Breast Cancer ScreeningBreast cancer is regarded as a prominent cause for premature mortality among US women. Since early detection can help to reduce breast cancer morbidity and mortality, breast cancer screening is very important for women’s health care. However, the American Cancer Society (ACS) updated its breast cancer screening guidelines for women who are at an average risk of developing breast cancer. This is the first update since 2003, which should be considered by both physicians and women in their discussion regarding breast cancer screening. The physicians should also bear this update in mind when it comes to radiology medical billing.

The ACS set the recommendations after commissioning a systematic evidence review of breast cancer screening. The previously recommended age for women to start screening with mammography was 40. After examining the data carefully, the guideline development group found the burden of disease among the women aged 40 to 54 is not uniform. It was concluded that the breast cancer risk is lower for women aged 40 to 44 while considering incidence and the risk of a false positive is a bit higher. With this conclusion, the earlier recommendation to begin screening at 40 has become invalid.

The new ACS breast cancer screening recommendations published in the JAMA journal are as follows.

  • Women having an average risk for breast cancer should undergo regular screening mammography beginning at age 45 years (strong recommendation)
  • Women aged 45 to 54 years should be screened annually (qualified recommendation)
  • Women 55 years and older should transition to biennial screening or have the opportunity to go on with their annual screening (qualified recommendation)
  • Women should have the opportunity to start annual screening between the ages of 40 and 44 years (qualified recommendation)
  • Women should continue screening mammography until their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation)
  • Clinical breast examination is not recommended for breast cancer screening among average-risk women at any age (qualified recommendation)

It is not clear whether these guidelines will have an impact on health insurance plans. Normally, health plans examine medical guidelines and evidence from different sources for developing their coverage rules. The new recommendations may provide insurance plans a different framework to evaluate their coverage decisions. It is expected that there may not be any significant impact since most health plans cover mammogram for women age 40 to 50 if recommended by relevant physician. Even so, it is always better to bill your claims for mammography with the help of experts in this field or professional medical billing and coding companies.

You can use the following CPT/HCPCS codes to report screening mammography.

  • Analog (conventional) Mammography: Bilateral Screening Mammogram 77057
  • Digital Mammography: Bilateral Screening Mammogram G0202
  • Digital mammogram with CAD: Computer Aided Detection (CAD) 77052 (add-on code to be used with 77057 and G0202)

Since screening mammography is considered bilateral, there is no need to report the code with modifier 50 or RT/LT.