United Healthcare Breast Imaging Policy Updates

With the new CPT code set for 2017, came changes to the codes for diagnostic and screening mammography.

Prior to 2017, two codes were needed to report diagnostic or screening mammography. Effective 1/1/2017, there are now just three codes which include computer-aided detection (CAD) when performed. Codes 77051, 77052 and 77055 -77057 were deleted.

United Healthcare updated their Breast Imaging policy on 1/13/2017 to include CAD when performed for diagnostic and screening mammography. These changes went into effect 1/1/2017.

Please review the addition of the new and deleted codes below to ensure that your documentation and coding are correct for the new year.

Effective Date: 2017-01-01

Updated list of applicable CPT/HCPCS codes:

The following CPT codes were added:

77065 – Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.

77066 – Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral.

77067 – Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.

The following CPT codes were removed:

77051 – Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure).

77052 – Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure).

77055 – Mammography; unilateral.

77056 – Mammography; bilateral.

77057 – Screening mammography, bilateral (2-view study of each breast).

The following HCPCS codes had revisions to the description of the codes:

G0202 – Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.

G0204 – Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral.

G0206 – Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.

The policy number has been updated from 2016T0375P to 2017T0375Q.