If a screening Mammogram (77067) and tomosynthesis (77063) are performed unilaterally, should Modifier 52 be placed on both CPTs®?
According to the AMA Clinical Examples in Radiology, 2016 Issue 4 (Fall), when a screening mammogram (77067) and screening digital breast tomosynthesis (77063) are performed unilaterally, it is appropriate to report both codes with modifier 52 (Reduced Services) to indicate that only one breast was imaged.
The CPT descriptors for both 77067 and 77063 specify bilateral imaging, so modifier 52 communicates that the service was performed at a reduced level. Some payers, including certain Medicare Administrative Contractors (MACs), prefer the use of RT or LT modifiers instead of 52 to indicate which breast was imaged; therefore, local payer guidance should be reviewed prior to claim submission.
Documentation should clearly specify the imaged breast and provide the clinical rationale for performing a unilateral study. Applying the modifier to both CPT codes ensures accurate reporting of services, supports proper reimbursement, and aligns with CPT guidance for unilateral procedures.
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