HCPCS C8908: MRI w/o contrast followed by w/ contrast, breast

Learn how to use and bill HCPCS code C8908 for bilateral breast MRI without and with contrast under the Hospital Outpatient Prospective Payment System (OPPS).

Use Code

## **What is HCPCS code C8908?** HCPCS code C8908 is a code with a full description of "Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral". It refers to a bilateral MRI scan that is performed on both breasts. Images are taken first without the contrast injection of a contrast agent (gadolinium) and then again after the contrast agent is administered intravenously to enhance the visibility of blood flow and potentially abnormal tissue. This is typically used for screening high-risk patients (e.g., those with a BRCA mutation or strong family history), evaluating abnormalities found on other imaging (mammogram, ultrasound), monitoring for cancer recurrence, or evaluating patients with breast implants

## **HCPCS code C8908 documentation requirements** Thorough and accurate documentation is essential for proper billing and to demonstrate the medical necessity of the procedure. Reputable sources, such as Medicare Administrative Contractors (MACs) and medical payers, typically require the following in the patient's medical record: - **Order and clinical indication**: A clear, written order or referral from the treating physician is required. This order must clearly state the medical necessity (i.e., the specific symptoms, high-risk factors, or inconclusive findings from other imaging) that warrants the bilateral breast MRI. - **Formal written report**: The radiologist's formal, written report must be included. This report should contain the reason for the test, a description of the procedure (including that is was performed without and then with contrast, bilaterally), the interpretation and results of the test, and the name of the physician to whom the report is being sent. - **Informed consent**: Documentation that the patient was informed of the procedure, including the use of contrast material and potential risks (e.g., allergies, risks associated with gadolinium in patients with impaired kidney function), and provided consent. - **Contrast administration details**: The type, dosage, and route of administration of the contrast agent (e.g., gadolinium) must be documented.

## **C8908 billing requirements** To prevent the denial of claims, the following coding guidelines - **Primary use**: C8908 is a "C" code created by the Centers for Medicare & Medicaid Services (CMS) specifically for use by hospital outpatient departments when billing Medicare under the Outpatient Prospective Payment System (OPPS). - **ICD-10-CM diagnosis codes**: The claim must include a valid ICD-10-CM code that supports the medical necessity of the procedure. Common diagnostic codes often include C50.77: malignant neoplasm of the breast, codes for high screening mammography Z12.31 for screening mammogram, and other codes for signs/symptoms. - **Contrast agent**: The contrast agent itself is typically packaged (bundled) into the payment for the procedure code (C8908) under the OPPS, but the specific HCPCS code for the contrast agent (e.g., A-codes) may still need to be reported for tracking purposes. - **Alternative setting**: The C-codes are generally not used by physician offices, freestanding imaging centers, or other non-hospital settings. These non-hospital settings generally use the corresponding CPT codes for billing.

## **Other relevant codes** - **C8906**: Magnetic resonance imaging with contrast, breast; bilateral - **C8905**: Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral - **C8903**: Magnetic resonance imaging with contrast, breast; unilateral - **C8937**: HCPCS Computer-aided detection, incl. computer algorithm analysis of breast MRI image data for lesion detection, characterization, and pharmacokinetic analysis

Frequently asked questions

C8908 is a temporary HCPCS Level II code (a "C" code). These codes are managed by CMS and are primarily used for procedures paid under the OPPS.

For Medicare, while the code is used for billing, Medicare coverage rules depend on the medical necessity criteria outlined in National and Local Coverage Determinations (NCDs/LCDs). For private payers, breast MRI is frequently subject to prior authorization or pre-certification requirements based on the payer's clinical appropriateness guidelines.

Yes, if the patient meets high-risk criteria defined by Medicare or the specific payer's medical policy, the procedure may be covered for screening. In such cases, the diagnosis code Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast) or a more specific high-risk code (like a confirmed gene mutation) should be reported.