On November 6, the Centers for Medicare and Medicaid Services (CMS) posted an FAQ on the CMS web site stating that breast tomosynthesis should be reported using one of the full-field digital mammography codes G0202, G0204 and G0206. The ACR disagrees with this coding recommendation and is in the process of requesting that CMS revise its coding guideline. The digital mammography codes do not accurately describe the procedure performed or take into consideration the additional work and associated practice expense involved with breast tomosynthesis. Therefore, the ACR maintains its current recommendation of reporting an unlisted procedure code to describe digital breast tomosynthesis while this is being discussed with CMS.
The ACR coding recommendation, as noted in the May/June 2011 ACR Radiology Coding Source, states, Breast tomosynthesis performed in conjunction with digital mammography is appropriately reported with the unlisted diagnostic procedure code 76499 to describe breast tomosynthesis and one of the HCPCS Level II “G” codes (G0202, G0204, or G0206) to describe the full-field digital mammography performed. If computer-aided detection (CAD) also is performed, it should be reported separately using one of the mammography CAD codes, 77051 (CAD performed in conjunction with diagnostic mammography) or 77052 (CAD performed in conjunction with screening mammography). It is not appropriate to report a three-dimensional reconstruction code in conjunction with the full-field digital mammography code."
The ACR has submitted an application for a formal CPT code for digital breast tomosynthesis for the February 2014 CPT Editorial Panel meeting, and if approved, a code would be available for the 2015 code cycle.