CPT 77067: screening mammography, both breasts, with 3D add-on 77063
77067 reports a bilateral screening mammogram: two views of each breast, with computer-aided detection included when performed. Medicare pays it annually from age 40 with no deductible or coinsurance, and the 3D add-on 77063 rides on it.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 77067 is the screening mammography code, with a 2026 MUE of 1, a PC/TC indicator of 1 and the bilateral value built in. Medicare pays once after at least 11 months have passed, and 3D add-on 77063 is billed only with it.
What does CPT 77067 report?
77067 reports a bilateral screening mammogram: at least two views of each breast, with computer-aided detection included when it is performed. Since January 1, 2018, Medicare uses it in place of the old HCPCS code G0202, per Claims Processing Manual Chapter 18, section 20.
| Check | What the CMS files show |
|---|---|
| Payment status (RVU26D) | A, active |
| PC/TC indicator | 1, so modifiers 26 and TC apply |
| Global period | XXX |
| Bilateral surgery indicator | 2: RVUs already reflect both breasts, so no modifier 50 |
| Total RVUs | 3.78 global, 1.05 with 26, 2.73 with TC |
| MUE, effective October 1, 2026 | 1 per date of service, indicator 2, rationale "CMS Policy" |
| Add-on 77063 total RVUs | 1.53 global, 0.83 with 26, 0.70 with TC; MUE 1 |
The technical part is about 72 percent of the global value; see modifier TC and modifier 26.
Is a screening mammogram billed differently from a diagnostic one?
Yes, by code, cost sharing and frequency. 42 CFR 410.34 defines screening mammography as a procedure for a woman without signs or symptoms of breast disease, and diagnostic mammography as one for a man or woman with signs or symptoms or a personal history of breast cancer or biopsy-proven benign breast disease.
| Code | Use | Patient cost sharing | Frequency limit |
|---|---|---|---|
| 77067 | Screening, bilateral | No Part B deductible or coinsurance (Chapter 18, section 20.3) | Age and annual limits |
| 77066 | Diagnostic, bilateral | Deductible and coinsurance apply | None (section 20.5.1) |
| 77065 | Diagnostic, one breast | Deductible and coinsurance apply | None |
A screening that turns diagnostic on the same day is paid for both. The diagnostic code carries modifier GG, which the October 2026 HCPCS file defines as performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day. Chapter IX of the NCCI manual adds that the screening code carries 59 or XU. Other imaging pages: 71046 and 74177.
How often does Medicare pay for 77067?
42 CFR 410.34(d) sets age-based limits, and Chapter 18, section 20, words them the same way.
| Age | What Medicare pays |
|---|---|
| Under 35 | Nothing |
| 35 to 39 | One screening only (a baseline) |
| 40 and older | One after at least 11 months have passed following the month of the last one |
Count from the month after the last exam. In Chapter 18's example, a January 2005 screening starts the count in February and the next is payable in January 2006. By the same count, a March 2026 screening makes March 2027 the first payable month.
How does 3D tomosynthesis add-on 77063 attach to 77067?
77063 is an add-on code for screening digital breast tomosynthesis, bilateral, and since January 1, 2018 it must be billed with 77067. NCCI Chapter IX says the same: 77063 requires a screening mammogram with direct digital images. A MAC denies 77063 billed without 77067.
The two stand or fall together: if 77067 fails the age or frequency edits in the Common Working File, both are rejected. Chapter 18 also has the MAC deny 77063 lines without a qualifying screening diagnosis with CARC 167 and RARC N386, group code PR with a GA modifier and CO with GZ. Diagnostic tomosynthesis is a different code, G0279, which goes with 77065 or 77066, not with 77067.
How does 77067 appear on the claim?
On the CMS-1500, 77067 goes in Item 24D with no modifier for global billing, 26 for the professional part or TC for the technical part, and 1 in Item 24G because the bilateral value is built in. Chapter 18 says to report the screening diagnosis Z12.31, "Encounter for screening mammogram for malignant neoplasm of breast".
Item 32 carries the facility's 6-digit FDA certification number, because Medicare pays only FDA-certified facilities. Global billing is not permitted in provider outpatient departments. A hospital bills the technical part on a CMS-1450 with bill type 12X, 13X, 22X, 23X or 85X and revenue code 0403, and the professional part goes to the MAC on a CMS-1500. A self-referred screening repeats the provider's own NPI in the attending field.
Where does the screening diagnosis go for 77067?
A screening mammogram line carries 77067 in Item 24D with 1 unit in Item 24G, because the bilateral study is built into the code. Item 24E points to the screening diagnosis in Item 21. When a facility bills the technical part on a UB-04, the code sits in FL 44 with the date in FL 45 and units in FL 46.
RVU26D gives 77067 status A and the MUE table shows 1 per date with indicator 2, a CMS policy edit.
Example: A 52-year-old has the yearly screening on 10/24 at a freestanding site. The line reads 77067, pointer A (Z12.31), 1 unit, $168.00 with no modifier because the site bills globally. A second 77067 line on the same date draws CO-151.
Why is 77067 denied?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CARC 119 with RARC M90 | Benefit maximum for this time period or occurrence has been reached; not covered more than once in a 12 month period | A woman 40 or older screened before 11 months have passed |
| CARC 119 with RARC M89 | Benefit maximum reached; not covered more than once under age 40 | A second screening for a woman aged 35 to 39 |
| CARC 6 with RARC M37 | The procedure/revenue code is inconsistent with the patient's age; not covered when the patient is under age 35 | A screening for a woman under 35 |
| CARC B7 with RARC N570 | This provider was not certified/eligible to be paid for this procedure/service on this date of service | Facility not certified for the film or digital type billed |
| CARC 16 with RARC MA128 | Claim/service lacks information or has submission/billing error(s); missing, incomplete or invalid FDA approval number | Item 32 certification number absent or wrong |
Chapter 18 assigns group code CO to each of these. If they keep coming back, our denial management team can work them.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- 2026 NCCI Medicare Policy Manual, all chapters (revision 1/1/2026) · CMS
- Medicare Claims Processing Manual, Chapter 18: Preventive and Screening Services · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- 42 CFR 410.34: Mammography services, conditions for and limitations on coverage · eCFR
- HCPCS quarterly update, October 2026 alpha-numeric file · CMS
- Claim Adjustment Reason Codes · X12
- Remittance Advice Remark Codes · X12
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01Is a screening mammogram billed differently from diagnostic?
Yes. A screening uses 77067 for a woman without breast symptoms and carries the screening diagnosis Z12.31, with no Part B deductible or coinsurance. A diagnostic mammogram uses 77065 or 77066, has deductible and coinsurance, and has no frequency limit. If a screening turns diagnostic the same day, the diagnostic code takes modifier GG.
02How often will Medicare pay for a screening mammogram?
None under age 35, one baseline between ages 35 and 39, and annually from age 40. 42 CFR 410.34(d) requires at least 11 months to have passed following the month of the last screening. A screening in March 2026 makes March 2027 the first payable month.
03What if a screening mammogram turns into a diagnostic one?
Medicare pays both when a radiologist orders additional films while the patient is still at the facility. The diagnostic code carries modifier GG, and NCCI says the screening code carries 59 or XU. Hospital technical claims use revenue code 0401 for the diagnostic line.
04Does a screening mammogram need a doctor's order?
No. Chapter 18, section 20, says a doctor's prescription or referral is not necessary for Medicare coverage of a screening mammogram. When it is self-referred and no attending physician NPI exists, the provider duplicates its facility NPI in the attending physician identifier field.
Screening mammography claims denying?
We check age, the 11-month interval, the 3D add-on and the facility certification number before the claim goes out.