Mammography coverage and certification of mammography facilities
This article is intended for providers who bill MACs for mammogram services provided to Medicare beneficiaries. In order to avoid claim denials or rejections, please be aware of the following claim processing instructions for mammography coverage and certification of mammography facilities.
Background
A recent advancement in 3-D (three-dimensional) imaging technology allows some facilities to offer 3-D mammography. Currently the Mammography Quality Standards Act (MQSA) file only contains two types of records indicating eligibility to bill for:
- Film, or
- Digital mammography claims
CMS instructs contractors to accept a new format of the MQSA file by adding three indicators (film, digital, and 3-D mammography). The redesign of the MQSA file enables contractors to properly pay for the type of mammography imaging service being billed.
MQSA file shows:
- Name of facility
- 6-position certification number of the facility
- Type of certification indicator (film, digital, or 3-D)
- Effective and expiration dates of each certification
- Letter “T” to designate the facility as terminated
MACs use the MQSA file to determine whether the mammography facility is certified to perform the mammography services billed. Providers must report the six-digit mammography certification number on the submitted claim that coincides with the mammography service that is being billed (film, digital, or 3-D).
Key points
Medicare pays for film, digital, and 3-D mammography services only if the provider is certified by the Food and Drug Administration (FDA) to perform the type of mammogram for which payment is expected. Claims for mammography services will deny or reject as unprocessable if:
- There is no FDA certification number reported on the claim
- The facility is not certified for the type of mammogram submitted on the claim
- A facility’s certificate is suspended or revoked
- The HCPCS or CPT code billed does not match the certification on file for the facility
- There is no FDA certification number on the MQSA file for the facility listed on the claim
If you need to update your mammography certification, please email your certification to JNPEPartACerts@fcso.com.
How to search on the FDA MQSA website for a certified facility:
- Click search for MQSA certified mammography facilities in your area
- Enter the first 3 digits of your ZIP code or select your state.
References