Billing for a breast exam

March 9th, 2009 - Codapedia Editor
Categories:   Coding   Preventive Medicine Service  
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Sometimes, a patient presents only for a breast exam, perhaps prior to a mammogram.   Is that a separately billable service?

Newly found lump: A patient who presents with a newly discovered lump and presents to the office can be billed with new or established patient visit codes (depending on the patient status, 99201--99215).  Select a code based on the level of service. (History, exam, MDM or time, as appropriate.)

Part of a preventive medicine visit:  The breast exam is part of an age/gender appropriate exam.

As part of a pelvic and clinical breast exam on a Medicare patient: Bill code G0101 for Medicare patients (frequency and diagnosis limists apply, see article in Codapedia on this topic.)  G0101 must include the clinical breast exam and a total of 7 of the 11 exam elements.

Breast exam only: There is no code for performing only a breast exam. 

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