CPT 77067 Screening Mammography Reimbursement | OpenPayer

Summary & Overview

CPT 77067: Screening Mammography, Bilateral with CAD

CPT code 77067 represents a bilateral screening mammography, a critical preventive service in breast cancer detection. This procedure involves a two-view study of each breast and may include computer-aided detection (CAD) to enhance diagnostic accuracy. Nationally, screening mammography is a cornerstone of women's health, recommended for early identification of malignant neoplasms before symptoms arise.

Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting broad access across commercial and government insurance plans. The publication provides an overview of payer coverage, clinical context, and policy updates relevant to screening mammography. Readers will gain insight into coding benchmarks, typical sites of service, and the role of screening mammography in preventive care.

Key topics include the clinical importance of screening mammography, payer coverage trends, and updates in radiology billing practices. The summary also highlights related codes and modifiers that may impact billing and reimbursement. This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking a comprehensive understanding of CPT code 77067 and its place in national breast imaging protocols.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 77067screening mammographybreast imagingradiologypreventive carebilling codeoutpatient hospitalIDTFpolicy updateclinical benchmarks

CPT Code Overview

CPT code 77067 is used to report a screening mammography procedure, which involves a bilateral (2-view study of each breast) imaging exam. This service is performed to detect early signs of breast cancer in asymptomatic women. The procedure includes computer-aided detection (CAD) when performed, enhancing the radiologist's ability to identify potential abnormalities.

Service Type: Radiology – Breast Imaging

Typical Site of Service: Screening settings such as outpatient hospitals or independent diagnostic testing facilities, including Hospital Outpatient Department (POS 22) or IDTF.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a woman aged 40 or older presenting for a routine breast cancer screening. She has no current symptoms or history of breast cancer. The procedure is performed in an outpatient hospital or an independent diagnostic testing facility. The clinical workflow includes patient registration, confirmation of eligibility for screening, performance of a bilateral (2-view) screening mammography, and documentation of the encounter for screening mammogram for malignant neoplasm of breast. Computer-aided detection (CAD) may be used as part of the imaging process.

Coding Specifications

Modifier GG: Indicates that both a screening mammography and a diagnostic mammography were performed on the same patient on the same day. Used when a screening mammogram is converted to a diagnostic study due to findings or symptoms.

Modifier Code	Description
GG	Performance and payment of a screening mammography and diagnostic mammography on same patient same day

Provider Taxonomies:

National Reimbursement Benchmarks

Nationally, the mean rate for CPT code 77067 is highest among commercial payers, with Cigna and UnitedHealth Group both averaging above $135. Medicare's mean rate is notably lower at $87.68, while the BUCA (average commercial) mean rate stands at $119.80, highlighting a substantial gap between government and commercial reimbursement levels.

Rate dispersion varies significantly across payers. Medicare exhibits the widest spread, with a difference of $85 between its 75th and 25th percentiles, indicating considerable variability in payment. In contrast, Aetna has the tightest range at $27.80, suggesting more consistent rates across providers. Other commercial payers, such as Blue Cross Blue Shield and UnitedHealth Group, show moderate dispersion, with ranges of $59.50 and $55.12, respectively.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

National Mean Rates for CPT 77067 by Payer

CPT 77054: Ductogram (Galactogram) Radiological Supervision and Interpretation

CPT-77061-DIGITAL-TOMOSYNTHESIS-ONE-BREAST-DIAGNOSTIC

CPT 77061: Digital Tomosynthesis of One Breast, Diagnostic

CPT-77049-BREAST-MRI-WITH-AND-WITHOUT-CONTRAST-BILATERAL

CPT 77049: Bilateral Breast MRI with and without Contrast

CPT-77063-DIGITAL-BREAST-TOMOSYNTHESIS-3D-MAMMOGRAPHY

CPT 77063: Digital Breast Tomosynthesis (3D Mammography)

CPT-77046-BREAST-MRI-NON-CONTRAST-SINGLE-BREAST-3D

CPT 77046: Breast MRI, Non-Contrast, Single Breast

CPT-77066-DIAGNOSTIC-BILATERAL-MAMMOGRAPHY-WITH-CAD