If you are Texas Children’s Health Plan Member, we have tips that can help you deal with the severe weather. Learn more
Si eres miembro de Texas Children’s Health Plan, tenemos consejos que pueden ayudarte a lidiar con el clima severo. Aprende Más
Obstetric Care Providers and Radiologists
Attention: Obstetric Care Providers and Radiologists Effective Date: March 1, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: Texas Children’s Health Plan (TCHP) would like to notify network providers that effective for dates of service on or after March 1, 2021, digital breast tomosynthesis (DBT) procedure codes 77063 and G0279 will become a benefit of Texas Medicaid. DBT is also known as three-dimensional (3D) mammography, provides 3D images and is a modification of conventional mammography. Diagnostic DBT is used, along with conventional diagnostic mammography, to diagnose breast disease in women or men who have breast symptoms or findings on physical examination or screening mammogram.
How this impacts providers:
77063 and 77067 Coding Information:
- Screening DBT (procedure code 77063) is used, along with conventional screening mammography, to detect breast changes in women who have no signs or symptoms of breast cancer.
- Procedure code 77063 must be billed with primary procedure code 77067.
- Reimbursement may be considered for procedure code 77063 when performed on the same date of service, any provider, as procedure code 77067 with the modifier GG.
- Procedure codes 77063 and 77067 will be limited to one per rolling year, any provider.
- 77067 Excluded for CHIP
- Diagnostic DBT (procedure code G0279) is used, along with conventional diagnostic mammography, to diagnose breast disease in women or men who have breast symptoms or findings on physical examination or screening mammogram.
- Procedure code G0279 must be billed with primary procedure code 77065 or 77066.
- Reimbursement may be considered for procedure code G0279 when performed on the same date of service, any provider, as procedure code 77065 or 77066 with the modifier GG.