3-D Mammo

CA locations

http://www.checksutterfirst.org/imaging/services/b...

https://www.lassenmedical.com/services/3d-mammogra...

http://www.hoag.org/Specialty/Breast-Program/Pages...

https://www.elcaminohospital.org/

http://www.nsradiology.com/locations/north-state-i...

https://www.pvhmc.org/#About_3D_Mammography

http://mdimaging.net/services/3D-mammography.php

3D mammo completed in June 2015; I was one of the first to use the new equipment; I have Aetna; billing code 77062/radiology = 3DMammo; is not a covered expense because it's considered experimental by my insurance company. I am appealing the decision and requesting the hospital oncology department address this issue and provide supporting evidence, as this has now replaced the 2D equipment. Someone forgot to update their billing data to cover said oncology machine upgrades for hundreds of hospitals across the US. Unless we (the cancer patients) say something, the patient will get billed when the performing facility should have the billing changes coordinated with the insurance companies on what is current and accurate with new equipment, not experimental equipment.

Billed amount: $590

Ineligible amount: $155

Approved amount: $235

Not covered amount: $200 (appealing this charge)

https://www.supercoder.com/my-ask-an-expert/topic/...

User id : 23481 Posted 9 months ago

Our facility performs digital mammograms - are these new codes used to report digital mammograms?

SuperCoder Posted 9 months ago

You will continue to bill the same way for digital mammogram as you were doing.

These new codes are introduced to include the practice expense of breast tomosynthesis when done with digital mammogram. Breast tomosynthesis is a new technology.

Digital mammography with breast tomosynthesis involves "two separate data acquisitions with two different sets of images, requiring the accompanying increased physician work and training," the association explained. "Digital mammography alone requires a single data acquisition per view, producing one image set involving less physician work and training to interpret."

Until now, no separate CPT codes existed for breast tomosynthesis, and providers assigned unlisted diagnostic radiographic procedure code 76499. These new codes 77061, 77062, and 77063 are introduced to address diagnostic and screening breast tomosynthesis.

Thanks !!

Percy, I have had several years of 3-D mammos now and my insurance covered it every time (two different companies as my employer changed carriers) so not sure why the above person's insurance is being so tough. It has become a standard treatment at Yale which is my provider. One of the two insurance companies that paid for the 3-d was Aetna btw. Check with your carrier.

It is NOT experimental anymore and almost all BC centers are using it. I do not understand the denial by insurance. If I were you Suz-Q, I would appeal it and see if you win. Often they try to get away with it but if your doctor appeals to the insurance saying it is better for you, they will allow it. Hugs and hope you get your approval.

Edited to add that you can appeal even after the fact meaning if you pay the 160, they have to reimburse you if you win the appeal...something to think about.