What is CPT code 77067?
CPT code 77067 covers a screening mammography of both breasts, two views per breast, including computer aided detection when performed.
CPT code 77067 covers a screening mammography of both breasts, two views per breast, including computer aided detection when performed.
The American Medical Association introduced it in January 2017 as part of a three code restructure that folded CAD into the base codes. You no longer bill CAD separately. That single change eliminated the old add on codes 77051 and 77052, and it still trips up practices running outdated charge masters nine years later.
Screening means the patient has no signs or symptoms. If she came in because she felt a lump, you’re not in 77067 territory anymore. You’re in diagnostic mammography, and the code changes. Getting this distinction right sits at the center of screening mammography coding rules.
Free resource
Radiology coding rules shift more often than most specialties. Our breast imaging coding checklist breaks down every mammography, ultrasound, and MRI code pairing in one page. Download it free.
The three mammography codes and when each applies
Most denials in this family come from picking the wrong code, not from documentation gaps.
There’s no unilateral screening code. If a patient had a mastectomy and you’re screening the remaining breast, you still report 77067 with modifier 52 for reduced services. Some payers want modifier 52. Some want you to report it without any modifier and let the diagnosis code carry the explanation. Check your top five payers individually, because they don’t agree with each other on this one. Our CPT 77066 diagnostic mammography guide covers the diagnostic side in the same depth.
Which ICD 10 codes pair with 77067
Screening mammography needs a screening diagnosis, and Z12.31 carries the majority of clean 77067 claims.
- Z12.31 — encounter for screening mammogram for malignant neoplasm of breast. This is your workhorse code. Use it on the majority of 77067 claims.
- Z80.3 — family history of malignant neoplasm of breast. Report as a secondary code when relevant. It supports medical necessity for earlier or more frequent screening.
- Z15.01 — genetic susceptibility to malignant neoplasm of breast. Use for BRCA positive patients. Also secondary.
Do not pair 77067 with a symptomatic diagnosis like N63, unspecified lump in breast. That mismatch is one of the fastest denials in radiology billing. The code says screening, the diagnosis says the patient has a problem, and the payer’s edit catches the contradiction before a human ever looks at it.
Modifiers that matter for 77067
Four modifiers show up regularly on screening mammography claims: 26, TC, 33, and GG.
Modifier 26 and TC
Report modifier 26 for the professional component (the radiologist’s interpretation) and TC for the technical component (the equipment and technologist). If your practice owns the equipment and employs the reading radiologist, bill globally with no modifier. Freestanding imaging centers that contract their reads almost always split these. Our medical coding services team handles split billing arrangements across every imaging modality.
Modifier 33
Preventive services modifier. The Affordable Care Act requires most commercial plans to cover screening mammography with no patient cost sharing. Modifier 33 tells the payer this is a preventive service so cost sharing gets waived. Medicare doesn’t require it, but many commercial payers do. Missing modifier 33 doesn’t usually deny the claim. It just sticks your patient with a copay she shouldn’t owe, and then she calls your front desk angry.
Modifier GG
Report modifier GG when a screening mammogram converts to a diagnostic study on the same day. The radiologist sees something on the screening images and orders additional views immediately. You bill the diagnostic code with modifier GG and the screening code, and Medicare pays both.
Modifier 52
Reduced services, used for post mastectomy unilateral screening as covered above.
Medicare frequency rules and why they cause denials
Medicare covers one screening mammogram every 12 months for women aged 40 and older, plus one baseline screening for women aged 35 to 39.
The frequency rule is where practices lose money without realizing it. Medicare counts 11 full months from the month of the last screening, so a patient screened in March 2025 becomes eligible again in March 2026, not April. Claims submitted a few weeks early deny for frequency, and most practices write them off instead of resubmitting after the eligibility date passes.
Run a frequency check against the Medicare Claims Processing Manual, Chapter 18 before you submit. Better yet, build the check into your eligibility verification workflow so it happens before the patient arrives. That’s one step in how mammography claims move through the revenue cycle.
Frequency denials are preventable
Screening frequency denials rarely get worked because they look like small write offs. Across a year they aren’t small. Our team runs eligibility and frequency verification before the appointment, so the claim goes out clean the first time.
The five reasons 77067 claims get denied
Diagnosis mismatch, frequency edits, missing component modifiers, retired CAD codes, and missing orders account for nearly every CPT 77067 denial we audit.
- Diagnosis mismatch. A symptomatic ICD 10 code paired with a screening CPT code. Fix the order at intake, not at billing.
- Frequency edit. Submitted before the 11 month window closed. Hold and resubmit rather than write off.
- Missing modifier 26 or TC. Split billing arrangements where the claim went out globally. The payer pays one component and denies the rest.
- Outdated CAD add on codes. Charge masters still carrying 77051 or 77052. These have been invalid since 2017 and deny automatically.
- No order on file. Screening mammography requires a referring provider order for Medicare. A missing NPI on the claim triggers a denial that looks like a coding problem but isn’t.
Four of those five get caught before submission if someone runs a scrub. The fifth gets caught at scheduling. Practices that route these through structured denial management recover most of what they’d otherwise write off.
Reimbursement expectations for CPT 77067
The 2026 Medicare Physician Fee Schedule national average for 77067 global runs roughly in the $130 to $145 range.
The technical component carries most of that value, and the professional component lands near $35 to $45. Your geographic practice cost index shifts the actual number, sometimes by 15 percent or more between a rural Texas locality and a major metro.
Pull your own numbers from the CMS Physician Fee ScheduleLook Up Tool rather than trusting a national average. Commercial rates typically land above Medicare for screening mammography because payers want utilization up on preventive services. If you run an imaging center, our radiology billing for imaging centers page covers the full modality mix.
Documentation checklist for a clean 77067 claim
The radiologist’s report must state the study was screening, document both breasts in two views each, and carry a BI RADS assessment.
- Statement that the study was screening, not diagnostic
- Both breasts imaged, two views each, CC and MLO at minimum
- Breast density category per the Mammography Quality Standards Act
- BI RADS assessment category
- Signature and date
- Referring provider name and NPI on the order
BI RADS 0, meaning incomplete and needs additional imaging, doesn’t change the code you bill for the screening study. It just means a diagnostic follow up is coming, which becomes a separate claim on a separate date unless the conversion happens same day with modifier GG.
FAQ
What is CPT code 77067 used for?
CPT Code 77067 reports a bilateral screening mammogram with two views per breast, including computer aided detection when performed. It applies only to patients with no breast symptoms or signs.
What is the difference between CPT 77067 and 77066?
CPT Code 77067 is screening. CPT Code 77066 is bilateral diagnostic mammography, used when the patient has symptoms, an abnormal screening result, or a personal history of breast cancer.
What ICD 10 code goes with CPT 77067?
Z12.31 is the primary diagnosis code for screening mammography. Add Z80.3 for family history or Z15.01 for genetic susceptibility as secondary codes when documented.
Does Medicare cover CPT 77067?
Yes. Medicare covers one screening mammogram every 12 months for women 40 and older, and one baseline screening for women 35 to 39. Medicare waives the deductible and coinsurance for this service.
Do I need modifier 33 on CPT 77067?
Many commercial payers require modifier 33 to identify the service as preventive and waive patient cost sharing. Medicare doesn’t require it. Check payer specific policies for your top contracts.
Can you bill 77067 for a unilateral screening?
There’s no unilateral screening code. For post mastectomy patients screening one breast, report 77067 with modifier 52 for reduced services, subject to payer preference.
How much does Medicare pay for CPT 77067?
The 2026 national average for the global service runs roughly $130 to $145, split between technical and professional components. Your actual rate depends on your geographic practice cost index.
Stop writing off radiology denials
Mammography coding looks simple until the frequency edits and modifier mismatches start stacking up. Docscare handles radiology and imaging billing for practices across all specialties, with a 99 percent clean claim rate and a 30 percent average revenue increase for clients. We catch the coding problems before the claim goes out.
