CPT Code 77067: Screening Mammography Billing and Coding Guide

What Is CPT Code 77067?

CPT code 77067 is the billing code for bilateral screening mammography, a two-view study of each breast that includes computer-aided detection (CAD) when performed. It is reported with ICD-10 code Z12.31 for patients without symptoms, pairs with add-on code 77063 when 3D tomosynthesis is added, and replaced Medicare’s HCPCS code G0202.

• Medicare frequency: One baseline screening between ages 35 and 39, then one screening after 11 full months have passed since the last one for women 40 and older.
• Screening vs. diagnostic: Symptoms, findings, or a clinical order for a problem move the exam to 77065 or 77066, not 77067.
• Who protects the revenue: Specialized radiology billing services apply the GG, 52, 26, and TC modifiers correctly so high-volume screening claims pay the first time.

New to imaging codes? Start here: our radiology billing and coding cheat sheet.

77067 Code Details and Related Codes

The American Medical Association introduced 77067, along with diagnostic codes 77065 and 77066, as part of a 2017 revision of the mammography code family that folded CAD into the base codes. Medicare later replaced its own G codes with these CPT codes, so screening that used to be billed as G0202 is now 77067. The descriptor covers both breasts, two views each, with CAD included when the facility uses it. CAD is never billed separately.

Screening mammography is one of the highest-volume codes in outpatient imaging, which makes small errors expensive. A facility performing hundreds of screenings a month feels every missing modifier, every mismatched diagnosis, and every frequency denial. Breast density reporting adds a related revenue line: since September 10, 2024, FDA’s Mammography Quality Standards Act rules have required facilities to tell patients whether their breasts are dense, which drives more supplemental ultrasound orders and more payer questions about coverage.

In our experience matching imaging centers with billing partners, the screening line is where revenue leaks quietly. Each claim is small, so no one notices a 3% denial rate until it adds up across a year.

Screening vs. Diagnostic Mammography: Which Code Applies?

Use 77067 when the patient has no signs or symptoms of breast disease and comes in for routine screening. Use 77065 or 77066 when the patient has a lump, pain, nipple discharge, or other finding, when a prior screening needs follow-up imaging, or when the ordering clinician documents a specific clinical problem.

The distinction drives both coverage and patient cost. Medicare covers screening mammography as a preventive service and waives the Part B deductible and coinsurance, while diagnostic mammography is subject to normal cost sharing. Most commercial plans follow a similar pattern under the Affordable Care Act’s preventive services rules. A screening exam miscoded as diagnostic can leave a patient with an unexpected bill, and a diagnostic exam miscoded as screening can be denied for frequency or downcoded.

A history of breast cancer does not automatically make every exam diagnostic. Many patients return to annual screening after treatment, and payer rules differ on how to code those visits. Follow the order and the clinical picture on the date of service rather than the patient’s history alone.

Same-day conversions are common. When a radiologist reviews a screening exam while the patient is still in the facility and orders additional views, both the screening and the diagnostic exam can be billed. Medicare allows the radiologist to order those additional views without a new order from the treating clinician in that situation, which keeps the patient from needing a second trip.

One question we hear constantly from imaging center managers is how to handle a callback that happens on a different day. Different dates of service need no special modifier; the diagnostic exam stands on its own.

What Are Medicare’s Rules for CPT 77067?

Medicare covers one baseline screening mammogram for women between their 35th and 40th birthdays, then one screening for women 40 and older after 11 full months have passed since the month of the last screening. No physician order is required, and the facility must hold FDA certification under the Mammography Quality Standards Act.

The 11-month count trips up schedulers. Medicare counts from the month after the last screening. A patient screened in March 2026 is not eligible again until 11 full months have passed beginning in April, so the next covered screening falls in March 2027. Booking her in February to beat a busy season produces a frequency denial, and the patient may owe the full charge unless an advance beneficiary notice was signed beforehand.

These rules come from the Medicare Benefit Policy Manual, Chapter 15, Section 280.3, and the Medicare Claims Processing Manual, Chapter 18. Medicare Advantage plans generally follow the same screening benefit, though some layer on their own network and authorization requirements for related services.

Commercial payers and Medicaid programs set their own frequency rules. Many follow annual screening starting at 40, and the U.S. Preventive Services Task Force updated its recommendation in April 2024 to biennial screening for women ages 40 to 74. Check each payer’s policy before assuming annual coverage.

The most common issue we see providers run into is a scheduling system that does not check the last screening date, which turns a preventable frequency edit into a write-off.

Modifiers for CPT 77067

Split billing is the first modifier decision. When a hospital or imaging center owns the equipment and a separate radiology group reads the exam, the group bills 77067-26 for the professional component and the facility bills 77067-TC for the technical component. Billed globally by one entity, 77067 needs neither. Mismatched component billing is one of the fastest ways to trigger duplicate-claim denials, because both entities appear to bill the full service. Our modifier 26 billing guide covers the full split-billing workflow.

Modifier 52 applies to unilateral screening. Because 77067 describes both breasts, a screening of one breast, such as after a mastectomy, is reported as 77067-52 for reduced services. Some payers reduce payment for the reduced service, so expect the allowed amount to differ from a bilateral exam. Document the reason in the report so the reduced service is clear.

Modifier GG handles same-day conversions. When a screening and a diagnostic mammogram happen on the same patient and same day, report 77067 for the screening and append GG to the diagnostic code, 77065 or 77066. Some contractors and the CMS correct coding guidance also expect a distinct-service modifier such as 59 or XU on one of the lines, so confirm your Medicare Administrative Contractor’s instructions before building the rule into your charge master.

Laterality modifiers RT and LT belong on unilateral diagnostic codes, not on 77067 itself. Watch quarterly edit updates as well; our summary of Q4 2026 NCCI edits for radiology lists current pairs.

ICD-10 Codes and 3D Tomosynthesis Pairing

Z12.31, encounter for screening mammogram for malignant neoplasm of breast, is the primary diagnosis for routine screening with 77067. Risk factors can be added as secondary codes when documented, such as Z80.3 for a family history of breast cancer, Z15.01 for genetic susceptibility to breast cancer, or Z98.82 for breast implant status, which also explains additional implant-displacement views. Secondary codes support the record, but they do not convert a screening into a diagnostic exam.

When the facility performs 3D imaging during a screening, report add-on code 77063 with 77067. The add-on cannot stand alone, and it requires the base screening code on the same claim. Medicare uses 77063 for screening tomosynthesis and HCPCS G0279 for tomosynthesis added to diagnostic exams, while many commercial plans follow CPT conventions for both. Our CPT 77063 screening tomosynthesis guide covers coverage differences in detail.

If a unilateral screening includes bilateral tomosynthesis, the claim can look contradictory to a payer, so documentation should make the clinical picture clear. The reverse error is more common: billing tomosynthesis without the base code, or billing 77063 on a diagnostic exam where G0279 belongs for Medicare. Keep the order, the report, and the claim aligned on screening versus diagnostic.

CAD deserves one more note. It is included in 77067 whenever performed, so billing a separate CAD charge is unbundling. As payers increase scrutiny of AI tools in imaging, described in our report on AI radiology billing and payer scrutiny, expect more questions about what software was used and how it was billed.

Why Do 77067 Claims Get Denied?

CPT 77067 claims are denied most often for frequency limits, a diagnosis that does not match a screening service, missing GG on same-day conversions, add-on codes billed without the base code, split-billing modifier errors, and services performed at a facility without current FDA certification on file with the payer.

These are the six errors that show up most often on screening mammography claims:

1. Missing the 11-month window. Scheduling a Medicare screening one month early triggers an automatic frequency denial.
2. Using a diagnostic diagnosis code. Pairing 77067 with symptom codes instead of Z12.31 confuses the payer and invites recoding.
3. Dropping modifier GG. Billing a same-day diagnostic exam without GG causes one of the two services to deny.
4. Orphaning the add-on. Submitting 77063 without 77067 on the same claim leaves the tomosynthesis line unpaid.
5. Confusing 26 and TC. Billing globally when a facility also bills the technical component creates duplicate-payment denials.
6. Skipping modifier 52. Billing a unilateral screening as a full 77067 invites recoupment on audit.

A short charge review that checks these six points before submission catches most of them, and it costs far less than reworking denials one at a time.

Here is what that costs. Consider a hypothetical imaging center performing 600 screenings a month at an illustrative global allowed amount of $130. If 4% deny and half are never recovered, the center loses about $1,560 a month, or nearly $19,000 a year, on one code. The figures are illustrative, but our coverage of radiology billing gaps and revenue leakage shows the pattern is common.

Should You Outsource Radiology Billing?

Screening mammography combines preventive benefit rules, frequency edits, split billing, add-on codes, and same-day conversions on one of the highest-volume claims in imaging. Payment pressure is rising too, from the 2027 Medicare fee schedule changes for radiology to the site-neutral imaging payment cuts proposed for 2027. Every avoidable denial matters more each year.

Keeping billing in-house works when a coder knows mammography rules well, the scheduling system checks frequency, and someone works denials weekly. When those pieces are missing, a specialized partner usually recovers more than it costs. Ask any prospective billing company how it handles GG conversions, how it audits split-billed claims, how it monitors FDA certification renewals, and how quickly it reworks frequency denials. Ask for sample denial reports from current imaging clients before you sign. Our guide on how to find the right radiology medical billing service walks through the evaluation.

Many billing companies in our network work inside the systems imaging practices already use, including eRAD RIS/PACS, athenahealth, and McKesson (Change Healthcare). Radiology Bill Co is part of the Billing Service Quotes network, which has matched more than 2,000 providers across all 50 states, brings over 15 years of industry experience, and offers billing rates starting as low as 2.95%. Requests are reviewed by a real person, including Tim Daniels, Director of Strategic Accounts at Billing Service Quotes, who helps radiology practices connect with billing companies that understand imaging billing. Most practices are matched in as little as 30 minutes at no cost.

Frequently Asked Questions

Next Steps

• Adding 3D imaging? Review our CPT 77063 screening tomosynthesis guide.
• Split billing with a facility? Read the modifier 26 billing guide.
• Planning for 2027 rates? See our breakdown of 2027 Medicare fee schedule changes for radiology.