CPT 77048Radiology

Mri breast c-+ w/cad uni

CPT 77048 covers an MRI scan of one breast that includes computer-aided detection (CAD) technology to help identify abnormalities. The computer software analyzes the images to highlight areas that may need closer examination.

Showing rates for

National Average

Base Medicare rate

$330.58

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

2.1

PE RVU (NF)

7.97

MP RVU

0.15

Total RVU

10.22

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

NCCI bundling edits

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Billing tips

Always append RT or LT modifier to specify laterality
Impact: Prevents automatic denial for missing laterality information, which accounts for 15-20% of initial claim rejections for this code
Verify that CAD post-processing was actually performed and documented before using 77048 instead of 77047
Impact: CPT 77048 includes CAD while 77047 does not; incorrect code selection can result in overpayment recovery or underpayment of approximately $30-50
For bilateral breast MRI with CAD, bill 77049 instead of two units of 77048
Impact: Prevents claim denial for incorrect coding; 77049 is the specific bilateral code with its own reimbursement structure
Document the specific medical necessity indication (high-risk screening, extent of disease, treatment response, problem-solving)
Impact: Medicare and commercial payers have specific coverage criteria; inadequate documentation leads to 25-30% denial rate for lack of medical necessity
Ensure contrast administration is documented with type, dose, and route
Impact: Code descriptor includes contrast; missing documentation can trigger downcoding or denial, affecting the full $330.58 reimbursement
Do not separately bill for CAD analysis (77046, 77047, 77048, 77049 are bundled codes)
Impact: Attempting to unbundle CAD results in denial and potential audit flags; all CAD work is included in the $330.58 payment

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77048 in 2025?

The 2025 Medicare national average payment for CPT 77048 is $330.58 for both facility and non-facility settings. This rate is based on 10.22 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local Medicare Administrative Contractors may have slight geographic variations.

What is the difference between CPT 77048 and 77047?

CPT 77048 includes computer-aided detection (CAD) post-processing while 77047 is breast MRI with contrast without CAD. Both are unilateral codes. If CAD software analyzes the MRI images and generates markers or findings, use 77048. The CAD component adds value to the interpretation and justifies the code selection.

Do I need to use modifier 50 for bilateral breast MRI with CAD?

No, do not use modifier 50 with 77048. For bilateral breast MRI with CAD, use CPT 77049 instead. CPT 77049 is the specific code for bilateral breast MRI with contrast and CAD. Using 77048 with modifier 50 or billing two units of 77048 will result in claim denial or incorrect payment.

How many RVUs is CPT 77048 worth in 2025?

CPT 77048 has 10.22 total RVUs in 2025, consisting of 2.1 work RVUs, 7.97 practice expense RVUs, and 0.15 malpractice RVUs. The facility and non-facility PE RVUs are identical at 7.97, which is why both settings have the same payment rate of $330.58.

Is contrast material required for CPT 77048?

Yes, CPT 77048 includes 'c-+' in the descriptor, indicating contrast material is required. The code assumes intravenous gadolinium-based contrast administration. If MRI breast is performed without contrast, a different code (77046 series) would apply. Documentation must show contrast type, dose, and administration.

Can I bill 77048 for breast cancer screening?

Yes, but only for patients meeting high-risk screening criteria established by Medicare and commercial payers. Typical criteria include BRCA mutation carriers, lifetime risk >20% based on risk models, personal history of breast cancer, or history of chest radiation between ages 10-30. Standard-risk screening is generally not covered.

What modifiers are required when billing CPT 77048?

RT (right) or LT (left) modifier is required to indicate which breast was imaged, as 77048 is a unilateral code. Additional modifiers like 26 (professional component) or TC (technical component) are used when billing is split between physician and facility. Modifier 59 may be needed to indicate distinct procedural service if performed with other procedures.