18 May Screening Mammography – Type of Service Code Change
The Type of Service (TOS) code for CPT code 77067 for Screening Mammography will be updated to “1” (Medical Care) instead of “4” (Diagnostic Radiology). This will allow for accurate claim submission and adjudication of screening mammography.
Correcting the TOS code for CPT code 77067 allows screening mammography claims to be submitted and adjudicated appropriately with no referring physician information on the claim, this is consistent with Medicare’s coverage policy for screening mammograms.
Be aware that MACs have been educated to automatically reprocess previously adjudicated screening mammography claims received with CPT – 77067 with a TOS code of “4” with dates of service on and after January 1, 2018, and through July 2, 2018, when the claim was denied because there was no referring provider information. For all dates of service between January 1, 2018 and July 2, 2018 which cannot be automatically reprocessed, you must notify your MAC. These claims will be adjudicated and reprocessed correctly using TOS code “1”.
For additional information please refer to MLN Matters Number: MM10607 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10607.pdf