What modifiers should be submitted to ensure both a screening and diagnostic mammogram performed on the same date of service are reimbursed, and how do they help bypass NCCI edits?
To ensure payment for both the screening mammogram and the diagnostic mammogram(s), submit both CPT/HCPCS codes as appropriate with modifier GG assigned to the diagnostic mammogram code, and modifier 59 assigned to the screening mammogram code. When modifiers GG and 59 are used, this will allow both the screening and diagnostic test to be reimbursed on the same date of service, thereby bypassing National Correct Coding Initiative (NCCI) edits.
This question was answered in our Breast & Bone Density Procedure Coding Guide. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24