Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography

Coverage for breast sonography, breast MRI, and mammary ductography is contingent on documentation of medical necessity consistent with the related LCD (L33585) and must be billed using the specified CPT/HCPCS codes. Claims must include a valid ICD-10-CM diagnosis code, the ordering/treating provider NPI (reported in CMS-1500 item 17a), required formal reports in the medical record, and adhere to coding restrictions (e.g., only specified CPT codes per date of service, Part A packaging rules, and NCCI/OPPS edits).

"Breast sonography (CPT 76641, 76642) is covered when the medical record documents medical necessity per the related LCD (L33585); if performed bilaterally, report modifier 50 with CPT 76641 or 76642."

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