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2022 Office Fee <br />Code Fee Allowed <br />Clinical breast examination N/A Yes <br />77063 51.44$ No <br />77063TC 22.48$ <br />77063-26 28.96$ <br />77067 124.70$ No <br />77067TC 88.60$ <br />77067-26 36.11$ <br />Radiological examination, surgical specimen 76098 39.52$ No <br />76098TC 24.37$ <br />76098-26 15.15$ <br />Diagnostic mammography, unilateral, includes CAD 77065 122.58$ No <br />77065TC 84.10$ <br />77065-26 38.48$ <br />Diagnostic mammography, bilateral, includes CAD 77066 154.81$ No <br />77066TC 107.22$ <br />77066-26 47.58$ <br />G0279 51.44$ No <br />G0279TC 22.48$ <br />G0279-26 28.96$ <br />Ultrasound, complete examination of breast including axilla,76641 101.19$ No <br /> unilateral (4)76641TC 66.44$ <br />76641-26 34.75$ <br />Ultrasound, limited examination of breast including axilla, 76642 83.08$ No <br /> unilateral (4)76642TC 50.70$ <br />76642-26 32.37$ <br />Surgical evaluation/Consultation N/A (10)Yes <br />Fine needle aspiration biopsy without imaging guidance, first lesion 10021 99.10$ Yes <br /> Each additional lesion 10004 50.07$ Yes <br />Fine needle aspiration biopsy including ultrasound guidance, first lesion 10005 134.99$ Yes <br /> Each additional lesion 10006 59.28$ Yes <br />Punch biopsy of skin (including simple closure when performed), single lesion 11104 123.44$ Yes <br /> Each additional lesion 11105 57.78$ Yes <br />11106 152.72$ Yes <br /> Each additional lesion 11107 69.81$ Yes <br />Puncture aspiration of cyst of breast 19000 100.63$ Yes <br />Puncture aspiration of cyst of breast, each additional cyst, used with 19000 19001 26.23$ Yes <br />Breast biopsy, with placement of localization device and imaging of 19081 499.59$ Yes <br /> biopsy specimen, percutaneous; stereotactic guidance; first lesion (5) <br /> Each additional lesion (5) 19082 389.49$ Yes <br />Breast biopsy, with placement of localization device and imaging of 19083 505.26$ Yes <br /> biopsy specimen, percutaneous; ultrasound guidance; first lesion (5) <br /> Each additional lesion (5)19084 385.18$ Yes <br />Breast biopsy, percutaneous, needle core, not using imaging guidance 19100 151.33$ Yes <br />Breast biopsy, open, incisional 19101 326.29$ Yes <br />Diagnostic digital breast tomosynthesis, unilateral or bilateral (3) <br />North Carolina Breast and Cervical Cancer Control Program <br />Breast Cancer Screening and Diagnostic Procedures <br />2022 Services Fee Schedule (1) <br />For the Period 01/01/2022 through 12/31/2022 <br />Incisional biopsy of skin (e.g., wedge; including simple closure when <br />performed), single lesion <br />Revised: 03/08/2022 <br />Screening mammography, bilateral, includes CAD <br />Screening <br />Screening digital breast tomosynthesis, bilateral (2) <br />Follow-Up <br />Exhibit BDocuSign Envelope ID: F603CD10-1FD6-4458-9C7C-EC1EB8CD2D18