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Update to EWC Diagnostic and Screening Mammography Benefits

February 20, 2018

A previously published Medi-Cal Update that added, changed and deleted CPT-4 and HCPCS codes for the 2018 annual update, effective February 1, 2018, failed to establish that the following HCPCS codes are no longer benefits for the Every Woman Counts (EWC) program:

HCPCS Code Description
G0202 Screening mammography, bilateral, including CAD when performed
G0204 Diagnostic mammography, including CAD when performed; bilateral
G0206 Diagnostic mammography, including CAD when performed; unilateral

Instead, providers should use the following CPT-4 codes when billing for screening or diagnostic mammography:

CPT-4 Code Description
77065 Diagnostic mammography, including CAD when performed; unilateral
77066 Diagnostic mammography, including CAD when performed; bilateral
77067 Screening mammography, bilateral, including CAD when performed

For specific billing policy for CPT-4 codes 77065 – 77067, providers should refer to the November 20, 2017, NewsFlash article titled “Update to EWC Diagnostic and Screening Mammography Benefits”, and Every Woman Counts in the appropriate Part 2 manual.

These changes will be reflected in the manual in a future Medi-Cal Update.

Providers should refer to the HCPCS Annual Update web page for ongoing updates.