If a radiologist interprets screening mammograms while the patient is still at the physician’s
facility, he or she may order and interpret additional films based on the results of the screening
mammogram.
When a radiologist’s interpretation results in the need for additional films, the mammography is
no longer considered a screening exam for payment purposes. Therefore, if the radiologist’s
interpretation requires additional films, submit the service as a diagnostic mammogram.
Modifier –GH
Effective October 1, 1998, if a radiologist interprets a screening mammogram and needs to
order and interpret additional films based on the results of the screening mammogram while the
beneficiary is still at the facility, the mammography is no longer considered screening. In this
case, age and frequency standards are not a factor when Medicare determines payment. When
this occurs, the claim will be paid as a diagnostic mammography instead of a screening mammography.
When you bill the claim, use HCPCS code 76090 or 76091 with modifier –GH.
GH Diagnostic mammogram converted from a screening mammogram on the same day.
A separate claim is not required in this instance.
The situation described here is the only case where a provider should use modifier –GH on a
claim. In any other circumstance, standard mammography billing instructions apply.
Note: If a screening mammogram converts to diagnostic due to discoveries made during the
mammogram on the same day and same visit, the provider should only bill the diagnostic
Procedure /HCPCS code (76090 or 76091) with modifier GH attached. The provider must also include
both the proper V-code diagnosis to document the screening mammogram and the diagnostic
diagnosis to support the diagnostic mammogram on the claim for the claim to be processed.
