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CPT 2020 <br />Code Fee <br />New patient; history, exam, straightforward decision-making; 99201 44.20$ <br />10 minutes <br />New patient; expanded history, exam, straightforward decision-making; 99202 73.61$ <br />20 minutes <br />New patient; detailed history, exam, straightforward decision-making; 99203 104.47$ <br />30 minutes <br />Established patient; evaluation and management, may not require 99211 22.21$ <br />presence of physician; 5 minutes <br />Established patient; history, exam, straightforward decision-making; 99212 43.86$ <br />10 minutes <br />Established patient; expanded history, exam, straighforward decision-99213 72.77$ <br />making; 15 minutes <br />Established patient; detailed history, exam, moderately complex 99214 105.81$ <br />decision-making; 25 minutes <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 />(1)NC BCCCP covers only the physician's fee. Any facility charges associated with these CPT codes are not covered. <br />(2) <br />(3) <br />(4)Bilateral ultrasound may be reimbursed at one and one-half times the unilateral rate (not double unilateral rate). <br />(5) <br />(6) <br />(7) <br />(8)Example: If procedure is 50 minutes, code 99156 + (99157 x 2). No separate charge allowed if procedure <10 minutes. <br />(9) <br />(10) <br />Not to exceed 3 base units plus time units (length of time spent providing anesthesia service in 15-minute increments) times <br />conversion rate ($21.63) 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 />https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf <br />The carrier-specific Medicare anesthesia conversion rates are available at: <br />https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center <br />List separately in addition to code for primary procedure 77067. <br />List separately in addition to 77065 or 77066. <br />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 must be pre-authorized. Codes 99204 and 99205 are typically not <br />appropriate for NC BCCCP screening visits, but may be used when provider spends extra time to do a detailed risk assessment. <br />BCCCP may pay for up to two surgical consultations. <br />HPV DNA testing is not a reimbursable procedure if used as an adjunctive screening test to the Pap for women under 30 years of a <br />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 />Codes 19081-19084 are to be used for breast biopsies that include image guidance, placement of localization device, and <br />imaging of specimen. They should not be used in conjunction with 19281-19286. <br />Global and Split Fees <br />Both global and split fees apply to the breast and cervical procedures listed on this fee schedule. The method and direction of payment will <br />NOTES: <br />Physician Visits <br />Office Visits (10) <br />North Carolina Breast and Cervical Cancer Control Program <br />2020 Services Fee Schedule (1) <br />DocuSign Envelope ID: FB8633A7-7427-4234-85C2-8B1508ED7177