Breast tomosynthesis bi
CPT code 77063 covers bilateral breast tomosynthesis, commonly known as 3D mammography, which creates layered images of both breasts to improve breast cancer detection compared to traditional 2D mammography.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Always bill 77063 as an add-on code to the primary mammography code (77065, 77066, or 77067); it cannot be billed as a standalone procedure
Impact: Billing without a primary mammography code results in automatic denial; proper sequencing ensures the full $50.78 reimbursement
Verify patient insurance coverage for tomosynthesis before the procedure, as not all commercial payers cover 3D mammography at the same rate as Medicare
Impact: Commercial payer reimbursement varies from $0 to $150+ depending on state mandates; some patients may face unexpected out-of-pocket costs if not verified
Ensure documentation clearly states that tomosynthesis was performed bilaterally; if only one breast was imaged, use the unilateral code instead
Impact: Billing bilateral code for unilateral service constitutes upcoding and may result in recoupment of the full $50.78 plus penalties
Check for state-specific mandates requiring insurance coverage of breast tomosynthesis; over 35 states have enacted such legislation as of 2025
Impact: State mandates often eliminate cost-sharing for screening tomosynthesis; awareness prevents incorrect patient billing and improves collections
For split billing scenarios, ensure modifier 26 or TC is appended correctly and that both components don't exceed the global reimbursement amount
Impact: Incorrect modifier use can result in payment of only one component or denial for duplicate billing
Monitor LCD/NCD policies as Medicare coverage for screening tomosynthesis has evolved; current coverage typically follows standard screening mammography guidelines
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