Summary & Overview
HCPCS M1302: Digital/3D Mammography Results Documented and Reviewed
HCPCS Level II code M1302 denotes documented and reviewed results from screening or diagnostic digital mammography or digital breast tomosynthesis (3D) interpretation. This code identifies the clinical activity of interpreting and recording findings from breast imaging, an increasingly important component of breast cancer detection and follow-up care. Clear capture of interpretation and documentation supports quality measurement, clinical communication, and appropriate downstream management.
Key payers commonly involved in national coverage and reimbursement for imaging interpretation include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what this code represents, its clinical context in breast imaging workflows, common modifiers associated with interpretation services, and how payers typically approach coverage and claims processing. The publication provides benchmarks for coding practice, notable policy updates affecting interpretation claims, and operational considerations for outpatient imaging centers and hospital outpatient departments.
This summary serves clinicians, billing professionals, and policy analysts seeking a national perspective on coding for breast imaging result documentation and review. Data not available in the input.
Billing Code Overview
HCPCS Level II code M1302 describes screening or diagnostic mammography where results from digital or digital breast tomosynthesis (3D) imaging are documented and reviewed. The service includes interpretation and documentation of imaging results rather than performance of the imaging acquisition itself.
Service type: Imaging interpretation and documentation
Typical site of service: Outpatient imaging centers, breast imaging clinics, and hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A 56-year-old female presents to an outpatient imaging center for screening digital mammography with or without digital breast tomosynthesis (3D) as part of routine breast cancer screening. The technologist acquires the mammographic images, uploads them to the PACS, and a radiologist reviews and interprets the images. The procedure documented under M1302 reflects that the screening or diagnostic mammography images (digital or tomosynthesis) were reviewed and the results were recorded in the patient’s medical record. Typical workflow steps include patient check-in and history confirmation, image acquisition (2D digital mammography and/or 3D tomosynthesis), radiologist image review and documentation of findings, communication of results to the referring clinician and patient, and placement of results in the electronic health record. Typical sites of service are outpatient imaging centers, hospital outpatient departments, and ambulatory surgery centers when diagnostic workup requires additional services. Common clinical indications include routine screening, palpable breast mass, focal breast pain, focal asymmetry or density on prior imaging, and follow-up of prior abnormal findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to review/document images is substantially greater than typical (rare for standard mammography reporting). |