"New Technology" Codes for Mammography
Beginning April 1, 2001, additional payment will be made for the use of new technology when it is used with diagnostic and screening mammography studies performed on Medicare patients. The Benefits Improvement and Protection Act (BIPA) of 2000 mandated payment amounts from April 1, 2001, through Dec. 31, 2001, for studies that directly take digital images and for studies that convert standard film images to digital form. For the period beginning Jan. 1, 2002, the Secretary of Health and Human Services will determine whether new codes are necessary for the use of this new technology.
The Health Care Financing Administration (HCFA) has issued a Program Memorandum (AB-01-20) covering the following HCFA Common Procedure Coding System (HCPCS) codes to be used for the new technology during the period April 1 to Dec. 31, 2001.
G0202 Screen Mammogram, Digital
G0203 Screen Mammogram, Film to Digital
G0204 Diagnostic Mammogram, Digital, Bilateral
G0205 Diagnostic, Mammogram, Film to Digital, Bilateral
G0206 Diagnostic, Mammogram, Digital, Unilateral
G0207 Diagnostic, Mammogram, Film to Digital, Unilateral
Radiologists should continue to use code 76092 for a screening mammography study that is not digital and does not convert standard film to digital form. However, if a screening mammogram is done using digital equipment, code G0202 should be used. If a screening mammogram study is converted to digital form from standard film images, G0203 should be used. If a diagnostic bilateral mammogram is done using digital equipment, G0204 should be used instead of code 70691. G0205 should be used for a bilateral diagnostic mammogram that is converted to digital from film.
The payment rate for both screening and bilateral diagnostic mammography direct digital imaging is 150 percent of the current rate for bilateral diagnostic (76091) mammography.
For those screening mammography and bilateral diagnostic mammography studies that convert film to digital images, HCFA has advised Medicare carriers to pay the lesser of the following: the actual charge submitted, the local payment rate for a bilateral diagnostic mammogram (the fee schedule rate) or $69.23 (the 2001 statutory limit for a screening mammogram) plus $15. The $15 additional payment is only added to the screening mammogram payment and not to the lesser of the actual charge or the bilateral diagnostic mammogram payment.
Note that the payment rates for bilateral mammography will differ throughout the country, based on the geographic practice cost index adjustment. That means that if a screening or bilateral diagnostic mammogram is done and converted from film to digital, and if either the actual charge or the reimbursement rate for a bilateral diagnostic mammogram study is less than $84.23, the radiology practice will be paid that amount and not the $84.23 authorized by Congress.
BIPA established payment amounts for the new technology with screening and bilateral diagnostic mammographic services only. There is no additional payment for unilateral (76090) mammography services using digital technology. However, when the new technology is used, HCFA requires that the “G” codes be used for tracking purposes, instead of the unilateral mammography CPT code 76090. This means that CPT code 76090 should not be used, and that the “G” codes must be used to designate unilateral diagnostic studies performed with the new technology.
BIPA makes provisions for payments to be made in the radiology office, freestanding setting and the professional component in the hospital setting. The technical component for any screening or diagnostic mammogram performed in the hospital outpatient setting is covered under the new Hospital Outpatient Prospective Payment System/Ambulatory Payment Classification.
Any member who has questions regarding this expanded coverage or wants a copy of the Medicare transmittal may call the economics and health policy department at (800) 227-5463, ext. 4584, or fax questions to (703) 391-1757.
| Procedure |
HCPCS Code |
Payment |
| Screen Mammo, Digital | G0202 | 150 percent of bilateral diagnostic |
| Screen Mammo, Film to Digital | G0203 | Payment will be the lesser of the following: theactual charge, the local payment amount for abilateral diagnostic mammogram, OR $69.23(the 2001 statutory payment amount) plus $15.* |
| Diagnostic Mammo, Digital, Bilateral | G0204 | 150 percent of bilateral diagnostic |
| Diagnostic Mammo, Film to Digital, Bilateral | G0205 | Payment will be the lesser of the following: theactual charge, the local payment amount for abilateral diagnostic mammogram, OR $69.23(the 2001 statutory payment amount) plus $15.* |
| Diagnostic Mammo, Digital, Unilateral | G0206 | Same payment as 76090 “G” code used for tracking only |
|
Diagnostic Mammo, Film to Digital, Unilateral |
G0207 |
Same payment as 76090“G” code used for tracking only |
* The $15 additional payment is only added to the screening mammogram paymentand not to the lesser of the actual charge or the bilateral diagnostic mammogram payment.
