Scr mammo bi incl cad
CPT code 77067 covers a screening mammogram of both breasts that includes computer-aided detection (CAD) to help identify potential abnormalities. This is a preventive service for patients without symptoms or known breast problems.
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
Verify Medicare frequency requirements: screening mammography is covered once every 12 months for women age 40+, with no minimum age requirement per Medicare guidelines effective 2024
Impact: Prevents automatic denials for frequency violations which account for 30-40% of screening mammography claim rejections
Do not bill 77067 with diagnostic mammography codes (77065, 77066) without modifier GG when both performed same day after abnormal screening finding
Impact: Without modifier GG, bundling edits will deny the diagnostic study, potentially losing $200+ in additional reimbursement
Ensure facility has current FDA certification and MQSA compliance documentation; include facility certification number in claims for audits
Impact: Non-certified facilities face 100% claim denial and potential exclusion from Medicare participation
Bill with diagnosis code Z12.31 (encounter for screening mammogram for malignant neoplasm of breast) as primary diagnosis, not symptom or finding codes
Impact: Using symptom codes converts screening to diagnostic status, triggering denials and requiring patient cost-sharing instead of $0 preventive benefit
For split billing scenarios, ensure TC and 26 modifiers are coordinated between facility and physician to equal 100% of allowed amount ($124.53 total)
Impact: Mismatched component billing can result in overpayment recovery or underpayment by approximately 40-60% of total reimbursement
Document and bill same-day ultrasound or other imaging separately with appropriate modifiers; screening mammography does not include supplemental screening
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