Summary & Overview
HCPCS C8903: Magnetic Resonance Imaging with Contrast, Breast; Unilateral
HCPCS Level II code C8903 represents a unilateral breast magnetic resonance imaging (MRI) study performed with intravenous contrast. This imaging procedure is used to characterize breast lesions, evaluate extent of known malignancy, assess the contralateral breast in newly diagnosed cancer, and clarify findings from mammography or ultrasound. As a diagnostic radiology service, it is nationally significant due to increasing use of advanced breast imaging in staging and treatment planning.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for C8903, typical sites of service, and the common operational and billing considerations associated with contrast-enhanced breast MRI. The publication outlines payer coverage patterns and benchmarks where available, summarizes relevant coding relationships, and highlights administrative details that affect claim submission and reimbursement processes.
The analysis provides actionable reference material for revenue cycle, coding professionals, and radiology administrators seeking to align documentation and billing practices for unilateral contrast-enhanced breast MRI. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C8903 describes magnetic resonance imaging with contrast of the breast, unilateral. The service is an MRI study of a single breast performed with intravenous contrast to evaluate breast tissue for diagnostic purposes.
Service type: Imaging — diagnostic MRI with contrast
Typical site of service: Outpatient imaging center or hospital outpatient radiology department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with a newly palpated unilateral breast mass and an indeterminate finding on diagnostic mammography is referred for advanced imaging. The ordering breast surgeon requests a contrast-enhanced magnetic resonance imaging study of the affected breast to better characterize lesion extent, evaluate for additional multifocal disease, and aid surgical planning. The patient arrives at an outpatient radiology center, verifies contrast allergy and renal function history, completes IV placement for gadolinium-based contrast, and undergoes a unilateral breast MRI in the prone position using dedicated breast coils. Images are reviewed by a board-certified radiologist with expertise in breast imaging, and a structured report is generated documenting lesion size, morphology, enhancement kinetics, and recommendations for biopsy or further management. The study is billed using C8903 (magnetic resonance imaging with contrast, breast; unilateral) with modifiers applied as appropriate for laterality, professional/technical components, or unusual circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | When imaging the right breast only and payer requires laterality modifier |
LT |