CPT 77047Radiology

Mri breast c- bilateral

CPT 77047 covers a magnetic resonance imaging (MRI) scan of both breasts performed with contrast dye, used to detect or evaluate breast cancer and other abnormalities when mammography or ultrasound results are inconclusive.

Showing rates for

National Average

Base Medicare rate

$215.10

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.6

PE RVU (NF)

4.96

MP RVU

0.09

Total RVU

6.65

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always verify prior authorization before scheduling - most commercial payers require pre-authorization for breast MRI, and failure to obtain it results in automatic denial
Impact: Prevents 100% payment loss ($215.10 Medicare; $400-800 commercial); prior auth denials rarely overturnable
Document medical necessity with specific ICD-10 codes indicating high-risk status, personal history, or diagnostic need - use Z80.3, Z85.3, or Z15.01 for screening in high-risk patients
Impact: Improves first-pass acceptance rate by 40-60%; inadequate diagnosis coding is the #1 denial reason
Bill 77047 only when both breasts are imaged; use 77046 for unilateral studies to avoid downcoding and payment reduction
Impact: Prevents automatic 50% reduction in reimbursement from incorrect code assignment
Ensure contrast administration is documented in the radiology report with type, dose, and route; contrast is inherent to 77047
Impact: Missing contrast documentation can trigger downcoding to non-contrast code with payment reduction of $30-50
Separate professional and technical components when provider does not own equipment - bill with modifier 26 (professional) or TC (technical) to match actual service provided
Impact: Ensures accurate payment split and prevents overpayment recovery demands averaging $150-160 per claim
Do not separately bill CAD (computer-aided detection) as it is bundled into 77047 per CCI edits effective 2019
Impact: Prevents automatic denial and recoupment of $50-75 for unbundled CAD codes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77047 in 2025?

The 2025 Medicare national average payment for CPT 77047 is $215.10 for both facility and non-facility settings. This rate is based on 6.65 total RVUs multiplied by the 2025 conversion factor of $32.3465. Actual payment may vary by geographic locality based on the Medicare Administrative Contractor's adjusted rates.

Does CPT 77047 require prior authorization from Medicare or commercial insurance?

Medicare typically does not require prior authorization for 77047 when medical necessity is documented, though some Medicare Advantage plans do require it. Most commercial payers require prior authorization for breast MRI as it is considered advanced imaging. Failure to obtain required authorization results in automatic claim denial, so always verify with the specific payer before scheduling.

What is the difference between CPT 77047 and 77046?

CPT 77047 is for bilateral breast MRI with contrast (both breasts), while CPT 77046 is for unilateral breast MRI with contrast (one breast only). The bilateral code 77047 should only be used when both breasts are imaged. Using 77047 for a single-breast study will result in overpayment and potential recoupment, while using 77046 for bilateral imaging results in underpayment.

Can you bill CPT 77047 with mammography codes on the same day?

Yes, but you must append modifier 59 or XU to indicate a distinct procedural service and document separate medical necessity for each imaging modality. Many payers have edit rules that bundle same-day breast imaging, so clear documentation showing different clinical questions or findings requiring both studies is essential to prevent denial.

What diagnosis codes support medical necessity for CPT 77047?

Common supporting diagnosis codes include: Z15.01 (genetic susceptibility to breast cancer/BRCA), Z80.3 (family history of breast cancer), Z85.3 (personal history of breast cancer), N63.xx (unspecified lump in breast), R92.8 (abnormal mammogram findings), and Z12.31 (screening for breast cancer in high-risk patient). High-risk criteria typically require 20%+ lifetime risk based on risk assessment models.

How often can CPT 77047 be billed for the same patient?

For screening purposes in high-risk patients, most payers allow 77047 once per 12-month period. For diagnostic purposes (evaluating specific findings or monitoring known cancer), frequency is determined by medical necessity and may be more frequent. Medicare does not have a specific frequency limit but requires documentation supporting medical necessity for each study. Commercial payers often have strict annual limits for screening MRI.

What are the RVU values for CPT 77047 in 2025?

The 2025 RVU values for CPT 77047 are: Work RVU 1.6, Practice Expense RVU 4.96 (both facility and non-facility), and Malpractice RVU 0.09, totaling 6.65 RVUs. When multiplied by the 2025 conversion factor of $32.3465, this yields the Medicare payment rate of $215.10.