Are your patients due for mammograms?
October is National Breast Cancer Awareness Month, so now is a great time to schedule mammograms and encourage your patients to do regular breast self-exams. Priority Health covers a mammogram every one to two years for women between ages 40 and 49, and annually for ages 50 and older.
- You can use your monthly Filemart reports or Patient Profile Health Condition Search to identify patients who are due for mammograms.
- Included in the PIP Mammography measure are women ages 42-69 with either HMO/POS or Priority Health Medicaid coverage.
- Women who have had a bilateral mastectomy, or two unilateral mastectomies, can be removed from the PIP measure via Patient Profile or the supplemental data spreadsheet.
Please use the following codes when billing for breast cancer screening services:
| Code |
Description |
| G0202 |
Screening mammography, producing direct digital image,
bilateral, all views |
| G0204 |
Diagnostic mammography, producing direct digital image,
bilateral, all views |
| G0206 |
Diagnostic mammography, producing direct digital image,
unilateral, all views |
| 77051 |
Computer-aided detection, with or without digitization of
radiographic images; screening mammogram (add-on code) |
| 77052 |
Computer-aided detection with further physician review for
interpretation, with or without digitization of film radiographic
images; screening mammography (add-on code) |
| 77055 |
Mammography, unilateral |
| 77056 |
Mammography, bilateral |
| 77057 |
Screening mammography, bilateral (two-view film study
of each breast) |
Topics: Incentives
