Coverage for Digital Breast Tomosynthesis

Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography. Providers must submit claims with Healthcare Common Procedure Coding System (HCPCS) code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral) in addition to screening or diagnostic mammography Common Procedural Terminology (CPT) codes 77065-77067. Clinical coverage policy 1K-1, Breast Imaging, is in the process of being updated to reflect the new coverage.

[This article originally appeared in the May 2018 Medicaid Bulletin.]