Summary & Overview
CPT 77063: Digital Breast Tomosynthesis (3D Mammography)
CPT code 77063 represents digital breast tomosynthesis, a three-dimensional X-ray imaging technique used for breast screening and diagnostic evaluation. Tomosynthesis acquires multiple angled images and reconstructs sectional views to improve detection of masses and architectural distortions compared with conventional mammography. Nationally, adoption of tomosynthesis has grown as payers and health systems seek improved diagnostic accuracy and reduced recall rates.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of 77063, typical settings where the service is delivered, and the payer landscape relevant to reimbursement and coverage. The publication highlights common billing modifiers associated with imaging services and notes related administrative details.
This summary prepares clinical and administrative stakeholders to understand where digital breast tomosynthesis fits within breast imaging workflows, how major payers approach the service, and which operational considerations to expect when coding and submitting claims for CPT code 77063.
Billing Code Overview
CPT code 77063 describes digital breast tomosynthesis imaging, a three-dimensional mammographic technique that captures X-ray images of the breast at multiple angles to improve detection of abnormalities. The procedure provides more accurate imaging than conventional two-dimensional mammography by reconstructing sectional images for clearer visualization of breast tissue.
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Service type: Diagnostic breast imaging (digital breast tomosynthesis)
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Typical site of service: Outpatient imaging centers or hospital radiology departments for routine breast cancer screening and diagnostic evaluation
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Clinical & Coding Specifications
Clinical Context
A typical patient is a woman aged 40–75 presenting for routine breast cancer screening or surveillance after prior benign biopsy. She arrives at an outpatient imaging center or hospital radiology department for screening digital breast tomosynthesis (77063). The imaging technologist verifies identity, obtains informed consent, and performs bilateral tomosynthesis with positioning to optimize visualization of all breast tissue. A radiologist reviews the three‑dimensional reconstruction images to detect masses, architectural distortion, or calcifications. Findings may prompt additional targeted diagnostic views, ultrasound, or biopsy. The encounter is commonly billed by the interpreting provider and includes documentation of a screening or diagnostic indication, technique (tomosynthesis), and the radiologist’s interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the radiologist’s interpretation separate from technical component |
TC | Technical component | When billing only the facility/technical component for equipment and technologist |
25 | Significant, separately identifiable E/M service | When a same‑day unrelated evaluation by the provider precedes the imaging |
59 | Distinct procedural service | When tomosynthesis is a distinct service from another procedure on the same day |
76 | Repeat procedure by same physician | When the same provider repeats the tomosynthesis during the same day |
77 | Repeat procedure by another physician | When a different provider repeats the imaging the same day |
91 | Repeat clinical diagnostic laboratory test | Rarely used for imaging; not typically applicable but included for repeat testing contexts |
QK | Medical direction of 2–4 technicians | When the physician medically directs multiple technologists (per payor policy) |
QX | Certified registered nurse anesthetist (CRNA) service | Not typical for mammography; listed if applicable per modifier list |
RT | Right side | If laterality reporting by modifier is required for single‑breast services |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Radiology | Diagnostic radiologists interpret tomosynthesis |
| 207RC0000X | Diagnostic Radiology | Providers who commonly perform and interpret breast imaging |
| 2085R0202X | Obstetrics & Gynecology | OB/GYNs often refer and manage screening for patients |
| 207K00000X | Interventional Radiology | Performs image‑guided breast biopsies when needed |
| 208000000X | Family Medicine | Primary care physicians who order screening mammography |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z12.31 | Encounter for screening mammogram for malignant neoplasm of breast | Standard screening indication for bilateral tomosynthesis |
N63 | Unspecified lump in breast | Symptomatic presentation prompting diagnostic tomosynthesis |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Indicates imaging findings that may be clarified with tomosynthesis |
C50.919 | Malignant neoplasm of unspecified site of unspecified female breast | Known or suspected breast cancer where tomosynthesis assists staging/assessment |
Z85.3 | Personal history of malignant neoplasm of breast | Surveillance imaging with tomosynthesis for prior breast cancer |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77067 | Screening mammography, bilateral (2-view study of each breast) | Often performed as the conventional 2‑D screening mammogram; tomosynthesis may be performed in addition or instead |
77065 | Diagnostic mammography, including CAD when performed; unilateral | Used when focal symptoms or prior abnormal screening require diagnostic views |
76641 | Ultrasound, breast, unilateral, real time with image documentation | Performed as adjunct when a tomosynthesis abnormality needs targeted evaluation |
19083 | Image-guided percutaneous breast biopsy, each lesion, with stereotactic guidance | Performed when tomosynthesis or mammography identifies a lesion requiring tissue diagnosis |
76098 | Stereotactic guidance for placement of radiation therapy fields; simple | Used in workflows requiring localization or pre‑operative marking related to mammographic findings |