Can 77067 and 77063 Be Billed Together?

Current Procedural Terminology (CPT) codes represent a standardized language utilized throughout the United States healthcare system to classify medical procedures and services. These five-digit numeric codes, developed and maintained by the American Medical Association (AMA), facilitate consistent communication among healthcare providers, patients, and insurance payers. CPT codes are fundamental to the medical billing process, enabling the accurate reporting of services performed for claim submission and reimbursement purposes. The precision of these codes directly influences the financial health of healthcare organizations, ensuring appropriate compensation for the care delivered. Accurate coding also streamlines administrative workflows and contributes to the integrity of patient health records.

Understanding CPT Code 77067

CPT code 77067 is specifically defined as “Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.” This code is designated for preventive examinations aimed at the early detection of breast cancer in individuals who do not exhibit any symptoms or signs of breast disease. The primary purpose of a screening mammogram is to identify potential abnormalities before they become clinically apparent, serving as a proactive health measure.

Typical patient scenarios for screening mammography involve routine annual check-ups, often based on age-related guidelines or individual risk factors, in the absence of specific breast concerns. For instance, many healthcare guidelines recommend annual screening mammograms for women starting at age 40 or 50, depending on their personal health history and other considerations. The “bilateral (2-view study of each breast)” aspect means that two distinct X-ray images are taken of each breast, typically a cranio-caudal (top-to-bottom) view and a mediolateral oblique (side-angle) view.

The inclusion of “computer-aided detection (CAD) when performed” indicates that if a computer system assists in highlighting potential areas of concern on the mammogram images for the radiologist’s review, this service is encompassed within the 77067 code. This technology aids in enhancing the detection capabilities of the screening process. It is important to recognize that CPT code 77067 is exclusively for non-symptomatic, preventive examinations, meaning the patient has no breast complaints or suspicious findings requiring further investigation at the time of the service.

Understanding CPT Code 77063

CPT code 77063 is defined as “Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure).” This code represents an advanced form of screening mammography, often referred to as 3D mammography, which utilizes multiple low-dose X-rays to create a three-dimensional image of the breast. Unlike conventional 2D mammography, tomosynthesis captures images from various angles, which are then reconstructed by a computer into a detailed 3D model of the breast tissue, allowing for a clearer visualization of structures by minimizing tissue overlap.

The primary purpose of screening digital breast tomosynthesis is to provide more detailed, layered views of breast tissue. This can help identify small tumors not visible on conventional 2D mammograms by minimizing the effect of overlapping tissue. This advanced imaging technique aims to reduce false positives and the need for additional testing by allowing radiologists to examine breast tissue layer by layer. It is particularly beneficial for women with dense breast tissue, where abnormalities might be obscured in 2D images. The Food and Drug Administration (FDA) has approved this technology for screening purposes.

As an “add-on code,” 77063 is always reported in addition to the primary 2D screening mammography code 77067 when both services are performed. This signifies that 3D tomosynthesis is an additional, complementary component of a bilateral screening examination, not a standalone procedure. The combination of 2D and 3D screening offers a comprehensive approach to preventive breast imaging. This improves the overall detection and diagnosis of breast abnormalities in asymptomatic patients.

Simultaneous Billing Considerations

The core question regarding CPT codes 77067 and 77063 centers on their simultaneous billing for the same patient on the same date of service. Current CPT definitions establish 77063 as “Screening digital breast tomosynthesis, bilateral,” which functions as an add-on code to 77067, “Screening mammography, bilateral.” Consequently, these two codes are indeed intended to be billed together when both a 2D screening mammogram and a 3D screening tomosynthesis are performed bilaterally during the same encounter for preventive purposes. This combined billing accurately reflects the provision of two distinct but complementary screening services.

When a patient receives both a 2D screening mammogram (77067) and a 3D screening tomosynthesis (77063), the latter is reported in addition to the former. This reflects the enhanced imaging capabilities provided by 3D tomosynthesis, which offers more detailed, layered views alongside the standard 2D images. Many commercial payers and Medicare accept claims where these two screening codes are billed concurrently. Proper documentation supporting the performance of both 2D and 3D components is important for reimbursement.

It is important to distinguish this combined screening examination from a diagnostic mammogram, which uses different CPT codes like 77066 for bilateral diagnostic studies. Diagnostic mammography is performed when a patient presents with specific symptoms, such as a palpable lump, persistent breast pain, or nipple discharge. It is also used when an abnormal finding from a prior screening requires further investigation. The fundamental difference lies in the patient’s clinical presentation and the exam’s purpose: screening is for asymptomatic individuals, while diagnostic is problem-focused.

If a patient initially presents for a screening mammogram (77067, potentially with 77063) and a finding during that visit necessitates an immediate diagnostic study, the service typically transitions to a diagnostic mammogram. In such instances, only the appropriate diagnostic code (e.g., 77066 for bilateral diagnostic mammography) would be reported for the comprehensive diagnostic service. Accurate medical documentation is always required to support the medical necessity of any service performed. This includes detailing the clinical indications and the specific procedures rendered, especially any transition from screening to diagnostic.