By: Lorna Simons, CPC
Medco Consultants, Inc
Effective on January 1, 2018 CPT code 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed was instructed to be used for Medicare patients replacing HCPCS G0202 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.
Medicare Administrative Contractors (MACs) were instructed to use the same payment methodologies with CPT code 77067 as they did for HCPCS code G0202. As such, the Type of Service (TOS) indicator has remained “1”. Using TOS indicator 1 will allow the screening Mammography claims to be billed out without the referring physician information on the claim form.
It is important to note that if the service is diagnostic, it would be appropriate to use TOS indicator 4. In cases where the services are diagnostic the referring provider information is necessary for the claim form.