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North Carolina Breast and Cervical Cancer Control Program <br /> 2012-2013 Services Fee Schedule(1) <br /> 12-13 Office Fee <br /> Cervical Procedures Code Fee Allowed <br /> Screening <br /> Pelvic Examination-Bimanual N/A Yes <br /> Pap Smear Yes <br /> 88142 $ 28.70 <br /> 88141 $ 27.94 <br /> 88164 $ 14.97 <br /> 88174* $ 28.70 <br /> 88175* $ 28.70 <br /> 1-IPV DNA High Risk Typing (3) 87621 $ 34.73 No <br /> Follow-Up** (4) <br /> Colposcopy 57452 $ 103.75 Yes <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 146.99 Yes <br /> Colposcopy with Biopsy 57455 $ 136.75 Yes <br /> Colposcopy with endocervical curettage 57456 $ 129.31 Yes <br /> Surgical Pathology-Level IV 88305 $ 99.84 No <br /> 88305TC $ 64.60 No <br /> 88305-26 $ 35.23 No <br /> *These procedures(88174,88175)must be reimbursed at the applicable 88142 Medicare reimbursement <br /> rate(or less) <br /> **Allowable fees for Colposcopy arc for the procedure performed in a physician's office or a similar facility. <br /> If Colposcopy is done in a hospital as an outpatient procedure or in an ambulatory <br /> surgery center,the following fees apply and no additional fee is allowed: <br /> Colposcopy 57452 $ 87.97 No <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 130.89 No <br /> Colposcopy with Biopsy '57455 $ 106.78 No <br /> Colposcopy with endocervical curettage 57456 $ 99.65 No <br /> Revised:3/22/12 <br />