C8937 Breast MRI CAD — Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS C8937: Breast MRI Computer-Aided Detection with Pharmacokinetic Analysis

HCPCS Level II code C8937 covers computer-aided detection (CAD) applied to breast MRI studies, including algorithmic lesion detection, characterization and pharmacokinetic analysis with further physician review. As an add-on service billed separately from the primary MRI procedure, this code captures advanced quantitative imaging analysis that can augment radiologist interpretation. Nationally, adoption of imaging CAD tools affects imaging workflow, documentation, and billing practices as radiology groups, hospitals and payers evaluate clinical value and appropriate use.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of what C8937 represents clinically and operationally, typical sites of service, and the payer landscape covered in the analysis. The publication provides benchmarks on utilization and reimbursement patterns, summaries of relevant policy and coverage considerations, and clinical context regarding the role of CAD and pharmacokinetic analysis in breast MRI interpretation.

The content is intended for national audiences including radiology administrators, billing professionals, and policy analysts seeking concise guidance on coding, billing implications and how payers approach coverage for adjunctive computer-aided breast MRI services. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC8937HCPCS Level IIbreast MRIcomputer-aided detectionquantitative imagingradiology billingimaging add-on code

Billing Code Overview

HCPCS Level II code C8937 describes computer-aided detection for breast MRI, specifically computer algorithm analysis of breast MRI image data for lesion detection and characterization, including pharmacokinetic analysis, with subsequent physician review for interpretation. This service is reported in addition to the primary procedure when the computer-aided detection is performed alongside the diagnostic MRI.

Service type: Advanced imaging adjunct (computer-aided detection/quantitative imaging analysis)
Typical site of service: Imaging center or hospital outpatient department where breast MRI studies are performed

Clinical & Coding Specifications

Clinical Context

A 52-year-old woman with a personal history of atypical ductal hyperplasia and a new palpable right breast mass is referred for contrast-enhanced breast MRI to further evaluate extent of disease and to assess for additional lesions not seen on mammography and ultrasound. During the MRI study, a computer-aided detection algorithm is applied to the breast MRI image dataset to perform lesion detection, pharmacokinetic (contrast wash-in/wash-out) analysis, and preliminary lesion characterization. A board-certified radiologist performs image acquisition supervision, reviews the algorithm output, integrates the CAD findings with raw MR sequences (including T1-weighted dynamic contrast-enhanced series and subtraction images), documents correlated imaging features, and issues a final interpretation and recommendation.

Typical clinical workflow:

Patient arrives to an outpatient radiology or breast imaging center and completes screening safety and contrast consent.
MRI technologist performs contrast-enhanced breast MRI sequences with standardized dynamic protocols and uploads datasets to the PACS and to the CAD workstation.
The CAD software processes the DICOM MRI series, performs pharmacokinetic modeling, highlights regions of interest, and generates quantitative outputs (kinetic curves, lesion volumes, enhancement maps) for physician review.
The interpreting radiologist reviews native and post-processed images, evaluates CAD-identified targets, confirms or refutes CAD findings, incorporates clinical history, and documents the final report. The CAD service is billed in addition to the primary MRI procedure using billing code C8937.

Coding Specifications

HCPCS C1773: Insertable Retrieval Device for Fractured Medical Devices

HCPCS-C9024-LIPOSOMAL-DAUNORUBICIN-CYTARABINE-INJECTION

HCPCS C9024: Liposomal Daunorubicin and Cytarabine Injection

HCPCS-C2621-IMPLANTABLE-MULTICHAMBER-PACEMAKER

HCPCS C2621: Implantable Pacemaker, Other Than Single or Dual Chamber

HCPCS-C1756-TRANSESOPHAGEAL-PACING-CATHETER

HCPCS C1756: Catheter, Pacing, Transesophageal

HCPCS-C8009-REMOVAL-HYPOGLOSSAL-NEUROSTIMULATOR-EXPLANTATION

HCPCS C8009: Removal of Hypoglossal Nerve Neurostimulator Array and Pulse Generator

HCPCS-C7535-FEMORAL-POPLITEAL-STENT-REVASCULARIZATION-WITH-IVUS

HCPCS C7535: Femoral–Popliteal Revascularization with Stent and IVUS

HCPCS-C9775-TIBIAL-PERONEAL-REVASCULARIZATION-LITHOTRIPSY-STENT-ATHERECTOMY

HCPCS C9775: Tibial/Peroneal Revascularization with Lithotripsy, Stent, Atherectomy

HCPCS-C9761-STEERABLE-URETERAL-CATHETER-VACUUM-ASPIRATION-LITHOTRIPSY

HCPCS C9761: Steerable Ureteral Catheter with Lithotripsy and Vacuum Aspiration

HCPCS-C1982-PRESSURE-GENERATING-CATHETER-ONE-WAY-VALVE

HCPCS C1982: Pressure-Generating Catheter (One-Way Valve)

HCPCS-C9484-ETEPLIRSEN-INJECTION-10MG

HCPCS C9484: Injection, eteplirsen, 10 mg

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Taxonomy Code	Specialty	Notes
`207R00000X`	Diagnostic Radiology	Primary specialty interpreting breast MRI and CAD outputs.
`208000000X`	Radiology	General radiology practices that perform breast MRI and CAD services.
`207T00000X`	Surgery of the Breast	Breast surgeons who may correlate imaging findings with operative planning; may order and review reports.
`207X00000X`	Diagnostic Radiologist — Breast Imaging (subspecialty)	Radiologists specialized in breast imaging who routinely use CAD adjuncts for MRI interpretation.
`261QG0200X`	Medical Oncology	Medical oncologists who use MRI/CAD reports for staging and systemic therapy planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N63`	Unspecified lump in breast	Common indication for diagnostic breast MRI with CAD to characterize a palpable mass.
`D05.90`	Lobular carcinoma in situ of breast, unspecified breast	High-risk lesion sometimes evaluated with MRI to assess extent of disease and search for occult foci.
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Known or suspected breast cancer where MRI with CAD assists in staging and lesion characterization.
`C50.911`	Malignant neoplasm of unspecified site of left female breast	Same as above for left-sided disease and bilateral comparison when CAD is applied.
`Z85.3`	Personal history of malignant neoplasm of breast	Surveillance imaging with MRI/CAD may be used in higher-risk surveillance strategies.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`72197`	Magnetic resonance (e.g., breast), bilateral, without and with contrast material, followed by further sequences	Primary MRI procedure commonly performed when CAD analysis `C8937` is applied; CAD is billed in addition to the MRI.
`77046`	Magnetic resonance guidance for needle placement, breast, single lesion; including initial needle placement, all imaging during procedure and radiological supervision and interpretation	Performed when CAD/MRI findings lead to MRI-guided biopsy; used in interventional workflow following diagnostic MRI/CAD.
`19083`	Biopsy, breast, with placement of breast localization device when performed (e.g., clip), open, with or without imaging guidance	Surgical/interventional code for lesion removal or localization guided by imaging findings from MRI/CAD.
`76098`	MRI guidance for breast biopsy, percutaneous, including imaging and interpretation	Alternative code used for image-guided percutaneous biopsy of breast lesions identified on MRI/CAD.
`77033`	Computer-aided detection (CAD) for screening mammography; independent computer-aided detection and/or display of results and image analysis for each mammographic image set	Related CAD concept in breast imaging; not specific to MRI but demonstrates CAD adjuncts in workflow.

`26`	Professional component	When billing only the radiologist's interpretation of the MRI (professional component) and technical component is billed separately.
`50`	Bilateral procedure	When the CAD analysis is applied to both breasts and bilateral MRI is performed.
`52`	Reduced services	When the CAD analysis or MRI is performed but limited compared with usual service.
`53`	Discontinued procedure	When the MRI/CAD service is started but terminated for patient safety or intolerance before completion.
`59`	Distinct procedural service	When CAD analysis is a distinct, separately identifiable service performed in addition to another imaging procedure (used cautiously with C8937 to indicate separate service).
`62`	Two surgeons	Not typical for imaging CPTs but used when two physicians share responsibility for complex patient care coordination related to imaging-guided interventions.
`78`	Unplanned return to OR following surgery	Rarely applicable; used if CAD-guided findings prompt immediate surgical return (used only when relevant).
`LT`	Left side	When the CAD analysis and MRI report focus specifically on the left breast.
`RT`	Right side	When the CAD analysis and MRI report focus specifically on the right breast.
`TC`	Technical component	When billing only the technical component of the MRI/CAD service (equipment, technologist) separate from professional interpretation.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable to imaging but occasionally reported in bundled professional situations—generally not used for `C8937`.

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