77065
Diagnostic mammography, unilateral
Diagnostic mammography, unilateral. CMS 2026 global wRVU 0.74, total RVU approximately 3.41, Medicare global allowable approximately $114. Used when a clinical indication or recall from screening requires focused imaging of one breast.
When to use it
Use 77065 when diagnostic (not screening) mammography is indicated for one breast: callback from screening abnormality, palpable mass or focal pain, nipple discharge, focal asymmetry on prior imaging, post-treatment surveillance for breast cancer (often only the treated side). 77066 is bilateral diagnostic.
Full guidance
Add 77061 (DBT diagnostic unilateral) when tomosynthesis is also performed.
Documentation checklist
- ✓Order with diagnostic indication (callback, palpable abnormality, focal symptom, post-treatment surveillance).
- ✓Standard diagnostic views performed (typically CC, MLO plus spot compression, magnification, or other targeted views as indicated).
- ✓Interpretation report with BI-RADS category and recommendation (BI-RADS 1 negative, 2 benign, 3 short-interval follow-up, 4 suspicious biopsy recommended, 5 highly suspicious).
- ✓If diagnostic recall from a screening, reference the screening study and finding.
- ✓Setting modifier; signed report.
Common pitfalls
- !Billing 77065 alongside 77067 (screening) on the same date for the same patient. Pick one based on the encounter purpose.
- !Billing 77065 (unilateral) when both breasts were imaged diagnostically. The correct code is 77066 (bilateral diagnostic).
- !Missing the DBT add-on 77061 if 3D was performed.
- !Confusing diagnostic mammography with breast ultrasound (76641 complete unilateral, 76642 limited). They are separate complementary studies often performed in the same encounter; each bills separately.
- !Failing to assign BI-RADS category. Drives all downstream care decisions.
Payer notes
Medicare and commercial payers cover 77065 with a documented diagnostic indication. May have patient cost share under commercial plans (unlike screening). Document the indication clearly so payer can match against medical necessity. Post-treatment surveillance is usually annual for the treated side; bilateral surveillance varies by oncology practice.