Billing code 77065: Diagnostic mammogramMedicare rate & RVUs in Rhode Island
Diagnostic mammography of a single breast, including computer-aided detection when used, reported for a symptom, a callback from screening, or follow-up of a known finding.
Medicare pays $127.35 for 77065 in the office in Rhode Island (Rhode Island). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 77065 covers
This service is a problem-focused mammographic exam of one breast. It is ordered for a palpable lump, focal pain, nipple discharge, or skin change; a callback for an area of concern on screening; or short-interval follow-up of a probably benign finding. A technologist obtains views tailored to the question, such as spot compression or magnification views when indicated. A radiologist interprets the images and issues a report with a BI-RADS assessment and recommendations. A targeted breast ultrasound may also be performed to evaluate the area of concern.
Report 77065 when one breast is imaged diagnostically; use 77066 when both breasts receive diagnostic mammography. Identify the examined breast with RT or LT. Computer-aided detection, when performed, is included rather than separately billed. The order and report should document the reason for the diagnostic exam and the side examined. For component billing, modifier 26 identifies the radiologist's interpretation, while modifier TC identifies equipment and technologist work. An entity furnishing both components reports the global service without either component modifier.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
77065 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | $127.35 | Unavailable |
How the 77065 rate is calculated
Each of 77065’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 77065
RVUs × geographic indexes × conversion factor
Work0.79
0.79 RVUs× 1.000 GPCI
Practice expense2.86
2.86 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
3.7100
Conversion factor
$33.4009
Medicare rate
$123.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77065
The CMS indicators that decide how 77065 is paid alongside other services.
CMS payment indicators · 77065
Diagnostic mammogram
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
77065 without 26 · national office
$123.92
Diagnostic mammogram
77065-26 · Professional component
$37.74
Pays only the interpretation and report.
77065 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 77066Diagnostic mammogram
- 77066 covers diagnostic mammography of both breasts in one session; 77065 covers one breast, identified with RT or LT.
- 77067Screening mammogram
- 77067 is a bilateral screening study; 77065 is a unilateral diagnostic exam for a symptom, screening callback, or follow-up finding.
- 77061Breast tomosynthesis uni
- 77061 is a unilateral diagnostic tomosynthesis add-on for payers recognizing that code, not a substitute for 77065. Medicare reports G0279 with 77065 when diagnostic tomosynthesis is performed.
77065 billing questions
When should the bilateral diagnostic code be used instead?
Report 77066 when both breasts are imaged diagnostically at the same session. Use 77065 when only one breast receives a diagnostic exam, even if the other breast had a screening study earlier.
Can CAD be billed separately with this code?
No. Computer-aided detection is included when performed; do not report a separate CAD code.
How is a same-day screening followed by a diagnostic exam reported to Medicare?
When a screening mammogram leads to a diagnostic mammogram on the same day, report the screening and diagnostic codes and append modifier GG to the diagnostic code.
How is diagnostic tomosynthesis reported with this code for Medicare?
Medicare uses add-on code G0279 for diagnostic digital breast tomosynthesis performed with 77065; it does not replace the diagnostic mammography code.
Which modifiers identify the professional and technical components?
A radiologist billing only the interpretation reports 77065-26. A provider billing only image acquisition reports 77065-TC; an entity furnishing both components reports 77065 without either component modifier.
How is the examined breast identified?
Append RT or LT to 77065 to identify the breast examined.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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