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Billing and Coding Guidelines Diagnostic Mammogram (RAD ...

Diagnostic Mammogram (RAD-005) Billing and Coding Guidelines Billing and Coding Information: 1. Place the appropriate procedure code in field 24c on the CMS 1500 form. 2. Do not submit claims reflecting HCPCS codes 77055 or 77056 ( Diagnostic mammography -film) and G0204 or G0206 ( Diagnostic mammography -digital). Claims will be denied when both a film and digital Diagnostic mammography are reported. However, a screening and Diagnostic mammography can be billed together. 3. When submitting a claim for a screening mammography and a Diagnostic mammography for the same patient on the same day, attach Modifier GG to the Diagnostic mammography . 4. To bill the technical component, only, use modifier TC. To bill the professional component, only, use modifier 26. When Billing a global fee, no modifier is needed. 5. If more than one modifier is needed ( for HPSA) place the component (TC or 26) modifier in position 1 and the other modifier in position 2. 6. List the ordering physician's name and NPI in item 17 and 17a of the CMS 1500 form.

will be investigating high volume transportation costs associated with diagnostic mammography testing. IV. Payment restrictions for screening and diagnostic mammography apply to those facilities that meet all FDA certifications as provided under the Mammography Quality Standards Act (MQSA). Refer to PUB 100-4 Chapter 18 section 20.

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