Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
Medicare coverage: Carrier judgment
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Medicare pricing for G0279
Physician Fee Schedule (CY 2026, RVU26D)
Status A: active, paid separately under the PFS if covered. Global period ZZZ. Qualifying APM participants are paid at a $33.5675 conversion factor.
global: national non-facility $40.42, facility $40.42 (total RVUs 1.21 / 1.21 × $33.4009 conversion factor; facility NA: rarely or never done in that setting)
professional component (26): national non-facility $27.72, facility $27.72 (total RVUs 0.83 / 0.83 × $33.4009 conversion factor)
technical component (TC): national non-facility $12.69, facility $12.69 (total RVUs 0.38 / 0.38 × $33.4009 conversion factor; facility NA: rarely or never done in that setting)
Payer policies and prior authorization for G0279
Payer coverage policies that name G0279
G0279 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Premera Blue Cross.
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.