Coding changes for preventive mammography screenings took effect Jan. 1, 2020.
Requirements introduced by the Affordable Care Act (ACA) state that a mammogram screening is covered as preventive care, not diagnostic.
As a result, we have removed diagnostic mammogram codes from our guidelines. Current mammogram screening codes are listed as Breast Cancer Screening. For more information on this change or to view other Preventive Care Services Guidelines, please visit Care Management. There you can access Clinical Guidelines to find a variety of medical guidelines as well as behavioral health and dental health guidelines.
| Service & Description | USPSTF, Bright Futures, HRSA or SACHDNC Recommendation | CPT/HCPCS Codes | ICD-10 CM Codes | Frequency & Criteria |
|---|---|---|---|---|
| Breast Cancer Screening | The USPSTF recommends screening mammography for women, with or without clinical breast examination, every 2 years for women ages 50 to 74 years. | 77063, 77067, G0202 | Payable with any diagnosis code. | Women ages 50-74 years. |
Updated on 7/22/20 to correct CPT/HCPCS Codes.