CPT 77049Radiology

Mri breast c-+ w/cad bi

CPT 77049 covers an MRI scan of the breast that includes computer-aided detection (CAD) software, which helps radiologists identify suspicious areas that might indicate cancer or other abnormalities.

Showing rates for

National Average

Base Medicare rate

$336.73

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

2.3

PE RVU (NF)

7.95

MP RVU

0.16

Total RVU

10.41

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

NCCI bundling edits

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Billing tips

Verify that CAD software analysis is documented in the radiology report and meets FDA approval requirements before billing 77049 instead of 77048
Impact: Using 77049 instead of 77048 adds approximately $45-60 per study when CAD is properly documented; incorrect coding risks audit and recoupment
Confirm contrast administration is documented with specific agent, dosage, and route; 77049 requires contrast enhancement unlike 77047
Impact: Missing contrast documentation can result in downcoding to 77047, reducing reimbursement by approximately $100-150 per study
Bill professional and technical components separately when services are split between facilities to maximize appropriate reimbursement
Impact: Splitting components allows each entity to receive their portion: TC receives approximately $262 and 26 receives approximately $75
Ensure medical necessity documentation supports high-risk screening or diagnostic indication; routine screening is not covered by Medicare
Impact: Lack of qualifying indication results in complete denial; appeals require strong clinical justification citing guidelines from ACR or NCCN
Verify payer-specific authorization requirements before scheduling; many commercial payers require pre-authorization for breast MRI with CAD
Impact: Missing pre-authorization can result in 100% denial of $336.73 Medicare rate or higher commercial rates ($800-1500)
Document bilateral imaging even if clinical concern is unilateral; 77049 is inherently bilateral and cannot be reduced with RT/LT modifiers
Incomplete bilateral documentation may trigger payer request for reduction to unilateral code, reducing payment by approximately 50%

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77049 in 2025?

The 2025 Medicare national average reimbursement for CPT 77049 is $336.73 for both facility and non-facility settings, based on 10.41 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT 77048 and 77049?

CPT 77049 includes computer-aided detection (CAD) analysis in addition to the MRI imaging, while 77048 is breast MRI with contrast without CAD. The CAD component adds approximately $45-60 to the reimbursement and requires specific documentation of the CAD software and findings.

Does Medicare cover CPT 77049 for breast cancer screening?

Medicare does not cover routine breast MRI screening with 77049. Coverage requires documented high-risk factors such as BRCA mutations, strong family history, prior chest radiation, or diagnostic indications like extent of disease evaluation or problem-solving for suspicious findings.

Can CPT 77049 be billed with modifier 26 or TC?

Yes, CPT 77049 can be split using modifier 26 for professional component (interpretation) or modifier TC for technical component (equipment and performance). This is common when the radiologist interpreting is at a different facility than where the MRI was performed.

How many RVUs is CPT code 77049 worth?

CPT 77049 has a total of 10.41 RVUs for 2025, consisting of 2.3 work RVUs, 7.95 practice expense RVUs, and 0.16 malpractice RVUs.

What documentation is required to bill CPT 77049 with CAD?

Required documentation includes the specific CAD software name and version, confirmation of FDA approval, explicit statement that CAD analysis was performed, CAD-identified findings, and how the CAD results influenced the radiologist's interpretation and final report.

Can CPT 77049 be billed with same-day mammography codes?

Yes, but it requires careful documentation of medical necessity for both procedures and may require modifier 59 to indicate a distinct procedural service. The MRI must have a separate clinical indication or be ordered for different diagnostic purposes than the mammography to avoid bundling denials.