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May 11, 2015

Add-On HCPCS Code G0279 for Diagnostic Digital Breast Tomosynthesis

CMS announced that HCPCS code G0279 is to be used for diagnostic digital breast tomosynthesis, unilateral or bilateral. Being an add-on code, it must be submitted in addition to either HCPCS codes G0204 or G0206; it cannot be reported as a stand-alone service. Being unilateral or bilateral, HCPCS code G0279 has been assigned a bilateral indicator '2' in the Medicare Physician Fee Schedule Database (MPFSDB). A '2' indicator means special payment adjustment for bilateral does not apply. Because of this, bilateral modifiers (e.g., CPT modifier 50, HCPCS modifiers RT/LT) are not to be included and the units field should indicate a quantity of '1'.

For additional information on bilateral services and accessing the MPFSDB, please refer to this article.

Details specific to billing CPT modifier 50 are also available.

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