Breast MRI: New Year, New Codes, New Questions

2019 brought us CPT^® code additions and deletions for breast MRI procedures, and these additions and deletions are impacting multiple areas – Category I CPT codes, Category III codes and HCPCS Level II Codes. Beginning January 1^st, we were introduced to four new CPT codes describing breast MRI procedures and said goodbye to two deleted codes – 77058 and 77059.

The two deleted codes were fairly generic so, naturally, the four new codes are more specific regarding breast MRI procedures. The codes in this new series split out breast MRI done unilaterally or bilaterally and also bundle CAD, whether performed or not.

The first two codes refer to unilateral or bilateral breast MRI performed without contrast:

Be aware that these codes are WITHOUT contrast and do not include CAD. Also, in 2019 Category III code 0159T for separate charging of CAD was deleted. The other two codes in this new series refer to unilateral or bilateral breast MRI performed without and with contrast, including CAD – whether CAD is performed or not.

It seems simple enough, but there’s something missing. Without contrast, without and with contrast…what about breast MRI performed with contrast only?

Presently, there is no CPT code option for this. Until there is a code choice available for breast MRI performed with contrast only what are the options for reporting?

1. CPT-wise, if performed in this fashion, this would be coded as an unlisted procedure – 76498. Also, keep in mind, the Category III code for CAD has been deleted and there is no option to charge this separately in CPT – this has been bundled into the new codes.

2. Level II HCPCS does provide choices for this (C8903 and C8906), and there was a code created in 2019 for separate billing of CAD (C8937). Before submitting these codes remember: Level II HCPCS codes are for hospital billing of outpatient Medicare services (i.e., OPPS). Before submitting these codes to ANY payer other than Medicare (for hospital outpatient services) be certain to check with payers for their policies and approval.

New codes tend to raise new questions and clarifications often come out throughout the year, stay tuned as we learn more together.

For more information, check out our Breast and Bone Density Procedure Coding Guide and CT/MR Coder.

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