Mammography
Provider Type
- Physicians
- Hospitals
- Participating Physician Groups (PPG)
- Ancillary
Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) cover conventional 2-D mammography for commercial members in accordance with the member's health plan policy and the Women’s Preventive Services Guidelines – Health Resources & Services Administration.
Health Net covers 3-D mammography, also known as digital breast tomosynthesis (DBT), for HMO, Point of Service (POS), HSP, PPO, and EPO (commercial) plans. Claims codes affected by this change are listed below.
When administered as a preventive screening, this benefit is subject to the annual screening limit, and cost-shares do not apply. If DBT services are provided for diagnostic purposes outside of the annual screening, they do not require prior authorization, but are subject to the member's applicable cost-share.
Claims coding for DBT:
CPT Codes | Description |
|---|---|
77061 | Digital breast tomosynthesis; unilateral |
77062 | Digital breast tomosynthesis; bilateral |
77063 | Screening digital breast tomosynthesis, bilateral |
HCPCS Codes | Description |
G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral |