Location: US/PA
My insurance benefits cover mammography as a preventative service. In a recent screening the following two codes were billed and submitted to the insurance
SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD – 77067 (CPT®)
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI – 77063 (CPT®)
My insurance (Horizon BCBS) covered 77063 in full but applied 77067 to my deductible. When I asked why that was the case, I was told this counts as 2 separate mammograms in one calendar year. Is this practice normal? My doctor explained Tomosynthesis is supplemental imaging to the main mammogram so I had to get them both for my annual screen but my insurance considers it as 2 separate tests.
Any insight here is helpful. I am just trying to make sure that my insurance is not making a mistake and/or my doctor is not requesting testing that is in excess of what is considered the norm (which if she is that’s fine but I would like to understand).
Thanks!
submitted by /u/pililies
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Location: US/PA My insurance benefits cover mammography as a preventative service. In a recent screening the following two codes were billed and submitted to the insurance SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD – 77067 (CPT®) SCREENING DIGITAL BREAST TOMOSYNTHESIS BI – 77063 (CPT®) My insurance (Horizon BCBS) covered 77063 in full but applied 77067 to my deductible. When I asked why that was the case, I was told this counts as 2 separate mammograms in one calendar year. Is this practice normal? My doctor explained Tomosynthesis is supplemental imaging to the main mammogram so I had to get them both for my annual screen but my insurance considers it as 2 separate tests. Any insight here is helpful. I am just trying to make sure that my insurance is not making a mistake and/or my doctor is not requesting testing that is in excess of what is considered the norm (which if she is that’s fine but I would like to understand). Thanks!
submitted by /u/pililies [link] [comments]Read Morer/HealthInsurance