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North Carolina Breast and Cervical Cancer Control Program <br /> 2015-2016 Services Fee Schedule(1) <br /> Physician Visits <br /> CPT 15-16 <br /> Office Visits(2) Code Fee <br /> Code Fee <br /> New patient;history,exam,straighforward decision-making; 10 minutes 99201 $ 41.59 <br /> New patient;expanded history,exam,straighforward decision-making; 99202 $ 71.51 <br /> 20 minutes <br /> New patient;detailed history,exam,straighforward decision-making; 99203 $ 104.24 <br /> 30 minutes <br /> Established patient;evaluation and management,may not require 99211 $ 19.04 <br /> presence of a physician,5 minutes <br /> Established patient;history,exam,straighforward decision-making; 99212 $ 41.59 <br /> 10 minutes <br /> Established patient;expanded history,exam,straighforward decision- 99213 $ 70.01 <br /> making; 15 minutes <br /> Established patient;detailed history,exam,moderately complex 99214 $ 103.46 <br /> decision-making;25 minutes <br /> 00400 Anesthesia <br /> Not to <br /> minute increments)times Conversion Rate($21.87)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 /> 50=Bilateral Procedure:Unless otherwise identified in the listing,bilateral procedures that are performed at the same session <br /> should be identified by adding modifier 50 to the appropriate 5 diget code. <br />