Mount Carmel Health Partners HEDIS Tip Sheets | Page 11

HEDIS Tip Sheet
Breast Cancer Screening
Definition: Women 50 to 74 years old who have had a mammogram.
Service Needed Mammogram between October 1 two years before the measurement year and December 31 of the
measurement year.
Coding:
CPT 4
HCPCS
Revenue
77055 - 77057
77061 - 77063
77065 - 77067
G0202
G0204
G0206
0401
0403
Exclusions:
• Bilateral mastectomy.
• Hospice care in the measurement year.
Chart Review Tips:
• Mammograms are usually in the "Radiology" section of the medical record.
• Types of mammograms: screening, diagnostic, film, digital, or digital breast tomosynthesis.
• Women need to have a mammogram every 2 years.
• If the patient has had a unilateral mastectomy, the patient still needs a mammogram on the remaining side.
• Review progress notes and correspondence for history of a mastectomy.
Member Outreach Tips:
• Ask the patient if she has had a bilateral mastectomy or recent mammogram before reminding her that she is due
for a screening.
• If the patient has had a bilateral mastectomy, please note it for future reference.
• If the patient is due to have another mammogram within the next 1-2 months, call to remind her to schedule one
soon.
• Patients may request an appointment for their mammogram with a physician order by visiting.
https://www.mountcarmelhealth.com/mammogram-appointment-request or calling 614-234-7400.
Supplemental Data Tips
• A copy of the actual mammogram must be in the chart to close the care gap. Self-reported data does not count.
• Avoid biopsies, breast ultrasounds and MRIs' results due to these are not appropriate methods for primary breast
cancer screening.
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