Skip to Main Content
Web Content Viewer


Web Content Viewer

Preventive Services Guide

Screening Mammography

A mammogram is an X-ray of the breast. Screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms.

Coverage Guidelines and Frequency Limits

Benefits are available for female beneficiaries with no signs or symptoms of breast cancer

  • Aged 35 through 39: one baseline screening
  • Age 40 and older: covered annually
    • At least 11 full months have elapsed since last covered screening (Performed January 2019, begin the count the next month [February 2019], payment for another screening will be eligible in January 2020)
  • Under age 35: no screening mammogram coverage
  • Physician referral/order not required
  • Qualified physician directly associated with facility where mammogram taken must interpret results

Components of screening mammogram include:

  • Radiographic test (mammogram)
  • Interpretation and report
  • Communication of results to patient

Coverage provided by hospital, IDTF or physician (office or clinic)

  • Cannot be performed by portable X-ray supplier

Mammogram must be provided in FDA-certified radiological facility under MQSA. Claims will deny or reject if:

  • No FDA certification number reported
  • Facility is not certified for the type of mammogram provided
  • Facility’s certification is suspended or revoked
  • There is no FDA certification number on the MQSA file


These codes are being replaced by the following CPT codes:

  • 77063: screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
    • Use 77063 as an add-on code to 77067 when tomosynthesis is used in addition to 2-D mammography
  • 77067: screening mammography, bilateral (2-view study of each breast), including CAD when performed

ICD-10 Coding

  • N63.15, N63.25, Z12.31
    • Deleted effective 12/31/2019: ICD-10-CM codes N63.10 and N63.20

Note: Report dual diagnosis codes depicting specific quadrants instead of unspecified quadrants, if appropriate.

Note: Additional ICD-10 codes pay apply. See the CMS ICD-10 webpage for individual Change Requests and the specific ICD-10-CM codes Medicare covers for this service.

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived


Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

Billing Tips

  • If billing a screening mammogram and a diagnostic mammogram on the same day, use modifier GG to show a screening mammography turned into a diagnostic mammography, bill both screening and diagnostic codes on same claim.
    • Use a screening ICD-10-CM code for the for the screening mammography
    • Diagnostic ICD-10-CM code supporting the reason warranting the diagnostic mammography
  • Cannot bill add-on code without appropriate mammography code
  • Submit rendering NPI as referring physician if self-referred
  • In Item 32 (or electronic equivalent), enter six-digit FDA-approved certification number
  • Use modifier 26 for professional component
    • Interpretations are only to be performed by the physicians who are associated with the certified mammography facility
      • Exceptions:
        • Patient has requested a transfer of the mammography from one facility to another for a second opinion
        • Patient has moved to another part of the country where the next screening mammography will be performed
  • Use modifier 52 for reduced services
    • When services are performed unilaterally

Additional Services

Prolonged Preventive Services

  • Clock symbol next to CPT codes 77063 and 77067 in the MLN Educational Tool for Medicare Preventive Services (ICN MLN 006559) indicates these codes can be billed with a Prolonged Preventive Services add-on code.
  • Used when the service time exceeds the typical service time for the specific service
  • Must be a valid clinical reason included in the documentation to support the medical necessity of the additional time

Common Claim Denials

  • Male beneficiary
  • Age requirement not met
  • Covered screening mammogram received within the past year
  • Non FDA-certified mammography provider

Related Content

[Return to Index]

Screening Mammography
Web Content Viewer
Web Content Viewer
Complementary Content