77065 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 77065

Payer coverage policies that name 77065

77065 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaBreast Biopsy Procedures (0269)listed, no stance (range 77065-77066)May 14, 2026payer document
AetnaBreast Reduction Surgery and Gynecomastia Surgery (0017)listed, no stance (range 77065-77067)Mar 12, 2026payer document
AetnaBreast Transillumination, Electrical Impedance Scanning (EIS), and Elastography (0386)listed, no stance (range 77065-77067)May 26, 2026payer document
AetnaMagnetic Resonance Imaging (MRI) of the Breast (0105)listed, no stance (range 77065-77067)Aug 6, 2026payer document
AetnaMammography (0584)covered if criteria are metSep 10, 2026payer document
Blue Cross & Blue Shield of MississippiComputeraided Detection In Conjunction With Digitized Screenfilm Mammography Or Fullfield Digital Mammography (L.6.01.416)covered if criteria are metpayer document
Premera Blue CrossPreventive Care
Breast biopsies and biopsy accessories
covered if criteria are metSep 21, 2026payer document

Medicaid fee-for-service

  • AZ: $128.66 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $105.61 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $61.56 (radiology), effective Jan 1, 2026
  • IL: $92.31 (practitioner), effective Apr 1, 2024
  • IN: $30.16 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $74.86 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $45.00 (asc), effective Jan 1, 2026
  • LA: $96.59 (lab_radiology), effective Jul 1, 2025
  • MA: $28.40 (physician_radiology), effective May 1, 2024
  • MS: $66.74 (comprehensive), effective Jul 1, 2026
  • ND: $96.50 (physician), effective Aug 1, 2026
  • NE: $127.17 (physician, non-facility), effective Jul 1, 2026
  • NY: $97.97 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $59.44 (physician), effective Jan 1, 2024
  • OK: $106.04 (physician, non-facility), effective Jul 1, 2026
  • TX: $30.47 (healthy_texas_women, Clinic/Group Practice, facility), effective Sep 1, 2021
  • VA: $38.32 (medical), effective Jul 1, 2026
  • VT: $72.91 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $54.46 (physician, facility), effective Jul 1, 2026
  • WY: $40.76 (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.