CPT Code 77067: Screening Mammography Billing, the Complete Code Family, and 2026 Denial Prevention

What Is CPT Code 77067?

CPT code 77067 is the American Medical Association code for bilateral screening mammography, a two-view study of each breast that includes computer-aided detection when performed. Radiologists and imaging facilities report it for routine, preventive breast cancer screening in women who have no symptoms.

Every major payer recognizes procedure code 77067 as the standard screening code in 2026. The billing team at One O Seven RCM works this code family every day, and this guide lays out each rule that keeps a 77067 claim clean.

The Official AMA Definition

The AMA CPT Code Set spells it out. The official 77067 CPT code description reads: screening mammography, bilateral, with computer-aided detection when performed. A complete study captures two standard views of each breast, the craniocaudal view and the mediolateral oblique view.

Read the 77067 CPT code description again and two facts stand out. The study always images both breasts, and CAD sits inside the code rather than billing on its own. That two-view requirement is what makes a screening exam billable.

What Makes 77067 Bilateral by Definition

CPT code 77067 is bilateral by definition. LCD L33950 makes this explicit: there is no unilateral screening mammography code, because a screening exam images both breasts every time.

Ask what the code means and the answer stays short. The short definition is a bilateral screening mammogram for an asymptomatic patient, nothing more. That structural fact drives a modifier rule later in this guide, where Modifier 50 gets ruled out for the same reason.

77067 does not stand alone. It sits inside a family of seven mammography codes: 77063, 77065, 77066, 77061, 77062, and the Medicare code G0279. Each one has its own trigger, and mixing them up is where clean claims go wrong.

CPT Code 77067 vs 77066, 77065, and 77063: The Complete Code Family

CPT code 77067 is the screening code, always bilateral, for patients with no symptoms. 77065 and 77066 are the diagnostic codes, used when a patient has a symptom, a prior abnormal finding, or a personal history that needs a closer look. 77065 covers one breast; 77066 covers both.

In plain terms, the screening mammogram CPT code is 77067, and the diagnostic mammogram CPT codes are 77065 and 77066. The right mammogram CPT code depends on intent and laterality.

Screening vs Diagnostic: The Core Distinction

The split comes down to why the patient is in the chair. A screening mammogram is a routine annual exam for someone with no complaints. A diagnostic mammogram answers a specific question: a lump, breast pain, nipple discharge, or a callback from a prior screening.

Get that wrong and the claim fails. Bill cpt 77067 for a symptomatic patient and the diagnosis will not support it, so the payer denies the screening. Match the code to the clinical intent every time.

The Seven-Code Family at a Glance

The full family fits in one table. No competing guide lists all seven codes correctly in one place, and that gap is where coding errors start.

Read down the Medicare column and the pattern is clear. cpt code 77065 covers one breast, cpt code 77066 covers both, and 77067, 77063, 77065, and 77066 are all Medicare-recognized. 77061 and 77062 are not, and G0279 is the code Medicare wants in their place.

Is CPT code 77067 a 3D mammogram? No. 77067 captures the standard 2D screening study. A 3D screening, or tomosynthesis, needs the add-on 77063 on the same claim.

77063: The Screening Tomosynthesis Add-On

cpt code 77063 confuses more billers than any other code in this family. It is the screening tomosynthesis add-on, and it never bills on its own.

A coder reports cpt code 77063 only alongside 77067 on the same claim, because 77063 adds the 3D layer to the flat 2D study. Send it in alone and a Medicare claims contractor denies it.

Practices describe this exact rejection in the AAPC coder forum, where the 77063 cpt code bounces every time it arrives without 77067. That is why cpt 77063 and 77067 belong on one claim.

Treat cpt code 77063 as a passenger, never a driver. When cpt 77063 and 77067 travel together, Medicare pays the pair, and the add-on earns nothing alone. Add-on codes follow the same logic across specialties, and our cardiology CPT codes guide breaks down the same standalone-versus-add-on rule.

77061 and 77062: Why Medicare Rejects Them

77061 and 77062 are valid CPT codes for diagnostic tomosynthesis, but Medicare recognizes neither one. For a Medicare claim, the program requires HCPCS code G0279 in their place.

Some commercial payers accept 77061 and 77062 directly, so the correct code depends entirely on the payer. Check the payer before you submit, because the same 3D diagnostic study bills under two different codes depending on who is paying.

Does CPT Code 77067 Replace G0202 for Medicare?

Yes. CPT code 77067 fully replaced HCPCS code G0202 for Medicare screening mammography effective January 1, 2018, a change CMS made in Transmittal R3844CP. G0202 has not been a valid billing code for any date of service since.

The January 1, 2018 Transition, Confirmed

The timeline explains the mix-up. CPT introduced 77065, 77066, and 77067 in 2017, but Medicare kept requiring its own G-codes, G0202, G0204, and G0206, through the end of that year while its claims systems caught up.

On January 1, 2018, Medicare adopted the CPT codes in full. It retired G0202, G0204, and G0206 on that date, permanently. Since then, cpt 77067 has been the only screening mammography code Medicare accepts.

Why This Confusion Persists in 2026

Some sources still tell billers that Medicare wants G0202. Two things explain it. A page written during the 2017 transition never got updated, or the writer confused the temporary 2017 rule with the permanent 2018 one.

The practical takeaway is blunt. Any billing system, superbill, or reference sheet that still lists G0202 as a live code is eight years out of date. Submit it on a current claim and the payer sends back a denial.

What ICD-10 Code Goes With CPT 77067?

The ICD-10 code for a routine screening mammogram billed under CPT 77067 is Z12.31, encounter for screening mammogram for malignant neoplasm of breast. It is the only diagnosis code that establishes medical necessity for a screening claim.

Put a diagnostic-intent code on a 77067 claim and you reclassify the encounter, which triggers a denial under the CO-11 denial code. Article A56448 lists the diagnosis codes that support the screen, and getting that pairing right is the core of clean mammography billing services.

Z12.31: The Only Screening Diagnosis Code That Qualifies

The ICD-10 code for screening mammography is Z12.31. It covers the routine, asymptomatic screen, and most screening claims carry it alone. When a patient screens at elevated risk, two secondary codes support the visit: Z80.3 for a family history of breast cancer, and Z15.01 for genetic susceptibility to breast cancer.

Z15.02 extends that genetic-risk picture to ovarian cancer for BRCA1 and BRCA2 carriers. These risk codes ride as secondary diagnoses, and Z12.31 stays the primary reason for a screening 77067.

When a Personal History of Breast Cancer Does Not Force a Diagnostic Code

A personal history of breast cancer, coded Z85.3, does not automatically push the visit to a diagnostic code. Without a current, active clinical concern, a patient with a history can still receive a routine screening 77067.

Article A56448 adds a limit. These history codes apply only until the patient reaches clinical stability, and after that point ongoing surveillance usually shifts to a diagnostic code. Read the note in the record before you choose.

Diagnosis Codes for Abnormal Findings and Diagnostic Follow-Up

The diagnosis code for an abnormal mammogram falls in the R92 range, which covers abnormal and inconclusive findings on diagnostic imaging of the breast. For an unspecified breast lump, the code is N63.0.

The specifics matter. Mammographic calcifications map to R92.1, and microcalcifications to R92.0. Neither code names a side, even though the breast-density codes in the same R92 range do carry right, left, and bilateral options.

These codes support a diagnostic mammogram, 77065 or 77066, not a screening claim. The dx code for a diagnostic mammogram has to match the finding that prompted the exam, so R92.2 fits an inconclusive reading and R92.8 covers other abnormal findings.

Mammogram Plus Ultrasound: Coding the Combined Encounter

When a diagnostic mammogram and a breast ultrasound happen at the same visit, they bill as separate CPT line items. Report 76641 or 76642 for the ultrasound alongside 77065 or 77066 for the mammogram.

Both fall under the same LCD L33950, and each line needs its own supporting diagnosis code. One code for the mammogram finding, and a separate code for the reason the ultrasound was ordered.

Our mammography-trained coders pair every screening claim with the correct diagnosis code before it ships.

Is CPT Code 77067 Covered by Medicare, and How Often Can It Be Billed?

Yes. Medicare Part B covers CPT code 77067 for female beneficiaries age 40 and older, once every 12 months, with at least 11 full months required between screenings. It also covers one baseline screening for women ages 35 to 39, all under NCD 220.4.

Age and Frequency Rules Under NCD 220.4

The frequency clock runs by calendar month. A screening in January starts the count the next month, so the next covered 77067 opens up the following January. Bill it a month early and Medicare denies the claim for frequency.

The 77067 age limit sets a floor. Coverage begins at 40 and never stops as the patient gets older, so there is no upper age limit on the covered screening.

Front-desk timing is where this breaks. Confirm the last screening date before you schedule, not after the claim bounces.

A quick eligibility check catches a too-early screening while the patient is still on the phone, which is the whole point of eligibility verification services. The local coverage determination guide shows how the NCD and LCD rules set these limits. Commercial payers set their own age limit, which is where verification earns its keep.

Zero Patient Cost-Sharing, and When That Changes

Screening mammography carries zero patient cost-sharing under Medicare. The patient owes no deductible and no coinsurance, as long as the provider accepts assignment, a benefit the Affordable Care Act set and Medicare.gov’s mammogram coverage page confirms.

Is CPT code 77067 preventive? Yes. Billed as a routine screen with Z12.31, it is a preventive service with no patient cost under Medicare.

The moment a screening converts to diagnostic, the math changes. The standard Part B deductible and 20% coinsurance apply to the diagnostic portion, a shift the next section covers in operational detail.

We confirm age, frequency, and coverage before the patient is even in the chair.

USPSTF Says Every Two Years, Medicare Pays Every Year

The clinical guideline and the payer rule diverge. The USPSTF breast cancer screening recommendation finalized in 2024 calls for screening every two years starting at 40, while Medicare pays for annual screening starting at 40.

Providers scheduling patients should know which standard they are following and why. Medicare mammogram guidelines set the payment frequency, the USPSTF sets a clinical recommendation, and patients often ask about the gap.

Commercial payers write their own rules. Aetna, for one, follows the Affordable Care Act’s no-cost preventive-screening standard for members, which can differ from Medicare’s age-40 annual schedule.

What Modifiers Apply to CPT Code 77067?

Seven modifiers can apply to CPT code 77067 across billing scenarios, and one modifier that looks like a fit does not belong on it at all.

Six of them fit into a clean reference list. The seventh, Modifier GG, gets its own section, because a same-day conversion needs more than a one-line rule.

Modifier 26 and TC: The Professional and Technical Split

Mammography carries a real professional and technical split. A radiologist appends Modifier 26 when billing only for the interpretation, while the facility bills the technical component separately.

The facility appends Modifier TC when billing for the equipment, the technologist’s time, and the overhead, with the professional read billed elsewhere. When one entity performs and interprets the exam, it bills globally, with no modifier at all.

Get the component wrong and two claims collide. If both the radiologist and the facility bill globally for the same exam, one of the two claims denies as a duplicate.

The Modifier 26 billing guide breaks down the 26 and TC split in more depth, and getting it right sits at the center of clean radiology billing services.

Modifier 52: Billing a Unilateral Screening Study

Modifier 52 handles a unilateral screening study, most often a post-mastectomy patient screening the one remaining breast. It signals reduced services on a code that normally images both sides.

The reduced-services signal matters for payment, because the payer expects a bilateral study under 77067 and needs to know why only one side was imaged.

One detail trips people up. When a unilateral screening tomosynthesis runs alongside a unilateral screening mammogram, Modifier 52 goes on both 77067 and 77063 together, not on the primary code alone.

Modifiers 76, 77, and 59: Repeat and Distinct Services

Three more modifiers cover repeat and distinct services. Modifier 76 marks a same-day repeat by the same physician, and Modifier 77 marks a same-day repeat by a different physician. Modifier 59 marks a distinct, separately identifiable service.

Modifier 59 draws the most payer scrutiny of the three, so document why the second service stands apart before you append it.

Why Modifier 50 Does Not Apply

Because CPT 77067 is bilateral by definition, per LCD L33950, Modifier 50 for a bilateral procedure should never be appended to it.

The instinct to add Modifier 50 comes from other bilateral radiology codes, where it does apply. Screening mammography already builds both breasts into the code, so the modifier would double-count what 77067 already includes.

One rule keeps this clean: never reach for Modifier 50 on a screening mammogram, no matter how the claim scrubber prompts you. Modifier GG, for a same-day screening-to-diagnostic conversion, belongs in the next section, because that scenario needs the detail a modifier list cannot give it.

Our radiology coders apply the right modifier on every mammography claim, every time.

When Screening Becomes Diagnostic: CPT 77067 and the Same-Day Conversion Rule

A patient comes in for a routine screening mammogram, billed under CPT code 77067. The radiologist spots something on the images that needs a closer look, and additional diagnostic views happen the same day. Both codes then go on one claim, the screening study and the diagnostic study.

How Modifier GG Works

Modifier GG reports the performance and payment of a screening mammography and a diagnostic mammography on the same patient, same day. It goes on the diagnostic code, 77065 or 77066, never on 77067 itself.

The claim shows both services on the same date, and Modifier GG tells the payer the diagnostic exam grew out of the screening rather than arriving as a separate visit.

This trips up more billing staff than almost any other rule here. The instinct is to modify the code that started the visit, when the modifier belongs on the code that ended it.

Why No New Referral Is Needed

No new order from the treating physician is required for the added views. The interpreting radiologist can order and perform them based on the screening findings, and a note in the radiologist’s own report satisfies the documentation requirement.

The screening findings are the order. A radiologist who sees a suspicious density writes the order for magnification or spot-compression views right in the reading room.

That authority saves a day or more of back-and-forth. The patient does not go home and return for a second appointment, and the practice does not chase a fresh referral for imaging the radiologist already knows is needed.

The GH Modifier Confusion, Resolved

Some sources still list a second modifier, GH, as an active option for this scenario. Every current CMS-derived source checked for this guide references only GG.

GH traces back to a set of mammography codes that were themselves retired years ago. Current evidence points to GG as the only active modifier for a same-day conversion.

A quick check against your own MAC’s current policy is worth doing before you write GG-only into a hard internal rule.

The 2026 Update on Diagnostic Cost-Sharing

A real 2026 change narrows the cost gap. Federal guidelines tied to the Women’s Preventive Services Initiative, effective for plan years beginning on or after December 20, 2025, now require many non-grandfathered commercial health plans to cover follow-up breast imaging with no cost-sharing.

That coverage applies when the imaging completes the screening process or evaluates a finding from the initial screening mammogram. It brings diagnostic follow-up closer to the zero-cost-sharing status screening has always held, at least for the plans the rule reaches.

Confirm the effective plan-year date with each commercial payer, because a non-grandfathered plan and a grandfathered plan handle this differently.

CPT Code 77067 Reimbursement in 2026: Rates, Conversion Factors, and the Regulatory Watch List

Medicare prices CPT code 77067 under the Physician Fee Schedule. Payment comes from relative value units multiplied by an annual conversion factor, then adjusted for the local cost of doing business.

The 2026 National Rate Breakdown

At the 2026 APM qualifying conversion factor of $33.5675, the national non-facility global rate for 77067 lands close to $126.89. The professional component sits near $35.25, and the technical component near $91.64.

That global rate assumes one entity performs and reads the exam. Split the components and the payment divides into the professional and technical pieces above.

Treat those as national benchmarks, not quotes. Locality adjustments move every figure, so pull the exact number from the CMS Physician Fee Schedule Look-up Tool before you quote a rate to a client.

The CY2026 Efficiency Adjustment

CMS finalized a negative 2.5% efficiency adjustment in the CY2026 Physician Fee Schedule final rule, applied across non-time-based physician services. Diagnostic radiology codes as a group see meaningful reductions under it.

The efficiency adjustment applies broadly, which means a code can lose ground even when its own RVUs did not change.

Whether 77067 specifically sits inside a single named affected-code list is worth confirming before a client conversation states a hard number. The direction is down, and the exact per-code impact needs the final rule read line by line.

Revenue Code 0403 for Facility Billing

Revenue Code 0403 is the correct institutional code for screening mammography, and Revenue Code 0401 covers diagnostic mammography. That distinction shows up on every UB-04 claim a hospital-based mammography suite submits.

Put the screening study under 0401 by mistake and the institutional claim misroutes. The revenue code has to match the exam type, the same way the CPT code and the diagnosis do. Hospital outpatient departments watch this closely, because the revenue code drives how the claim maps to the outpatient payment system.

The State-by-State Push for Diagnostic Cost-Sharing

A growing list of states now mandates zero patient cost-sharing for diagnostic mammography and related breast imaging, the protection screening already carries. New York, Arkansas, Colorado, Connecticut, Delaware, and Illinois have moved, closing a gap federal law never fully addressed.

The specific state list shifts as more legislatures act, so confirm your state’s current rule rather than relying on last year’s map.

As reimbursement tightens, our AR team recovers every dollar your radiology claims are owed.

The Find It Early Act, Still in Committee

The Find It Early Act, Senate bill 1410, would extend no-cost-sharing coverage to screening and diagnostic breast imaging for women at elevated risk or with dense breast tissue. Senators Amy Klobuchar and Roger Marshall introduced it on April 10, 2025.

Representatives Rosa DeLauro and Brian Fitzpatrick reintroduced a House companion on November 20, 2025. The bill remains in committee as of mid-2026, with no enacted status, so it changes nothing on a claim you file today. Track it if your patient mix skews toward high-risk or dense-breast screening, since that population is exactly who the bill would cover.

MQSA Certification: The Compliance Gate Behind Every CPT 77067 Claim

Every facility that bills Medicare for CPT code 77067 must hold current certification under the Mammography Quality Standards Act, issued by an FDA-approved accreditation body. Let that certification lapse and Medicare will not pay the claim, no matter how clean the coding is.

What MQSA Requires

Certification reviews three things. It checks equipment quality, the qualifications of the interpreting physicians, radiologic technologists, and medical physicists, and the quality of the clinical images themselves. The interpreting physician requirement is strict, and it covers initial qualifications plus continuing experience and education.

An FDA-approved body verifies all of it through at least an annual inspection. A facility cannot bill a Medicare screening on equipment or staff that fall outside those standards. Track the certificate’s expiration date the way you track a payer contract, because a lapse stops payment cold.

The 2024 Breast Density Notification Rule

The FDA’s 2023 MQSA Final Rule, with enforcement that began September 10, 2024, changed what patients and clinicians receive. Every facility now notifies the patient of her breast density using one of two standardized statements, dense or not dense. Patients receive the notification in language they can read, part of a national push toward earlier detection.

The written report to the referring clinician must include a formal breast density assessment. The FDA refined the language as recently as mid-2025, approving an alternative phrasing standard, so check that your report templates match the current wording.

Why a Perfectly Coded Claim Still Gets Denied

A claim can carry the correct code, the correct modifier, and the correct diagnosis, and still be denied outright if the performing facility’s MQSA certification has expired. Certification tracking is a revenue cycle function, and a lapse stops payment cold, which puts the renewal date on the billing team’s radar.

The fix is a calendar. Assign someone to watch the renewal date and flag it 90 days out, and track each site on its own, since two facilities in the same group can hold different renewal dates.

Why CPT 77067 Claims Get Denied: The CARC Table

Every recurring CPT code 77067 denial traces back to one of five causes. Each one shows up on the remittance advice under a claim adjustment reason code, and most billing teams never connect that code to the rule that would have prevented it.

Most teams work these denials one at a time, reactively. Group them by cause and the same five fixes clear the bulk of a mammography denial queue.

The Five Most Common Denial Causes and Their Codes

X12 maintains these reason codes, so the language on your remittance is standardized across payers. Read the code, trace it to the cause, and the fix is already written. The five causes are not exotic, and four of them start at the front desk or in the code scrubber, long before a coder ever touches the claim.

How Each One Traces Back to a Fixable Rule

Every one of these five was covered earlier in this guide. The wrong-diagnosis denial is the CO-11 denial code, and the ICD-10 section already fixed it with Z12.31. The add-on rejection is the CO-97 denial code, and the code family section already paired 77063 with 77067.

The missing-information denial is the CO-16 denial code, solved by capturing the ordering provider’s name and NPI up front. The frequency denial traces straight back to the 11-month rule under NCD 220.4.

None of these denials needs an appeal if the edit runs before submission. Prevention costs a rule in the scrubber, and an appeal costs staff hours plus a cash-flow delay. A denial table earns its keep by pointing to the fix behind each code.

We overturn 87% of denied radiology claims. Let us take yours back.

CPT 77067 Pre-Submission Checklist

Before any procedure code 77067 claim leaves the building, run it through this list. Every checkpoint below traces to a rule covered earlier in this guide.

One line deserves its own callout. G0202 has no place on any current claim, so pull it out of every legacy superbill and billing template that still lists it. That single leftover code remains the most common source of an avoidable denial in this whole topic.

The medical billing audit services team runs this same scrub across a full sample of your claims.

Run this exact scrub across your mammography claims. We will show you what it finds.

CPT Code 77067 FAQ

What is CPT code 77067 used for?

It reports bilateral screening mammography for patients with no symptoms, including CAD when performed. The screening mammogram CPT code is 77067, billed for routine annual breast cancer screening.

Is CPT 77067 a radiology service or surgery?

A radiology service. It sits under diagnostic radiology on the fee schedule, not under surgery.

What is the difference between CPT 77066 and 77067?

77067 is screening, always bilateral, for asymptomatic patients. 77066 is diagnostic, for patients with symptoms or findings, and the full comparison sits in the code family section above.

Can a radiologist apply CPT code 77067?

Yes. A radiologist bills it for the professional interpretation, or globally when the same entity performs and reads the exam.

When can I use Modifier TC with CPT code 77067?

When the facility bills only for the equipment, the technologist’s time, and the overhead. The radiologist then bills the interpretation separately with Modifier 26.

How often can CPT 77067 be billed?

Once every 12 months for women 40 and older, with at least 11 full months between screenings. The 77067 CPT code cannot bill again until that window closes.

Is CPT code 77067 covered by Medicare?

Yes, under Part B, at zero patient cost when the provider accepts assignment. Coverage starts at age 40, with one baseline screening allowed for ages 35 to 39.

Is CPT code 77067 preventive?

Yes, when it is billed with Z12.31. The moment it converts to diagnostic, the cost-sharing rule from the conversion section applies.

Does Medicare require G0202 instead of CPT 77067?

No. CPT code 77067 replaced G0202 effective January 1, 2018, and any source stating otherwise is describing a rule that has not been current for eight years.

What is the ICD-10 code for CPT 77067?

Z12.31, the only code that establishes medical necessity for a screening claim. Add a diagnostic-intent code instead and the claim reclassifies and denies.

Is CPT 77067 a 3D mammogram?

No. 77067 is the base 2D screening code, and 3D imaging requires the add-on 77063 billed alongside it.

CPT Code 77067 Billing: The Bottom Line

CPT code 77067 reports bilateral screening mammography with CAD, for asymptomatic patients only. Z12.31 is the sole diagnosis code that establishes medical necessity for a screening claim. G0202 has been invalid since January 1, 2018, and it is not a current alternative.

77063 rides only alongside 77067, never on its own. Modifier 50 never applies, and Modifier GG belongs on the diagnostic code during a same-day conversion, never on 77067. MQSA certification is a compliance gate that stands apart from coding accuracy.

The seven-code family, from 77063 to G0279, each carries its own trigger, and mixing them up is where clean claims fail. 2026 brings a new efficiency adjustment, a live state-by-state push on diagnostic cost-sharing, and a federal bill still moving through committee. Code the fundamentals right and these shifts become watch items you plan for.

Talk to a mammography billing team that codes 77067 right the first time, every time.