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New codes for digital breast tomosynthesis

December 30, 2014

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Effective January 1, 2015, new Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes for digital breast tomosynthesis were created.

As a reminder, Independence considers this technology experimental/investigational, as the available published peer-reviewed literature does not provide adequate information on the outcomes when this technology is used in clinical practice. Randomized controlled trials, which provide clinically and statistically significant data (i.e., technical accuracy and precision, clinical sensitivity, specificity, and utility) for digital tomosynthesis over well-established and well-studied digital mammography are currently lacking. Therefore, the following CPT and HCPCS codes are considered experimental/investigational and are not covered as a screening or diagnostic tool for breast cancer:

  • CPT codes:
        –77061: Digital breast tomosynthesis; unilateral
        –77062: Digital breast tomosynthesis; bilateral
        –77063: Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)
  • HCPCS code:
        –G0279: Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206)
For more information about digital breast tomosynthesis, refer to the medical policies available on our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the version of the policy you'd like to view:
  • Commercial: #09.00.52b: Digital Breast Tomosynthesis;
  • Medicare Advantage:#MA09.016: Digital Breast Tomosynthesis.
You can also view policy activity through the NaviNet® web portal by selecting the Reference Tools transaction, then Medical Policy.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

CPT copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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