DBT gets its due: CMS establishes add-on payment codes for 3D mammography
Responding to calls to offer payment for 3D mammography, or digital breast tomosynthesis (DBT), the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that will go into effect Jan. 1, 2015, and extend additional payment when DBT is performed along with 2D digital mammography.
The payment policy was included in CMS’ recent final rule that updates payment rates under the Medicare Physician Fee Schedule. Prior to the update, there were not separate codes to pay for the extra resources needed for DBT.
CPT code 77063 can now be used for screening DBT and is assigned a payment rate of approximately $57. This is an add-on to G0202, a 2D mammography screening code with an assigned payment rate of approximately $135.
The other change was establishing HCPCS code G0279 for diagnostic DBT, which also assigns a payment rate of $57 for unilateral or bilateral images. This is an add-on to existing 2D mammography codes G0206 and G0204, which covered unilateral and bilateral images, respectively.
CMS said it will revisit payment for DBT and 2D mammography for 2016 as part of a review under its misvalued codes initiative.
Evan joined TriMed in 2011, writing primarily for Health Imaging. Prior to diving into medical journalism, Evan worked for the Nine Network of Public Media in St. Louis. He also has worked in public relations and education. Evan studied journalism at the University of Missouri, with an emphasis on broadcast media.