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North Carolina Breast and Cervical Cancer Control Program <br /> REF:North Carolina Breast and Cervical Cancer Control Program 20134 Fee Schedule <br /> 13-14 Office Fee <br /> Cervical Procedures Code Fee Allowed <br /> Screening <br /> Pelvic Examination-Bimanual N/A Yes <br /> Pap Smear Yes <br /> 88142 $ 27.85 <br /> 88141 $ 30.14 <br /> 88143* $ 27.85 <br /> 88164 $ 14.53 <br /> 88174* $ 27.85 <br /> 88175* $ 27.85 <br /> HPV DNA High Risk Typing (3) 87621 $ 33.71 No <br /> Follow-Up** (4) <br /> Colposcopy 57452 $ 104.65 Yes <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 147.55 Yes <br /> Colposcopy with Biopsy 57455 $ 137.64 Yes <br /> Colposcopy with endocervical curettage 57456 $ 129.88 Yes <br /> Surgical Pathology-Level IV 88305 $ 66.68 No <br /> 88305TC $ 30.83 No <br /> 88305-26 $ 35.85 No <br /> These procedures(88143,88174, 88175)must be reimbursed at the applicable 88142 Medicare reimbursement <br /> rate(or less) <br /> **Allowable fees for Colposcopy are 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 $ 88.56 No <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 131.15 No <br /> Colposcopy with Biopsy 57455 $ 106.73 No <br /> Colposcopy with endocervical curettage 57456 $ 99.60 No <br /> Revised: 3/22/12 <br />