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North Carolina Breast and Cervical Cancer Control Program <br /> 2014-2015 Services Fee Schedule(1) <br /> 14-15 Office Fee <br /> Cervical Procedures Code Fee Allowed <br /> Screening <br /> Pelvic Examination-Bimanual N/A Yes <br /> Pap Smear Yes <br /> 88142 $ 27.64 <br /> 88141 $ 22.85 <br /> 88143* $ 27.64 <br /> 88164 $ 14.42 <br /> Cytopathology(manual screening and rescreening under Physician supery 88165 $ 14.42 <br /> 88174* $ 27.64 <br /> 88175* $ 27.64 <br /> HPV DNA High Risk Typing (3) 87621 $ 33.46 No <br /> Follow-Up** (4) <br /> Colposcopy 57452 $ 79.48 Yes <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 112.42 Yes <br /> Colposcopy with Biopsy 57455 $ 104.38 Yes <br /> Colposcopy with endocervicat curettage 57456 $ 98.75 Yes <br /> Surgical Pathology- Level IV 88305 $ 50.61 No <br /> 88305TC $ 22.69 No <br /> 88305-26 $ 27.92 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 $ 67.86 No <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 100.80 No <br /> Colposcopy with Biopsy 57455 $ 82.40 No <br /> Colposcopy with endocervical curettage 57456 $ 76.77 No <br /> Physician Visits <br /> Office Visits(2) CPT 14-15 <br /> Code Fee <br /> New patient, brief 99201 $ 30.96 <br /> New patient,limiter{ 99202 $ 53.35 <br /> New patient,intermediate 99203 $ 77.39 <br /> Established patient,brief 99211 $ 14.32 <br /> Established patient,limited 99212 $ 31.21 <br /> Established patient,intermediate 99213 $ 52.39 <br /> 00400 Anesthesia <br /> Not to exceed 3 Base Units plus Time Units(length of time spent providing anesthesia service in 15 increments) <br /> minute increments) times Conversion Rate($16.33)or$250,whichever is lower. <br />