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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.

A radiological mammogram is a covered diagnostic test under the following conditions: - A patient has distinct signs and symptoms for which a mammogram is indicated; - A patient has a history of breast cancer; or - A patient is asymptomatic but, on the basis of the patient’s history and other factors the physician

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