2018-692 Health-UNC Health Care mammogram screenings

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North Carolina Breast and Cervical Cancer Control Program Maximum Allowable Fees - WISEWOMAN For the Period 01/01/2018 - 12/31/2018 Revised: 12/21/2017 Procedures CPT Code Fee Automated Lipid Panel * 80061 $ 16.53 Lipid Panel (CLIA waived)' 80061QW $ 16.53 Cholesterol, Total Saturn 82465 $ 5.37 Cholesterol, Total Serum (CLIA waived) 82465QW $ 5.37 Lipoprotein (HDL) 83718 $ 10.12 Lipoprotein (HDL) (CLIA waived) 83718QW $ 10.12 Glucose, blood, quantitative 82947 $ 4.85 Glucose, blood, quantitative (CLIA waived) 82947QW $ 4.85 Glucose, blood, reagent strip 82948 $ 5.04 Glucose, tolerance test, three specimens 82951 $ 15.89 Glucose, tolerance test, three specimens (CLIA waived) 82951QW $ 15.89 Hemoglobin AIC 83036 $ 11.99 Hemoglobin AIC (CLIA waived) 83036QW $ 11.99 Basic Metabolic Profile ** 80048 $ 10.44 Basic Metabolic Profile (CLIA waived)** 80048QW $ 10.44 Other Routine venipuncture 36415 $ 3.00 Health Coaching (HC) - Initial HC session is incorporated into screening visit; 2 additional HC sessions are advised and will be reimbursed as below: Individual HC, Face-to-face, 15 minutes 99150 $ 15.00 Individual HC, Phone, 15 minutes 99150T $ 15.00 Office Visits New Patient, Brief 99201 $ 42.57 New Patient, Limited 99202 $ 71.85 New Patient, Intermediate 99203 $ 103.20 New Patient, Limited (Comprehensive) 99204 $ 157.83 New Patient, Intermediate (Comprehensive) 99205 $ 198.62 Established Patient, Brief 99211 $ 20.64 Established Patient, Limited 99212 $ 41.98 Established Patient, Intermediate 99213 $ 69.98 Note: Office Visits listed above may be used to reimburse for consultations associated with WISEWOMAN referrals, when applicable. *Lipid Panel tests are: Total Serum Cholesterol, Lipoprotein (HDL and LDL) and Triglycerides. **Basic Collection Container: I ml, Serum / One SST Remarks: Includes NA, K, CL, CO2, Metabolic Profile GLUC, BUN, CREA, CA The Clinical Laboratory Improvement Amendments of 1988 (CLIA) law specifies that laboratory requirements be based on the complexity of the test performed and established provisions for categorizing a test as waived. Tests may be waived from regulatory oversight if they meet certain requirements established by the statute. CLIA waived tests employ methodologies that are so simple and accurate as to render the likelihood of erroneous results negligible; pose no reasonable risk of harm to the patient if the test is performed incorrectly; and/or are cleared by the Food and Drug Administration for home use.