Effective for dates of service beginning Jan. 1, 2018, Harvard Pilgrim will cover digital breast tomosynthesis (DBT), commonly known as 3D mammography, for screening or diagnostic purposes in all states. Previously, 3D mammography services were denied as experimental/investigational*.
In 2018, when 3D mammography is performed for medically necessary screening, Harvard Pilgrim will accept the 3D add-on code 77063+ when filed with a 2D CPT (77067 or G0202) code.
When 3D mammography/DBT is used for diagnostic purposes, providers may submit 3D services in one of the following ways:
- Using one of the following 3D-specific codes: 77061 and 77062
- Using 2D (77065 or 77066) diagnostic codes with the following 3D add-on code: G0279.
Harvard Pilgrim will not separately reimburse 3D add-on codes filed with 2D services. These add-on codes will deny as provider liable and the member cannot be balance billed.
Harvard Pilgrim will add any newly covered codes to the fee schedules as needed. For additional information, please refer to the updated Mammography Medical Policy.
*Harvard Pilgrim recognizes and reimburses all 3D mammography in Connecticut in accordance with a 2016 state mandate.