77063 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 77063

Payer coverage policies that name 77063

77063 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaBreast Biopsy Procedures (0269)covered if criteria are met (range 77061-77063)May 14, 2026payer document
AetnaMammography (0584)covered if criteria are metSep 10, 2026payer document
Blue Cross & Blue Shield of MississippiDigital Breast Tomosynthesis (L.6.01.418)listed, no stancepayer document
Premera Blue CrossPreventive Care
Breast biopsies and biopsy accessories		covered if criteria are metSep 21, 2026payer document

Medicaid fee-for-service

  • AZ: $53.70 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $42.70 (health_first_colorado), effective Jul 1, 2026
  • FL: $18.18 (radiology), effective Jan 1, 2026
  • IL: $34.15 (practitioner), effective Apr 1, 2024
  • IN: $40.72 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $14.11 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $42.81 (physician, facility), effective Jan 1, 2026
  • LA: $41.00 (lab_radiology), effective Jul 1, 2025
  • MA: $40.67 (physician_radiology), effective May 1, 2024
  • ND: $30.41 (physician), effective Aug 1, 2026
  • NE: $46.88 (physician, non-facility), effective Jul 1, 2026
  • NY: $10.21 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $40.91 (physician), effective Jan 1, 2018
  • OK: $19.55 (physician, non-facility), effective Jul 1, 2026
  • TX: $52.46 (hospital_outpatient_imaging_services, Urban Hospitals), effective Mar 1, 2026
  • VA: $28.15 (medical), effective Jul 1, 2026
  • VT: $20.10 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $30.00 (professional), effective Jan 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.