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HCPCS G0279 · Level II · G code

G0279: Diagnostic digital breast tomosynthesis, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0279

Medicare payment
$40.42
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
0 hospital outpatient
LCDs and articles
1 / 3
add-on code

TL;DR

HCPCS Level II G0279 reads "Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)" in the October 2026 file; it dates from 2015. Medicare's October 2026 physician fee schedule pays G0279 $40.42 non-facility and no facility amount facility nationally, from 0.59 work, 0.59 practice-expense and 0.03 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $40.62 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). MUE limits for G0279: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). G0279 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 2 primary codes such as 77065, 77066. 1 active LCD and 3 billing and coding articles list G0279 across 15 states: L33950 (Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography), A56448, A57848. OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS I1C (standard imaging - breast); pricing indicator 13; type of service 4 (diagnostic radiology). Nearby codes: G0278, G0277, G0281, G0282.

G0279 descriptor and code status

The October 2026 HCPCS Level II file describes G0279 as “Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0279 CPT code", G0279 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0279
FieldValue
Short descriptorTomosynthesis, mammo
Added to HCPCS2015-01-01
Last actionN (no maintenance), effective 2018-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryI1C: standard imaging - breast
Type of service4: diagnostic radiology

Medicare payment for G0279

Medicare's October 2026 physician fee schedule pays G0279 $40.42 non-facility and no facility amount facility nationally, from 0.59 work, 0.59 practice-expense and 0.03 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $40.62 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period ZZZ (add-on service inside the primary service's global period); PC/TC indicator 1 (diagnostic test with professional (26) and technical (TC) components).

PFS relative values and national payment for G0279
ComponentNon-facilityFacility
Work RVU0.590.59
Practice expense RVU0.59NA
Malpractice RVU0.030.03
Total RVUs1.21NA
National payment (CF $33.4009)$40.42n/a
Qualifying APM participant (CF $33.5675)$40.62n/a
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): already priced as bilateral
  • Assistant at surgery: assistant-at-surgery concept does not apply; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

G0279 also carries 26 and TC rows in the RVU file, priced separately from the global service.

Component rows for G0279
ModifierStatusNon-facilityFacility
26A$27.72$27.72
TCA$12.69n/a

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for G0279

MUE limits for G0279: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0279 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0279 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0279 in v323r0.

G0279 is an add-on code: it is payable only with a primary service on the same claim (77065, 77066). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0279 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0279

1 active Local Coverage Determination and 3 billing and coding articles list G0279. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0279
ArticleTitleContractor(s)Related LCD
A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/DuctographyCGS Administrators, LLCL33950
A57848Billing and Coding: Tomosynthesis-Guided Breast BiopsyNoridian Healthcare Solutions, LLC—
A58559Billing and Coding: Independent Diagnostic Testing Facilities (IDTF)Palmetto GBA—

Denials to expect on G0279

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0279

CARC 151 · N362

units of G0279 exceed the practitioner MUE of 1 per date of service

CARC 4

the 26 or TC modifier does not fit the component billed

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0279 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0279 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0279

What does HCPCS code G0279 describe?

"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)" (short descriptor "Tomosynthesis, mammo"), in the G section (procedures and professional services, temporary). Added 2015-01-01; last action N (no maintenance) effective 2018-01-01.

Is G0279 a CPT code?

No: CMS maintains G0279 in HCPCS Level II, while the AMA maintains CPT. People do search "G0279 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0279?

Medicare's October 2026 physician fee schedule pays G0279 $40.42 non-facility and no facility amount facility nationally, from 0.59 work, 0.59 practice-expense and 0.03 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $40.62 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G0279 an add-on code?

G0279 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 2 primary codes such as 77065, 77066.

How many units of G0279 can be billed per day?

MUE limits for G0279: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0279?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 3 billing and coding articles list G0279 across 15 states: L33950 (Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography), A56448, A57848.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.