Breast CT CPT Codes: Advancing Access to Dedicated 3D Breast Imaging

On June 15, 2020, the American Medical Association (AMA) granted six Category III CPT codes for the FDA PMA-cleared dedicated breast CT imaging procedure. The newly assigned CPT codes, in addition to the previous FDA PMA clearance process, formally introduced access to this new and advanced modality on January 1, 2021.

The AMA technical subcommittee, comprised of prominent members of the American College of Radiology (ACR) assigned to evaluate the merit of the new technology, unanimously advocated for the six dedicated CT codes for breast CT, further validating this advance in breast imaging.

The establishment of dedicated CPT codes represented an important step in bringing breast CT into clinical practice. New imaging technology requires more than technical capability. Healthcare providers also need a practical framework for documenting procedures and pursuing reimbursement as adoption expands.

CPT codes allow providers to bill insurance payors for AMA-recognized procedures and form the foundation for economic justification when evaluating a transition from conventional full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) to breast CT.

Why Dedicated Breast CT Represents a Different Approach

Conventional mammography has played an important role in breast imaging for decades. However, traditional mammographic imaging requires breast compression and produces images that represent three-dimensional anatomy through a compressed imaging process.

Dedicated breast CT introduces a different approach.

Rather than flattening breast tissue between compression plates, breast CT images the breast in its natural position. This allows physicians to evaluate true isotropic three-dimensional image data without the tissue distortion created by compression.

The technology is designed to provide detailed volumetric information while maintaining an efficient imaging workflow for both patients and healthcare professionals.

Key Features of Dedicated Breast CT

The key features of this landmark technology, which moves breast imaging away from flat, two-dimensional compressed images, include:

• Elimination of painful compression, addressing one of the most common patient complaints associated with conventional mammography.
• True isotropic three-dimensional imaging, presenting breast anatomy in a natural, undistorted view without compressing breast tissue.
• Multiplanar reconstruction, allowing physicians to examine the acquired data from multiple viewing planes.
• Rapid image acquisition, with approximately one 10-second acquisition of each breast and radiation doses in the same range as diagnostic mammography.
• Complete breast image data at acquisition, allowing physician-directed manipulation of the dataset and reducing the need to request additional mammographic views.
• X-ray-guided needle biopsy capabilities, with image quality designed to replicate the original imaging environment accurately.
• Contrast-enhanced breast imaging, which can be administered using standard CT contrast solutions when clinically appropriate and is not required for every patient.
• Implant imaging without displacement views, providing another potential advantage for patients with breast implants.
• Neoadjuvant therapy monitoring, allowing physicians to evaluate treatment response as needed.

Together, these capabilities are intended to give physicians more comprehensive imaging information while creating a different experience for patients.

Reducing the Need for Additional Imaging

One of the practical advantages of acquiring complete three-dimensional breast data is the ability to manipulate the image dataset after acquisition.

With conventional mammography, a physician may determine that additional views are necessary to evaluate a particular area. This can require additional imaging and potentially another step in the patient’s diagnostic journey.

Breast CT provides a complete volumetric dataset that physicians can examine and reconstruct in different planes. This physician-directed data manipulation can replace requests for certain additional mammographic images, potentially saving both time and additional patient radiation exposure.

For healthcare organizations evaluating new breast imaging technologies, these workflow considerations are important alongside image quality and patient experience.

Breast CT and the Patient Experience

Patient experience remains an important consideration in breast imaging.

Breast compression is frequently cited as an uncomfortable or painful part of mammography. For some patients, anticipation of that discomfort can make the imaging experience more stressful.

Dedicated breast CT eliminates breast compression from the imaging process. Instead, the patient lies comfortably on the imaging table while each breast is positioned naturally for acquisition.

The approximately 10-second acquisition per breast also supports an efficient examination.

By combining compression-free imaging with true three-dimensional visualization, breast CT offers a fundamentally different approach to acquiring breast images.

Supporting Diagnostic Breast Imaging Workflows

Breast CT technology also has the potential to simplify parts of the diagnostic imaging workflow.

Implementing breast CT can reduce the need for diagnostic mammograms and separate stereotactic devices in applicable workflows. Consolidating capabilities can save time while potentially improving the overall patient experience.

Contrast-enhanced breast CT provides another option when additional diagnostic information is required. Because contrast enhancement can be performed using standard CT contrast solutions, physicians can determine when contrast is clinically appropriate rather than requiring it for every examination.

Breast CT can also support imaging of breast implants without the displacement views traditionally associated with mammography.

These capabilities make the technology relevant not only to image acquisition but also to broader questions about how breast imaging services are organized and delivered.

An Alternative to More Resource-Intensive Imaging

Breast MRI can provide valuable diagnostic information, but it can also require significant time, resources, and expense.

Breast CT technology presents an opportunity to bring long-awaited change to breast imaging while providing detailed three-dimensional information without automatically absorbing the cost and time associated with breast MRI.

The goal is not simply to replace one imaging modality with another in every circumstance. Different patients and clinical situations require different imaging approaches.

Instead, dedicated breast CT provides physicians with an additional advanced imaging option that can be incorporated into breast imaging workflows based on clinical needs.

CPT Codes Help Support Clinical Adoption

Technology adoption in healthcare depends on more than regulatory clearance.

Healthcare organizations must consider clinical performance, patient experience, workflow requirements, equipment investment, and reimbursement pathways. The establishment of dedicated Category III CPT codes therefore represented an important milestone for breast CT.

These codes provide healthcare providers with a defined mechanism for reporting dedicated breast CT procedures and help establish an economic framework for organizations evaluating the technology.

Combined with FDA PMA clearance, the CPT codes helped create a clearer pathway for breast CT to move from technological innovation toward broader clinical implementation.

The Next Step in Breast Imaging

Breast CT brings together several capabilities that address longstanding challenges in breast imaging: compression-free acquisition, true three-dimensional visualization, multiplanar reconstruction, rapid imaging, and the ability to work with a complete volumetric dataset.

These features can help physicians obtain detailed breast imaging information while giving patients an experience that differs significantly from conventional compressed mammography.

As breast imaging continues to evolve, technologies that combine clinical information, efficient workflows and a more comfortable patient experience will play an increasingly important role.

Koning Corporation is currently the only company with FDA PMA clearance to manufacture and distribute dedicated breast CT technology.

We invite healthcare providers, imaging centers, and other organizations interested in dedicated breast CT to explore additional information on our website and contact us for further details, including information about the best methods for utilizing the applicable CPT codes.