2024-468-E-Health Dept-UNC Healthcare System -BCCCP Mammogram Screening

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(1)NC BCCCP covers only the physician's fee. Any facility charges associated with these CPT codes are not covered. (2) (3) (4)Bilateral ultrasound may be reimbursed at one and one-half times the unilateral rate (not double unilateral rate). (5) (6) (7) (8)Example: If procedure is 50 minutes, code 99156 + (99157 x 2). No separate charge allowed if procedure <10 minutes. (9) (10) (11) All consultations should be billed through the standard "new patient" office visit CPT codes: 99202-99205. Consultations billed as 99204 or 99205 must meet the criteria for these codes, and must be pre-authorized. Codes 99204 and 99205 are typically not appropriate for NC BCCCP screening visits, but may be used when provider spends extra time to do a detailed risk assessment. BCCCP may pay for up to two surgical consultations. Codes 19281-19286 are for image guidance placement of a localization device without image-guided biopsy. These codes should not be used in conjunction with 19081-19084. HPV DNA testing is not a reimbursable test for women under 30 years of age. Not to exceed 3 base units plus time units (length of time spent providing anesthesia service in 15-minute increments) times conversion rate ($19.48) or $325, whichever is lower. Medicare's methodology for the payment of anesthesia services is outlined in chapter 12 of the Medicare Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf The carrier-specific Medicare anesthesia conversion rates are available at: https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center List separately in addition to code for primary procedure 77067. The National Breast & Cervical Cancer Early Detection Program (NBCCEDP) allows telehealth visits using regular office visit codes through the end of December 2024. These visits can be performed using routine technology platforms (e.g., phones, facetime, free Zoom, etc.) and relaxes the use of only HIPAA-compliant platforms. Future allowance for the use of telehealth visits will be based upon guidance we receive from NBCCEDP. By law, NC BCCCP can only cover Medicare-approved and allowable procedures. NOTES: Codes 19081-19084 are to be used for breast biopsies that include image guidance, placement of a localization device, and imaging of biopsy specimen using stereotactic or ultrasound guidance. They should not be used in conjunction with 19281- List separately in addition to 77065 or 77066. Docusign Envelope ID: E3FD8286-9BF1-4ABB-A975-EA9FB3BD2524