Summary & Overview
HCPCS C9788: Opto-Acoustic Breast Imaging with Ultrasound
HCPCS Level II code C9788 represents unilateral opto-acoustic (photoacoustic) breast imaging, including the axilla when performed, with image documentation, analysis and report obtained with an ultrasound examination. This emerging diagnostic imaging code captures hybrid imaging that augments ultrasound with opto-acoustic data to characterize breast tissue and regional lymphatics. Nationally, the code matters as payers and imaging facilities assess coverage, clinical utility, and billing pathways for advanced breast imaging modalities.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, common billing modifiers in use, and the clinical context for when opto-acoustic imaging is performed with ultrasound. The publication summarizes service settings, typical documentation requirements, and what to expect in claims submission for this service line.
This report provides benchmarks and policy-relevant context rather than clinical guidance. It is intended to inform billing staff, coding professionals, and policy analysts about how C9788 is described, where the service is typically delivered, and which payers are most commonly involved in reimbursement discussions. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code C9788 describes opto-acoustic imaging of the breast, unilateral, including the axilla when performed, with image documentation, analysis, and report, obtained alongside an ultrasound examination. This service involves combining opto-acoustic (photoacoustic) imaging technology with ultrasound to produce documented images, perform analytic processing, and generate a clinical report.
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Service type: Diagnostic breast imaging with integrated opto-acoustic analysis performed in conjunction with ultrasound
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Typical site of service: Imaging centers or hospital outpatient departments where breast ultrasound examinations are performed
Clinical & Coding Specifications
Clinical Context
A 52-year-old woman with a newly identified suspicious palpable breast mass on clinical exam is referred to breast imaging for advanced evaluation. The radiology breast clinic schedules opto-acoustic imaging of the affected breast performed in conjunction with targeted diagnostic ultrasound to provide complementary vascular and functional tissue information. The patient arrives at an outpatient breast imaging center where a mammography and breast ultrasound technologist prepares the patient, obtains informed consent, and positions her for the unilateral opto-acoustic imaging study (including axilla when performed). A sonographer or advanced imaging technologist acquires ultrasound images while the opto-acoustic device captures optical absorption and acoustic signals; the imaging physician (breast radiologist) reviews real-time images, documents findings, performs analysis, and generates a formal report. Images and measurements are archived in the PACS and the report is routed to the referring surgeon or primary care provider. Typical indications include abnormal screening mammogram, focal breast pain with palpable abnormality, focal or asymmetric breast density, or concern for neoplasm requiring additional characterization of lesion vascularity and tissue composition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to perform the opto-acoustic imaging is substantially greater than usual (extensive additional image acquisition or complex analysis). |