August 31, 2015

CMS Issues Claims Processing Guidance for Tomosynthesis

The Centers for Medicare and Medicaid Services (CMS) issued additional instruction regarding the payment of claims for Diagnostic Digital Breast Tomosynthesis, unilateral or bilateral (code G0279). CMS has previously stated that payment for G0279 would only be permitted when billed in conjunction with HCPCS code G0204 or G0206. The additional guidance illuminates the type of bills (TOBs) which will be paid when claims are submitted with specific revenue codes. For example, Professional claims for Diagnostic Digital Breast Tomosynthesis will be paid for TOB 85X (services provided in a Critical Access Hospital) when they are submitted with revenue code 096X, 097X or 098X (professional fees).

For further details regarding claims and payment for types of bills see MLN Matters article MM9191.

Please contact Dominick Parris in the Economics and Health Policy Department with you questions at