CPT® Code 77063

Add-On Code

Quick Reference

• Code definition: CPT 77063 reports the bilateral screening digital breast tomosynthesis (3D mammography) component performed in conjunction with a standard screening mammogram; it captures the tomosynthesis add-on only, not the full mammography service.
• Key billing rule: 77063 is an add-on code (ZZZ global days) and must always be reported alongside 77067 (bilateral screening mammography with CAD); submitting 77063 without the primary code results in automatic denial.
• Modifier essentials: Modifier 26 (professional component) and modifier TC (technical component) are the primary modifiers; modifier GG applies when a screening visit converts to a diagnostic mammogram on the same date of service. Do not append modifier 50; the code is inherently bilateral.
• Documentation must-have: The radiologist report must document the BI-RADS assessment category and breast density classification per MQSA requirements; without a compliant MQSA report, the service lacks the required clinical documentation for the interpretation component.
• Top confusion point: 77063 is a screening-only code; using it for a patient with breast symptoms, a palpable lump, or a prior abnormal mammogram requiring follow-up is a compliance error. Those scenarios require diagnostic codes 77065 or 77066.
• Payer alert: Medicare covers 77063 with no patient cost-sharing under the Part B preventive mammography benefit (finalized CY2018 MPFS Final Rule) [1]. Diagnostic DBT codes 77061 and 77062 are not valid for Medicare purposes; commercial payers may cover them separately.

When to Use This Code

CPT 77063 reports the tomosynthesis component of a bilateral screening mammography encounter. The code is appropriate when an asymptomatic patient presents for routine breast cancer surveillance and the facility performs combined 2D plus 3D (tomosynthesis) imaging in a single session.

Clinical indications include average-risk annual screening for women aged 40 and older, baseline screening for women aged 35 to 39 (Medicare benefit), and routine surveillance in patients with no current breast complaints. DBT adds particular clinical value in patients with heterogeneous or extremely dense breast parenchyma (ACR BI-RADS density categories c and d), where tissue overlap on standard 2D mammography can mask or mimic lesions.

Scope boundaries: 77063 covers only the bilateral screening tomosynthesis add-on service. The primary 2D mammography service must be coded separately with 77067. The code does not cover diagnostic tomosynthesis, unilateral tomosynthesis, or any encounter where a breast symptom or prior abnormal finding is the reason for imaging.

Provider and setting context: The code carries PC/TC indicator 1 (Diagnostic Tests for Radiology Services), meaning it can be split between the interpreting physician (modifier 26) and the facility performing the acquisition (modifier TC). Hospital outpatient departments bill the TC component; independent radiologists billing globally or for interpretation only bill 26 or the global code respectively. An MQSA-accredited facility and FDA-cleared DBT equipment are prerequisites for performing and billing the service.

Code Differentiation Table

The critical differentiator is screening versus diagnostic intent. An asymptomatic patient with a physician order for routine annual mammography uses 77067 + 77063. Once any symptom, sign, or diagnostic clinical question drives the encounter, the screening codes are inappropriate regardless of the technology used. Auditors specifically flag 77063 claims where the diagnosis code does not support a screening encounter, particularly when R92.x (abnormal mammographic findings) appears as the primary diagnosis on a claim that should carry Z12.31.

Billing and Modifier Rules

Add-on code mechanics: The ZZZ global days indicator confirms that 77063 has no independent global period; it inherits the global period of its primary code, 77067. The multiple procedures indicator is 0, meaning no modifier 51 payment reduction applies. MUE = 1; only one unit per date of service is payable regardless of how many tomosynthesis passes are acquired.

Modifier 26 and TC: Bill 77063-26 when the radiologist provides the professional interpretation component only. Bill 77063-TC when the facility provides the equipment and acquisition only. When a radiologist bills globally (interpretation and equipment under the same TIN), no modifier is appended. This split mirrors how 77067 is billed in the same encounter.

Modifier GG (same-day conversion to diagnostic): When a screening mammogram triggers same-day diagnostic imaging on the same patient, append modifier GG to 77067 and include 77063 as the add-on. Report 77065 or 77066 separately for the diagnostic portion. GG signals Medicare that the encounter originated as a preventive service, preserving the cost-sharing waiver for the screening component while subjecting the diagnostic portion to Part B deductible and coinsurance.

Modifier 50 — do not use: The code descriptor explicitly states "bilateral" and the bilateral surgery indicator is set to "2" (150% payment adjustment does not apply). Appending modifier 50 is both clinically redundant and technically incorrect; it may trigger an NCCI edit rejection.

NCCI bundling: Reporting 77063 without 77067 on the same claim will result in denial. Reporting 77063 alongside 77066 or 77065 without 77067-GG is appropriate only in the same-day conversion scenario described above; without GG, the pairing is non-compliant.

Documentation Essentials

Required elements for the radiologist report:

• Patient name, date of birth, date of service, ordering provider
• Clinical indication: confirmation that the encounter is for routine asymptomatic screening
• Technique: documentation that bilateral tomosynthesis was performed, including equipment used
• Findings with BI-RADS assessment category (1 through 6) for each breast
• Breast density notation using BI-RADS density categories (a through d); this is an FDA/MQSA requirement, not optional
• Radiologist signature and credentials confirming qualification as an interpreting physician under MQSA

Audit red flags specific to 77063:

• Primary diagnosis is not a screening code. Auditors look for Z12.31 or Z12.39 as the primary diagnosis; an R92.x or C50.x primary diagnosis on a 77063 claim triggers medical necessity review.
• 77063 appears without 77067 on the same date. This is structurally non-compliant with add-on code rules.
• The radiologist report does not mention tomosynthesis or 3D acquisition. If the documentation describes only a "standard bilateral mammogram," the claim for 77063 lacks supporting documentation for the additional technology component.
• Modifier 26 or TC mismatches between the facility and professional claims. When both entities bill for the same date and both claim the global code (no modifier), a duplicate claim edit fires.

Medical necessity: Documentation must establish that the patient is asymptomatic and presenting for routine screening. A referral or order citing a specific symptom or diagnostic question converts the encounter from screening to diagnostic and invalidates the use of 77063. Note that patients with a personal history of breast cancer (Z85.3) or family history (Z80.3) may still be coded as screening encounters with 77067 + 77063, but some payers and MAC jurisdictions may classify post-treatment surveillance as diagnostic; verify payer-specific LCD guidance for those patients.

Medicare, Commercial and Medicaid Payer Rules

Medicare:

Medicare covers CPT 77063 billed with 77067 under the Part B annual preventive mammography benefit [1]. Coverage became effective January 1, 2018, following finalization in the CY2018 Physician Fee Schedule Final Rule (82 FR 52976). No patient deductible or coinsurance applies to the screening mammography benefit, including the tomosynthesis add-on. Frequency: once every 12 months for women aged 40 and older; one baseline exam for women aged 35 to 39. NCD 220.4 (Screening Mammographies) governs Medicare coverage criteria for the broader mammography benefit [2].

Medicare does not cover 77061 or 77062 (diagnostic DBT); claims for those codes are denied as "not valid for Medicare purposes." For diagnostic DBT in Medicare patients, HCPCS G0279 is the appropriate add-on to 77065 or 77066.

HCPCS G0202 (bilateral screening mammography with CAD) was terminated effective December 31, 2017, and replaced by CPT 77067 [3]. Any claim submitted to Medicare using G0202 for dates of service on or after January 1, 2018 will be denied.

Commercial payers:

Most major commercial payers cover 77067 + 77063 for annual bilateral screening mammography. Unlike Medicare, commercial payers may separately reimburse 77061 and 77062 for diagnostic DBT. Verify individual plan policies before billing diagnostic DBT codes to commercial payers, as coverage and prior authorization requirements vary. Age and frequency parameters may differ from Medicare; some commercial plans follow USPSTF guidelines that recommend initiating screening at 50, which can affect coverage for patients aged 40 to 49.

Medicaid:

State Medicaid programs vary substantially in coverage of screening DBT. Some states have adopted coverage policies aligned with Medicare; others limit tomosynthesis coverage or require prior authorization. Because no state-specific LCD or coverage determination was available in the research document, verify coverage with the applicable state Medicaid agency or managed Medicaid plan before billing 77063 for Medicaid beneficiaries.

Common Denials and Prevention

Denial: Missing primary procedure 77063 submitted without 77067 on the same claim. The payer rejects the add-on code because the required primary code is absent. Prevention: Charge capture workflows must link 77063 and 77067 as a required pairing. If 77067 is denied or edited off a claim, 77063 will also deny; correct the root cause on 77067 first, then resubmit both codes together.

Denial: Diagnosis does not support screening The claim carries an R92.x (abnormal mammographic finding) or a symptomatic diagnosis as the primary code. The payer rejects the screening code as inconsistent with the diagnosis indicating a diagnostic encounter. Prevention: Confirm the clinical indication before assigning 77063. Asymptomatic routine screening maps to Z12.31. If a prior finding or symptom drives the encounter, recode to 77065 or 77066 and remove 77063.

Denial: Frequency exceeded Medicare rejects the claim because a prior screening mammography claim was paid within the preceding 12-month benefit period. Prevention: Verify the patient's last Medicare-covered mammography date through the provider portal or by querying the patient's Part B claims history before scheduling. If the patient had a diagnostic mammogram (not a screening mammogram) in the prior year, the screening benefit is not affected; distinguish the claim type in eligibility verification.

Denial: Code not covered (Medicare, 77061/77062 submitted in error) A biller submits 77061 or 77062 to Medicare instead of the appropriate code combination. Medicare denies as "not valid for Medicare purposes." Prevention: Update chargemasters and billing system payer rules to suppress 77061 and 77062 for Medicare claims. For diagnostic DBT in Medicare patients, map to G0279 listed in addition to 77065 or 77066.

Denial: Modifier 50 rejection Modifier 50 is appended to 77063, triggering an NCCI edit or payer-specific rejection because the bilateral indicator already excludes the 150% payment adjustment. Prevention: Flag 77063 in the billing system as a code that should never receive modifier 50. The descriptor is inherently bilateral; no laterality modifier is appropriate.

Coding Scenarios

Scenario 1: Routine annual screening, asymptomatic patient, facility and professional split billing

A 58-year-old woman presents to a hospital-based imaging center for her annual bilateral mammogram. She has no breast complaints. The technologist performs bilateral 2D views plus DBT (tomosynthesis). An employed radiologist interprets the study and reports BI-RADS 2 (benign findings) with heterogeneous breast density bilaterally.

Hospital bills: 77067-TC + 77063-TC; Z12.31 primary diagnosis Radiologist bills: 77067-26 + 77063-26; Z12.31 primary diagnosis

Why: The encounter is asymptomatic screening, so 77067 + 77063 is correct. The PC/TC indicator for both codes permits component splitting between the facility and the interpreting physician billed under a separate TIN.

Scenario 2: Same-day conversion from screening to diagnostic, Medicare patient

A 67-year-old Medicare beneficiary undergoes bilateral 2D + DBT screening. During interpretation, the radiologist identifies a new asymmetry in the left breast that was not present on prior imaging. Additional diagnostic bilateral mammographic views are obtained the same day. The radiologist reports BI-RADS 4B for the left breast.

Correct coding: 77067-26-GG + 77063-26 (screening portion) + 77066-26 (diagnostic bilateral mammography, subject to Part B cost-sharing); Z12.31 for the screening codes; R92.8 (other abnormal imaging finding) or the specific finding code for 77066

Why: Modifier GG on 77067 signals that the encounter started as a preventive screening, preserving the cost-sharing waiver for 77067 and 77063. The diagnostic portion (77066) is separately reportable and subject to deductible and coinsurance.

Scenario 3: Patient with family history of breast cancer, average-risk screening

A 45-year-old woman with a documented family history of breast cancer in a first-degree relative presents for annual bilateral screening mammography with tomosynthesis. She has no current symptoms and no personal history of breast disease.

Correct coding: 77067 + 77063; Z12.31 primary diagnosis; Z80.3 (family history of malignant neoplasm of breast) as additional diagnosis

Why: Family history alone does not convert a screening encounter to diagnostic. Z12.31 is the correct primary diagnosis for routine asymptomatic screening regardless of elevated risk. Z80.3 documents the clinical context supporting annual surveillance.

Scenario 4: Dense breast tissue finding with supplemental ultrasound ordered

A 42-year-old woman undergoes bilateral 2D + DBT screening. The mammogram is negative (BI-RADS 1) but the radiologist notes bilateral extreme breast density and recommends supplemental whole-breast ultrasound, which is performed the same day.

Mammogram codes: 77067 + 77063; Z12.31 primary; R92.343 (mammographic extreme density, bilateral) as additional diagnosis Ultrasound codes: 76641 per breast (confirm same-day bundling rules per payer); Z12.39 (encounter for other screening for malignant neoplasm of breast) for the supplemental ultrasound indication

Why: The mammography encounter is correctly coded as screening regardless of the density finding. R92.343 documents the density classification required by MQSA and supports the medical necessity for supplemental imaging. The supplemental ultrasound is coded separately with Z12.39 as its supporting diagnosis.

Related Codes

• 77067 — Screening bilateral mammography with CAD; required primary code for 77063
• 77065 — Diagnostic mammography, unilateral with CAD; use instead of 77067+77063 when patient is symptomatic (unilateral)
• 77066 — Diagnostic mammography, bilateral with CAD; use instead of 77067+77063 when patient is symptomatic (bilateral)
• 77061 — Diagnostic digital breast tomosynthesis, unilateral; commercial payer only, not valid for Medicare
• 77062 — Diagnostic digital breast tomosynthesis, bilateral; commercial payer only, not valid for Medicare
• G0279 — Diagnostic DBT, unilateral or bilateral (add-on to 77065 or 77066); Medicare equivalent of 77061/77062 for diagnostic encounters
• Z12.31 — Encounter for screening mammogram for malignant neoplasm of breast; standard primary diagnosis for 77063 encounters
• Z80.3 — Family history of malignant neoplasm of breast; common secondary diagnosis supporting annual screening

Sources

1. CMS CY2018 Physician Fee Schedule Final Rule, 82 FR 52976 (November 2, 2017) — Federal Register — Finalized Medicare coverage and payment for CPT 77063 billed with 77067 under the Part B preventive mammography benefit, effective January 1, 2018.
2. NCD 220.4 – Screening Mammographies — CMS Medicare Coverage Database — National Coverage Determination governing Medicare screening mammography coverage criteria including bilateral DBT.
3. HCPCS G0202 Termination Record — CMS HCPCS Annual Update — Termination of G0202 effective December 31, 2017, with cross-reference to CPT 77067.
4. AMA CPT Code Descriptors and Add-On Code Appendix — American Medical Association — Official descriptors for 77063, 77067, 77061, 77062, 77065, 77066; add-on code status and parenthetical instructions.
5. CMS NCCI Policy Manual — CMS National Correct Coding Initiative — Bundling rules, add-on code requirements, and modifier GG guidance for mammography code pairs.