CPT code 77067 is a diagnostic radiology code used to report bilateral screening mammography performed on asymptomatic patients as a preventive measure for early breast cancer detection. Procedure code 77067 covers a two-view study of each breast, typically craniocaudal and mediolateral oblique projections, and includes computer-aided detection when performed, with CAD bundled into the code and not separately billable.
CPT 77067 code is classified as a preventive service under Medicare and is exempt from beneficiary coinsurance and deductible when the patient qualifies under Medicare’s screening mammography benefit.
What Is the Description of CPT Code 77067?
CPT code 77067 is defined by the AMA as: “Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.”
Code 77067 CPT replaced HCPCS code G0202 effective January 1, 2018, when CMS adopted the CPT mammography code set in place of the legacy G-code system. It covers only bilateral, asymptomatic screening studies. Symptomatic patients or those with known abnormalities requiring further evaluation are reported under the diagnostic mammography codes 77065 (unilateral) or 77066 (bilateral).
What Does the Two-View Bilateral Protocol Include for CPT Code 77067?
The examination reported under procedure code 77067 involves positioning each breast on a dedicated mammography unit and obtaining a minimum of two standard views per breast. The craniocaudal (CC) and mediolateral oblique (MLO) projections. Both breasts are imaged in the same session. The breast is compressed between plates to even out dense tissue and minimize motion artifact.
Computer-aided detection (CAD), when applied, uses algorithm-based analysis of the digital image data to highlight areas of potential concern for the interpreting radiologist. CAD is not a separate service. It is an inclusive component of CPT code 77067 and must not be additionally reported with a separate CAD code. Additional screening views beyond the standard two per breast do not change the code reported; 77067 CPT code covers the complete bilateral screening encounter regardless of view count within the standard protocol.
Is Computer-Aided Detection (CAD) Separately Billable With CPT Code 77067?
No, CAD is bundled into CPT code 77067 per the AMA CPT code descriptor, which explicitly includes “computer-aided detection (CAD) when performed.” The former add-on CAD codes 77051 and 77052 were deleted effective January 1, 2018, concurrent with the adoption of the current mammography code set. Billing a separate CAD code alongside procedure code 77067 will result in denial. Whether or not CAD software is used during interpretation, the code remains 77067 CPT code. Its use or non-use does not change the code selected.
How Does CPT Code 77067 Differ From CPT 77065 and 77066?
These three codes are distinguished by the scope of the examination and whether it is a screening or diagnostic study:
- CPT 77065: Diagnostic mammography, unilateral, including CAD when performed. Used when one breast is evaluated in a diagnostic context. The patient has symptoms, a palpable finding, or a prior abnormal result requiring evaluation.
- CPT 77066: Diagnostic mammography, bilateral, including CAD when performed. Same as 77065, but covers both breasts when bilateral diagnostic evaluation is required.
The defining distinction is patient symptom status. CPT code 77067 is used exclusively for asymptomatic patients presenting for routine preventive screening. If the patient has a symptom like pain, nipple discharge, palpable mass, or known abnormality, the correct code is 77065 or 77066, not procedure code 77067, regardless of how the appointment was originally scheduled.
What Are the Modifiers for CPT Code 77067?
CPT 77067 code is a radiology code with PC/TC Indicator 1, supporting separate professional and technical component billing.
Modifier 26: Professional Component Only
Modifier 26 is appended when the interpreting radiologist bills only for the reading, interpretation, and written report of the mammogram, and the technical component is billed separately by the facility or imaging center. Append modifier 26 to CPT code 77067 on the physician’s claim when the physician does not own or operate the mammography equipment.
Modifier TC: Technical Component Only
Modifier TC is appended by the facility billing for the mammography equipment, technologist, and overhead. Physician interpretation is not included. Append modifier TC to procedure code 77067 on the facility claim when the interpreting radiologist bills separately with modifier 26.
Modifier 52: Reduced Services (Unilateral Screening Only)
Modifier 52 is used when screening mammography is performed on only one breast. For example, in a patient with a prior mastectomy on one side. Since CPT code 77067 is defined as bilateral, unilateral performance requires modifier 52 to indicate a reduced service. Per Bracco Reimbursement guidance (citing CMS policy), when a unilateral screening is performed, modifier 52 must be appended to both 77067 and 77063 when tomosynthesis is also performed.
Modifier GG: Screening Converted to Diagnostic on Same Day, Same Patient
Modifier GG is used when a screening mammography encounter reveals an abnormality that requires immediate diagnostic evaluation on the same day. Per CMS Billing and Coding Article A56448 and CMS Transmittal R3160CP, modifier GG is appended to the diagnostic mammography code (77065 or 77066), not to CPT code 77067. Medicare pays both the screening and diagnostic studies when modifier GG is correctly applied.
Modifier 59: Distinct Procedural Service
Modifier 59 is used when code 77067 CPT is performed as a distinct and separately identifiable service from another imaging procedure on the same date. Apply modifier 59 only when documentation supports a separate clinical context and an NCCI edit would otherwise bundle the services.
Modifier 76: Repeat Procedure by Same Physician
Modifier 76 is used when CPT code 77067 is repeated on the same date by the same interpreting physician. For example, when a technical repeat is required due to image quality failure. Document the clinical reason for repeat in the radiology report before appending modifier 76.
Modifier 77: Repeat Procedure by Another Physician
Modifier 77 is used when the same screening mammography service is repeated on the same date but interpreted by a different physician than the one who read the original study. Append modifier 77 to procedure code 77067 on the second radiologist’s claim and document the clinical basis for the repeat interpretation.
When Should CPT 77067 Be Billed Globally vs. With Modifier 26 or TC?
- Global billing (no modifier): Used when the same entity, typically a freestanding breast imaging center employing its radiologists, performs both the technical acquisition and the professional interpretation of the mammogram
- Modifier 26 (professional only): Used by the interpreting radiologist when the technical component is billed separately by a hospital, ASC, or imaging facility
- Modifier TC (technical only): Used by the facility that owns the mammography equipment and employs the technologist, when the reading physician bills the professional component separately
Billing the global code while another entity bills the TC, or having both parties bill globally, results in a duplicate payment denial. CMS Medicare Claims Processing Manual, Chapter 4, Section 10.6.2.2, governs payment for screening mammography services furnished in hospitals and other facility settings.
Which Documents Are Required For CPT Code 77067?
Documentation for 77067 CPT code must confirm the screening indication, asymptomatic patient status, and bilateral two-view acquisition.
Required documents checklist:
- Physician order for bilateral screening mammography
- Radiology report documenting bilateral two-view acquisition (CC and MLO projections for each breast) with findings and final assessment
- Confirmation of asymptomatic patient status, no current breast symptoms documented
- Patient age and date of last screening mammography (supports frequency eligibility)
- Breast composition and any incidental findings, including BI-RADS assessment category
- Documentation of CAD use if performed (included but not separately billed)
- Documentation of examination limitations (implants, prior surgery, technical factors) when applicable
- MQSA facility certification confirming the mammography facility and equipment meet FDA standards
- Prior comparison mammograms reviewed, if available, noted in the report
What is the Cost of CPT Code 77067?
The cost of CPT code 77067 varies by billing component (global, professional, or technical), place of service, payer, and geographic location.
RVUs & Medicare Payment
Procedure code 77067 carries the following CY 2026 Medicare national average payment rates, sourced directly from Hologic’s 2026 Mammography Coding Guide, citing the CMS RVU26A National PFS Relative Value File January Release:
| Component | Total RVU | Medicare Rate (QP CF $33.5675) |
|---|---|---|
| Global (Office/Freestanding) | 3.78 | $126.89 |
| Professional (Facility/Non-Facility) | 1.05 | $35.25 |
| Technical (Facility) | 2.73 | $91.64 |
Providers using the non-QP conversion factor of $33.4009 will receive slightly lower payments. CPT code 77067, when billed as a qualifying preventive screening service under the Medicare Part B benefit, is exempt from beneficiary coinsurance and deductible per the Affordable Care Act preventive services provisions and CMS Chapter 18 claims processing guidance.
Commercial Payers
Most commercial payers cover procedure code 77067 as a preventive service under the Affordable Care Act’s zero cost-sharing requirement. This means no patient cost-sharing applies when the service is coded as screening. Commercial reimbursement for the global service typically exceeds Medicare by 1.5× to 2.5×, depending on contract and geographic market.
Place-of-Service & Geographic Adjustments
CPT 77067 code carries separate facility and non-facility payment rates. The global rate of $126.89 applies in freestanding imaging centers and office-based settings. When performed in a hospital outpatient department or ASC, the facility bills separately under OPPS or the ASC fee schedule. And the interpreting radiologist bills the professional component only with modifier 26.
What Are Example Clinical Scenarios or Use Cases for CPT Code 77067?
CPT code 77067 applies when bilateral screening mammography is performed on an asymptomatic patient with no current breast complaints or known pathology requiring diagnostic evaluation.
Scenario 1: Routine Annual Screening in an Asymptomatic 50-Year-Old Woman
ICD-10: Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast)
A 52-year-old asymptomatic woman with no personal history of breast cancer presents for her annual bilateral screening mammogram. Two-view images of each breast are obtained. No abnormalities are identified, and no additional imaging is performed. CPT code 77067 is reported as the sole mammography code.
Scenario 2: Annual Screening in a Breast Cancer Survivor With No Current Symptoms
ICD-10: Z85.3 (Personal history of malignant neoplasm of breast)
A 58-year-old woman with a remote personal history of breast cancer treated with lumpectomy and radiation presents for her annual screening mammogram. She has no current symptoms, no palpable findings, and no clinical concern requiring diagnostic evaluation at this visit. The radiologist performs bilateral two-view screening mammography. Procedure code 77067 is correctly reported. A personal history of breast cancer does not automatically convert a screening study to a diagnostic study in the absence of current symptoms or an active clinical concern.
Scenario 3: Employer-Sponsored Preventive Screening in an Asymptomatic 45-Year-Old
ICD-10: Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast)
A 45-year-old asymptomatic woman presents to a freestanding imaging center as part of an employer-sponsored preventive health program. She has no symptoms, no prior abnormal mammogram findings, and no family history elevating her risk beyond average. Bilateral two-view screening mammography is performed. The imaging center performs both the technical acquisition and professional interpretation, billing 77067 CPT code globally without a component modifier.
What Are the CPT Code 77067 Rules To Ensure Successful Reimbursement?
Follow CMS, payer, and MQSA rules for patient selection, frequency, component billing, and screening-to-diagnostic conversion documentation. Meeting these rules reduces denials and ensures correct payment.
Bundling / NCCI / Same-Day Procedure Rules
CPT code 77067 must not be reported with 77065 or 77066 for the same breast study on the same date, unless a screening encounter converts to a diagnostic encounter. In which case, modifier GG must be appended to the diagnostic code per CMS Article A56448 guidance.
Do not separately bill the former CAD codes 77051 or 77052 alongside code 77067 CPT, as these codes were deleted January 1, 2018, and CAD is bundled into the descriptor. Do not report a 3D reconstruction code (76376 or 76377) in conjunction with CPT 77067 code for the same breast study per MedLearn Publishing and AMA CPT guidelines. When screening tomosynthesis is also performed, CPT 77063 is reported as an add-on code alongside procedure code 77067, not in its place.
Units, MUEs & Medicare 12-Month Frequency Restrictions
CPT code 77067 is billed as one unit per screening encounter.
- Medicare covers one screening mammography per beneficiary per 11-month interval (not strict 12-month calendar year).
- Per CMS Chapter 18 and CWF frequency edits, when 77067 fails the frequency edit, the add-on code 77063 also fails, and both are rejected together.
- Code 77067 CPT carries a 0-day global period. Follow-up imaging, additional views, or diagnostic workup are separately billable.
- Medicare covers screening mammography for female beneficiaries age 35–39 (one baseline exam) and annually for all female beneficiaries age 40 and older.
- When modifier 52 is appended for a unilateral screening, the same modifier must also be appended to 77063 if tomosynthesis was also performed unilaterally.
When a Screening Encounter Converts to Diagnostic and How to Recode Correctly
When an abnormality is identified during the screening mammography, and additional diagnostic imaging is performed on the same day:
Per CMS Billing and Coding Article A56448 and Transmittal R3160CP, the correct approach is to report CPT code 77067 for the screening component and 77065 (unilateral) or 77066 (bilateral) for the diagnostic component. The modifier GG must be appended to the diagnostic code. Medicare pays for both services.
Modifier GG must be documented on the claim line with the diagnostic CPT code. The specific abnormality prompting the conversion must be documented in the medical record. CPT code 77067 is not recoded or replaced. It remains on the claim representing the screening service that was completed before the conversion occurred.
Top Reasons For Denials Specific To 77067 & Quick Remedies
- Frequency Edit Failure (Less Than 11 Months Since Last Screening): Prevent by verifying the patient’s last Medicare-covered screening mammography date in the medical record and CWF prior to scheduling and billing.
- Missing or Incorrect Modifier on Same-Day Screening-to-Diagnostic Conversion: Prevent by appending modifier GG to the diagnostic code, not to CPT code 77067, and ensuring the abnormality is documented in the record.
- Separate Billing of CAD Code Alongside 77067: Prevent by confirming that CAD is bundled into CPT 77067 code and removing any separately billed CAD add-on codes before submission.
- MQSA Facility Non-Compliance: Prevent by confirming the facility’s FDA MQSA certification is current before billing. Claims from non-certified or expired-certified facilities are denied and may trigger additional review.
Is CPT 77067 a Stand-Alone Primary Code or an Add-On Code?
77067 is a stand-alone primary procedure code, not an add-on code. As a primary mammography code, 77067 can be reported on its own without requiring a parent code, which separates it structurally from add-on codes like 77063 that cannot be billed independently and must always be appended to a primary code on the same claim. The distinction reflects how the AMA organizes different CPT codes within the code set, where each type follows specific reporting, pairing, and reimbursement rules.
