Breast Cancer Awareness

Today, in the United States alone, it is estimated there are more than four million women living as a breast cancer survivor. 

One in eight women in the United States will be diagnosed with breast cancer in her lifetime. According to the American Cancer Society, it is estimated that in 2025, 316,950 women and 2,800 men will experience new diagnosis of invasive breast cancer (breast cancer that has spread). It is the second-leading cause of cancer death in women after lung cancer. The chance of death from breast cancer for women is approximately 1 in 43. Black women, at every age, have a higher rate of death from breast cancer than all other women. This is related to the fact that black women have a higher risk of triple-negative breast cancer. Overall, there has been a decrease in the rates of death due to screening, increased awareness, and better treatment. 

Breast cancer swareness is the key to empowering providers to assist patients with making informed decisions about their health, as it focuses on facts and statistics. Screening is the best way for early detection. Mammography looks for signs of cancer before symptoms may be noticeable to the patient.

The Centers for Disease Control (CDC) states the US Preventive Services Task Force recommends that women 40 to 74 years of age who are at an average risk for breast cancer get a mammogram every two years. Since screening recommendations may be different for women at higher risk it is important for providers to know their patient’s’ medical/family/social history. Providers should talk with their patients; ensure they understand what a mammogram can and cannot do and teach them what to expect. 

The American Cancer Society's estimates for breast cancer in the United States for 2025 are: 

• 316,950 new cases of invasive breast cancer will be diagnosed in women
• 59,080 new cases of ductal carcinoma in situ (DCIS) will be diagnosed 
• 42,170 women will die from breast cancer

Medicare Part B Covers Female Patients Aged 35 and Older

• The benefits of breast cancer screening reduce deaths, decrease the number of women diagnosed at a late stage, increase in life expectancy, and increase five-year survival rates
• Screening also saves money!

Frequency

• Aged 35–39: 1 baseline
• Aged 40 and older: annually

Patient Pays

No copayment, coinsurance, or deductible

Mammography Screening 

National Coverage Determination (NCD 220.4)

HCPCS & CPT© Codes

• 77063 — Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
• 77067 — Screening mammography, bilateral (two-view study of each breast), including computer-aided detection (CAD) when performed
  • Use 77063 in addition to 77067 (2D mammography) when using tomosynthesis (3D mammography)

ICD-10 CM Codes

Z12.31

Other Important Coding Information

• Report dual dx codes showing specific quadrants instead of unspecified quadrants, if appropriate
• Additional ICD-10 codes may apply. When performing and billing a screening mammogram find individual change requests and specific ICD-10-CM service codes we cover on the CMS ICD-10 web page. Go to Palmetto GBA for more information.
• If you perform and bill a screening mammogram and a diagnostic mammogram on the same day, use modifier GG to show a screening mammography turned into a diagnostic mammography

Resources

• American Cancer Society Breast Cancer
• Breast Cancer (CDC)
• Checking Medicare Eligibility (PDF)
• Breast Cancer Screening Disparities in Medicare Beneficiaries (PDF)
• Women’s Health and Cancer Rights Act (WHCRA)
• Medicare Preventive Services Mammography Screening
• National Cancer Institute Breast Cancer Health Professional