Issue 32 - Updated Claim Process for Digital Breast Tomosynthesis€¦ · Issue 32 - Updated Claim...
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Updated Claim Process for Digital Breast Tomosynthesis Why you’re receiving this Stat The way claims are processed for digital breast tomosynthesis (three-dimensional mammography) will change effective Feb. 1, 2014. What you need to know This procedure does not meet our technology assessment review process criteria (Technology Assessment Protocol) and is considered investigational. (See Protocol Digital Breast Tomosynthesis, October 1, 2012, on our provider web.) If you elect to provide and bill for a digital breast tomosynthesis in conjunction with a mammogram, the service will deny as " No Separate Fee" and the patient cannot be billed. Currently, there is no specific CPT or HCPCS procedure code for this testing. If billed, it should be reported with the appropriate mammography code along with the unlisted code 76499 for the additional views. Mammography Reimbursement Effective Jan. 1, 2014, the fee schedule for mammography services will be enhanced approximately 2.07% and applies to the following CPT codes: 77055-77057, G0202-G0206. What you need to do If you have any questions regarding this bulletin, please contact your Provider Relations and Contracting account specialist at 1-800-666-4627. STAT Bulletin R8797(B)_5510_5510 December 20, 2013 Volume: 19 Issue: 32 To: MDs/DOs and Facilities Contracts Affected: All lines of business
Transcript of Issue 32 - Updated Claim Process for Digital Breast Tomosynthesis€¦ · Issue 32 - Updated Claim...
Updated Claim Process for Digital Breast Tomosynthesis
Why you're receiving this Stat
The way claims are processed for digital breast tomosynthesis (three-dimensional mammography) will change effective Feb. 1, 2014.
What you need to know
This procedure does not meet our technology assessment review process criteria (Technology Assessment Protocol) and is considered investigational. (See Protocol Digital Breast Tomosynthesis, October 1, 2012, on our provider web.)
If you elect to provide and bill for a digital breast tomosynthesis in conjunction with a mammogram, the service will deny as "No Separate Fee" and the patient cannot be billed.
Currently, there is no specific CPT or HCPCS procedure code for this testing. If billed, it should be reported with the appropriate mammography code along with the unlisted code 76499 for the additional views.
Mammography ReimbursementEffective Jan. 1, 2014, the fee schedule for mammography services will be enhanced approximately 2.07% and applies to the following CPT codes: 77055-77057, G0202-G0206.
What you need to do
If you have any questions regarding this bulletin, please contact your Provider Relations and Contracting account specialist at 1-800-666-4627.
STAT Bulletin
R8797(B)_5510_5510
December 20, 2013Volume: 19 Issue: 32
To: MDs/DOs and Facilities
Contracts Affected: All lines of business
