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See a sample rate comparisonHealthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Radiology Procedures Breast, Mammography |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 77054 |
| Medicaid Fee Schedule | View Medicaid rates for 77054 |
National average reimbursement for CPT 77054 by major payers:

$111.97

$103.66

$85.49

$123.79
Choose a payer to see a sample of rates for CPT 77054.
Urology Specialists Of The Carolinas, PLLC
Northern Arizona Healthcare Corporation
Samaritan Emergency Medical Services PC
Northern Arizona Healthcare Corporation
Northern Arizona Healthcare Corporation
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 77054 vs. Other Breast, Mammography Codes
The CPT 77054 code is part of the Radiology Procedures services used for Breast, Mammography. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 77054 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 77049-CPT | Moderate | Mri Breast C W Cad Bi, Magnetic Resonance Imaging Breast Without And With Contrast Material S Including Computer Aided Detection Cad Real Time Lesion Detection Characterization And Pharmacokinetic Analysis When Performed Bilateral |
| 77053-CPT | Low | Mammary Ductogram Or Galactogrm Sngle Duct Rdiological Superv, Mammary Ductogram Or Galactogram Single Duct Radiological Supervisio |
| 77054-CPT | Low | Mammary Ductogram Or Galactogrm Multi Ducts Radiologi Superv, Mammary Ductogram Or Galactogram Multiple Ducts Radiological Supervi |
| 77066-CPT | Low | Mammogram To Aid Diagnosis, X-Ray Images Of Breast(S) Using Computer Assisted Detection System In Order To Facilitate Early Tumor Detection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 77054. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 77054 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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