images; the service may include real-time computer-aided detection (CAD) during image acquisition.
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Service type: Diagnostic advanced imaging (breast MRI with and without contrast, bilateral)
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Typical site of service: Outpatient imaging centers, hospital outpatient departments, or specialized breast imaging clinics
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Clinical & Coding Specifications
Clinical Context
A typical patient is a woman aged 40–75 referred for a contrast-enhanced breast MRI (77049) after abnormal findings on screening mammography or diagnostic ultrasound, or for high-risk surveillance (personal or strong family history, BRCA mutation). The workflow begins with an order from the referring physician documenting the indication (eg, suspicious mammographic mass, extent-of-disease staging, or high-risk screening). The patient completes MRI safety screening (implant, pacemaker, renal function), IV access is obtained, and gadolinium-based contrast is administered unless contraindicated. The MRI technologist positions the patient prone with a dedicated breast coil and acquires multiplanar, high-resolution 3D sequences before and after contrast. A radiologist interprets the images, may use real-time computer-aided detection (CAD) during review, and issues a diagnostic report with BI-RADS assessment. Results are communicated to the referring provider for management decisions such as biopsy, short-interval follow-up, or surgical planning. Typical site of service is an outpatient radiology center or hospital outpatient imaging department. The service type is diagnostic breast MRI with and without contrast, including potential real-time CAD.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/report is billed separate from technical imaging. |