Appendix Table 1.

Diagnosis, Procedure, and Pharmacy Codes Used to Define Screening MRI

Identify breast MRI procedures in medical claims using the following:
	CPT: 76093, 77058; HCPCS: C8903–05 (breast MRI, unilateral) CPT: 76094, 77059; HCPCS: C8906–08 (breast MRI, bilateral) Note: Exclude from screening numerator if there is another MRI procedure within 30–90 days before (2000–2005) or 1–90 days before (after 2006)
Exclude as workup for breast implant complication if within 270 days after any of the following:
Mechanical Complication of Breast Implant	ICD-9 Diagnosis codes: 99654 (mechanical complications due to breast prosthesis), 99679 (other complications of internal prosthetic device, implant, and graft) ICD-10 Diagnosis codes: T854*XA (mechanical complication of breast prosthesis and implant, initial), T858*XA (other complications of internal prosthetic devices, implants and grafts, not elsewhere classified, initial)
Exclude as a diagnostic MRI if within 90 days after any of the following:
Breast Surgery	CPT: 19160, 19180, 19182, 19200, 19220, 19240, 19301–7, 19162 (mastectomy); 19361, 19364, 19366–9 (breast reconstruction); 19260, 19271, 19272 (excision of chest wall tumor); 38525 (biopsy or excision of deep axillary lymph nodes); 38740, 38745 (axillary lymphadenectomy); 19340 (insertion of breast prosthesis) ICD-9 Procedure Codes: 403, 4022, 4023, 4051 (excision of regional, axillary or mammary lymph nodes); 8521 (lumpectomy); 8522 (resection of quadrant of breast); 8524 (excision of ectopic breast tissue); 8525 (excision of nipple); 8523, 8541–8 (mastectomy) ICD-10 Procedure Codes: 0H5(W or X)ZZ (destruction of nipple); 0HB(T, U, or V)ZZ (excision of breast); 0HB(W,X, or Y)ZZ (excision of nipple); 0HT(U or V)ZZ (resection of breast); 0HT(W or X)ZZ (resection of nipple); 0HTY0ZZ (resection of supermumerary breast)
Radiation Therapy	CPT: 77261–3, 77280, 77285, 77290, 77295, 77299 (therapeutic radiology treatment planning); 77300, 77301, 77305, 77310, 77315, 77321, 77326, 77327, 77328, 77331 (dosimetry); 77332–4 (design of treatment devices); 77336, 77370, 77399 (medical physics consultation); 77401–9, 77411–8 (radiation treatment delivery); 77427, 77431, 77432, 77499 (radiation treatment management); 77470 (special treatment procedure) HCPCS: Q3001 (brachytherapy radioelements)
Exclude as a diagnostic MRI if within 90 days after any of the following:
Breast Biopsy	CPT: 10021–2, 88170–1 (fine needle aspiration); 19081–6, 19100–3, 77031 (breast biopsy); 76095–6, 77032,19295 (guidance for breast biopsy or needle placement); 88173 (cytopathology) ICD-9 Procedure Codes: 8511–2 (breast biopsy), 8520 (excision or destruction of breast tissue, not specified) ICD-10 Procedure Codes: 0H9(T, U, or V)ZX (drainage of breast); 0H9(W or X)ZX (drainage of nipple); 0HB(T, U, or V)ZX (excision of breast, diagnostic); 0HB(W or X)ZX (excision of nipple, diagnostic); 0HBY*ZX (excision of supernumerary breast, diagnostic)
Sign or Symptom of Breast Problem	ICD-9 Diagnosis Codes: 6117* (signs and symptoms of breast problem) ICD-10 Diagnosis Codes: N63** (unspecified lump in breast); N645*(other symptoms in breast)
Abnormal Breast Image	ICD-9 Diagnosis Codes: 79380, 79381, 79389 (nonspecific abnormal findings on radiological and other examination of breast) Note: DO NOT use 79382, as this corresponds to dense breasts ICD-10 Diagnosis Codes: R920, R921, R928 (abnormal and inconclusive findings on diagnostic imaging of breast) Note: DO NOT use R922, as this corresponds to dense breasts
Diagnostic Mammogram	CPT: 76082, 76090, 76091, 77055, 77056, 77065, 77066, 77051 HCPCS: G0204, G0206, G0205, G0207, G0236, G0205, G0207, G0236
Chemotherapy for Breast Cancer	CPT: 96400, 96405, 96406, 96413, 96415, 96520, 96408, 96409, 96410, 96411, 96412, 96414, 96416, 96417, 96420, 96422, 96423, 96425, 96440, 96445, 96450, 96530, 96542, 96545, 96549 (chemotherapy administration) HCPCS: C9280, J8520, J8521, J8530, J8540, J9000, J9001, J9025, J9035, J9045, J9060, J9062, J9070, J9080, J9090–7, J9170, J9171, J9190, J9201, J9207, J9208, J9211, J9260, J9264, J9265, J9355, J9390, J9395, Q0083–5, Q0163, Q0164, Q0166, Q0167, Q0169, Q0173, Q0174, Q0175, Q0177, Q0180, Q0181, X7052, X7624, X7646 (various chemotherapeutic agents) ICD-9 Procedure codes: 8592, 9925 (injection or infusion of cancer chemotherapeutic substance)
Chemotherapy for Breast Cancer (continued)	ICD-10 Procedure codes: 3E00XGC, 3E0(3, 4, 5, 6, 9, B, C, D, R, S, or U)** 05 (antineoplastic), XW03351, XW033B3, XW033C3, XW04351, XW043B3, XW043C3 (new antineoplastic technologies) NDC Codes: available from authors upon request. Note: Require active breast cancer diagnosis (carcinoma in situ ICD9/10 233.**; D05.** or malignant breast neoplasm ICD9/10 174.**; C50.**) within 7 days to exclude treatment for other cancers