HCPCS Code G0279: Diagnostic Digital Breast Tomosynthesis, Unilateral or Bilateral (List Separately in Addition to 77065 or 77066)

## **Documentation requirements** When billing G0279 (diagnostic digital breast tomosynthesis, bilateral), the medical record must demonstrate medical necessity and confirm that DBT was performed in addition to a diagnostic mammogram (77065 or 77066). Key documentation elements include: ### **Procedure details** Records should clearly state why the diagnostic mammogram was ordered. This may include an abnormal screening result, breast symptoms, or follow-up of a known abnormality. Documentation must specify that digital breast tomosynthesis (DBT) was performed on the same day as the diagnostic mammogram. It should also note whether the imaging was unilateral or bilateral. A signed physician order for diagnostic DBT must be also be in the record, along with the radiologist’s signed report. ### **Medical necessity** CMS requires documentation showing why DBT was clinically appropriate. For example, DBT may be necessary for dense breast tissue, inconclusive prior images, or when improved visualization is needed. ### **Imaging report** - The radiologist’s report should confirm: - DBT images were acquired and reviewed - The side(s) imaged (left, right, or bilateral) The radiologist’s findings and interpretation ### **Compliance with coverage policies** Documentation should follow the criteria outlined in Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for breast imaging services.

## **Billing requirements** HCPCS code G0279 is not billable as a standalone procedure. Medicare requires this code to clearly distinguish 3D tomosynthesis from standard 2D diagnostic mammography, ensuring accurate reporting and reimbursement. - **Conjunction with diagnostic mammography**: Always reported with a diagnostic mammogram such as 77065 (unilateral) or 77066 (bilateral). - **Commercial payer differences**: Many private payers use CPT 77066 with 77061 instead of G0279, but Medicare specifically requires G0279 for diagnostic 3D breast imaging. - **Billing units**: Report 1 unit per diagnostic encounter for bilateral imaging. - **Modifier use**: Append a modifier when both a screening and diagnostic mammogram are performed on the same date for the same patient. This ensures that providers correctly bill for tomosynthesis unilateral or bilateral services, avoid denials, and maintain compliance with Medicare and payer-specific guidelines.

## **Other relevant codes** - **77065** – Diagnostic mammography, including computer-aided detection (CAD), unilateral - **77066** – Diagnostic mammography, including CAD, bilateral - **77061** – Add-on for screening digital breast tomosynthesis, unilateral (used by some commercial payers) - **77062** – Add-on for screening digital breast tomosynthesis, bilateral

### **References** GE Healthcare. (2018). 2018 Reimbursement information for mammography, CAD and digital breast tomosynthesis. https://www.gehealthcare.com/-/media/1f6a7cd9ac304842bb8c04fc9c76dd9f.pdf