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HMSA Payment Transformation 2020 Measure Value Set Breast Cancer PT - 2020 Measure Value Set_Breast Cancer Screening Numerator Value Set Name Code Definition Code System Mammography 77055 CPT Mammography 77056 CPT Mammography 77057 CPT Mammography 77061 CPT Mammography 77062 CPT Mammography 77063 CPT Mammography 77065 CPT Mammography 77066 CPT Mammography 77067 CPT Screening mammography, bilateral (2-view study of each breast), including computer-aided Mammography G0202 HCPCS detection (cad) when performed (G0202) Diagnostic mammography, including computer-aided detection (cad) when performed; Mammography G0204 HCPCS bilateral (G0204) Diagnostic mammography, including computer-aided detection (cad) when performed; Mammography G0206 HCPCS unilateral (G0206) Mammography 87.36 Xerography of breast ICD9PCS Mammography 87.37 Other mammography ICD9PCS Mammography 24604-1 MG Breast Diagnostic Limited Views LOINC Mammography 24605-8 MG Breast Diagnostic LOINC Mammography 24606-6 MG Breast Screening LOINC Mammography 24610-8 MG Breast Limited Views LOINC Mammography 26175-0 MG Breast - bilateral Screening LOINC Mammography 26176-8 MG Breast - left Screening LOINC Mammography 26177-6 MG Breast - right Screening LOINC Mammography 26287-3 MG Breast - bilateral Limited Views LOINC Mammography 26289-9 MG Breast - left Limited Views LOINC Mammography 26291-5 MG Breast - right Limited Views LOINC Mammography 26346-7 MG Breast - bilateral Diagnostic LOINC Mammography 26347-5 MG Breast - left Diagnostic LOINC Mammography 26348-3 MG Breast - right Diagnostic LOINC Mammography 26349-1 MG Breast - bilateral Diagnostic Limited Views LOINC Mammography 26350-9 MG Breast - left Diagnostic Limited Views LOINC November 2019 Page 1 of 203 PT - 2020 Measure Value Set_Breast Cancer Screening Numerator Value Set Name Code Definition Code System Mammography 26351-7 MG Breast - right Diagnostic Limited Views LOINC Mammography 36319-2 MG Breast 4 Views LOINC Mammography 36625-2 MG Breast Views LOINC Mammography 36626-0 MG Breast - bilateral Views LOINC Mammography 36627-8 MG Breast - left Views LOINC Mammography 36642-7 MG Breast - left 2 Views LOINC Mammography 36962-9 MG Breast Axillary LOINC Mammography 37005-6 MG Breast - left Magnification LOINC Mammography 37006-4 MG Breast - bilateral MLO LOINC Mammography 37016-3 MG Breast - bilateral Rolled Views LOINC Mammography 37017-1 MG Breast - left Rolled Views LOINC Mammography 37028-8 MG Breast Tangential LOINC Mammography 37029-6 MG Breast - bilateral Tangential LOINC Mammography 37030-4 MG Breast - left Tangential LOINC Mammography 37037-9 MG Breast True lateral LOINC Mammography 37038-7 MG Breast - bilateral True lateral LOINC Mammography 37052-8 MG Breast - bilateral XCCL LOINC Mammography 37053-6 MG Breast - left XCCL LOINC Mammography 37539-4 MG Breast Grid Views LOINC Mammography 37542-8 MG Breast Magnification Views LOINC Mammography 37543-6 MG Breast - bilateral Magnification Views LOINC Mammography 37551-9 MG Breast Spot Views LOINC Mammography 37552-7 MG Breast - bilateral Spot Views LOINC Mammography 37553-5 MG Breast - left Spot Views compression LOINC Mammography 37554-3 MG Breast - bilateral Magnification and Spot LOINC Mammography 37768-9 MG Breast - right 2 Views LOINC Mammography 37769-7 MG Breast - right Magnification and Spot LOINC Mammography 37770-5 MG Breast - right Tangential LOINC Mammography 37771-3 MG Breast - right True lateral LOINC Mammography 37772-1 MG Breast - right XCCL LOINC Mammography 37773-9 MG Breast - right Magnification LOINC Mammography 37774-7 MG Breast - right Views LOINC November 2019 Page 2 of 203 PT - 2020 Measure Value Set_Breast Cancer Screening Numerator Value Set Name Code Definition Code System Mammography 37775-4 MG Breast - right Rolled Views LOINC Mammography 38070-9 MG Breast Views for implant LOINC Mammography 38071-7 MG Breast - bilateral Views for implant LOINC Mammography 38072-5 MG Breast - left Views for implant LOINC Mammography 38090-7 MG Breast - bilateral Air gap Views LOINC Mammography 38091-5 MG Breast - left Air gap Views LOINC Mammography 38807-4 MG Breast - right Spot Views LOINC Mammography 38820-7 MG Breast - right Views for implant LOINC Mammography 38854-6 MG Breast - left Magnification and Spot LOINC Mammography 38855-3 MG Breast - left True lateral LOINC Mammography 42415-0 MG Breast - bilateral Views Post Wire Placement LOINC Mammography 42416-8 MG Breast - left Views Post Wire Placement LOINC Mammography 46335-6 MG Breast - bilateral Single view LOINC Mammography 46336-4 MG Breast - left Single view LOINC Mammography 46337-2 MG Breast - right Single view LOINC Mammography 46338-0 MG Breast - unilateral Single view LOINC Mammography 46339-8 MG Breast - unilateral Views LOINC Mammography 46350-5 MG Breast - unilateral Diagnostic LOINC Mammography 46351-3 MG Breast - bilateral Displacement Views for Implant LOINC Mammography 46356-2 MG Breast - unilateral Screening LOINC Mammography 46380-2 MG Breast - unilateral Views for implant LOINC Mammography 48475-8 MG Breast - bilateral Diagnostic for implant LOINC Mammography 48492-3 MG Breast - bilateral Screening for implant LOINC Mammography 69150-1 MG Breast - left Diagnostic for implant LOINC Mammography 69251-7 MG Breast Views Post Wire Placement LOINC Mammography 69259-0 MG Breast - right Diagnostic for implant LOINC SNOMED CT US Mammography 12389009 Xeromammography (procedure) Edition SNOMED CT US Mammography 24623002 Screening mammography (procedure) Edition SNOMED CT US Mammography 43204002 Bilateral mammography (procedure) Edition November 2019 Page 3 of 203 PT - 2020 Measure Value Set_Breast Cancer Screening Numerator Value Set Name Code Definition Code System SNOMED CT US Mammography 71651007 Mammography (procedure) Edition SNOMED CT US Mammography 241055006 Mammogram - symptomatic (procedure) Edition SNOMED CT US Mammography 241057003 Mammogram coned (procedure) Edition SNOMED CT US Mammography 241058008 Mammogram magnification (procedure) Edition SNOMED CT US Mammography 258172002 Stereotactic mammography (procedure) Edition SNOMED CT US Mammography 439324009 Mammogram in compression view (procedure) Edition SNOMED CT US Mammography 450566007 Digital breast tomosynthesis (procedure) Edition SNOMED CT US Mammography 709657006 Fluoroscopy of breast (procedure) Edition SNOMED CT US Mammography 723778004 Digital tomosynthesis of right breast (procedure) Edition SNOMED CT US Mammography 723779007 Digital tomosynthesis of left breast (procedure) Edition SNOMED CT US Mammography 723780005 Digital tomosynthesis of bilateral breasts (procedure) Edition SNOMED CT US Mammography 726551006 Contrast enhanced spectral mammography (procedure) Edition SNOMED CT US Mammography 384151000119104 Screening mammography of bilateral breasts (procedure) Edition SNOMED CT US Mammography 392521000119107 Screening mammography of right breast (procedure) Edition SNOMED CT US Mammography 392531000119105 Screening mammography of left breast (procedure) Edition SNOMED CT US Mammography 566571000119105 Mammography of right breast (procedure) Edition November 2019 Page 4 of 203 PT - 2020 Measure Value Set_Breast Cancer Screening Numerator Value Set Name Code Definition Code System SNOMED CT US Mammography 572701000119102 Mammography of left breast (procedure) Edition November 2019 Page 5 of 203 PT - 2020 Measure Value Set_Breast Cancer Screening Exclusion Value Set Name Code Definition Code System Bilateral Mastectomy 0HTV0ZZ [0HTV0ZZ] Resection of Bilateral Breast, Open Approach ICD10PCS Bilateral Mastectomy 85.42 Bilateral simple mastectomy ICD9PCS Bilateral Mastectomy 85.44 Bilateral extended simple mastectomy ICD9PCS Bilateral Mastectomy 85.46 Bilateral radical mastectomy ICD9PCS Bilateral Mastectomy 85.48 Bilateral extended radical mastectomy ICD9PCS SNOMED CT US Bilateral Mastectomy 14693006 Bilateral subcutaneous mammectomy (procedure) Edition SNOMED CT US Bilateral Mastectomy 14714006 Bilateral mastectomy with excision of bilateral regional lymph nodes (procedure) Edition SNOMED CT US Bilateral Mastectomy 17086001 Modified radical mastectomy, bilateral (procedure) Edition SNOMED CT US Bilateral Mastectomy 22418005 Bilateral simple mastectomy (procedure) Edition SNOMED CT US Bilateral Mastectomy 27865001 Bilateral mastectomy (procedure) Edition SNOMED CT US Bilateral Mastectomy 52314009 Bilateral mastectomy extended simple (procedure) Edition SNOMED CT US Bilateral Mastectomy 60633004 Bilateral subcutaneous mammectomy with synchronous implant (procedure) Edition SNOMED CT US Bilateral Mastectomy 76468001 Bilateral radical mastectomy (procedure) Edition SNOMED CT US Bilateral Mastectomy 456903003 Bilateral extended radical mastectomy (procedure) Edition SNOMED CT US Bilateral Mastectomy 726636007 Prophylactic bilateral mastectomy (procedure) Edition Bilateral Modifier 50 Bilateral Procedure [50] Modifier History of Bilateral Z90.13 [Z90.13] Acquired absence of bilateral breasts and nipples ICD10CM Mastectomy 6 of 203 November 2019 PT - 2020 Measure Value Set_Breast Cancer Screening Exclusion Value Set Name Code Definition Code System History of Bilateral SNOMED CT US 428529004 History of bilateral mastectomy (situation) Mastectomy Edition History of Bilateral 136071000119 SNOMED CT US History of bilateral prophylactic mastectomy (situation) Mastectomy 101 Edition Unilateral Mastectomy 19180 CPT Unilateral Mastectomy 19200 CPT Unilateral Mastectomy 19220 CPT Unilateral Mastectomy 19240 CPT Unilateral Mastectomy 19303 CPT Unilateral Mastectomy 19304 CPT Unilateral Mastectomy 19305 CPT Unilateral Mastectomy 19306 CPT Unilateral Mastectomy 19307 CPT Clinical Bilateral
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