Summary & Overview
CPT 77065: Diagnostic X-ray Imaging of One Breast with Computer Analysis
CPT code 77065 denotes diagnostic X-ray imaging of a single breast performed for patients with a palpable lump or suspected breast cancer and may incorporate computer-aided detection and analysis. This procedure is a targeted diagnostic mammographic study focused on evaluating a specific breast area for abnormalities, supporting timely diagnosis and clinical decision-making. Nationally, accurate reporting of this service affects surveillance of breast cancer detection, imaging utilization patterns, and reimbursement for specialized diagnostic procedures.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for CPT code 77065, typical sites of service, and how this code fits within breast imaging workflows. The report summarizes common billing practices and allowable service definitions, highlights relevant policy considerations and payer coverage patterns, and outlines benchmarking metrics where available. Where specific input data is not provided, the publication notes the absence and confines conclusions to available information.
This resource is intended for billing professionals, radiology administrators, and policy analysts seeking a concise reference on CPT code 77065 and its role in breast diagnostic imaging nationwide.
Billing Code Overview
CPT code 77065 describes diagnostic X-ray imaging of one breast performed when a patient has a known lump or suspected breast cancer. The service may use specialized computer software that converts imaging signals into digital data and assists in identifying or diagnosing potential abnormalities within the images.
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Service type: Diagnostic breast imaging with computer-aided detection/analysis
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Typical site of service: Outpatient radiology departments, dedicated breast imaging centers, and hospital outpatient imaging suites
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Clinical & Coding Specifications
Clinical Context
A 52-year-old woman presents to a breast imaging center with a palpable left breast mass felt on self-examination. The patient has localized breast tenderness and focal skin dimpling on exam. The referring clinician orders targeted diagnostic mammographic imaging of the left breast using computer-aided detection/diagnostic software to assist interpretation. The radiology workflow includes patient registration, review of prior imaging if available, positioning for spot compression and magnification views, acquisition of diagnostic full-field mammographic images of the affected breast (77065 describes imaging of a single breast for a known lump or suspected cancer with use of software that converts signals into digital data and analyzes images). The technologist documents laterality and views obtained; the interpreting radiologist reviews images, correlated clinical findings, and generates a diagnostic report with BI-RADS assessment and recommended next steps (ultrasound, biopsy, or short-interval follow-up). Image sequence, technical factors, and use of CAD/AI software are documented in the report and technical record for billing and quality assurance. Typical site of service is an outpatient radiology department, breast imaging center, or ambulatory imaging clinic. The service type is diagnostic targeted mammography with computer-assisted image analysis for a single breast.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |