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North Carolina Breast and Cervical Cancer Control Program <br /> 2018 Services Fee Schedule (1) <br /> Physician Visits CPC 2018 <br /> Office Visits (8) Code Fee <br /> New patient; history, exam, straightforward decision-making; 99201 $ 42.57 <br /> 10 minutes <br /> New patient; expanded history, exam, straightforward decision-making; 99202 S 71.85 <br /> 20 minutes <br /> New patient; detailed history, exam, straightforward decision-making; 99203 $ 103.20 <br /> 30 minutes <br /> Established patient; evaluation and management, may not require 99211 $ 20.64 <br /> presence of physician; 5 minutes <br /> Established patient; history, exam, straightforward decision-making; 99212 $ 4L98 <br /> 10 minutes <br /> Established patient; expanded history, exam, straighforward decision- 99213 $ 69.98 <br /> making; 15 minutes <br /> Established patient; detailed history, exam, moderately complex 99214 S 103.41 <br /> decision-making; 25 minutes <br /> _ Global and Split Fees <br /> Both global and split fees apply to the breast procedures listed on page I of this fee schedule. The method and direction of payment will <br /> determine their usage for your facility. The following are the codes and 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 /> NOTES: <br /> (1) NC BCCCP covers only the physicians fee. Any facility charges associated with these CPT codes are not covered. <br /> (2) Code 77063 should be listed as a separate code in addition to the code for the screening mammogram code, 77067. <br /> (3) Code 00279 should be listed as a separate code in addition to 77065 or 77066 for the primary mammogram. <br /> (4) Codes 19081-19084 are to be used for breast biopsies that include image guidance, placement of localization device, and <br /> imaging of specimen. These codes should not he used in conjunction with 19281-19286. <br /> (5) Codes 19281-19286 are for image guidance placement of localization device without image-guided biopsy. These codes should <br /> not be used in conjunction with 19081-19084. <br /> (6) Not to exceed 3 base units plus time wits (length of time spent providing anesthesia service in 15-minute increments) times <br /> conversion rate ($21.10) or $325, whichever is lower. Medicare's methodology for the payment of anesthesia services is outlined <br /> in chapter 12 of the Medicare Claims Processing Manual at: <br /> hMM71/wwwcroseav/Re laze d-G 'dsn /G 'd /NI als/d d= lan df <br /> The carrier-specific Medicare anesthesia conversion rates are available at: <br /> hUns7l,'www,gms.gov/Center/Provider-TNveAnesth i rs-C t h=P d' r--/ t / th <br /> (7) HPV DNA testing is not a reimbursable procedure if used as an adjunctive screening test to the Pap for women under 30 years of <br /> The CDC will allow for reimbursement of Cervista HPV HR at the same rate as the Digene Hybrid Capture 2 HPV DNA Assay. <br /> CDC funds may be used for reimbursement of HPV genotyping. <br /> (8) All consultations should be billed through the standard "new patient" office visit CPT codes: 99201-99205. Consultations billed <br /> as 99204 or 99205 must meet the criteria for these codes, and most be pre-authorized. Codes 99204 and 99205 are not <br /> appropriate for NC BCCCP screening visits. <br />