Orange County NC Website
Browse       Search
(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 />(11) <br />HPV DNA testing is not reimbursable if used as an adjunctive screening test to a Pap for women under 30 years of age. <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 ($21.07) 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 />NOTES: <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 />List separately in addition to 77065 or 77066. <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 />List separately in addition to code for primary procedure 77067. <br />The Centers for Medicare & Medicaid Services (CMS) currently allow telehealth visits to be billed using standard office visit <br />CPT codes during the public health emergency. These visits can be performed using routine technology platforms (e.g., phones, <br />facetime, free Zoom, etc.) and relaxes the use of only HIPAA-compliant platforms. Future allowance for the use of telehealth <br />will be based upon guidance we receive post-pandemic. By law, NC BCCCP can only cover Medicare-approved and allowable <br />procedures. <br />All consultations should be billed through the standard "new patient" office visit CPT codes: 99202-99205. 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 />DocuSign Envelope ID: F603CD10-1FD6-4458-9C7C-EC1EB8CD2D18