Radiology Coding Alert

Question: What is the correct way to code a unilateral screening mammogram? We’ve been receiving denials from our Medicare Administrative Contractor (MAC) using modifier 52.

Pennsylvania Subscriber

Answer: You are correct in reporting modifier 52 (Reduced Services) alongside 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed). The American College of Radiology (ACR) explains that “because the CPT^® code descriptor for 77067 states ‘bilateral,’ it would be appropriate to use a 52 modifier (reduced level of service) to designate a screening procedure of only one breast. However, radiology practices should check with their local carrier and other third-party payers regarding the use of the 52 modifier in this situation, because some payers have stated that a 52 modifier is not necessary for reporting a unilateral screening mammogram.”

Most MACs and commercial payers are accustomed to physicians billing modifier 52 for unilateral screening mammograms, but as the ACR explains, that’s now always the case. You should contact your MAC to confirm whether modifier 52 is necessary for unilateral screening mammogram claims.