Orange County NC Website
Browse       Search
North Carolina Breast and Cervical Cancer Control Program <br /> REF:North Carolina Breast and Cervical Cancer Control Program 2013-4 Fee Schedule <br /> Physician Visits <br /> Office Visits(2) CPT 12-13 <br /> Code Fee <br /> New patient,brief 99201 $ 41.56 <br /> New patient,limited 99202 $ 70.83 <br /> New patient,intermediate 99203 $ 102.72 <br /> Established patient,brief 99211 $ 19.29 <br /> Established patient,limited 99212 $ 41.56 <br /> Established patient,intermediate 99213 $ 69.35 <br /> 00400 Anesthesia <br /> Not to exceed 3 Base Units plus Time Units(length of time spent providing anesthesia service in 15 <br /> minute increments)times Conversion Rate($21.09)or$250,whichever is lower. <br /> Global and Split Fees <br /> Both global and split fees apply to the breast procedures listed on page 1 of this fee schedule. The method <br /> and direction of payment will determine their usage for your facility. The following are the codes and <br /> definitions that apply: <br /> G=Global;the all-inclusive fee for performing and interpreting the service. <br /> TC=Technical Component;the fee for performing the service. <br /> 26=Professional Component;the fee for interpreting the service. <br /> Notes: <br /> (1) <br /> NC BCCCP covers only the physician's fee. Any facility charges associated with these CPT codes <br /> are not covered. <br /> (2) <br /> All consultations should be billed through the standard"new patient"office visit CPT codes:99201-99205. Consultations <br /> billed as 99204 or 99205 must meet the criteria for these codes,and must be pre-authorized. Codes 99204 and 99205 are <br /> not appropriate for screening visits. <br /> (3) <br /> HPV DNA testing is a reimbursable procedure if used for screening in conjunction with Pap testing or for follow-up of an <br /> abnormal Pap result or surveillance per ASCCP guidelines. <br /> It is not reimbursable as a primary screening test for women of all ages or as an adjunctive screening test to the Pap for <br /> women under 30 years of age. <br /> Providers should specify the high-risk HPV DNA panel only. Reimbursement of screening for low-risk HPV types is not <br /> permitted. <br /> The CDC will allow for reimbursement of Cervista HPV HR at the same rate as the Digene Hybrid-Capture 2 HPV DNA <br /> Assay. CDC funds cannot be used for reimubrsement of genotyping(e.g.,Cervista HPV 16118). <br /> (4) <br /> Up to three cervical biopsies,including ECC(endocervical currettage),per colposcopy will be covered <br /> by the BCCCP when the appropriate algorithm is followed. Each specimen container is counted as one <br /> biopsy. Under no circumstances are endometrial or vaginal biopsies covered by the BCCCP. <br /> Revised: 3122/12 <br />