CPT code 77047 – Bilateral breast MRI without contrast

Key takeaways

CPT code 77047 reports one MRI session that images both breasts, with no contrast given at any point in the study.

Laterality and contrast pick the code: 77046 is one breast without contrast, and 77049 is both breasts without and with contrast.

Medical necessity rides on a specific ICD-10 code, such as Z15.01 for genetic susceptibility or Z80.3 for a family history of breast cancer.

Most commercial payers and many Medicare Advantage plans require prior authorization, and an approval issued for a neighboring code is a common denial reason.

Pabau’s claims management checks eligibility and submits US claims through Claim.MD, with each prior authorization attached to the booking.

CPT code 77047 is a bilateral breast MRI without contrast

CPT code 77047 is the code for an MRI of both breasts performed without contrast.

The American Medical Association’s CPT code set defines it as magnetic resonance imaging, breast, without contrast material(s); bilateral. It sits in the Breast, Mammography subsection of the radiology codes, alongside the other breast MRI codes, 77046 through 77049.

Two words in that descriptor decide whether you can use it. “Bilateral” means both breasts were imaged in the same encounter. “Without contrast” means no gadolinium or other agent was given at any point, including a pre- and post-contrast sequence.

Because the descriptor already says bilateral, modifier 50 doesn’t belong on the claim. The code also leaves out computer-aided detection (CAD), which CPT bundles only into the contrast studies, 77048 and 77049.

If your practice bills breast imaging through radiology claims management software, set up 77047 as its own charge, separate from the contrast studies.

Four breast MRI codes, two variables

The four breast MRI codes share one structure built on two variables. One is laterality (one breast or both), and the other is contrast (without, or without and with). Pick the wrong cell and the claim no longer matches the report.

Since both cover two breasts, 77047 and 77049 are the pair coders most need to tell apart. If the report lists any post-contrast sequence, the study is 77049.

The report and the order must both prove bilateral, no contrast

A 77047 claim stands on two documents: the radiologist’s report and the referring clinician’s order. Each one has to state the key facts outright, because a payer reviewer won’t infer them from context.

Required in the radiology report:

• A statement that both breasts were imaged. A report covering one breast cannot support 77047.
• Explicit confirmation that the study was performed “without contrast.” If the report says nothing about contrast, payer reviewers may assume it was used and reroute the claim to 77049 for a bilateral study.
• A formal written interpretation, signed and dated by the radiologist. Technologist notes don’t satisfy this.
• The clinical indication, tied to the ICD-10 code on the claim.

Required in the order:

• A written order for a bilateral breast MRI without contrast
• The clinical reason, such as high-risk status, prior screening results or a specific finding
• The prior authorization number, where the payer requires one

A non-contrast study fits when the patient can’t receive gadolinium, for example because of severe chronic kidney disease. It also fits when the protocol calls for structural assessment without dynamic enhancement. When the clinical question needs contrast, 77049 (bilateral) or 77048 (unilateral) is the correct code, not 77047.

Build laterality and contrast into your EHR or radiology information system (RIS) order template as required fields, not free text. A required field forces the answer at order entry, before the scan, rather than during a records review months later.

ICD-10 codes that support 77047 medical necessity

Payers check medical necessity by matching 77047 against a qualifying diagnosis code. Local Coverage Determinations (LCDs) vary by Medicare Administrative Contractor (MAC), but the codes below appear across most payer policies. Check the current policy on CMS.gov before billing.

Use the most specific subcode available. A C50 code without its subsite digits, or an N63 code without laterality, is a common denial trigger. You can look up each subcode in our ICD-10-CM code library.

Medicare covers 77047 as a diagnostic service

Traditional Medicare covers 77047 under Part B when medical necessity is documented and the service meets the applicable LCD.

Breast MRI is covered only as a diagnostic service, so the Part B deductible and 20% coinsurance apply. The preventive deductible waiver belongs to screening mammography (77067), not to MRI.

Outside traditional Medicare, coverage shifts in four ways:

• LCD and coverage policies vary by MAC, so check your MAC’s LCD database before billing in a new jurisdiction.
• Medicare Advantage plans set their own coverage and prior authorization rules, which often differ from traditional Medicare.
• Commercial payers such as BCBS, Aetna and UHC usually want high-risk documentation, and some run their own imaging management programs.
• After a positive genetic test, ask the payer whether the scan falls under a preventive or diagnostic benefit. That decides the patient’s share.

Medicare pays roughly $210 to $216 for 77047 nationally

Medicare pays for 77047 under the Medicare Physician Fee Schedule (MPFS), which multiplies relative value units (RVUs) by a conversion factor. At 6.48 total RVUs, the national global payment comes to about $210 in 2025 and $216 in 2026.

These figures come from the FastRVU lookup tool, a third-party source. Confirm them against the CMS PPRRVU file before you set fees, because the conversion factor changes every January.

The global payment covers both the scan and the read. When a hospital owns the scanner, the radiologist bills 77047 with modifier 26 for the interpretation, and the facility bills the technical side. An imaging center that owns the equipment and employs the reader bills the global code.

Geographic Practice Cost Indices (GPCI) adjust each RVU component by locality. High-cost markets pay above the national figure, and many rural localities pay below it. For a precise estimate, use the CMS MPFS lookup or the AAPC Codify CPT lookup with your MAC locality.

Payment comes back on the electronic remittance advice (ERA). Check each 77047 line against the expected rate for your locality, so an underpayment gets appealed rather than written off.

Prior authorization has to name 77047 itself

Most commercial payers and Medicare Advantage plans require prior authorization (PA) for breast MRI, including 77047.

Traditional Medicare fee-for-service doesn’t require PA across the board, but MAC policies and imaging programs vary. Run insurance eligibility verification at scheduling, so the PA rules are known before the appointment.

A standard PA request for 77047 usually needs four pieces:

• Ordering physician documentation: A written order stating the clinical indication, the patient’s risk category (high-risk designation, BRCA status, dense breasts) and any prior imaging results.
• Prior imaging records: Most payers want proof that mammography or ultrasound was done within a set timeframe before they approve MRI.
• High-risk determination: For BRCA-related requests, the genetic test report or a genetics consult note. For risk-based requests, a model result such as Tyrer-Cuzick showing a lifetime risk above 20%.
• ICD-10 codes on the request: The diagnosis on the PA must match the diagnosis on the claim exactly. A mismatch is a common denial reason.

If your practice sends breast MRI requests every week, a set prior authorization process with one checklist per payer saves a lot of resubmissions.

How a 77047 claim moves from order to payment

Follow one claim from start to finish and the weak points are easy to spot. The path below shows the five stops a typical 77047 claim makes, and the most common way each one fails.

Here’s how that looks for one patient. A 42-year-old BRCA1 carrier with severe chronic kidney disease needs supplemental screening, but gadolinium isn’t safe for her. Her physician orders a bilateral breast MRI without contrast and documents the kidney disease as the reason.

The front desk confirms coverage and requests PA for 77047 with Z15.01. After the scan, the report states both breasts were imaged without contrast. The biller codes 77047 with Z15.01, matching the approval, and checks the ERA when payment posts.

Six denials that hit 77047 claims, and how to fix each

The denials below come up again and again on breast MRI claims, and most start with authorization or documentation. Good denial management tracks which one hit, so the same fix lands on the next claim.

• Missing or expired prior authorization. The PA was never obtained, lapsed before the date of service, or was issued for 77049 rather than 77047. Fix: confirm the PA number and the authorized CPT code at check-in for every breast MRI.
• Contrast documentation mismatch. The report doesn’t state “without contrast,” or the order mentions contrast. Fix: add a required contrast field to the order template and read the report before billing. If contrast was given, bill 77049 for a bilateral study.
• Wrong laterality code. The claim went out as unilateral (77046) when the report confirms both breasts, or the reverse. Fix: add a laterality check to charge entry.
• ICD-10 specificity failure. An N63 code without its subcategory digits, or Z80.3 where the LCD wants a more specific high-risk code. Fix: keep a list of accepted ICD-10 codes inside your 77047 charge setup.
• LCD non-compliance. The clinical indication doesn’t meet the coverage criteria in your MAC’s LCD. Fix: add a medical necessity review before PA for any 77047 order that doesn’t cite BRCA status, a known malignancy or a formal high-risk designation.
• Untimely filing. The claim went out after the payer’s filing window, which runs from 90 to 365 days from the date of service depending on the payer. Fix: track filing deadlines in your billing workflow, and send a clean claim the first time.

Before you submit: A 60-second 77047 check

Run this check on every 77047 claim before it leaves the practice. It takes about a minute, while a denied breast MRI claim can take weeks to rework.

• The report states that both breasts were imaged.
• The report states “without contrast,” and the order agrees.
• The PA number is on the claim and names 77047.
• The ICD-10 code matches the PA and carries full specificity.
• No modifier 50 is attached.
• The claim date sits inside the payer’s filing window.

Dense breast tissue alone rarely justifies 77047

CPT 77047 shows up often in supplemental screening for patients with dense breasts or confirmed genetic risk. Dense tissue lowers mammography sensitivity. Since September 2024, FDA mammography rules require facilities to tell patients whether their breasts are dense, and those notices often prompt a referral for MRI.

Density alone rarely secures coverage, though. Most payers want a high-risk designation on top of it. A patient with heterogeneously dense tissue (BI-RADS category C) but no family history, genetic risk or prior atypia may not meet the LCD.

The pathway that most reliably supports 77047 combines:

• A formal risk assessment showing lifetime risk above 20%, or confirmed BRCA1/BRCA2 susceptibility
• Dense breast classification (BI-RADS C or D) within a high-risk protocol
• A documented discussion between the ordering clinician and the patient about supplemental screening

Screening mammography, 77067, is a lower-complexity service with broader coverage. When a patient moves from annual mammography to MRI, the record should explain why MRI was chosen and support the specific code billed.

How Pabau keeps 77047 claims clean from booking to payment

In many imaging practices, the pieces of one claim live in different places. The PA approval sits in a payer portal, the report sits in the RIS, and the charge sits in a billing spreadsheet.

In Pabau, the practice software we build for scheduling and insurance billing, each prior authorization is stored as a case and attached at booking. The authorization code carries through to the claim, and a claim without one is flagged before it goes out.

For US practices, Pabau checks eligibility through Claim.MD before the visit and submits CMS-1500 claims through the same connection. Payments settle straight from the ERA file, so each 77047 line can be checked against the expected rate.

Send breast MRI claims with the approval attached

Pabau attaches each prior authorization at booking, checks eligibility through Claim.MD and submits US claims, so 77047 claims leave with their approval on file.

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Conclusion

Coding 77047 is simple once the record is right. The hard part is making sure the order, the authorization, the report and the claim all describe the same study.

If you change one habit, make laterality and contrast required fields at order entry. That one step protects the PA, the report language and the charge at once. It costs a few seconds per order, against weeks spent reworking a denial.

Book a demo to see how Pabau carries each breast MRI authorization from the booking to the paid claim.

Continue your research

Submitting claims through a clearinghouse? Pabau’s Claim.MD clearinghouse guide explains how electronic claim submission works and which payers are covered.

Sending a breast MRI authorization request? Medical prior authorization form gives you a ready template for documenting the clinical reason behind a request.

Checking imaging payments line by line? Electronic remittance advice explains how to read an ERA and spot an underpaid claim.

Want to understand how denials are coded? Denial codes in medical billing covers CARC and RARC codes and how to read your EOB remark codes.

Need a full primer on medical billing workflows? What is medical billing walks through the claims process from patient encounter to payment posting.

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