Z12.31
Z12.31: Encounter for screening mammogram for malignant neoplasm of breast
Billable / specific codeICD-10-CMPOA exempt
Z12.31 is a billable, specific ICD-10-CM code for encounter for screening mammogram for malignant neoplasm of breast. It is valid for submission on a claim.
Check Z12.31 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- inconclusive mammogram (R92.2)
Excludes1 inherited from the categories above Z12.31
A category’s note binds every code beneath it.
Written on Z12: Encounter for screening for malignant neoplasms
- encounter for diagnostic examination-code to sign or symptom
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
Z12.31 is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
Alphabetic index entries that lead here
- Mammogram›routine
- X-ray›breast(mammogram) (routine)
- Screening›neoplasm›breast›routine mammogram
Code history
Unchanged in every release from FY2024 to FY2027.