Diagnostic Mammogram, One Breast
CPT 77065
Performed to evaluate a lump, breast symptom, or an abnormality seen on a prior study on one side.
No national payment amount
Status I is not separately payable under the PFS.
Did Medicare pay separately for CPT 77065 in Q4 2017?
Not at a published national rate. CPT 77065 carries status I (not valid) in the Q4 2017 release. Medicare uses a different code to report and pay for this service. Treat the blank amount as unpriced, not as $0.
Source: Physician relative value file (Q4 2017) · effective October 2017 · materially updated Aug 4, 2026 · compact facts
How often 77065 is billed
Across Original Medicare in CY2024, 77065 ranked #283 of the 7,879 CPT codes billed to Medicare that year, ranked by patients served or total allowed dollars.
2024 Medicare fee-for-service only, national totals — Medicare Advantage, Medicaid and commercial volume are excluded, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2017 fee schedule the rates above come from.
Common questions
Why is there no payment amount for 77065?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 77065 be denied or paid less?
Each item below comes from a CMS indicator on this page — not general billing advice.
- Its status indicator is I (not valid) — Medicare uses a different code to report and pay for this service. See status indicators
- 77065 splits into a professional component (modifier 26) and a technical component (modifier TC) — a claim for only one part needs that modifier to price correctly. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The 77065 rate last moved in Q1 2026 (+1.6% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill?
What is a 77065 visit in patient-friendly terms?
In plain terms: A mammogram of a single breast performed to investigate a specific problem, with computer-aided detection included when it is used. Diagnostic means the study is driven by a finding - a lump, nipple discharge, focal pain, or something flagged on a screening exam - so the technologist tailors the views and the radiologist typically reviews images while the patient is still there. The one-breast version is used when the concern is confined to a single side. Think of being called back after a screening mammogram found something on the left side only. This visit takes longer than a screening: extra angles, sometimes spot compression on the exact area of concern, and often an answer before the patient leaves the department. You'll typically see CPT 77065 on a bill or explanation of benefits (EOB) when a clinician performs or bills for this service.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
Billing policy
What 77065's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Professional/technical split | 1 | Splits into professional and technical. This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable. |
Rate history by release
National non-facility amount for 77065 across quarterly releases. Down 10.1% since Q1 2018 · high $137.88 in Q1 2018
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jun 30, 2026 – present | A | $123.92 (0.0%) | $123.92 (0.0%) |
| Q2 2026 Mar 10, 2026 – Jun 29, 2026 | A | $123.92 (0.0%) | $123.92 (0.0%) |
| Q1 2026 Dec 29, 2025 – Mar 9, 2026 | A | $123.92 (+1.6%) | $123.92 (+1.6%) |
| Q4 2025 Sep 11, 2025 – Dec 28, 2025 | A | $121.95 (0.0%) | $121.95 (0.0%) |
| Q3 2025 Jun 5, 2025 – Sep 10, 2025 | A | $121.95 (0.0%) | $121.95 (0.0%) |
| Q2 2025 Jun 5, 2025 – Jun 4, 2025 | A | $121.95 (0.0%) | $121.95 (0.0%) |
| Q1 2025 Dec 23, 2024 – Jun 4, 2025 | A | $121.95 (-2.6%) | $121.95 (-2.6%) |
| Q4 2024 Aug 9, 2024 – Dec 22, 2024 | A | $125.16 (0.0%) | $125.16 (0.0%) |
| Q3 2024 May 3, 2024 – Aug 8, 2024 | A | $125.16 (0.0%) | $125.16 (0.0%) |
| Q2 2024 Mar 15, 2024 – May 2, 2024 | A | $125.16 (0.0%) | $125.16 (0.0%) |
| Q1 2024 Mar 11, 2023 – Mar 14, 2024 | A | $125.16 (-1.8%) | $125.16 (-1.8%) |
| Q4 2023 Aug 1, 2023 – Mar 10, 2023 | A | $127.42 (0.0%) | $127.42 (0.0%) |
| Q3 2023 May 10, 2023 – Jul 31, 2023 | A | $127.42 (0.0%) | $127.42 (0.0%) |
| Q2 2023 Feb 3, 2023 – May 9, 2023 | A | $127.42 (0.0%) | $127.42 (0.0%) |
| Q1 2023 Jan 30, 2023 – Feb 2, 2023 | A | $127.42 (-2.1%) | $127.42 (-2.1%) |
| Q4 2022 Jul 29, 2022 – Jan 29, 2023 | A | $130.12 (0.0%) | $130.12 (0.0%) |
| Q3 2022 Jun 17, 2022 – Jul 28, 2022 | A | $130.12 (0.0%) | $130.12 (0.0%) |
| Q2 2022 Feb 14, 2022 – Jun 16, 2022 | A | $130.12 (0.0%) | $130.12 (0.0%) |
| Q1 2022 Dec 15, 2021 – Feb 13, 2022 | A | $130.12 (-0.8%) | $130.12 (-0.8%) |
| Q4 2021 Aug 3, 2021 – Dec 14, 2021 | A | $131.20 (0.0%) | $131.20 (0.0%) |
| Q3 2021 Jun 10, 2021 – Aug 2, 2021 | A | $131.20 (0.0%) | $131.20 (0.0%) |
| Q2 2021 Feb 26, 2021 – Jun 9, 2021 | A | $131.20 (0.0%) | $131.20 (0.0%) |
| Q1 2021 Dec 29, 2020 – Feb 25, 2021 | A | $131.20 (-3.8%) | $131.20 (-3.8%) |
| Q4 2020 Oct 21, 2020 – Dec 28, 2020 | A | $136.42 (0.0%) | $136.42 (0.0%) |
| Q3 2020 Jun 18, 2020 – Oct 20, 2020 | A | $136.42 (0.0%) | $136.42 (0.0%) |
| Q2 2020 Apr 30, 2020 – Jun 17, 2020 | A | $136.42 (0.0%) | $136.42 (0.0%) |
| Q1 2020 Nov 8, 2019 – Apr 29, 2020 | A | $136.42 (+0.4%) | $136.42 (+0.4%) |
| Q4 2019 Aug 2, 2019 – Nov 7, 2019 | A | $135.87 (0.0%) | $135.87 (0.0%) |
| Q3 2019 May 3, 2019 – Aug 1, 2019 | A | $135.87 (0.0%) | $135.87 (0.0%) |
| Q2 2019 Mar 1, 2019 – May 2, 2019 | A | $135.87 (0.0%) | $135.87 (0.0%) |
| Q1 2019 Dec 13, 2018 – Feb 28, 2019 | A | $135.87 (-1.5%) | $135.87 (-1.5%) |
| Q4 2018 Aug 3, 2018 – Dec 12, 2018 | A | $137.88 (0.0%) | $137.88 (0.0%) |
| Q3 2018 Apr 30, 2018 – Aug 2, 2018 | A | $137.88 (0.0%) | $137.88 (0.0%) |
| Q2 2018 Feb 12, 2018 – Apr 29, 2018 | A | $137.88 (0.0%) | $137.88 (0.0%) |
| Q1 2018 Feb 9, 2018 – Feb 11, 2018 | A | $137.88 | $137.88 |
| Q4 2017 Aug 18, 2017 – Feb 8, 2018 | I | — | — |
| Q3 2017 May 3, 2017 – Aug 17, 2017 | I | — | — |
| Q2 2017 Feb 9, 2017 – May 2, 2017 | I | — | — |
| Q1 2017 Nov 14, 2016 – Feb 8, 2017 | I | — | — |
Did this answer your question about CPT 77065?
We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.
Source & method
Show sources
Hide
This is computed from CMS's Medicare Physician Fee Schedule Q4 2017 release (schedule pfs, effective October 2017). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them. Our methodology covers all of this in depth — sourcing, parsing, versioning, and how claims are cross-checked before they ship.
Description written from primary sources: CMS Medicare Physician Fee Schedule Relative Value Files. Not derived from AMA CPT descriptor text.
Conversion factor $35.8887 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q4 2017 figures, even after a newer release lands.
CPT 77065 Medicare Physician Fee Schedule rate (Q4 2017). Localis. https://localishealth.com/cpt/77065/2017/D