{"id":4924,"date":"2025-09-25T18:24:12","date_gmt":"2025-09-25T18:24:12","guid":{"rendered":"https:\/\/medibillmd.com\/blog\/?p=4924"},"modified":"2025-09-25T18:24:14","modified_gmt":"2025-09-25T18:24:14","slug":"cpt-code-77065","status":"publish","type":"post","link":"https:\/\/medibillmd.com\/blog\/cpt-code-77065\/","title":{"rendered":"Ultimate Guide to CPT Code 77065"},"content":{"rendered":"\n<p>Seeking the correct code to bill for a unilateral diagnostic mammogram? CPT code 77065 is the right choice. But do you really know its billing requirements?&nbsp;<\/p>\n\n\n\n<p>Approximately <a href=\"https:\/\/www.fda.gov\/radiation-emitting-products\/mammography-information-patients\/mqsa-national-statistics\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">43 million mammography procedures<\/a> are performed annually in the U.S. However, only <a href=\"https:\/\/www.ssmhealth.com\/services\/womens-health\/breast-health\/mammography#:~:text=Early%20detection%20is%20the%20best%20defense%20against,or%20concerns%20about%20the%20procedure%20before%20scheduling.\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">10% of patients<\/a> are recalled for further evaluation, that is, a diagnostic mammogram.<\/p>\n\n\n\n<p>So, while this procedure may be routine for you as a radiologist, we understand how tricky its coding can be. The main reason? Screening and diagnostic mammography codes are quite similar. That\u2019s why we are taking a closer look at the 77065 CPT code today.<\/p>\n\n\n\t\t\t\t<div class=\"wp-block-uagb-table-of-contents uagb-toc__align-left uagb-toc__columns-1 uagb-toc__collapse uagb-block-6ceaf9fd      \"\n\t\t\t\t\tdata-scroll= \"1\"\n\t\t\t\t\tdata-offset= \"30\"\n\t\t\t\t\tstyle=\"\"\n\t\t\t\t>\n\t\t\t\t<div class=\"uagb-toc__wrap\">\n\t\t\t\t\t\t<div class=\"uagb-toc__title\">\n\t\t\t\t\t\t\tTable Of Contents\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\"><path d=\"M192 384c-8.188 0-16.38-3.125-22.62-9.375l-160-160c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L192 306.8l137.4-137.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-160 160C208.4 380.9 200.2 384 192 384z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"uagb-toc__list-wrap \">\n\t\t\t\t\t\t<ol class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-77065-description\" class=\"uagb-toc-link__trigger\">CPT Code 77065 \u2013 Description<\/a><li class=\"uagb-toc__list\"><a href=\"#scenarios-where-cpt-code-77065-is-applicable\" class=\"uagb-toc-link__trigger\">Scenarios Where CPT Code 77065 is Applicable<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#breast-mammography-to-investigate-a-lump\" class=\"uagb-toc-link__trigger\">Breast Mammography to Investigate a Lump<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#diagnostic-mammography-for-the-suspicious-calcifications\" class=\"uagb-toc-link__trigger\">Diagnostic Mammography for the Suspicious Calcifications<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#diagnostic-mammography-to-analyze-nipple-discharge-localized-pain\" class=\"uagb-toc-link__trigger\">Diagnostic Mammography to Analyze Nipple Discharge &amp; Localized Pain<\/a><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#applicable-modifiers-for-cpt-code-77065\" class=\"uagb-toc-link__trigger\">Applicable Modifiers for CPT Code 77065<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-26\" class=\"uagb-toc-link__trigger\">Modifier 26<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-tc\" class=\"uagb-toc-link__trigger\">Modifier TC<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-lt\" class=\"uagb-toc-link__trigger\">Modifier LT<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-rt\" class=\"uagb-toc-link__trigger\">Modifier RT<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-gg\" class=\"uagb-toc-link__trigger\">Modifier GG<\/a><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#cpt-code-77065-billing-reimbursement-guidelines\" class=\"uagb-toc-link__trigger\">CPT Code 77065 \u2013 Billing &amp; Reimbursement Guidelines<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#use-cpt-code-77065-for-diagnostic-mammography\" class=\"uagb-toc-link__trigger\">Use CPT Code 77065 for Diagnostic Mammography<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#bill-for-a-unilateral-procedure\" class=\"uagb-toc-link__trigger\">Bill for a Unilateral Procedure<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#justify-medical-necessity\" class=\"uagb-toc-link__trigger\">Justify Medical Necessity<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#append-appropriate-modifiers\" class=\"uagb-toc-link__trigger\">Append Appropriate Modifiers<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#verify-payer-specific-requirements\" class=\"uagb-toc-link__trigger\">Verify Payer-Specific Requirements<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#summary\" class=\"uagb-toc-link__trigger\">Summary<\/a><\/ul><\/ul><\/ul><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>CPT Code 77065<\/strong><strong> \u2013 Description<\/strong><\/h2>\n\n\n\n<p>So, what exactly does this code specify? As hinted in the intro, CPT code 77065 refers to a unilateral diagnostic procedure. To be more specific, this code reports a detailed examination of a single breast with computer-aided detection (CAD).&nbsp;<\/p>\n\n\n\n<p>The primary purpose? To investigate abnormalities identified during a screening mammogram or a new symptom, such as a lump or nipple discharge. In short, diagnostic mammography is more comprehensive than a screening breast examination.&nbsp;<\/p>\n\n\n\n<p>During this procedure, a radiologist takes multiple X-ray images of the breast while it is compressed. He then uses specialized software to analyze these detailed images, examining the area of concern.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Scenarios Where <\/strong><strong>CPT Code 77065<\/strong><strong> is Applicable<\/strong><\/h2>\n\n\n\n<p>Need some real-world examples to understand CPT code 77065 better? Here are three specific scenarios:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Breast Mammography to Investigate a Lump<\/strong><\/h3>\n\n\n\n<p>While <a href=\"https:\/\/www.nationalbreastcancer.org\/breast-lump\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">60 to 80%<\/a> of breast lumps are non-cancerous, they should always be investigated for early detection. Some lumps, discovered through self-exam or any method, can be malignant. So, let\u2019s come up with a similar scenario for this example.<\/p>\n\n\n\n<p>Suppose a 34-year-old woman with a family history of breast cancer often performs a self-examination. During one of these, she feels a lump in her right breast near the armpit. She immediately consults a primary care physician who orders a mammogram after examination.<\/p>\n\n\n\n<p>A radiologist performs the imaging test and analyzes the images via software. He then sends the report to the physician and bills the diagnostic mammography procedure involving CAD with CPT code 77065.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Diagnostic Mammography for the Suspicious Calcifications<\/strong><\/h3>\n\n\n\n<p>Abnormalities detected on the screening mammography procedures often require a follow-up procedure. Therefore, let\u2019s consider a 45-year-old woman who arrives at a radiology department following a screening mammography.<\/p>\n\n\n\n<p>The key reason? The radiologist found a suspicious abnormality, let\u2019s say certain patterns of calcifications (bits of calcium), in the left breast. Hence, the patient\u2019s physician called her back for a follow-up mammogram of that breast.<\/p>\n\n\n\n<p>The radiologist performs the procedure with CAD detection to analyze the calcifications better. He then uses CPT code 77065 to report this unilateral diagnostic mammography.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Diagnostic Mammography to Analyze Nipple Discharge &amp; Localized Pain<\/strong><\/h3>\n\n\n\n<p>Breast cancer, the second most common cancer among women in the U.S., accounts for <a href=\"https:\/\/www.breastcancer.org\/facts-statistics\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">30% of all new cases annually<\/a>. The most common symptoms? Lumps, nipple discharge, breast swelling, and dimpling skin.<\/p>\n\n\n\n<p>So, for this example, assume a 41-year-old woman arrives at a hospital outpatient department with two complaints: localized pain and nipple discharge from her left breast. The healthcare provider examines her condition, takes her history, and orders a diagnostic mammogram.<\/p>\n\n\n\n<p>A radiologist performs the test, taking several X-ray images of the patient\u2019s left breast and analyzing them in detail via software. He then uses CPT code 77065 to bill for the procedure.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Applicable Modifiers for <\/strong><strong>CPT Code 77065<\/strong><\/h2>\n\n\n\n<p>To provide extra details about this diagnostic mammography, you can use the following modifiers with CPT code 77065:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier 26<\/strong><\/h3>\n\n\n\n<p>Were the mammographs interpreted by the physician? Append <a href=\"https:\/\/medibillmd.com\/blog\/modifier-26\/\" target=\"_blank\" rel=\"noreferrer noopener\">modifier 26<\/a> to CPT code 77065 to bill for the professional component.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier TC<\/strong><\/h3>\n\n\n\n<p>Did you only perform breast mammography without interpretation? For example, the test was performed at an imaging center, and the facility wants to bill for its equipment and technologist support.&nbsp;<\/p>\n\n\n\n<p>In this case, you can use <a href=\"https:\/\/medibillmd.com\/blog\/modifier-tc\/\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/medibillmd.com\/blog\/modifier-tc\/\" rel=\"noreferrer noopener\">modifier TC<\/a> with CPT code 77065 to indicate the technical part of the diagnostic procedure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier LT<\/strong><\/h3>\n\n\n\n<p>Was mammography performed on the left breast? Communicate this information by applying modifier LT to the 77065 CPT code.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier RT<\/strong><\/h3>\n\n\n\n<p>On the other hand, use modifier RT with the 77065 CPT code if the procedure was performed on the right breast.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier GG<\/strong><\/h3>\n\n\n\n<p>Did you perform a diagnostic mammography on the same patient and on the same day as the screening mammography? Append modifier GG with CPT code 77065 to differentiate the procedures.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>CPT Code 77065<\/strong><strong> \u2013 Billing &amp; Reimbursement Guidelines<\/strong><\/h2>\n\n\n\n<p>Now, here comes the most important part! To avoid billing issues and outright denials, follow these billing and reimbursement guidelines for CPT code 77065:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Use <\/strong><strong>CPT Code 77065<\/strong><strong> for Diagnostic Mammography<\/strong><\/h3>\n\n\n\n<p>Special emphasis on diagnostic! The 77065 CPT code only covers a diagnostic mammography on one of the breasts with computer-aided detection. Keep in mind that a test without CAD is often considered a screening mammography.<\/p>\n\n\n\n<p>Therefore, you cannot use it to bill for a screening procedure. We are highlighting this point again and again because radiologists and radiology coders often make this mistake.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Bill for a Unilateral Procedure<\/strong><\/h3>\n\n\n\n<p>Unilateral is another important keyword! Avoid using the 77065 CPT code for bilateral diagnostic mammography. There is a different code for that (CPT code 77066).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Justify Medical Necessity<\/strong><\/h3>\n\n\n\n<p>Payers cannot distinguish between screening and diagnostic procedures unless you provide complete documentation. Therefore, clarify why you have performed a mammography. You must document the following details in the <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/article.aspx?articleid=56448&amp;ver=18&amp;\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">patient\u2019s medical record as well as in the referral order<\/a>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Written referral<\/li>\n\n\n\n<li>Patient\u2019s symptoms (pain, nipple discharge) or relevant abnormal screening results<\/li>\n\n\n\n<li>Appropriate ICD-10 codes<\/li>\n\n\n\n<li>Description of the test<\/li>\n\n\n\n<li>Interpretation and results<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Append Appropriate Modifiers<\/strong><\/h3>\n\n\n\n<p>You must always specify laterality, that is, the exact breast on which you performed the mammography. To do that, append either the LT or RT modifier with CPT code 77065. For communicating additional details, you can also use other modifiers like 26, TC, GG, or 59.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Verify Payer-Specific Requirements<\/strong><\/h3>\n\n\n\n<p>Medicare and commercial payers may have different coverage rules for diagnostic mammography. Therefore, always verify their requirements before filing a claim for the 77065 CPT code.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Summary<\/strong><\/h2>\n\n\n\n<p>Do you now understand all the billing requirements for CPT code 77065? We hope that you do, since it is an important code. You can use it to report a mammogram with CAD, but only if it is diagnostic and performed on one breast. Our blog has explained this code in quite detail, even providing you with three detailed examples, so you know how to apply it correctly.<\/p>\n\n\n\n<p>Simply follow our instructions to file clean claims. But if you want to be paid on time, it is best to bring a professional into the mix. An expert with reliable<strong> <\/strong><a href=\"https:\/\/medibillmd.com\/specialties\/radiology-billing-services\" target=\"_blank\" rel=\"noreferrer noopener nofollow\"><strong>radiology billing services<\/strong><\/a> can help you stay compliant and ahead of your competition.<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Seeking the correct code to bill for a unilateral diagnostic mammogram? CPT code 77065 is the right choice. But do [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":4925,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","content-type":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[10],"tags":[],"class_list":["post-4924","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cpt-codes"],"uagb_featured_image_src":{"full":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065.webp",1200,720,false],"thumbnail":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065-150x150.webp",150,150,true],"medium":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065-300x180.webp",300,180,true],"medium_large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065-768x461.webp",768,461,true],"large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065-1024x614.webp",1024,614,true],"1536x1536":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065.webp",1200,720,false],"2048x2048":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/09\/CPT-Code-77065.webp",1200,720,false]},"uagb_author_info":{"display_name":"Fred Allen","author_link":"https:\/\/medibillmd.com\/blog\/author\/fred-allen\/"},"uagb_comment_info":0,"uagb_excerpt":"Seeking the correct code to bill for a unilateral diagnostic mammogram? CPT code 77065 is the right choice. But do [&hellip;]","_links":{"self":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/4924","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/comments?post=4924"}],"version-history":[{"count":0,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/4924\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media\/4925"}],"wp:attachment":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media?parent=4924"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/categories?post=4924"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/tags?post=4924"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}