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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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