G0202 Screening Mammography HCPCS: Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G0202: Screening Mammography, Bilateral (2-View), with CAD

HCPCS Level II code G0202 denotes a bilateral screening mammogram consisting of a two-view study of each breast and includes computer-aided detection (CAD) when performed. Screening mammography is a widely used preventive imaging service with national relevance for early breast cancer detection and population health initiatives. The code standardizes reporting for routine, asymptomatic screening exams and supports consistent billing across outpatient imaging centers and hospital outpatient departments.

Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service represented by G0202, typical sites of service, and the administrative context for billing this preventive imaging exam. The analysis outlines common billing practices, relevant modifiers, and how G0202 fits within preventive care coding frameworks. It also summarizes benchmarks and policy considerations that affect coverage and payment for screening mammography, and highlights documentation and coding elements pertinent to accurate claim submission.

This summary is intended for national audiences including payers, providers, and billing professionals seeking a clear, focused reference on HCPCS Level II code G0202 and its role in breast cancer screening workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0202HCPCS Level IIscreening mammographybreast imagingpreventive servicesmedical billingoutpatient imagingcomputer-aided detection

Billing Code Overview

HCPCS Level II code G0202 represents screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. This service is a preventive imaging study intended to detect breast cancer in asymptomatic individuals.

Service type: Screening mammography, bilateral, 2-view study of each breast
Typical site of service: Outpatient imaging centers and hospital outpatient departments where screening mammography is routinely performed

Clinical & Coding Specifications

Clinical Context

A 56-year-old woman presents to an outpatient imaging center for routine breast cancer screening. She has no breast-related symptoms and no known breast cancer history; screening is performed per age-based guidelines. The technologist escorts the patient to the mammography suite. A certified mammography technologist acquires a two-view study of each breast (craniocaudal and mediolateral oblique views) using digital mammography. Images are processed and the technologist performs quality checks. The interpreting radiologist (breast imaging specialist) reviews the images, applies computer-aided detection (CAD) if available, and documents findings and an imaging report with BI-RADS assessment. The clinic bills the screening mammography service using HCPCS Level II code G0202. Typical workflow includes scheduling, patient intake and consent, image acquisition (technical component), radiologist interpretation (professional component), report generation, and communication of results to the ordering provider and patient. Typical site of service is an outpatient imaging center, hospital outpatient radiology department, or freestanding mammography clinic. Common modifiers applied are 26 (professional component) and TC (technical component) when billing components separately.

Coding Specifications

Modifier	Description	When to Use

HCPCS G0452: Molecular Pathology Physician Interpretation and Report

HCPCS-G0144-CERVICAL-VAGINAL-CYTOLOGY-AUTOMATED-THIN-LAYER-SCREENING

HCPCS G0144: Cervical or Vaginal Cytopathology Screening, Automated

HCPCS-G9204-HEPATITIS-C-RNA-TESTING-NOT-DOCUMENTED

HCPCS G9204: Hepatitis C RNA Testing Not Documented Within 12 Months

HCPCS-G8651-HIP-IMPAIRMENT-RESIDUAL-SCORE

HCPCS G8651: Hip Impairment Residual Score Recorded

HCPCS-G0468-FQHC-VISIT-IPPE-AWV

HCPCS G0468: FQHC Visit Including IPPE or AWV

HCPCS-G9639-NO-MAJOR-AMPUTATION-OR-BYPASS-WITHIN-48-HOURS

HCPCS G9639: No Major Amputation or Bypass Within 48 Hours

HCPCS-G9201-VTE-PROPHYLAXIS-ADMISSION-DAY

HCPCS G9201: Venous Thromboembolism Prophylaxis on Admission Day

HCPCS-G0255-SENSORY-NERVE-CONDUCTION-TEST-PER-LIMB

HCPCS G0255: Sensory Nerve Conduction Test, Per Limb Any Nerve

HCPCS-G9796-HIGH-INTENSITY-STATIN-THERAPY

HCPCS G9796: High-Intensity Statin Therapy

HCPCS-G0257-UNSCHEDULED-EMERGENCY-DIALYSIS-OUTPATIENT-NON-ESRD-FACILITY

HCPCS G0257: Unscheduled or Emergency Dialysis for ESRD Patients

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RP1000X`	Radiology - Diagnostic Radiology	Interpreting physicians for screening mammography and diagnostic follow-up.
`207RH0000X`	Radiology - Nuclear Medicine	In some breast imaging centers with combined imaging services.
`363A00000X`	Physician Assistant	PAs may perform preliminary image acquisition or coordinate care in imaging centers.
`174400000X`	Radiologic Technologist	Technologists perform image acquisition and quality control.
`207L00000X`	Interventional Radiology	May be involved if image-guided biopsy is required after screening (coordinate workflow).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z12.31`	Encounter for screening mammogram for malignant neoplasm of breast	Primary preventive screening indication for bilateral screening mammography.
`Z80.3`	Family history of malignant neoplasm of breast	Increased screening consideration; documented as reason for adherence to screening protocols.
`N63`	Unspecified lump in breast	If patient reports a palpable abnormality at presentation, screening may convert to diagnostic imaging.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of breast	Used when imaging yields inconclusive or abnormal findings requiring further workup.
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Relevant if an established breast cancer diagnosis exists; screening code would not be appropriate for active cancer surveillance but may relate to imaging workflow.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`77063`	Screening digital breast tomosynthesis, bilateral (List separately in addition to screening mammography if performed)	Performed in addition to 2‑view mammography when tomosynthesis is used for improved detection; often billed alongside mammography where supported by payer policy.
`77067`	Screening mammography, bilateral, including computer-aided detection (CAD) when performed; digital	An alternative CPT code for screening mammography in CPT code sets; may be used instead of `G0202` depending on payer.
`76092`	Radiologic examination, breast, including magnification when performed; unilateral or bilateral	Performed for diagnostic or spot-compression views following an abnormal screening mammogram; used in diagnostic workflow after `G0202` if additional mammographic views are required.
`19083`	Biopsy, breast, with stereotactic guidance	Performed when a suspicious mammographic finding requires tissue sampling; follows screening and diagnostic mammography when indicated.
`88305`	Surgical pathology, gross and microscopic examination	Used when biopsy specimens obtained after mammography are submitted for histopathologic diagnosis.

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