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Printed Date: 9/22/2015
A 3D mammography claim is received by a facility not certified for 3D mammography using the following criteria: CPT code 77063 or HCPCS code G0279 is present on the claim and one or more of the following conditions exist:
Guidelines and Suggestions
This edit is set to line reject if a certification is not listed on the provider file when a 3D mammography claim is billed to Medicare. For further information, please refer to Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Chapter 18 - Preventive and Screening Services (PDF, 1.3 MB).
Submission of updated certificates may be faxed to Provider Reimbursement at 803-935-0262. Once the provider file is updated with the current certification date; the provider may resubmit the claim.
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Last Updated: 12/27/2018