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North Carolina Breast and Cervical Cancer Control Program <br /> 2017 Services Fee Schedule(1) <br /> Physician Visits CPT 2017 <br /> Office Visits(7) Code Fee <br /> New patient;history,exam,straightforward decision-making; 99201 $ 42.16 <br /> 10 minutes <br /> New patient;expanded history,exam,straightforward decision-making; 99202 $ 72.23 <br /> 20 minutes <br /> New patient;detailed history,exam,straightforward decision-making; 99203 $ 104.35 <br /> 30 minutes <br /> Established patient;evaluation and management,may not require 99211 $ 19.42 <br /> presence of physician;5 minutes <br /> Established patient;history,exam,straightforward decision-making; 99212 $ 42.00 <br /> 10 minutes <br /> Established patient;expanded history,exam,straighforward decision- 99213 $ 70.73 <br /> making; 15 minutes <br /> Established patient;detailed history,exam,moderately complex 99214 $ 104.24 <br /> decision-making;25 minutes <br /> 00400 Anesthesia for procedures on the integumentary system,anterior trunk,not otherwise specified.Medicare Base Units=3 <br /> Not to exceed 3 Base Units plus Time Units(length of time spent providing anesthesia service in 15 minute increments) <br /> times Conversion Rate($21.45)or$325,whichever is lower. <br /> Medicare's methodology for the payment of anesthesia services is outlined in chapter 12 of the Medicare Claims <br /> Processing Manual at www.cros.hhs.gov/manuaWdownloads/clml04cl2.ndf.The carrier-specific Medicare anesthesia <br /> conversion rates are available at www.cros.hhs.2ov/center/anesth.asD. <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 /> N.C.Department of Health and Human Services,Division of Public Health, Page 4 <br /> Chronic Disease and Injury Section,Cancer Prevention and Control Branch 2/2017 <br />