Summary & Overview
HCPCS G0279: Diagnostic Digital Breast Tomosynthesis
HCPCS Level II code G0279 represents diagnostic digital breast tomosynthesis performed unilaterally or bilaterally and billed in addition to diagnostic mammography codes 77065 or 77066. As a supplemental three-dimensional imaging technique used in diagnostic mammography, tomosynthesis improves lesion conspicuity and can affect downstream diagnostic workups and care pathways. Nationally, utilization of diagnostic tomosynthesis has implications for outpatient imaging capacity, equipment investment, and payer coverage policies.
Key national payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding intent and clinical context, comparative benchmarks for utilization and reimbursement, common modifier and billing considerations, and recent policy updates affecting coverage and bundling with diagnostic mammography codes. The publication also summarizes typical sites of service and operational considerations for outpatient imaging centers and hospital outpatient departments.
This report is intended to inform revenue cycle, clinical imaging leadership, and payer policy analysts about how G0279 is used in diagnostic breast imaging workflows, what to expect in claims processing, and where policy or practice changes may affect billing and access.
Billing Code Overview
HCPCS Level II code G0279 describes diagnostic digital breast tomosynthesis, performed unilaterally or bilaterally. This service is listed separately in addition to 77065 or 77066 and is used when three-dimensional breast imaging is performed for diagnostic evaluation.
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Service type: Diagnostic breast imaging (digital breast tomosynthesis)
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Typical site of service: Outpatient imaging centers or hospital outpatient departments where diagnostic mammography and supplemental tomosynthesis are performed
Clinical & Coding Specifications
Clinical Context
A 52-year-old woman with a recent screening mammogram showing a focal area of concern is referred for diagnostic breast imaging. The clinician orders diagnostic digital breast tomosynthesis to better characterize a suspicious mass seen on prior 2D mammography. The patient arrives to the outpatient radiology department; registration verifies insurance (examples: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare). The radiologic technologist obtains targeted unilateral tomosynthesis views of the symptomatic breast, or bilateral views if indicated, using a DBT-capable mammography unit. A radiologist reviews the tomosynthesis images, documents findings, and determines next steps which may include ultrasound, stereotactic biopsy, or short-interval imaging follow-up. The imaging encounter is billed with G0279 in addition to the appropriate diagnostic mammography procedure code (77065 or 77066) to indicate the added tomosynthesis component when performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the radiologist interpretation separate from the technical component |
TC | Technical component | When billing only the facility/technical portion of the service |
50 | Bilateral procedure | When both breasts are imaged and payer requires a bilateral modifier |
RT | Right side | When only the right breast is imaged and side-specific reporting is required |
LT | Left side | When only the left breast is imaged and side-specific reporting is required |
59 | Distinct procedural service | When tomosynthesis is a separate and distinct service from other imaging on the same day |
52 | Reduced services | When full tomosynthesis protocol cannot be completed for clinical or patient-related reasons |
53 | Discontinued procedure | When the procedure was started but discontinued prior to completion due to patient intolerance |
22 | Increased procedural services | For substantially greater work or resources required during the imaging encounter |
76 | Repeat procedure by same physician | When the same provider repeats the tomosynthesis study the same day |
77 | Repeat procedure by another physician | When a different provider repeats the study the same day |
AS | Physician assistant, nurse practitioner, clinical nurse specialist services for assistant at surgery | Rarely used; may apply per payer policy for advanced practitioner involvement in image-guided procedures |
GA | Waiver of liability statement on file (individual payer) | When a voluntary payer waiver has been obtained for an item or service not typically covered |
GZ | Unlikely to be paid (no ABN on file) | When the service is expected not to be paid and no advance notice form is on file |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RX0200X | Radiology | Diagnostic breast tomosynthesis is performed and interpreted by diagnostic radiologists |
207QS0011X | Diagnostic Radiology - Breast Imaging | Subspecialists in breast imaging commonly perform and interpret DBT |
363A00000X | Radiologic Technologist | Technologists perform the acquisition of tomosynthesis images in outpatient imaging centers |
261QR0201X | Physician Assistant | May participate in coordinating image-guided procedures and follow-up care |
3336C0003X | Nurse Practitioner | May order diagnostic mammography and manage patient follow-up |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N63 | Unspecified lump in breast | Common indication for diagnostic tomosynthesis to evaluate a palpable or image-detected mass |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Used when prior imaging yields inconclusive results requiring tomosynthesis for clarification |
R92.1 | Mammographic microcalcification found on diagnostic imaging of breast | Tomosynthesis helps characterize calcifications and guide management |
N64.4 | Mastodynia (breast pain) | Targeted tomosynthesis may be used when focal pain correlates with imaging findings |
Z12.31 | Encounter for screening mammogram for malignant neoplasm of breast | If a screening mammogram leads to additional diagnostic tomosynthesis for further evaluation |
C50.912 | Malignant neoplasm of unspecified site of right female breast | Diagnostic tomosynthesis may be used in staging workup or assessment of focal disease |
C50.911 | Malignant neoplasm of unspecified site of left female breast | As above, for contralateral or ipsilateral assessment |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77065 | Diagnostic mammography; unilateral, including single view tomosynthesis when billed accordingly | Often billed as the primary diagnostic mammography code with G0279 listed separately to denote DBT addition |
77066 | Diagnostic mammography; bilateral, including single view tomosynthesis when billed accordingly | Used when diagnostic mammography is performed bilaterally; G0279 may be listed per payer rules for DBT component |
76641 | Ultrasound, chest wall, breast, unilateral, real time with image documentation; limited | Commonly performed same-day to further evaluate a mass visualized on tomosynthesis |
19083 | Biopsy, breast, with placement of localization device when performed, and imaging guidance | Performed after tomosynthesis if tissue sampling and localization are required |
76085 | Fluoroscopic guidance for needle placement (e.g., stereotactic) | May be used in image-guided localization or biopsy workflows following tomosynthesis |