Summary & Overview
CPT 77067: Screening Mammography, Bilateral with CAD
CPT code 77067 represents a bilateral screening mammography, a critical preventive service in breast cancer detection. This procedure involves a two-view study of each breast and may include computer-aided detection (CAD) to enhance diagnostic accuracy. Nationally, screening mammography is a cornerstone of women's health, recommended for early identification of malignant neoplasms before symptoms arise.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting broad access across commercial and government insurance plans. The publication provides an overview of payer coverage, clinical context, and policy updates relevant to screening mammography. Readers will gain insight into coding benchmarks, typical sites of service, and the role of screening mammography in preventive care.
Key topics include the clinical importance of screening mammography, payer coverage trends, and updates in radiology billing practices. The summary also highlights related codes and modifiers that may impact billing and reimbursement. This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking a comprehensive understanding of CPT code 77067 and its place in national breast imaging protocols.
CPT Code Overview
CPT code 77067 is used to report a screening mammography procedure, which involves a bilateral (2-view study of each breast) imaging exam. This service is performed to detect early signs of breast cancer in asymptomatic women. The procedure includes computer-aided detection (CAD) when performed, enhancing the radiologist's ability to identify potential abnormalities.
Service Type: Radiology – Breast Imaging
Typical Site of Service: Screening settings such as outpatient hospitals or independent diagnostic testing facilities, including Hospital Outpatient Department (POS 22) or IDTF.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a woman aged 40 or older presenting for a routine breast cancer screening. She has no current symptoms or history of breast cancer. The procedure is performed in an outpatient hospital or an independent diagnostic testing facility. The clinical workflow includes patient registration, confirmation of eligibility for screening, performance of a bilateral (2-view) screening mammography, and documentation of the encounter for screening mammogram for malignant neoplasm of breast. Computer-aided detection (CAD) may be used as part of the imaging process.
Coding Specifications
- Modifier
GG: Indicates that both a screening mammography and a diagnostic mammography were performed on the same patient on the same day. Used when a screening mammogram is converted to a diagnostic study due to findings or symptoms.
| Modifier Code | Description |
|---|---|
| GG | Performance and payment of a screening mammography and diagnostic mammography on same patient same day |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
| 207XR0400X | Diagnostic Radiology |
| 207XS0101X | Diagnostic Radiology – Breast Imaging |
These taxonomies represent physicians specializing in radiology, with a focus on breast imaging for the latter.
Related Diagnoses
Z12.31: Encounter for screening mammogram for malignant neoplasm of breast- This code is used to document the clinical reason for the screening mammography procedure. It indicates that the patient is undergoing a screening exam to detect possible malignant neoplasms of the breast, even in the absence of symptoms.
Related CPT Codes
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77066: Diagnostic mammography, including computer‑aided detection (CAD) when performed; bilateral- Used when a diagnostic evaluation is required for both breasts, often following abnormal screening results.
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77065: Diagnostic mammography, including computer‑aided detection (CAD) when performed; unilateral- Used for diagnostic imaging of one breast, typically when a screening mammogram or clinical exam identifies a concern in a single breast.
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77063: Screening breast tomosynthesis; bilateral (list separately in addition to code for primary procedure)- Used as an add-on code for bilateral screening breast tomosynthesis, often performed in conjunction with
77067for enhanced imaging.
- Used as an add-on code for bilateral screening breast tomosynthesis, often performed in conjunction with
77066 and 77065 are alternatives to 77067 when diagnostic imaging is required. 77063 is commonly used together with 77067 for advanced screening.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 77067 is highest among commercial payers, with Cigna and UnitedHealth Group both averaging above $135. Medicare's mean rate is notably lower at $87.68, while the BUCA (average commercial) mean rate stands at $119.80, highlighting a substantial gap between government and commercial reimbursement levels.
Rate dispersion varies significantly across payers. Medicare exhibits the widest spread, with a difference of $85 between its 75th and 25th percentiles, indicating considerable variability in payment. In contrast, Aetna has the tightest range at $27.80, suggesting more consistent rates across providers. Other commercial payers, such as Blue Cross Blue Shield and UnitedHealth Group, show moderate dispersion, with ranges of $59.50 and $55.12, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.