| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $138.96 |
| Typical Billed Amount What providers commonly charge | $200 – $800 |
| Potential Markup How much more you might pay vs. Medicare rate | 476% above Medicare |
What CPT Code 77067 Means
When you see CPT code 77067 on your medical bill, it means you received a screening mammogram of both breasts that included computer-aided detection (CAD) technology. This is the standard preventive mammogram that women get annually or as recommended by their doctor to screen for breast cancer.
The "bilateral" part means both breasts were examined, and CAD refers to computer software that helps radiologists spot potential areas of concern. This code is specifically for screening mammograms when you have no symptoms or breast problems – it's purely preventive care.
Your doctor will order this test as part of routine breast cancer screening, typically starting at age 40 or 50 depending on your risk factors and medical guidelines. The mammogram technologist will position you for several X-ray images of each breast, and a radiologist will review the images with computer assistance.
How Billing Works for CPT 77067
The cost for CPT code 77067 varies significantly depending on where you get your mammogram. Typical charges range from $200 to $800, while Medicare pays $138.96 for this service. Your actual out-of-pocket cost depends on your insurance coverage and whether you've met your deductible.
Most insurance plans, including Medicare, cover screening mammograms at 100% with no copay or deductible when performed at the recommended intervals. This is because mammograms are considered preventive care under the Affordable Care Act. However, if your mammogram is coded differently or performed more frequently than recommended, you might have some cost-sharing.
On your bill or explanation of benefits, you'll see CPT 77067 listed along with the facility charge. Some providers may also bill separately for the radiologist's interpretation, though this is often included in the main charge. Make sure the service is coded as a screening mammogram to ensure you receive full preventive care coverage.
How to Verify Your Bill is Correct
To check if you were billed correctly for CPT 77067, first confirm that you received a routine screening mammogram of both breasts with no symptoms or problems. If you had breast pain, a lump, or other concerns, your mammogram might be coded differently as a diagnostic exam, which could affect your coverage.
Compare the charged amount to the typical range of $200-$800. If the charge seems unusually high, contact your provider's billing department to ask for an itemized explanation. Also verify that your insurance processed the claim as preventive care – you should have little to no out-of-pocket cost for a routine screening mammogram.
If you notice any billing errors, such as being charged for a diagnostic mammogram when you had a screening, or if your insurance didn't cover the service as preventive care, contact both your healthcare provider and insurance company. Keep records of your communications and don't hesitate to ask for a supervisor if the first representative can't resolve the issue.