Author: Clinical Policy and Programs
Effective May 1, 2018, North Carolina Medicaid began offering coverage of digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography using code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral).
Providers informed Medicaid that the parenthetical information in the 2018 Healthcare Common Procedure Coding System (HCPCS) Manual for this code was incorrect, stating that G0279 was to be billed with only diagnostic mammography services.
Effective May 1, 2018, in response to feedback received, Medicaid has added coverage for CPT code 77063 (Screening digital breast tomosynthesis, bilateral) to be billed with screening mammograms.
Clinical coverage policy, 1K-1, Breast Imaging, has been updated to reflect the new coverage.