Reimbursement
$131.93
Threshold
N/A
2026 Status
Active
What is CPT Code 77067?
CPT 77067 is defined as: A preventive screening mammography procedure consisting of a bilateral, two-view study of each breast (typically craniocaudal and mediolateral oblique views). This code includes computer-aided detection (CAD) if performed. It is intended for asymptomatic women to detect early signs of breast cancer. Under the Affordable Care Act (ACA), this service is covered by Medicare with no patient cost-sharing (no deductible or coinsurance).
This code is primarily used for Specialist services. It falls under the category of Radiology / Breast Mammography and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.85
Physician Effort
PE (Non-Fac)
3
Practice Expense
Malpractice
0.1
Risk Factor
Total RVU
3.95
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency adjustment
Subject to -2.5% Efficiency Adjustment. CMS assumes that digital breast tomosynthesis (DBT) and improved PACS workflows have increased interpretive efficiency.
cost sharing exemption
Remains exempt from the Medicare Part B deductible and coinsurance as a preventive service.
conversion factor
Payment based on the 2026 Non-QP baseline of $33.40.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
frequency
Medicare covers one screening mammogram every 12 months for women aged 40 and older. One baseline mammogram is covered for women between ages 35-39.
documentation standards
The report must use the BI-RADS (Breast Imaging-Reporting and Data System) assessment categories (0-6).
order not required
Unlike diagnostic tests, a physician's order is NOT required for a screening mammogram under Medicare; patients may self-refer.
cad inclusion
CPT 77067 bundled CAD in 2018; do not bill separate CAD codes (e.g., 77051/77052 are obsolete).
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Work RVU reduced by 2.5% Efficiency Adjustment. Remains a zero-cost-sharing preventive service for patients.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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