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77065

Diagnostic Mammogram, One Breast

Code Description

CPT code 77065 is used to report diagnostic mammography performed on one breast. The service includes computer-aided detection (CAD) when performed.

Unlike routine screening mammography, diagnostic mammography is performed to evaluate a specific symptom, abnormal finding, or area of concern. Common reasons include a breast lump, focal breast pain, suspicious nipple discharge, or follow-up of an abnormality identified during previous breast imaging.

When to Use 77065

Common examples include:

  • Evaluation of a breast lump

  • Follow-up of an abnormal mammogram

  • Focal breast pain

  • Suspicious nipple discharge

  • Short-term follow-up of a previous imaging finding

  • Diagnostic evaluation limited to one breast

Documentation Requirements

Documentation should include:

  • Reason for the diagnostic examination

  • Breast examined

  • Relevant symptoms or abnormal findings

  • Medical necessity for diagnostic imaging

  • Radiologist interpretation

  • Diagnostic findings and recommendations

Common Billing Mistakes

Common billing mistakes include:

  • Reporting 77065 for bilateral diagnostic mammography

  • Confusing diagnostic and screening mammography

  • Failing to document the reason for the diagnostic examination

  • Incorrect reporting of professional or technical components

  • Insufficient documentation supporting medical necessity

Related CPT Codes
77066

Diagnostic Mammogram, Both Breasts

77067

Screening Mammogram

76641

Complete Breast Ultrasound

FAQ

What does CPT code 77065 cover?

CPT code 77065 reports diagnostic mammography of one breast, including computer-aided detection when performed.

What is the difference between CPT 77065 and 77066?

CPT 77065 is used for unilateral diagnostic mammography involving one breast. CPT 77066 is used when diagnostic mammography is performed bilaterally.

Is CPT 77065 used for screening mammograms?

No. CPT 77065 is a diagnostic mammography code. Bilateral screening mammography is reported with CPT 77067.

When is diagnostic mammography performed?

Diagnostic mammography may be performed to evaluate symptoms such as a breast lump, focal pain, or suspicious nipple discharge, as well as to investigate or monitor abnormalities found on previous breast imaging.

Procedure Type

Diagnostic Mammography

Body Area

Laterality

Breast

Unilateral