ACR Disagrees With CMS Breast Tomosynthesis Coding Guideline

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The ACR has asked the Centers for Medicare and Medicaid Services (CMS) to revise a coding recommendation posted in a November 6 CMS website FAQ because it tells providers to use codes for digital breast tomosynthesis that do not accurately describe the procedure or the work and expense involved in performing this test.

CMS has not issued a formal CPT code specifically for digital breast tomosynthesis and in the FAQ advised providers to code the procedure using one of the full-field digital mammography codes G0202, G0204 and G0206.

The ACR maintains that instead breast tomosynthesis performed together with digital mammography should be coded with the unlisted diagnostic procedure code 76499 to describe breast tomosynthesis and one of the HCPCS Level II “G” codes (G0202, G0204, or G0206) to describe the full-field digital mammography performed. If computer-aided detection (CAD) is also used, that should be coded separately. (Read the ACR's coding recommendation here.)

The Academy has applied to CMS for a digital breast tomosynthesis CPT code for the February 2014 CPT Editorial Panel meeting, and if approved, a code would be available for the 2015 code cycle.