May is Women’s Health Month, a time to recognize and explore the impact of the many significant health issues women face every day. Mammography remains a critical area of women’s healthcare, influencing lives through preventive screenings, early detection, and follow-up care needs identified through mammography services. However, ongoing challenges continue to create significant risks for providers and organizations alike. Our nationally renowned subject matter experts have identified common FAQs based on the challenges healthcare professionals encounter each year across the country. By understanding these foundational and widespread issues, professionals can better overcome obstacles and position themselves for success in 2026.
Q. If a physical exam is performed in conjunction with a diagnostic mammogram or breast ultrasound and the results are discussed with the patient, is it appropriate to bill for an office visit, such as 99212, if performed in a private office setting?
A. It is only appropriate to bill for a consultation or other evaluation and management (E&M) service when the service is provided and documented according to established E&M guidelines. For breast interventional procedures, a brief review of history and physical exam and obtaining informed consent is not a separately reportable E&M service. This service is considered bundled into the surgical procedure code.
Q. We did a bilateral diagnostic mammogram on a patient and because of the findings decided to perform an ultrasound guided breast biopsy on the same day. A unilateral mammogram was done after the biopsy to verify clip placement. Can we code both of the mammograms?
A. Currently, a national correct coding initiative (NCCI) edit precludes billing both a bilateral and a unilateral mammogram on the same day. The edit has a “0” indicator, so it cannot be bypassed with a modifier. Since there is no limit to the number of views required for a bilateral diagnostic mammogram, all diagnostic images taken on the same day are considered to be included in the more comprehensive service (i.e., CPT 77066).
Q. Do we need to report CPT® add-on code +77063 with modifier 52 when reporting it with 77067-52 during the same encounter?
A. Yes. Both +77063 and 77067 are bilateral codes, so if a unilateral screening mammogram is performed with a unilateral screening tomosynthesis, modifier 52 should be appended to both CPT codes to indicate the reduced nature of the services.
Q. Is breast tomosynthesis considered a three-dimensional (3D) study?
A. While vendors and the lay press often describe breast tomosynthesis as “three-dimensional” (3D), for coding purposes, breast tomosynthesis is not a 3D study. For this reason, the American College of Radiology (ACR) collaborated with the Current Procedural Terminology (CPT) Editorial Panel and Relative Value Scale Unit Update Committee to discourage the use of the terms “2D” and “3D.” In practice, breast tomosynthesis is similar to acquiring tomographic images during conventional tomography (eg, intravenous pyelogram) and viewing the individual tomographic images in a stacked set. Therefore, this is not a 3D study for the purposes of CPT coding.
Q. If we perform a bone density on the hips and forearm can we bill both CPT code 77080 and 77081 together?
A. Yes, in 2020, the American Medical Association (AMA) and the American College of Radiology (ACR) changed their policy on this, and CMS followed suit soon after with Transmittal 10193, which was effective July 1, 2020, allows for modifier XU to bypass Common Working File (CWF) edits when 77080 and 77081 are reported together on the same claim. However, although the 2025 NCCI edit file version 31.3 allows for the reporting of both appendicular (peripheral) and axial (central) studies if performed at separate encounters or under other unusual non-overlapping circumstances with a modifier indicator of “1,” Chapter 9, Section H, #15 of the 2025 NCCI Policy Manual guidance still precludes this. Check with your MAC or watch for updated LCDs or policy manual guidance for clarification.
With reimbursement pressures rising and regulatory complexity continuing to evolve, accurate CPT® coding and compliant documentation are more critical than ever. Gain the expert guidance you need to confidently navigate coding challenges impacting women’s health services in 2026.
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