2025 CPT code 77065

Diagnostic mammography, unilateral, with computer-aided detection (CAD) when performed.

Adhere to the current CPT coding guidelines for radiology procedures.Appropriate modifier usage is crucial for accurate billing.

Modifiers 26 (professional component only), TC (technical component only), and others may be applicable depending on the services rendered and payer requirements.Consult payer guidelines.

Medical necessity for a diagnostic mammogram is established based on the clinical presentation (e.g., palpable lump, abnormal findings on screening mammogram), patient history (e.g., family history of breast cancer), or other relevant clinical indicators that suggest a need for further investigation. Payer specific guidelines should be consulted.

The clinical responsibility includes image acquisition (performed by the provider or a technician), image interpretation (by the provider), and the use of CAD software where applicable.The provider reviews and interprets the images to determine the presence or absence of abnormalities.

IMPORTANT For bilateral mammography with two views from different angles, use CPT code 77067. For bilateral mammography, use CPT code 77066.

In simple words: This code covers an X-ray of one breast to check for problems like lumps or cancer.A special computer program might be used to help find any issues in the X-ray pictures.

This CPT code encompasses the radiological procedure of diagnostic mammography performed on one breast.The procedure involves X-ray imaging to detect abnormalities, potentially including the use of computer-aided detection (CAD) software to analyze the images and highlight potential areas of concern.The CAD software processes the digital X-ray data, assisting in the identification and diagnosis of subtle abnormalities that might be missed by the human eye. The physician reviews the images, considering the CAD findings.

Example 1: A 45-year-old female patient presents with a palpable lump in her right breast.A diagnostic mammogram (77065) is ordered to evaluate the lesion.CAD is used to assist in the interpretation. The radiologist's report dictates the findings, including location, size and characteristics of the abnormality., A 60-year-old female patient undergoes a screening mammogram, which shows a suspicious area in her left breast.A diagnostic mammogram (77065) is performed to further characterize the finding, and CAD is utilized during interpretation., A 38-year-old female patient with a family history of breast cancer has a unilateral diagnostic mammogram (77065) as part of her breast cancer risk assessment. CAD is used and no significant findings are detected.

* Patient demographics and relevant history.* Indication for the procedure (e.g., palpable lump, abnormal screening mammogram, family history).* Images from the mammogram.* Radiologist's report detailing findings and interpretations.If CAD is used, this should be noted in the report.* Any additional imaging or biopsy results if performed.

** The use of CAD is optional.If not used, it does not affect code selection.Always check payer guidelines for specific coverage criteria.

  • Revenue Code: I4B (IMAGING/PROCEDURE - OTHER)
  • RVU: Information not available in provided source.Consult the AMA CPT codebook for the most up-to-date RVUs.
  • Global Days : Information not available in provided source.Global surgical days are not applicable to this radiology procedure.
  • Payment Status: Active
  • Modifier TC rule: Modifier TC may be used to indicate a technical component only, although payer policies vary. Typically used by facilities.
  • Fee Schedule : Information not available in the provided source. Fee schedules vary by payer and location. Refer to payer-specific fee schedules.
  • Specialties:Radiology, Breast Surgery, Oncology
  • Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center
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