CAM 60153

Digital Breast Tomosynthesis

Category:Radiology   Last Reviewed:December 2019
Department(s):Medical Affairs   Next Review:December 2020
Original Date:July 2011    

Description:
Digital breast tomosynthesis (DBT) uses existing digital mammography equipment with specialized software to obtain low dose images acquired in an arc (3-D acquisition) which are then reconstructed into slices which can be viewed on a workstation. This allows for visualization of the breast in layers and therefore reduces the issue of tissue overlap. Currently at most sites both a 2-D image as well as the 3-D acquisition is obtained for each patient. Potential advantages of DBT are similar to those for full field digital mammography; more accurate estimation BI-RADS classification of a lesion (improved conspicuity), reduction of distortions, reduction of false positives associated with glandular clusters, greater security in the study of dense breasts, and the reduction of the number of recalls. Tomosynthesis involves some additional imaging time and doubling of the radiation exposure. To reduce the increased radiation exposure when obtaining both 2D images along with DBT, C-view software has been developed which allows 2D images to be generated as a part of the breast tomosynthesis exam. The 2D images created from C-View software are reviewed together with the tomosynthesis slices to make a clinical decision or diagnosis.

Background     
Conventional mammography produces 2D images of the breast. Overlapping tissue on a 2D image can mask suspicious lesions or make benign tissue appear suspicious, particularly in women with dense breast tissue. As a result, women may be recalled for additional mammographic spot views. Inaccurate results may lead to unnecessary biopsies and emotional stress, or to a potential delay in diagnosis. Spot views often are used to evaluate microcalcifications, opacities or architectural distortions; to distinguish masses from overlapping tissue; and to view possible findings close to the chest wall or in the retroareolar area behind the nipple.1 The National Cancer Institute reports that approximately 20% of cancers are missed at mammography screening.2 Average recall rates are approximately 10%, with an average cancer detection rate of 4.7 per 1,000 screening mammography examinations.3 The Mammography Quality Standards Act audit guidelines anticipate 2 to 10 cancers detected per 1,000 screening mammograms.4 Interval cancers, which are detected between screenings, tend to have poorer prognoses.5 

Digital breast tomosynthesis was developed to improve the accuracy of mammography by capturing 3-dimensional (3D) images of the breast, further clarifying areas of overlapping tissue. Developers proposed that its use would result in increased sensitivity and specificity, as well as fewer recalls due to inconclusive results.6 Digital breast tomosynthesis produces a 3D image by taking multiple low-dose images per view along an arc over the breast. During breast tomosynthesis, the compressed breast remains stationary while the X-ray tube moves approximately 1º for each image in a 15º to 50º arc, acquiring 11 to 49 images.7 These images are projected as cross-sectional “slices” of the breast, with each slice typically 1-mm thick. Adding breast tomosynthesis takes about 10 seconds per view. In 1 study in a research setting, mean time (SD) for interpretation of results was 1.22 (1.15) minutes for digital mammography and 2.39 (1.65) minutes for combined digital mammography and breast tomosynthesis.8 

With conventional 2D mammography, breast compression helps decrease tissue overlap and improve visibility. By reducing problems with overlapping tissue, compression with breast tomosynthesis may be reduced by up to 50%. This change could result in improved patient satisfaction.7 

A machine equipped with breast tomosynthesis can perform 2D digital mammography, 3D digital mammography or a combination of both 2D and 3D mammography during a single compression. Radiation exposure from tomosynthesis is roughly equivalent to mammography. Therefore, adding tomosynthesis to mammography doubles the radiation dose, although it still is below the maximum allowable dose established in the U.S. Mammography Quality Standards Act.

Studies typically compare 1-view (i.e., mediolateral oblique [MLO] view), or more commonly, 2-view (MLO plus craniocaudal view) breast tomosynthesis alone or combined with standard 2D mammography with standard 2D mammography alone. A 2014 TEC Assessment9 (updated in 201510) focused on 2-view tomosynthesis. The FDA Radiological Devices Panel, which reviewed this new modality in 2011, recommended that 2-view breast tomosynthesis is preferable to 1-view tomosynthesis (both used in combination with full-field digital mammography).11 

In May 2013, FDA approved new tomosynthesis software that permits creation of 2D images (called CView) from images obtained during tomosynthesis.12 As a result, 2D mammography may become unnecessary, thereby lowering radiation dose. In other words, only the tomosynthesis procedure will be needed, and both 2D and 3D images will be created. It is too early to gauge how traditional mammography plus tomosynthesis compares with C-View plus tomosynthesis.

Regulatory Status
The Selenia® Dimensions® 3D System manufactured by Hologic (Bedford, MA), received FDA approval on Feb. 11, 2011, through the premarket application (PMA) approval process (PMA P080003). This system is a software and hardware upgrade of the Selenia® Dimensions 2D full-field digital mammography system, which FDA approved in 2008. The SenoClairebreast tomosynthesis system, from GE Healthcare (Waukesha, WI), received FDA approval on Aug. 26, 2014, through the PMA process. SenoClaire is an imaging option for the SenographeEssential Full-Field Digital Mammography system. A screening examination using this system may consist of either a 2-view mammogram or a 1-view craniocaudal mammogram with a 1-view MLO oblique tomosynthesis image. On April 21, 2015, FDA approved the MammomatInspiration® mammography platform with tomosynthesis option by Siemens Medical Solutions (Malvern, PA). FDA product code: OTE. 

Facilities using a digital breast tomosynthesis system must apply to FDA for a certificate extension covering use of the breast tomosynthesis portion of the unit. The Mammography Quality Standards Act requires interpreting physicians, radiologic technologists and medical physicists to complete 8 hours of digital breast tomosynthesis training and mandates a detailed mammography equipment evaluation before use.

In May 2013, FDA approved Hologic’s C-View 2D imaging software. This software is used to create 2D images from the tomosynthesis results, intended to eliminate the need for a separate mammogram.

Related Policies
60118 Scintimammography and Gamma Imaging of the Breast and Axilla
60129 Magnetic Resonance Imaging of the Breast
60152 Positron Emission Mammography

Policy:
Digital breast tomosynthesis is considered MEDICALLY NECESSARY in the screening or diagnosis of breast cancer.

Policy Guidelines
Effective Jan. 1, 2015, there are specific CPT codes for this imaging:

77061 Digital breast tomosynthesis; unilateral
77062 bilateral
77063 Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)

Also effective Jan. 1, 2015, Medicare established an add-on HCPCS G code specific to diagnostic breast tomosynthesis:

G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206).

Prior to 2015, there were no specific CPT codes for this testing. The testing would have been reported with the appropriate breast mammography code (77055-77057 or G0202-G0206) along with an unlisted code (e.g., 76499) for the additional views.

Benefit Application
Blue Card®/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational, and, thus, these devices may be assessed only on the basis of their medical necessity.

Rationale
On February 11, 2011, the U.S. Food and Drug Administration (FDA) approved Hologic, Inc. to market its Selenia Dimensions 2D Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT) system. This DBT is the first mammography system that provides 3D images of the breast for breast cancer screening and diagnosis. Since the date of the FDA approval, a number of facilities in the U.S. have been using the Selenia Dimensions 2D (with the
DBT locked). Facilities that have an accredited (or have applied to be accredited) Selenia Dimensions 2D unit can activate the DBT modality of the unit after applying to and obtaining FDA approval to extend its certificate to include the DBT modality.

Because DBT is a new mammographic modality, facilities wanting to use DBT on patients must meet all Mammography Quality Standards Act (MQSA) applicable requirements: (1) personnel must obtain at least 8 hours of DBT training; (2) the unit must undergo a mammography equipment evaluation prior to use; and (3) the facility must follow the manufacturer's recommended quality control procedures.

The Selenia Dimensions 3D DBT is a hardware and software upgrade to the Selenia Dimensions 2D FFDM system, which is FDA approved for conventional mammography imaging (P010025/S013, approved December 22, 2008).

The FDA approved new tomosynthesis software (May 2013) that enables a 2D image (called C view) to be created from the tomosynthesis images. As a result, the radiation dose will be lowered since both the tomosynthesis and the 2D mammography can be created from one procedure versus two. Studies are still needed to determine if the combined C view and 3D reconstruction to digital tomosynthesis alone are comparable.

A 2014 Blue Cross Blue Shield TEC Assessment, "Use of digital breast tomosynthesis with mammography for breast cancer screening or diagnosis" concluded that recent studies have provided some evidence that adding breast tomosynthesis to mammography may increase the accuracy (and possibly the sensitivity) of screening while reducing the number of women who are recalled unnecessarily. However studies with longer follow-up of women with negative screening results are needed. Digital breast tomosynthesis as an addition to diagnostic mammography (such as spot views) has the potential to screen out some women with false-positive results. As a consequence the number of women who are biopsied may be reduced. The body of evidence on the use of breast tomosynthesis to evaluate women who are recalled for a diagnostic work-up after a suspicious finding on screening mammography is weaker than that on adding breast tomosynthesis to mammography for screening. In addition, diagnostic mammography is not the only imaging modality used during the diagnostic work-up. Thus assessing the value of tomosysnthesis compared to the available set of different diagnostic tests (e.g., ultrasound, MRI) is problematic.

The American College of Obstetricians Technical Assessment (2013) on digital breast tomosynthesis concluded clinical data suggest that digital mammography with tomosynthesis produces a better image, improved accuracy, and lower recall rates compared with digital mammography alone. Further study will be necessary to confirm whether digital mammography with tomosynthesis is a cost-effective approach capable of replacing digital mammography alone as the first-line screening modality of choice for breast cancer screening.

The American College of Radiology (ACR) released a statement on digital breast tomosynthesis (11/24/2014). A new digital technology, breast tomosynthesis has shown to be an advance over digital mammography, with higher cancer detection rates and fewer patient recalls for additional testing. This is extremely important. The medical community has long sought ways to improve breast cancer screening accuracy. Better sensitivity will likely translate into more lives saved. Lower recall rates result in fewer patients who may experience short-term anxiety awaiting test results. As this technology is used in clinical practice, we anticipate that further studies will clarify its impact on long-term clinical outcomes, including reduced mortality. It will also be important to further elucidate which subgroups of women might benefit most from these exams (by age, breast density, frequency of examination, etc.). To facilitate such large scale outcome data collection, the technology must be widely available. Availability is greatly impacted by reimbursement for the service provided. The College applauds the decision by the Centers for Medicare and Medicaid Services (CMS) to facilitate access to these exams by covering beneficiaries for tomosynthesis and urges private payers to do the same. To be clear: tomosynthesis is no longer investigational. Tomosynthesis has been shown to improve key screening parameters compared to digital mammography. While the College encourages more studies to clarify the clinical role(s) of tomosynthesis and its long-term outcomes, it is clear that tomosynthesis represents an advance in breast imaging.

While there is strong evidence that tomosynthesis will have an important role in breast imaging, further studies are needed to assess tomosynthesis’ relationship to long-term clinical outcomes, including reduced mortality. It will also be important to learn which subgroups of women might benefit most from these exams (by age, breast density, frequency of examination, etc.). To facilitate such large scale research, the technology must be widely available. Availability is greatly impacted by reimbursement for the service provided. The College urges the Centers for Medicare and Medicaid Services (CMS) and private insurers to facilitate access to these exams by covering beneficiaries for tomosynthesis - now that it has been shown to improve key screening parameters compared to digital mammography. While the College encourages more studies to clarify the clinical role(s) of tomosynthesis and its long-term outcomes, it is fairly clear that tomosynthesis represents an important advance in breast imaging. The ACR will continue to monitor this technology.

The National Comprehensive Cancer Network (2016) guidelines state early studies show promise for tomosynthesis mammography. Two large trials showing a combined use of digital mammography and tomosynthesis resulted in improved cancer detection and decreased call back rates; of note this is double the dose of radiation. The radiation dose can be minimized by synthetic 2-D reconstruction.

NCCN also suggests that tomosynthesis be considered whenever an annual screening mammogram is recommended.

The U.S. Preventive Services Task Force (USPSTF) updated its recommendations for breast cancer screening using film mammography and methods other than film mammography in 2016. USPSTF recommends mammography, but concluded that there is insufficient evidence to conduct a risk-benefit assessment of digital breast tomosynthesis as a primary screening strategy. USPSTF also stated that there is insufficient evidence to conduct a risk-benefit assessment of DBT as adjunctive screening for breast cancer in women who are identified as having dense breast tissue in an otherwise negative screening mammogram.

References:

  1. Tagliafico A, Astengo D, Cavagnetto F, et al. One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol. Mar 2012;22(3):539-544. PMID 21987214
  2. National Cancer Institute (NCI). Factsheet: Mammograms. 2012; http://www.cancer.gov/cancertopics/factsheet/detection/mammograms. Accessed April, 2015.
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  6. Smith A. Fundamentals of breast tomosynthesis [WP-00007]. Bedford, MA: Hologic, Inc.; 2008:8.
  7. Alakhras M, Bourne R, Rickard M, et al. Digital tomosynthesis: A new future for breast imaging? Clin Radiol. Mar 1 2013. PMID 23465326
  8. Gur D, Abrams GS, Chough DM, et al. Digital breast tomosynthesis: observer performance study. AJR Am J Roentgenol. Aug 2009;193(2):586-591. PMID 19620460
  9. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Use of digital breast tomosynthesis with mammography for breast cancer screening or diagnosis. TEC Assessments 2014; Volume 28, Tab 6.
  10. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Use of digital breast tomosynthesis with mammography for breast cancer screening. TEC Assessments 2015; Volume 29, Tab TBA.
  11. U.S. Food and Drug Administration (FDA). Summary of Safety and Effectiveness Data (SSED). 2011; http://www.accessdata.fda.gov/cdrh_docs/pdf8/P080003b.pdf. Accessed April, 2015.
  12. Hologic, Inc. Press release: Hologic Receives FDA Approval for a New Low-dose 3D Mammography (Breast Tomosynthesis) Solution for Breast Cancer Screening; May 21, 2013. http://investors.hologic.com/2013-05-21-Hologic-Receives-FDA-Approval-for-a-New-Low-dose-3D-Mammography-Breast-Tomosynthesis-Solution-for-Breast-Cancer-Screening. Accessed May 12, 2015.
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  17. Houssami N, Macaskill P, Bernardi D, et al. Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading - Evidence to guide future screening strategies. Eur J Cancer. Jul 2014;50(10):1799-1807. PMID 24746887
  18. University of Bristol. QUADAS: a quality assessment tool for diagnostic accuracy studies. http://www.quadas.org. Accessed May 13, 2015.
  19. Rafferty EA, Park JM, Philpotts LE, et al. Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology. Jan 2013;266(1):104-113. PMID 23169790
  20. Good WF, Abrams GS, Catullo VJ, et al. Digital breast tomosynthesis: a pilot observer study. AJR Am J Roentgenol. Apr 2008;190(4):865-869. PMID 18356430
  21. Gur D, Bandos AI, Rockette HE, et al. Localized detection and classification of abnormalities on FFDM and tomosynthesis examinations rated under an FROC paradigm. AJR Am J Roentgenol. Mar 2011;196(3):737-741. PMID 21343521
  22. Destounis S, Arieno A, Morgan R. Initial experience with combination digital breast tomosynthesis plus full field digital mammography or full field digital mammography alone in the screening environment. J Clin Imaging Sci. 2014;4:9. PMID 24744966 
  23. Durand MA, Haas BM, Yao X, et al. Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology. Jan 2015;274(1):85-92. PMID 25188431
  24. Greenberg JS, Javitt MC, Katzen J, et al. Clinical Performance Metrics of 3D Digital Breast Tomosynthesis Compared With 2D Digital Mammography for Breast Cancer Screening in Community Practice. AJR Am J Roentgenol. Jun 11 2014:1-7. PMID 24918774
  25. Haas BM, Kalra V, Geisel J, et al. Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology. Dec 2013;269(3):694-700. PMID 23901124
  26. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499-2507.
  27. Lourenco AP, Barry-Brooks M, Baird GL, et al. Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. Feb 2015;274(2):337-342. PMID 25247407
  28. McCarthy AM, Kontos D, Synnestvedt M, et al. Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst. Nov 2014;106(11). PMID 25313245
  29. Rose SL, Tidwell AL, Bujnoch LJ, et al. Implementation of Breast Tomosynthesis in a Routine Screening Practice: An Observational Study. AJR Am J Roentgenol. 2013/06/01 2013;200(6):1401-1408.
  30. Gilbert FJ, Tucker L, Gillan MG, et al. The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme--a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technol Assess. Jan 2015;19(4):i-xxv, 1-136. PMID 25599513
  31. U.S. Food and Drug Administration. MAMMOMAT Inspiration with Tomosynthesis. Summary. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTopic/pma/pma.cfm?num=P140011&source=govdelivery&utm_medium=email&utm_source=govdelivery. Accessed May 19, 2015.
  32. Zuley ML, Guo B, Catullo VJ, et al. Comparison of Two-dimensional Synthesized Mammograms versus Original Digital Mammograms Alone and in Combination with Tomosynthesis Images. Radiology. Jun 2014;271(3):664-671. PMID 24475859
  33. Skaane P, Bandos AI, Eben EB, et al. Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology. Jun 2014;271(3):655-663. PMID 24484063
  34. Lei J, Yang P, Zhang L, et al. Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis. Eur Radiol. Mar 2014;24(3):595-602. PMID 24121712
  35. Lei J, Yang P, Zhang L, et al. Reply to Letter to the Editor re: Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis. Eur Radiol. Apr 2014;24(4):928-929. PMID 24442445
  36. Michell MJ, Iqbal A, Wasan RK, et al. A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis. Clin Radiol. May 23 2012. PMID 22625656
  37. Bernardi D, Ciatto S, Pellegrini M, et al. Prospective study of breast tomosynthesis as a triage to assessment in screening. Breast Cancer Res Treat. May 2012;133(1):267-271. PMID 22270938
  38. Zuley ML, Bandos AI, Ganott MA, et al. Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology. Jan 2013;266(1):89-95. PMID 23143023
  39. Skaane P, Gullien R, Bjorndal H, et al. Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol. Jun 1 2012;53(5):524-529. PMID 22593120
  40. Rafferty EA, Park JM, Philpotts LE, et al. Diagnostic accuracy and recall rates for digital mammography and digital mammography combined with one-view and two-view tomosynthesis: results of an enriched reader study. AJR Am J Roentgenol. Feb 2014;202(2):273-281. PMID 24450665
  41. Thibault F, Dromain C, Breucq C, et al. Digital breast tomosynthesis versus mammography and breast ultrasound: a multireader performance study. Eur Radiol. Sep 2013;23(9):2441-2449. PMID 23673573
  42. Gennaro G, Hendrick RE, Toledano A, et al. Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol. Aug 2013;23(8):2087-2094. PMID 23620367
  43. Tagliafico A, Mariscotti G, Durando M, et al. Characterisation of microcalcification clusters on 2D digital mammography (FFDM) and digital breast tomosynthesis (DBT): does DBT underestimate microcalcification clusters? Results of a multicentre study. Eur Radiol. Jan 2015;25(1):9-14. PMID 25163902
  44. American College of Radiology. ACR Appropriateness Criteria®: breast cancer screening; date of origin, 2015. http://www.acr.org/Quality-Safety/Appropriateness-Criteria/ACR-Appropriateness-Criteria-in-Publications/2015. Accessed April, 2015.
  45. American College of Radiology. ACR Appropriateness Criteria®: breast microcalcifications initial diagnostic workup; last review date, 2009. http://www.acr.org/Quality-Safety/Appropriateness-Criteria. Accessed April, 2015. 
  46. American College of Radiology (ACR). ACR, SBI Statement on Skaane et al. -- Tomosynthesis Breast Cancer Screening Study. News Releases 2013; http://www.acr.org/About-Us/Media-Center/Press-Releases/2013-Press-Releases/20130110ACR-SBI-Statement-on-Skaane-et-al. Accessed April, 2015.
  47. American College of Radiology. Position statements: ACR statement on breast tomosynthesis, 11/24/2014. http://www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/20141124-ACRStatement-on-Breast-Tomosynthesis. Accessed June 11, 2015.
  48. The American College of Obstetricians and Gynecologists. Practice bulletin no. 122: Breast cancer screening. Obstet Gynecol. Aug 2011;118(2 Pt 1):372-382. PMID 21775869
  49. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: breast cancer screening and diagnosis, version 1.2014 (discussion update in progress). http://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. Accessed May 18, 2015.
  50. U.S. Preventive Services Task Force. Screening for breast cancer: recommendation statement, updated December 2009. http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm. Accessed April, 2015.
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Coding Section

Codes Number Description
CPT 77061

Digital breast tomosynthesis; unilateral (new code 01/01/15)

  77062

bilateral (new code 01/01/15)

  77063

Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) (new code 01/01/15)

ICD-9-CM Diagnosis

174.0-174.9

Malignant neoplasm of female breast

 

175.0-175.9

Malignant neoplasm of male breast

 

198.81

Secondary malignant neoplasm of breast

 

233.0

Carcinoma in situ of breast

 

611.72

Lump or mass of breast

 

V10.3

Personal history of breast cancer

 

V16.3

Family history of breast cancer

 

V84.01

Genetic susceptibility to malignant neoplasm of breast

HCPCS

G0279

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206) (new code 01/01/15)

ICD-10-CM (effective 10/01/15)

C50.011-C50.019, C50.111-C50.119, C50.211-C50.219, C50.311-C50.319, C50.411-C50.419, C50.511-C50.519, C50.611-C50.619, C50.811-C50.819, C50.911-C50.919

Malignant neoplasm of female breast code range

 

C50.021-C50.029, C50.121-C50.129, C50.221-C50.229, C50.321-C50.329, C50.421-C50.429, C50.521-C50.529, C50.621-C50-629, C50.821-C50.829, C50.921-C50.929

Malignant neoplasm of male breast code range

 

C79.81

Secondary malignant neoplasm of breast

 

D05.9

Carcinoma in situ of breast

 

N63

Lump or mass of breast

 

Z85.3

Personal history of breast cancer

 

Z80.3

Family history of breast cancer

 

Z15.01

Genetic susceptibility to malignant neoplasm of breast

ICD-10-PCS (effective 10/01/15)  

ICD-10-PCS codes are only used for inpatient services.

 

BH00ZZZ, BH01ZZZ, BH02ZZZ

Imaging, breast, plain radiography, code by location (right, left or bilateral)

Type of Service

Radiology

 

Place of Service

Outpatient

 

 Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive. 

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

12/10/2019 

Annual review, no change to policy intent. Updating rationale and description. 

12/04/2018 

Annual review, no change to policy intent. 

12/7/2017 

Annual review, no change to policy intent.

12/01/2016 

Annual review, no change to policy intent. 

12/22/2015 

Interim review, making changes effective 01012016 related to codes 77061, 77062, 77063, G02079.

10/08/2015 

Annual review, updating verbiage to allow as medically necessary. This will not be separately reimbursable if filed with a mammography code. Updated background, description, rationale, references. Added guidelines, regulatory status and coding.

07/29/2014

Annual review. Added related policies. Updated description, background, regulatory status, rationale and references. No change to policy intent. 


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