NC Medicaid Began Coverage of 3D Breast Tomography May 1

As of May 1, 2018, North Carolina Medicaid began covering digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography. Practices must submit claims with Healthcare Common Procedure Coding System (HCPCS) code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral) in addition to screening or diagnostic mammography Common Procedural Terminology (CPT) codes 77065-77067.

As reported earlier in the NCMS Bulletin, the North Carolina Medical Society (NCMS) and radiologists detailed the benefits of 3D mammography to the North Carolina Division of Medical Assistance. We are pleased the Medicaid program decided to begin covering breast tomosynthesis, or 3D mammography.

Using these higher quality images cuts down on the need for additional tests; help physicians detect more cancers earlier and especially helps detect tumors in women with dense breast tissue.

The North Carolina General Assembly passed legislation requiring physicians report when a woman has dense breast tissue to make them aware of the special benefits of 3D mammography in their particular case. Commercial insurers, like Blue Cross Blue Shield of North Carolina, does cover 3D mammography.

 
 

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2 Comments

  • Elaine Ellis

    Thank you for your comment, Dr. Wilcox. The Division of Medical Assistance (DMA) is aware of this coding issue and is in the process of correcting it. The following is the email response the NCMS received when we inquired about the issue earlier this month:

    DMA is in the process of adding coverage for screening tomosynthesis code 77063. I anticipate the clinical coverage policy to be updated 6/1/18 with the code and rate information in NCTracks by this date, if not sooner. Providers may submit claims for diagnostic mammograms with 3D tomosynthesis immediately for reimbursement. I would recommend holding screening claims until notified by DMA that 77063 is in the system to prevent duplication of submissions.

  • Chuck Wilcox

    G0279 is the approved code for diagnostic breast tomosynthesis for MEDICARE only. Other payers are calling for the CPT standard codes 77061 and 77062. In addition, 77063 is the most accurate CPT code for screening breast tomosynthesis. Although this policy position is excellent, the coding creates confusion and will cause denials if Medicaid does not correct this coding. I have asked the Medical Director at NC Medicaid to review this in hopes that the coding can be corrected.