MRI Breast Screening for Every Woman Counts Program

May 15, 2020

Effective for dates of service on or after June 1, 2020, the following Magnetic Resonance Imaging (MRI) procedures and MRI-Guided services are reimbursable Every Woman Counts (EWC) program benefits.

CPT® codes 19081 – 19086 are to be used for breast biopsies that include image guidance, placement of a localization device and imaging of specimen. These codes cannot be billed in conjunction with codes 19281 – 19288 for image guidance placement of a localization device without image guided biopsy.

These MRI services are not subject to any authorization or Treatment Authorization Request (TAR) requirements.

No action is required of providers. An Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims, as appropriate.

CPT® Code Definition
10011 Fine needle aspiration biopsy, including MR guidance, first lesion
10012   each additional lesion
19085 Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; magnetic resonance guidance, first lesion
19086   additional lesion
19287 Placement of breast localization device, percutaneous; magnetic resonance guidance; first lesion, including magnetic resonance guide
19288   each additional lesion
77046 Magnetic resonance imaging (MRI), breast, without contrast, unilateral
77047   bilateral
77048 Magnetic resonance imaging (MRI), breast, including computer-aided detection (CAD), without and with contrast material(s), when performed; unilateral
77049   bilateral

Use of modifiers (required and optional) is the same for Medi-Cal and EWC claims.