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North Carolina Breast and Cervical Cancer Control Program <br /> 2017 Services Fee Schedule(1) <br /> 2017 Office Fee <br /> Cervical Procedures Code Fee Allowed <br /> Screening <br /> Pelvic Examination-Bimanual N/A Yes <br /> Yes <br /> Cytopathology,cervical or vaginal, requiring interpretation 88141 $ 31.64 <br /> by physician <br /> Cytopathology(liquid based Pap test)cervical or vaginal,collected 88142 $ 27.79 <br /> in preservative fluid,automated thin layer preparation;manual <br /> screening under physician supervision <br /> Cytopathology(liquid based Pap test)cervical or vaginal,collected 88143 $ 27.79 <br /> in preservative fluid,automated thin layer preparation;manual <br /> screening and rescreening under physician supervision <br /> Cytopathology(conventional Pap test),slides cervical or vaginal, 88164 $ 14.49 <br /> manual screening under physician supervision <br /> Cytopathology(conventional Pap test),slides cervical or vaginal, 88165 $ 14.49 <br /> manual screening and rescreening under physician supervision <br /> Cytopathology,cervical or vaginal,collected in preservative fluid, 88174 $ 29.31 <br /> automated thin layer preparation,screening by automated system, <br /> under physician supervision <br /> Cytopathology,cervical or vaginal,collected in preservative fluid, 88175 $ 35.65 <br /> automated thin layer preparation,screening by automated system <br /> and manual rescreening under physician supervision <br /> Human Papillomavirus,high-risk types(6) 87624 $ 33.64 No <br /> Human Papillomavirus,types 16 and 18 only(6) 87625 $ 33.64 No <br /> Follow-Up <br /> Colposcopy 57452 $ 105.86 Yes <br /> Colposcopy with Biopsy and endocervical curettage 57454 $ 148.78 Yes <br /> Colposcopy with Biopsy 57455 $ 138.46 Yes <br /> Colposcopy with endocervical curettage 57456 $ 130.57 Yes <br /> Surgical Pathology-Level IV 88305 $ 66.46 No <br /> 88305TC $ 27.66 No <br /> 88305-26 $ 38.80 No <br /> N.C.Department of Health and Human Services,Division of public Health, Page 3 <br /> Chronic Disease and Injury Section,Cancer Prevention and Control Branch 2/2017 <br />