Revenue Cycle Management Services
Medical Billing Services
Specialized Services
Operational Finance
Credentialing (CVO)
Enrollment & Licensing
Patient Access & Contact Center
Authorization & Verification
Neolytix Growth Services
Payer Analytics & Contract Strategy
Workforce & Recruitment
The Full Lifecycle
InCredibly
Operational Dashboards & Reporting
Integrated Partner Ecosystem
Multi-Location & Specialty Groups
Behavioral Health Organizations
PE-Backed Platforms & MSOs
FQHCs & Community Health
Rural RHC
How We Think / About
Careers
Articles
Billing & Coding Guides
Case Studies
Events & Press
Industry Reports & Benchmarks
Testimonials
- Key Takeaways
- CPT code 77067 reports a bilateral screening mammography for an asymptomatic patient, a preventive service paired with ICD-10 Z12.31, encounter for screening mammogram.
- 77067 is for screening only; a symptom like a lump or pain, or follow-up of an abnormality, makes it diagnostic (77065 or 77066) instead.
- Medicare retired the G-codes G0202, G0204, and G0206 in 2018, so screening mammography is billed as 77067; submitting G0202 today denies as an invalid code.
- As a USPSTF-recommended preventive service, screening mammography is covered with no cost-sharing under ACA plans, and Medicare waives the deductible and coinsurance.
- Add 77063 for same-session 3D tomosynthesis, and use modifier GG when a screening converts to a diagnostic mammogram on the same day so both can be billed.
In April 2024, the US Preventive Services Task Force lowered the recommended age to begin breast cancer screening from 50 to 40, recommending a mammogram every two years for women 40 to 74. That single change extended eligibility for no-cost screening to roughly 20 million more people. CPT code 77067 is the code behind that screening, and its billing turns on one distinction that most other codes do not have to worry about: whether the study was a screening or a diagnostic exam. That choice decides the code, the diagnosis, the reimbursement, and, increasingly, whether the patient gets a bill. This guide works through the scenarios that decide it.
77067 is used by imaging centers, dedicated breast centers, hospitals, and the radiologists who interpret the studies. It replaced the former screening code 77057 in 2017.
Current as of 2026. Always verify code status and payment with your specific payer, since policies change.
What 77067 covers
77067 reports a bilateral screening mammography: a routine, scheduled breast cancer screening for a patient with no breast symptoms. “Screening” is the operative word. It applies only when the patient is asymptomatic and the exam is preventive, and it is paired with the screening diagnosis Z12.31, encounter for screening mammogram. If the patient has a symptom or an abnormal finding to work up, the study is diagnostic, and a different code applies.
Two facts inside the descriptor drive most of the billing decisions
The full descriptor is “screening mammography, bilateral,” and both words do real work.
- Screening means asymptomatic and preventive. The moment a symptom or an abnormal finding is in play, the study is diagnostic, not 77067. This single word decides the code, the diagnosis, and the patient’s cost-sharing.
- Bilateral means both breasts in one code. 77067 is not reported per side and takes no laterality modifier. A one-sided study is a different situation, generally diagnostic and unilateral (77065).
Hold onto those two facts and most 77067 questions answer themselves.
- Neolytix • Medical Billing
Medical Billing
Three scenarios that decide the code
Almost every 77067 question comes down to which of these a given visit is.
Scenario one: the routine annual screening. A 52-year-old with no breast complaints comes in for her scheduled mammogram. No lump, no pain, no prior abnormal finding. This is a true screening: 77067, paired with Z12.31, covered as a preventive service with no patient cost-sharing.
Scenario two: the screening that finds something. The same patient’s screening mammogram shows a suspicious area, and the radiologist performs additional diagnostic views the same day. Now two services happened: the screening (77067) and a diagnostic mammogram (77066). Both can be billed, with modifier GG appended to the diagnostic code to show that a screening and a diagnostic mammogram were performed on the same patient on the same day.
Scenario three: the symptomatic patient. A patient presents because she felt a lump. This is not a screening at all, even though it is a mammogram. Because a symptom is present, the correct code is a diagnostic mammogram (77065 unilateral or 77066 bilateral), not 77067. Billing 77067 here, or billing a diagnostic code for scenario one, is the error that drives denials.
Screening versus diagnostic, and why the diagnosis drives it
The line between 77067 and the diagnostic codes is the single most important thing to get right, and the diagnosis code is how payers police it. A screening mammogram is reported with a screening diagnosis (Z12.31). A diagnostic mammogram is reported with the symptom or finding that prompted it (a breast lump, pain, or an abnormal prior study).
Two errors cluster here. The first is a mismatch: pairing 77067 with a symptom diagnosis, which contradicts itself and denies. The second is upcoding: billing a diagnostic code when the visit was truly a screening. Diagnostic mammography reimburses more than screening, so payers audit the diagnosis to validate the distinction, and a pattern of diagnostic billing on screening visits is a flagged overpayment risk.
There is a patient-cost dimension that makes this more than a coding nicety, and it is becoming a live issue. Screening mammography is covered at no cost-sharing, but the diagnostic follow-up after an abnormal screening is not federally required to be free, so a patient can face an unexpected bill for the diagnostic workup. At least a dozen states have passed laws eliminating cost-sharing for diagnostic breast imaging, so the correct screening-versus-diagnostic coding, and the patient’s state and plan, together determine what she owes.
The ICD-10 side: Z12.31 does the heavy lifting
For 77067, the diagnosis code is not a formality; it is the proof that the exam was a screening. The pairing is specific:
- Z12.31, encounter for screening mammogram for malignant neoplasm of breast, is the primary diagnosis for 77067. It tells the payer the patient was asymptomatic and the exam was preventive, which is what unlocks no-cost-sharing coverage.
- Z80.3, family history of malignant neoplasm of breast, can be added as a secondary code when relevant, but it does not replace Z12.31 and does not convert the exam to diagnostic.
- A symptom code (a breast lump, N63.x; breast pain, N64.4) does not belong on a 77067 claim. If one of those is the reason for the exam, the study is diagnostic, and the code changes to 77065 or 77066.
Because the diagnosis is what payers audit to validate screening versus diagnostic, a mismatched ICD-10 is one of the most common and most avoidable 77067 denials.
The Medicare G-code myth still causing denials
Here is an error that survives in chargemasters and in published billing guides years after it stopped being correct. Some sources still tell billers that Medicare wants G0202 for screening mammography instead of 77067. That has not been accurate since January 1, 2018.
What happened: in 2017, CMS created temporary G-codes (G0202 for screening, G0204 and G0206 for diagnostic) while claims systems transitioned to the new CPT codes. Effective January 1, 2018, CMS retired all three and adopted 77065, 77066, and 77067. Since then, 77067 is the screening mammography code Medicare accepts, and submitting G0202 today returns a denial for an invalid code.
Two practical points:
- Use 77067 for Medicare screening mammography. If a crosswalk, superbill, or chargemaster still lists G0202, update it.
- One mammography G-code does still exist: G0279, diagnostic breast tomosynthesis. It is billed with the diagnostic mammography codes 77065 or 77066, never with screening (77067).
The 3D tomosynthesis add-on (77063)
Many screening mammograms today include 3D imaging, and that is a separate add-on code. When digital breast tomosynthesis is performed with the 2D screening, report 77063 (screening digital breast tomosynthesis, bilateral) in addition to 77067. The two are billed together for a combined 2D and 3D screening. 77063 is an add-on, so it is not reported alone for screening; it attaches to the base screening code. Coverage and any cost-sharing for the 3D component can vary by payer, so verify the patient’s benefit.
Cost-sharing and frequency
Because 77067 is a USPSTF-recommended preventive service, it is covered with no cost-sharing under ACA-compliant plans, and Medicare waives the deductible and coinsurance for the annual screening. Frequency rules do apply, and this is a common denial point:
- Medicare covers one screening mammogram every 12 months for women age 40 and older, and one baseline for women 35 to 39.
- The USPSTF recommends biennial (every two years) screening for ages 40 to 74, while some medical societies and many commercial plans support annual screening. Coverage frequency follows the plan.
Billing 77067 more often than the plan allows results in a frequency denial, so confirm the patient’s last screening date and the plan’s interval.
Does CPT 77067 need a modifier?
In the simple case, no. A routine screening mammogram is reported as 77067 with no modifier. Modifiers come into play in specific situations:
- GG: when a screening converts to a diagnostic mammogram on the same day, appended to the diagnostic code so both are payable.
- 26 and TC: the professional and technical components, when the radiologist and the facility bill separately. Bill 77067 globally, with no modifier, when one entity performs and interprets.
- 76 or 77: a repeat study by the same (76) or a different (77) provider, with documentation supporting the repeat.
Modifiers that do not belong: there is no laterality modifier, since 77067 is inherently bilateral, and no contrast modifier, since mammography does not use IV contrast.
Reimbursement
77067 is paid under the Medicare Physician Fee Schedule and split across its components, with the technical portion the largest share, the professional the smallest, and the global service the sum of both. Screening mammography reimburses less than diagnostic mammography, which is precisely why the screening-versus-diagnostic distinction is audited. Treat any single figure as illustrative and confirm the current rates for your code, component, and setting through the CMS Physician Fee Schedule Look-Up Tool, which updates annually.
Related codes
- Diagnostic mammography: 77065 (unilateral), 77066 (bilateral), for symptomatic patients or abnormal-screening follow-up.
- Screening tomosynthesis: 77063, the 3D add-on to 77067.
- Diagnostic tomosynthesis: 77061 (unilateral), 77062 (bilateral); G0279 is the Medicare diagnostic tomosynthesis add-on, billed with 77065 or 77066.
The organizing rule: screening is asymptomatic and preventive (77067, with Z12.31); diagnostic is symptom-driven or follow-up (77065 or 77066, with the clinical diagnosis). Our guide to CPT code 99396 covers the same no-cost-preventive logic on the office-visit side.
The bottom line
77067 is a high-volume preventive code with one decision at its center: screening or diagnostic. Code the asymptomatic screening as 77067 with Z12.31, move to a diagnostic code the moment a symptom or finding is in play, use modifier GG when a screening converts the same day, add 77063 for 3D, retire any lingering G0202, and watch the frequency interval. Get that right and the patient keeps her no-cost benefit and the claim clears. For practices that would rather not police the screening-versus-diagnostic line and the frequency rules exam by exam, Neolytix has supported healthcare organizations across the United States for over 14 years, with imaging and preventive coding review built into its medical billing services so mammography claims are clean before they go out.
- Neolytix • Contact Us
Schedule a Consultation
Neolytix partners with healthcare organizations across revenue cycle, credentialing, and administrative operations ,14+ years of expertise and AI-enabled automation to reduce inefficiencies and drive sustainable growth.
This guide reflects Neolytix’s expertise in healthcare revenue cycle management and is intended for educational purposes only. It does not constitute legal or compliance advice. CPT codes and reimbursement rates are periodically updated by the AMA and CMS.
Sources
- US Preventive Services Task Force. Breast Cancer: Screening (2024 recommendation, biennial, ages 40 to 74). https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
- National Institutes of Health, National Library of Medicine. Cancer screening coverage and the screening-to-diagnosis cost-sharing gap. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453166/
- Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chapter 23 (Mammography Services) and Transmittal R3844CP (retirement of G0202, G0204, G0206). https://www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only-manuals-ioms
- American Medical Association. CPT mammography codes (77067, 77066, 77065, 77063). https://www.ama-assn.org/practice-management/cpt
- AAPC. CPT code 77067 reference. https://www.aapc.com/codes/cpt-codes/77067
Frequently Asked Questions
What is CPT code 77067 used for?
77067 reports a bilateral screening mammography for an asymptomatic patient, as a preventive breast cancer screening. It is used for routine, scheduled screening in patients with no breast symptoms, paired with ICD-10 Z12.31. It is billed by imaging centers, breast centers, hospitals, and the interpreting radiologists. It replaced the former code 77057 in 2017.
What is the difference between 77067 and 77066?
77067 is screening mammography, bilateral, for an asymptomatic patient. 77066 is diagnostic mammography, bilateral, used when the patient has a symptom such as a lump or pain, or needs follow-up of an abnormal screening. The deciding factor is whether symptoms or an abnormal finding exist. Diagnostic codes reimburse more, so payers audit the diagnosis.
What ICD-10 code is used with 77067?
The standard diagnosis for 77067 is Z12.31, encounter for screening mammogram for malignant neoplasm of breast. Because 77067 is a screening code, it must be paired with a screening diagnosis, not a symptom code. Z80.3 may be added for family history. Pairing 77067 with a symptom diagnosis like a breast lump is a mismatch that causes denials.
Does Medicare still use G0202 for screening mammography?
No. Medicare retired G0202, along with G0204 and G0206, effective January 1, 2018, and adopted the CPT codes. For 2026, bill Medicare screening mammography as 77067. Submitting G0202 returns a denial for an invalid code. Update any superbill or chargemaster that still lists it.
What is the difference between 77067 and 77063?
77067 is the 2D bilateral screening mammogram. 77063 is screening digital breast tomosynthesis (3D), billed as an add-on to 77067 when 3D imaging is performed in the same session. When both 2D and 3D screening are done, report 77067 and 77063 together. 77063 is not billed alone for screening.
