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North Carolina Breast and Cervical Cancer Control Program <br /> 2016-2017 Services Fee Schedule(1) <br /> 16-17 Office Fee <br /> Cervical Procedures Code Fee Allowed <br /> Screening <br /> Pelvic Examination-Bimanual N/A Yes <br /> Pap Smear Yes <br /> 88141 $ 31.57 <br /> 88142 $ 27.60 <br /> 88143 $ 27.60 <br /> 88164 $ 14.39 <br /> Cytopathology(manual screening and rescreening under Physician <br /> supervision) <br /> 88165 $ 14.39 <br /> 88174 $ 29.11 <br /> 88175 $ 35.40 <br /> Human Papillomavirus,hig-risk types(3) 87624 $ 33.41 No <br /> Human Papillomavirus,types 16 and 18 only(3) 87625 $ 33.41 No <br /> Follow-Up <br /> Colposcopy 57452 $ 105.49 Yes <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 148.40 Yes <br /> Colposcopy with Biopsy 57455 $ 138.06 Yes <br /> Colposcopy with endocervical curettage 57456 $ 130.17 Yes <br /> Surgical Pathology-Level IV 88305 $ 70.63 No <br /> 88305TC $ 31.91 No <br /> 88305-26 $ 38.72 No <br /> Physician Visits <br /> Office Visits(2) CPT 16-17 <br /> Code Fee <br /> New patient,brief 99201 $ 41.87 <br /> New patient,limited 99202 $ 71.79 <br /> New patient,intermediate 99203 $ 103.91 <br /> Established patient,brief 99211 $ 19.04 <br /> Established patient,limited 99212 $ 41.59 <br /> Established patient,intermediate 99213 $ 70.29 <br /> 00400 Anesthesia <br /> Not to exceed 3 Base Units plus Time Units(length of time spent providing anesthesia service in 15 minute increments) <br /> minute increments)times Conversion Rate($21.44)or$325,whichever is lower. <br />