Corporate

August 12, 2016

Mammography Services Billing Reminder

Providers and suppliers that furnish and bill Medicare for film, digital, or 3-D mammography services are reminded that claims for these mammography services will either deny or reject as unprocessable if:

  • There is no FDA certification number reported on the claim
  • The facility is not certified for the type of mammogram submitted on the claim (film, digital, or 3-D)
  • A facility's certificate is suspended or revoked
  • The HCPCS/CPT code billed does not match the certification on file for the facility, or
  • There is no FDA certification number on the MQSA file for the facility listed on the claim.

For additional information, providers and supplies that furnish and bill Medicare for film, digital, or 3-D mammography services can refer to Medicare's Internet Only Manual (IOM) Publication 100-04, Chapter 18, Section 20 and its subsections found here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdfExternal PDF

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