A revision in the Type of Service (TOS) code permits Medicare beneficiaries to receive coverage for routine screening mammography performed without a physician’s referral. The policy applies to claims with dates of services on or after January 1, 2018.
The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 10607, which corrects the TOS code for Current Procedural Terminology (CPT®) code 77067 Screening mammogram, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. As of January 1, 2018, CMS replaced the Healthcare Common Procedure Coding System Level II code G0202 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed with CPT code 77067.
Effective for claims with dates of service on or after January 1, 2017, the TOS indicator is updated to reflect “1”, Medical Care, instead of “4”, Diagnostic Radiology, to allow for proper claim submission and adjudication. Correcting the TOS code for 77067 allows the screening mammography claims to be billed without the referring physician’s information on the claim, which is consistent with Medicare’s coverage policy for screening mammograms.
Medicare Administrative Contractors will do the following:
- Automatically reprocess previously adjudicated screening mammography claims received with CPT code 77067 with a TOS code of “4” with dates of service on and after January 1, 2018, and through July 2, 2018, when the claim was denied because there was no referring provider information.
- Reprocess screening mammography claims with dates of service between January 1, 2018, and July 2, 2018, which cannot be automatically reprocessed only if brought to their attention.
For detailed information, see the April 13, 2018 issue of Medicare Learning Network’s MLN Matters.
Additional information is available in the Medicare Claims Processing Manual, Chapter 18.