AFFORDABLE HEALTHCARE MAMMOGRAMS: know your code!

August 1, 2012

the new affordable health care regulations go into place this week.  i wanted to understand how they would affect my benefits – especially concerning mammograms since, as you might guess, i finally have no need for contraceptive nor gestational diabetes screening.  i found out that mammograms are covered and no longer limited to one per year but ‘as many as deemed necessary.’  but here’s the rub – and why you, the patient/consumer must be on your administrative guard:  it all depends on THE CODE!  so insist, talk and review with your doctor and with the administrative assistant who has your code-destiny at their fingertips. 

if it’s coded as PREVENTATIVE:  COVERED AND COVERED AND COVERED (not that anyone wants multiple mammograms in one year – smush…owe).  for my fellow survivors: i understand that you are entitled to COVERED-PREVENTATIVE MAMMOGRAMS if you have been 5 years post-diagnosis and with no recurrence/evidence of disease.  

if it’s coded as DIAGNOSTIC:  you are still on the hook for your CO-PAY.

Please check and recheck but here’s what I’ve been told:

SCREENING/PREVENTATIVE (COVERED) MAMMOGRAM CODES (2):  G0202 AND 77052

 DIAGNOSTIC BILATERAL MAMMOGRAM (NOT FULLY COVERED): G0204 AND 77051

we’re not talking pennies out of our pockets so KNOW BEFORE YOU GO. GET YOUR MAMMOGRAM AND BE HEALTHY – and save your co-pay for your next stress-reducing vacation!   


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