Provider Alert! Obstetric Care Providers and Radiologists

Attention: Obstetric Care Providers and Radiologists    

Effective Date: March 1, 2021

Providers 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

G0279, 77065, and 77066 Coding Information:

• 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.

Resource: https://www.tmhp.com/news/2021-01-15-effective-march-1-2021-procedure-codes-77063-and-g0279-become-benefits-texas

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.