CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Billing and Reimbursement Guideline: Mammography Screening

Guideline governing coding, documentation, and reimbursement for screening and diagnostic mammography claims submitted to Neighborhood Health Plan of Rhode Island; affects providers submitting CMS-1500 and UB-92 claims.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyBilling and Reimbursement Guideline: Mammography Screening

Policy CodePolicy N/A

Change TypeFormat change, minor edits (9/1/2013)

Effective DateSeptember_1,2010

Next Review DateN/A

Key ActionAttach modifier GG to diagnostic mammography when both screening and diagnostic mammography are submitted the same day.

SourceLink

POLICY UPDATE CHANGES

Format change, minor edits

2screening diagnosis codes listed (V76.11, V76.12)

4primary mammography procedure codes referenced

2component modifiers called out (TC, 26)

CMS-1500/UB-92claim form types

Mammography Coverage and Billing Guidance

Mammography reimbursement guidance

Coverage and billing guidance for submitting screening and diagnostic mammography claims.

Follow billing and documentation guidance in this mammography screening guideline; plan coverage, eligibility and claim payment edit rules may apply and this guideline is not a guarantee of reimbursement.

ALL of the following

Billable screening diagnoses
- V76.11 — Special screening for malignant neoplasm, screening mammogram for high-risk patients
- V76.12 — Special screening for malignant neoplasm, other screening mammogram
Primary mammography procedure codes (examples listed)

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyBilling and Reimbursement Guideline: Mammography Screening

Policy CodePolicy N/A

Change TypeFormat change, minor edits (9/1/2013)

Effective DateSeptember_1,2010

Next Review DateN/A

Key ActionAttach modifier GG to diagnostic mammography when both screening and diagnostic mammography are submitted the same day.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Diagnosis, Procedure Codes and Component Billing

Mammography diagnosis and procedure codesmixedCovered

V76.11	Special screening for malignant neoplasm, screening mammogram for high-risk patients
V76.12	Special screening for malignant neoplasm, other screening mammogram
77051	Computer aided detection for diagnostic mammography (list separately in addition to primary diagnostic procedure)
77052	Computer aided detection for screening mammography (list separately in addition to primary screening procedure)
77055	Primary diagnostic mammography code (example listed)
77056	Primary diagnostic mammography code (example listed)
G0204	Diagnostic mammography HCPCS code (listed as example)
G0206	Diagnostic mammography HCPCS code (listed as example)
77057	Primary screening mammography code (example listed)
G0202	Screening mammography HCPCS code (document lists GO202/G0202 variant)

Component billing

Technical component modifierUse modifier TC to bill the technical component only.

Professional component modifierUse modifier 26 to bill the professional component only.

Global feeWhen billing a global fee, no modifier is needed.

Submission Actions and Billing Modifiers

Billing Rule

Attach GG modifier and order modifiers; use TC/26 for components

When submitting both a screening and a diagnostic mammography for the same patient on the same day, attach modifier GG to the diagnostic mammography. If more than one modifier is necessary, place the mammography modifier in position 1 and the other modifier in position 2. Use modifier TC to bill the technical component only and modifier 26 to bill the professional component only; no modifier is needed when billing the global fee.

Attach modifier GG to the diagnostic mammography when both screening and diagnostic mammography are submitted same day.
Place the mammography modifier in position 1 when multiple modifiers are necessary; other modifier(s) go in position 2.
Use TC for the technical component and 26 for the professional component; no modifier for the global fee.

Modifier Definitions

Technical component (billing modifier)

Modifier for technical componentTC

Usage noteUse TC when billing only the technical component of the mammography service.

Claim formsApplies to CMS-1500 and UB-92 submissions.

Professional component (billing modifier)

Modifier for professional component26

Usage noteUse 26 when billing only the professional component of the mammography service.

Claim formsApplies to CMS-1500 and UB-92 submissions.

Modifier for same‑day screening and diagnostic mammography

Modifier to attach when both screening and diagnostic performed same dayGG

Placement noteAttach modifier GG to the diagnostic mammography when both screening and diagnostic mammography are submitted on the same day.

Multiple modifiersIf more than one modifier is necessary, place the mammography modifier (e.g., GG) in position 1 and the other modifier in position 2.