**Mammogram & Breast Imaging: Comprehensive CPT Coding Guide**

Introduction

Mammography and breast imaging are critical for early detection of breast cancer and other abnormalities. Proper CPT coding ensures accurate reimbursement and prevents denials due to incorrect modifier use or bundling issues. This guide covers key CPT codes for mammograms and breast imaging, including billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.

Understanding Mammogram & Breast Imaging Coding

  • Screening mammograms are preventive exams performed on asymptomatic patients.
  • Diagnostic mammograms are used when a patient has symptoms or abnormal screening results.
  • Tomosynthesis (3D mammography) is often billed separately or bundled depending on payer policies.

CPT Codes for Mammogram & Breast Imaging

Screening Mammogram CPT Codes

  • 77067 – Screening mammogram, bilateral, includes CAD.

    • Used for asymptomatic patients as part of routine breast cancer screening.

  • 77063 – Screening digital breast tomosynthesis (DBT), bilateral.

    • Used when 3D imaging (tomosynthesis) is performed in addition to a screening mammogram.

Diagnostic Mammogram CPT Codes

  • 77065 – Diagnostic mammogram, unilateral, includes CAD.

  • 77066 – Diagnostic mammogram, bilateral, includes CAD.

    • Used for patients with symptoms, history of breast cancer, or abnormal screening findings.

  • 77061 – Digital breast tomosynthesis (DBT), unilateral.

  • 77062 – Digital breast tomosynthesis (DBT), bilateral.
    • Used when 3D imaging is performed as part of a diagnostic evaluation.

Breast Ultrasound & MRI CPT Codes

  • 76641 – Ultrasound, breast, unilateral, complete.
  • 76642 – Ultrasound, breast, unilateral, limited.
  • 77048 – MRI, breast, without contrast, unilateral.
  • 77049 – MRI, breast, without contrast, bilateral.
  • 77046 – MRI, breast, with contrast, unilateral.
  • 77047 – MRI, breast, with contrast, bilateral.

Breast Biopsy & Localization Procedures

  • 19081 – Breast biopsy, percutaneous, with stereotactic guidance.
  • 19083 – Breast biopsy, percutaneous, with ultrasound guidance.
  • 19085 – Breast biopsy, percutaneous, with MRI guidance.
  • 19281 – Placement of breast localization device, stereotactic guidance.
  • 19283 – Placement of breast localization device, ultrasound guidance.
  • 19285 – Placement of breast localization device, MRI guidance.

Billing Guidelines & Modifier Usage

  • Common Modifiers:

    • -52 – Reduced service if the full imaging study is not performed.
    • -TC – Technical component only (imaging equipment use).
    • -26 – Professional component only (radiologist interpretation).

  • Bundling Considerations:

    • 77063 (3D mammography) is sometimes bundled with 77067 (screening mammogram)—check payer-specific guidelines.
    • Breast biopsy codes (19081–19085) include imaging guidance and should not be reported separately.

Common Denials & How to Avoid Them

  • Medical Necessity Denials: Ensure proper documentation of symptoms or prior abnormal findings.
  • Modifier Use Issues: Apply -26 or -TC correctly when billing for only the professional or technical component.
  • Duplicate Claim Rejections: Avoid submitting both 2D and 3D mammography claims separately unless payer allows unbundling.

Final CPT Code Table: Descriptions & RVUs

CPT Code Description RVU
77067 Screening mammogram, bilateral 8.75
77063 Screening 3D mammogram, bilateral 10.30
77065 Diagnostic mammogram, unilateral 9.85
77066 Diagnostic mammogram, bilateral 12.40
77061 Digital breast tomosynthesis, unilateral 8.60
77062 Digital breast tomosynthesis, bilateral 10.90
76641 Ultrasound, breast, unilateral, complete 6.50
76642 Ultrasound, breast, unilateral, limited 5.80
77048 MRI, breast, without contrast, unilateral 13.75
77049 MRI, breast, without contrast, bilateral 15.20
77046 MRI, breast, with contrast, unilateral 14.60
77047 MRI, breast, with contrast, bilateral 16.10
19081 Breast biopsy, percutaneous, stereotactic guidance 12.95
19083 Breast biopsy, percutaneous, ultrasound guidance 11.75
19085 Breast biopsy, percutaneous, MRI guidance 13.20
19281 Placement of breast localization device, stereotactic guidance 10.10
19283 Placement of breast localization device, ultrasound guidance 9.80
19285 Placement of breast localization device, MRI guidance 11.45

Conclusion

Accurate CPT coding for mammography and breast imaging is essential for maximizing reimbursement and preventing denials. Understanding bundling rules, modifier application, and payer-specific guidelines will help ensure accurate claims.

If this guide was useful, check out our other radiology CPT coding guides on MRI, ultrasound, and PET scans!