CPT Code 77063
Screening 3D Breast Tomosynthesis (Bilateral)
Simple English Explanation
Digital 3D breast imaging performed as an add-on during a routine screening mammogram.
Why doctors use this: Takes multiple X-ray slices to reconstruct a 3D view of breast tissue. Enhances cancer detection in dense breasts and reduces false alarms and recall rates.
🔗 Frequently Billed With CPT 77067
Patients routinely see CPT 77063 and CPT 77067 (Screening Mammography (2D)) listed together on the same bill or EOB.
CPT 77063 is an add-on procedure that cannot legally be billed alone. It must be paired with primary screening code CPT 77067.
Clinical & Billing Details
CPT 77063 represents Screening Digital Breast Tomosynthesis (commonly called a 3D Mammogram), bilateral. In American Medical Association (AMA) coding guidelines, CPT 77063 is explicitly designated as an 'add-on code' (+77063). This means it cannot be billed on its own; it must always be billed in conjunction with primary screening mammogram code CPT 77067. If you see both codes on your statement, it reflects the base 2D mammogram plus the advanced 3D tomosynthesis imaging technology.
Typical US Price Range
$50 – $160*Estimated cash price before insurance adjustments.
Why prices vary: The cost can change drastically depending on whether you are at a hospital ER (most expensive), a hospital outpatient department, or a private doctor's office. Your location and specific insurance plan also play a huge role.
Insurance Coverage & Mandates
Medicare Part B covers CPT 77063 at 100% with $0 copay and $0 deductible when performed as part of your annual screening mammogram. Under the Affordable Care Act (ACA), preventive screening mammography is mandated without cost-sharing. Additionally, over 38 states have enacted laws requiring private commercial health plans to cover 3D mammograms without deductible or copayment. However, some self-funded ERISA employer plans or out-of-network providers may balance-bill $50 to $150 for the 3D portion.
⚠️ Often Misunderstood
This code is frequently confusing for patients. Sometimes it appears as a separate line item from the main procedure, or it might be a "facility fee" component. Always ask for an itemized bill to see exactly what this charge covers.
Questions to Ask Billing
- "Why did my insurance cover CPT 77067 at 100% but apply a charge or deductible to add-on code 77063?"
- "Was this claim submitted with preventive modifier 33 or modifier 59 to ensure zero-cost preventive coverage?"
- "Does state insurance mandate law in my state require commercial plans to cover 3D tomosynthesis without cost-sharing?"
- "If 77063 was denied as investigational or non-covered, can billing resubmit the claim with pre-authorization or clinical notes regarding breast density?"
Frequently Asked Questions
Why do I see both CPT 77063 and CPT 77067 on my bill?
CPT 77067 is the primary charge for the standard 2D screening mammogram, while CPT 77063 is the add-on charge for 3D breast tomosynthesis technology. When clinics perform a 3D mammogram, billing rules require them to submit both codes together. You were not double-billed; they represent the two components of your screening.
Is CPT 77063 covered by insurance or should it be free under ACA?
Under Medicare guidelines and in over 38 states, CPT 77063 must be covered at 100% with $0 copay and $0 deductible. While the ACA mandates standard screening mammograms (77067) be free, some non-compliant, grandfathered, or self-insured employer plans still pass the 3D portion (typically $50-$150) to the patient's deductible. Call your insurer to confirm if preventive modifier 33 was attached.
Can CPT 77063 be billed by itself without 77067?
No. CPT 77063 is strictly an 'add-on code' (+77063) under AMA guidelines. It can never be billed as an independent stand-alone procedure. If you see CPT 77063 without CPT 77067 on your bill, the medical provider's billing office made a coding error and should issue a corrected claim.
What should I do if I received a bill or denial for CPT 77063?
First check your Explanation of Benefits (EOB) for denial codes. If your insurer denied 77063 as 'not medically necessary' or applied it to your deductible, call both the billing department and your insurer. Ask them to verify that the diagnosis code was preventive screening (ICD-10 Z12.31) and request a formal appeal based on state 3D mammography coverage mandates.
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Disclaimer: This website provides educational information only and does not provide medical, legal, or insurance advice. CPT® is a registered trademark of the American Medical Association. Prices are estimates based on national averages.