2025 CPT code 77049
(Active) Effective Date: N/A Revision Date: N/A Radiology Procedures - Mammography Radiology Feed
Magnetic resonance imaging (MRI) of both breasts, with and without contrast material, including computer-aided detection (CAD).
Modifiers 26 (professional component) and TC (technical component) may be applicable depending on who performs which aspect of the service and payer requirements.
Medical necessity for breast MRI varies by payer. Generally, it is indicated for high-risk individuals (strong family history, genetic mutations), women with dense breast tissue where mammography is less effective, and in specific clinical scenarios such as palpable masses or abnormal findings on other imaging studies.
The radiologist is responsible for performing the MRI, interpreting the images, and generating a report.The referring physician is responsible for ordering the test and managing patient care based on the results.
In simple words: This test uses a strong magnet and radio waves to take detailed pictures of both breasts. A special dye may be injected into a vein to help the pictures show more detail. A computer program helps the doctor see any unusual areas in the breast tissue.
This code encompasses a bilateral breast MRI examination involving image acquisition both with and without intravenous contrast material.The procedure includes real-time computer-aided detection (CAD) for lesion detection, characterization, and pharmacokinetic analysis.The CAD software analyzes images, corrects for motion artifacts, and provides color-coded visualizations of tissue perfusion, aiding in the differentiation of benign and malignant lesions.Pharmacokinetic modeling is used to analyze contrast enhancement patterns.
Example 1: A 45-year-old woman with extremely dense breast tissue undergoes a screening breast MRI with and without contrast.The radiologist uses CAD to assess the images., A 50-year-old woman with a family history of breast cancer presents for a high-risk screening MRI with contrast. The radiologist utilizes CAD during the assessment., A 38-year-old woman with a palpable breast mass undergoes diagnostic breast MRI with and without contrast. CAD is used to help characterize the lesion.
* Physician order specifying the reason for the MRI.* Relevant patient history, including family history of breast cancer and risk factors.* Radiologist's interpretation report, including the use of CAD and any findings.* Images from the MRI examination.
** If only contrast-enhanced images are acquired, code 76498 (Unlisted magnetic resonance procedure) might be appropriate, however, this is unusual for breast MRI. Always check payer guidelines for specific requirements.
- Revenue Code: I4B (Imaging/Procedure - Other)
- RVU: The RVUs for this code will vary depending on the specific geographic location and payer. Consult your local fee schedule for the most accurate information.
- Global Days: Not applicable. This is a radiology procedure, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Modifier TC is generally appended to the technical component of the service, typically billed by the facility.
- Fee Schedule: Historical fee schedule data can be obtained from the AMA or various payer websites. The fee will vary based on location and payer.
- Specialties:Radiology, Oncology, Surgery, Breast Surgery
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center, Imaging Center