CPT Code 77067: Code Description, Billing Requirements, RVU Values, and Medicare Reimbursement Rates
Explore CPT code 77067 for screening mammography, billing guidelines, documentation requirements, RVU values, and Medicare reimbursement considerations.
The CPT code 77067 has been used for bilateral screening mammograms for eligible patients who are undergoing routine breast cancer screening. Getting in and claim rads are accurate can help eliminate preventable claims denials, ensure the proper diagnosis codes are applied and get claims submitted correctly. But, a good bill must go beyond picking the right procedure code. Providers will also need to check the applicant’s eligibility for screening, document the service, adhere to reimbursement rate requirements from the payer, and ensure they meet appropriate reimbursement rates.
Medical billing teams need to understand the meaning of CPT code 77067 for claims payment and to ensure that the revenue cycle is consistent and correct. This guide describes the purpose of the code, requirements, related mammography codes, relative value units (RVUs), and considerations for reimbursement by Medicare, as well as risks for claim denials.
What Is CPT Code 77067?
The cpt code 77067 is used to describe a radiological examination of both breasts in a patient who is not having the exam to evaluate signs or symptoms of breast cancer. When performed, the service will consist of a two-view study of each breast plus with computer-aided detection (CAD).
According to the Centers for Medicare & Medicaid Services (CMS), cpt code 77067 is the code for bilateral screening mammography which includes CAD if performed. Practices cannot bilateralize any work that is documented as part of the code description for CAD.
CPT code 77067 is not an abnormal breast evaluation, but rather is used for routine screening. If the patient has a lump in the breast or any committing symptoms such as an abnormal lumps that has requested diagnostic imaging, the code should be dependent on the actual service and clinical indication.
Key Billing Details for CPT Code 77067
| Coding detail | Description |
|---|---|
| CPT code | 77067 |
| Service | Bilateral screening mammography |
| Imaging scope | Two-view study of each breast |
| Computer-aided detection | Included when performed |
| Common screening diagnosis | ICD-10-CM Z12.31 |
| Related screening add-on | CPT 77063 for bilateral screening breast tomosynthesis |
| Primary purpose | Routine breast cancer screening |
Confirm official code descriptor with the most recent CPT code set and payer instructions prior to filing claims.
CPT Code 77067 Billing Guidelines and Documentation Requirements
First an accurate bill for cpt code 77067 should include documentation that the exam is actually being performed as a screening mammography, not as a diagnostic procedure. Before a claim is sent, the billing team should review the order, clinical indication, imaging report, diagnosis, and requirements by the payers. A clinical examination of the breasts should be to screen for breast cancer. If the symptom or abnormal finding suggests making a diagnosis, the documentation/collection of procedures should state that purpose instead.
Required Documentation for CPT Code 77067
For CPT code 77067, the following documentation is required:
- The medical record should be in alignment with the service billed. Billing teams should verify the following info, although needs differ based on a payers:
- Referral Order, other documentation justifies a screening exam.
- The record is used to identify patients and date of service.
- The imaging report document states that a “bilateral screening mammography” was done.
- There is an indication for screening not diagnostic testing.
- The diagnostic code is typically a statement documenting the reason for the examination.
- If applicable, any additional imaging services used are captured on a separate document.
- Claim is compliant with the payer requirements for eligibility, frequency, eligibility modifiers, and billing.
ICD-10-CM Diagnosis Code for CPT Code 77067
Z12.31, ICD-10-CM: Screening mammogram for malignant neoplasm of breast, is often reported with the CPT code 77067 when the screening mammogram is conducted for a routine screening. Diagnosis must be corresponding with documented indication. Cross-sectional diagnosis should not be categorized, or counted as diagnostic imaging used to investigate a symptom or an abnormal finding. Ensure that the diagnosis is confirmed prior to submission with the current ICD-10-CM code set and payer policy. Proper diagnosis coding assists coverage review and avoiding unnecessary insurance claim denial.
Patient Eligibility and Screening Frequency
Criteria and screening frequency vary based on insurance status and screening guidelines. Screening check-up mammograms provided for qualified females age 40 and up are typically paid for by Medicare Part B on an annual basis. Under the law, commercial insurers are allowed to adhere to the applicable guidelines on preventive health services and the plan’s provisions. Before billing the claim the billing teams should include the patient’s eligibility, last screening date, and benefit limitations. Do not presume that patient age leads to an examination, contact your performer marketing representative for details.
Same-Day Screening and Diagnostic Mammography Billing
Sometimes a screening examination shows an area that needs further imaging tests. If the radiologist does diagnostic views on the same day, then the billing staff must ascertain which services they did and what the payers have told them to report. In some cases, diagnostic mammography is the same visit as screening mammography and Medicare has special rules for this.
Only when applicable Medicare requirements are met can Modifier GG be relevant to claims where screening for same day diagnosis occurs and screening was not reimbursed. Don’t add modifiers as you go. Please review existing CMS guidance, claim edits, and payer-specific guidance prior to reporting screening and diagnostic services. Support must be provided for every service billed, in the medical record.
CPT Code 77067 vs. Related Mammography Codes
Choosing the appropriate mammography code will depend on the reason for the exam, and the service rendered or imaging being performed. CPT code 77067 is for screening mammography, codes for diagnostic mammography and mammography, screening or diagnostic, tomosynthesis are in the appendix.
| CPT or HCPCS code | Service | Main billing distinction |
|---|---|---|
| 77065 | Unilateral diagnostic mammography | Diagnostic imaging of one breast |
| 77066 | Bilateral diagnostic mammography | Diagnostic imaging of both breasts |
| 77067 | Bilateral screening mammography | Routine screening of both breasts |
| 77063 | Bilateral screening breast tomosynthesis | Add-on code for qualifying screening tomosynthesis |
| G0279 | Diagnostic digital breast tomosynthesis | Add-on code for qualifying diagnostic tomosynthesis |
Combinations will be based on the official code descriptors and the policies of the payers. Don’t choose a code based on just being left or right. There must also be consistency between the documented purpose of the clinical service and the actual service provided.
Cpt code 77063 and 77067
The CPT code 77067 is used to bill for bilateral screening mammography. When the appropriate coding and coverage criteria are met, bilateral screening breast tomography is-reportable as an add-on service on CPT code 77063. The codes are intended for services that are related, but different. CPT code 77063 should not be used as a substitute for CPT code 77067. Opens payer’s coverage, code-pair edits, and documentation requirements prior to submission of both codes.
When to Report Diagnostic Tomosynthesis Code G0279
When appropriate, diagnostic digital breast tomosynthesis, unilateral or bilateral, is billed as G0279 with Q70H. This is not the same as CPT code 77063 for screening breast tomosynthesis. Positioned to be determinative of the clinical purpose is the following coding. Practices will confirm to practitioners’ current Medicare instructions and commercial payer policies prior to reporting tomosynthesis services.
CPT Code 77067 RVU Values and Medicare Reimbursement Rates
Reimbursement rates for Medicare are dependent on the Physician Fee Schedule, geographic adjustment, rules and payment circumstances for all payments using CPT code 77067. Knowing the meaning of RVUs can provide practices with a helpful frame of reference for understanding allowed amounts and can offer an opportunity for them to explore differences in RVUs payment. Multiple CMS files called the Medicare Physician Fee Schedule are issued and distributed annually with various procedure-specific RVUs, payment indicators, and associated billing and payment data. The CMS Physician Fee Schedule Lookup Tool also offers payments data that is by code and Medicare locality.
CPT Code 77067 RVU Values for 2026
These 2026 RVUs should be checked with the applicable Physician Fee Schedule files from CMS for the service date. In the table below, we list bills that the billing team will want to look through.
| RVU component | What it measures |
|---|---|
| Work RVU | Physician effort, time, skill, and clinical judgment |
| Practice expense RVU | Resources required to provide the service |
| Malpractice RVU | Relative professional liability expense |
| Total RVUs | Combined work, practice expense, and malpractice components before geographic adjustments |
The RVU values are not monetary values. There should not be a direct correlation between the total RVUs and what Medicare will pay for the procedure. The component RVU values are provided prior to published values for 2026. Please verify each separately against the appropriate CMS file. Please note that proposed rates or aged payment tables or third party estimates are not an accurate alternative to actual final rates.
CPT Code 77067 Global, Professional, and Technical Component Payments
The national average Medicare reimbursement amounts for CPT code 77067 vary by billing component and payment rules, which applies to 2026.
| Billing component | 2026 national average Medicare payment |
|---|---|
| Global service | $126.89 |
| Professional component | $35.25 |
| Technical component | $91.64 |
These numbers are outlined in Hologic’s coding and reimbursement guide for 2026 mammograms. The global rate applies for both components billed in the same invoice in accordance with the applicable rules. The professional rate includes the services of the interpreter and reporting and the technical rate summarizes the resources required to conduct the screening. The actual Medicare reimbursement could vary based on geographic locality and applicable conversion factor. Check the current rate with the Medicare Physician Fee Schedule prior to claims.
How Medicare Locality Affects CPT Code 77067 Reimbursement
To compensate for site-to-site differences in the costs of providing services the Medicare program uses geographic practice cost indices. Because of this, the maximum allowed charge varies by location for cpt code 77067. This is also down to the applicable conversion factor. The conversion factor is set by CMS under the Physician Fee Schedule and the factor is dependent on the payment rules for services as well as the date to which the conversion factor is applicable.
Billing teams need to be aware of the proper service date, location, conversion factor and billing situation for the accurate quote. Having a national baseline is helpful for reference, but will not necessarily guarantee the ultimate payment of a specific claim.
Medicare Coverage and Patient Cost-Sharing for CPT Code 77067
For most women aged 40 and older that are covered by Medicare, screening mammograms are typically covered every 12 months in Medicare Part B. Coverage based on the Medicare requirements that apply. If the provider accepts Medicare assignment, and performs a covered screening mammogram, the patient typically does not have to pay anything for the screening exam. Diagnostic mammography is subject to other cost sharing parameters, and is typically subject to 20% coinsurance following a deductible, along with coverage requirements.
Billing staff should recognize the difference between preventative screening vs. diagnostic imaging when reviewing benefits and determining patient responsibility. A diagnostic exam should not simply be ordered as screening to get cost-sharing for prevention, it should be ordered as a diagnosis.
Medicare Screening Mammography Eligibility
Whether Medicare will pay coverage depends on the patient’s eligibility, and the service’s compliance with screening criteria as they relate to Medicare. Verify prior to submission of the claim the patient’s Medicare status, prior screening date, and the provider billing circumstances. Apply Medicare coverage guidance as it exists today when providing explanations of benefits. To make payment decisions, do not solely use clinical guideline recommendations that are relevant to each outcome.
Annual Screening Coverage and Frequency Limits
The guidelines for how often screening occurs under Medicare are different from some of the guidelines for clinical screening. People with an average risk of breast cancer should be screened every two years from ages 40 to 74, based on guidelines from the US Preventive Services Task Force, and Medicare generally provides eligible people to screen for breast cancer every year. There is no single time that these recommendations are used. The coverage interval of an insurer is not necessarily determined by a clinical recommendation. Check the patient’s prior screening date and payer’s frequency policy prior to claiming. Make sure to enquire if any exception or supplement coverage applies before noting the service is covered.
Commercial Payer Coverage Considerations
Preventative mammography may be covered under the applicable federal requirements in commercial plans, coverage is subject to patient eligibility, network status and provisions of the plan. When possible, review patients’ benefits prior to the examination. Verify screening tomosynthesis includes frequency/authorization requirements and if the imaging provider is in network. Record the outcome of the verification of eligibility and keep in-hand the key information. Verification helps the billing process but not payment necessarily.
Common CPT Code 77067 Billing Errors and Claim Denials
Reimbursement can be delayed if there is an incorrect code selection, documentation that is missing, or if you don’t confirm that the rules for coverage are being met. There is a consistent claim review process that can detect these issues prior to submitting claims.
Incorrect Screening Diagnosis Codes
Avoidable claim risk occurs when an incorrect diagnosis is used for a claim when the indicated diagnosis is identified. Routine screening mammography is often appropriate for Z12.31, but should be avoided in the absence of a symptom or a specific diagnosis when diagnostic imaging is performed. Check the clinical order and make a report prior to final diagnosis. Compare the code to the applicable ICD-10-CM and Payer coding requirements and policy.
Billing Screening Services as Diagnostic Procedures
The purpose of screening and diagnostic mammography is different. Wrong codes can cause issues with coverage, with some patients requiring more at cost-sharing, and with the need for supporting records. Be sure to verify the rationale for the exam and the actual service received. In the event of a shift in the nature of the examination from screening to diagnostic workup, the appropriate instructions for reporting each service shall apply.
Frequency Limitations and Duplicate Claims
Including the patient’s screening interval criteria and another claim representing the service are factors that may result in a claim being rejected or denied. Please refer to eligibility and screening dates prior to submission. Check claim history for duplicates, verify claims for erroneous claims and submit resubmission or claims for appeal as directed by the payers.
How to Prevent cpt code 77067 Claim Denials
A well-documented billing process enables practices to streamline their complaints process.
- Check patient eligibility and benefits prior to appointment.
- Verify the clinical indication and verify the correct Mammography Code.
- Accept feedback appropriate to the service provided.
- Verify add on codes and modifiers.
- Check limits for review and what has already been claimed.
- Compare the allowed amount with the fee schedule.
- Monitor and identify the reasons for denial and common errors.
- Submit corrected claims and/or appeals on time with the payers.
In case of declines, check the remittance/denial reason before re-entering the claim. Begin to solve the root problem instead of repeating the same claim data.
Improve Mammography Billing and Radiology RCM with Billing Care Solutions
Radiology coding and diagnostic imaging claims are complex and for accurate billing a dedicated expert in this area is required to bill for mammographies properly. Practices should also be aware of the coverage policies and guidelines for reimbursement by payers. Educate imaging centers given the right codes (CPT and ICD-10-CM) and make sure they ensure all patients are eligible. They also have to file correct claims and follow up on any corrections or denials made to claims for underpayment.
Billing Care Solutions can assist medical care providers in radiology, diagnostic imaging and medical billing. Our services involve Revenue cycle management (RCM), insurance eligibility verification and mammography coding. We assist clinics with claims for screening mammography and rehearse Medicare reimbursements. There is denial resolution and proper payment tracking as well. A radiology bill review with a nose for problem coding and duplicate claim submissions can be helpful for practices. It can also identify discrepancies in reimbursement and missed opportunities for follow-up. Regular claim monitoring and denial management can support mammography providers to enhance claiming accuracy. These actions also help to improve revenue cycle performance.
Conclusion: Manage CPT Code 77067 Billing More Accurately
CPT Code 77067 is referred to as bilateral screening mammography which incorporates CAD when used. The proper diagnosis code and indication for screening must be documented for an accurate bill. Practices also need to determine patient eligibility and ensure coding and coverage practices according to the payer’s rules.
The RVUs are used to understand your payments to Medicare. They are not specific reimbursements amounts, however. The final payment may be impacted by locality adjustments, conversion factors, billing components, and by payer contracts.
Consistent billing can be improved through imaging practice with accurate documentation of it. They also need to confirm existing fee schedules and need to conduct a periodic review of claim denials. These are the steps to better manage reimbursement.
