| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
G0204 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral |
| HCPCS Short Description |
Dx mammo incl cad bi |
| HCPCS Pricing Indicator Code 1 |
13 - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion) |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Cross Reference Code 1 |
77066 |
| HCPCS Coverage Code |
C - Carrier judgment |
| HCPCS Berenson-Eggers Type Of Service Code |
I1C - Standard imaging - breast |
| HCPCS Type Of Service Code 1 |
4 - Diagnostic radiology |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
4/1/2001 |
| HCPCS Action Effective Date |
1/1/2018 |
| HCPCS Termination Date |
12/31/2017 |
| HCPCS Action Code |
D - Discontinue procedure or modifier code |