Breast Imaging, Percutaneous Biopsy, Coding

Breast Imaging

  1. Mammography
    1. Screening vs diagnostic
    2. Coverage policies
    3. Breast density
    4. Tomosynthesis (3-D mammography)
  2. WBUS
  3. Intra-operative imaging
    1. US
    2. Specimen X-ray
  4. Molecular Imaging
  5. PET Mammography




Screening mammography is a preventive service for asymptomatic women.
Medicare waives the coinsurance or copayment and the Medicare Part B deductible for screening mammography (USPSTF 2002 recommendations)

Age of Woman


Younger than age 35

No Medicare payment allowed

Aged 35–39years

Baseline (Medicare pays for only one screening for women in
this age group)

Aged 40 and older

Annual (at least 11 months after the last covered screening mammography)


  • Diagnostic mammography
  • Beneficiary pays any applicable coinsurance or copayment and Medicare Part B deductible

Medicare covers  diagnostic  mammography  under  the following conditions:

  • An individual has distinct signs and symptoms for which mammography is indicated;
  • An individual has a history of breast cancer or a personal history of biopsy-proven benign breast disease; or
  • An individual is asymptomatic, but based on the individual’s history and other factors the physician considers significant, the physician’s judgment is that mammography is appropriate.

Project details

Tags: Breast Biopsy

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