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2024 Office Fee <br />Code Fee Allowed <br />Clinical breast examination N/A Yes <br />77063 48.16$ No <br />77063TC 21.83$ <br />77063-26 26.33$ <br />77067 117.42$ No <br />77067TC 83.90$ <br />77067-26 33.52$ <br />Radiological examination, surgical specimen 76098 39.13$ No <br />76098TC 25.08$ <br />76098-26 14.05$ <br />Diagnostic mammography, unilateral, includes CAD 77065 115.09$ No <br />77065TC 79.36$ <br />77065-26 35.74$ <br />Diagnostic mammography, bilateral, includes CAD 77066 145.60$ No <br />77066TC 101.71$ <br />77066-26 43.89$ <br />G0279 43.92$ No <br />G0279TC 17.59$ <br />G0279-26 26.33$ <br />Ultrasound, complete examination of breast including axilla,76641 94.32$ No <br /> unilateral (4)76641TC 62.07$ <br />76641-26 32.25$ <br />Ultrasound, limited examination of breast including axilla, 76642 78.16$ No <br /> unilateral (4)76642TC 48.13$ <br />76642-26 30.04$ <br />Surgical evaluation/Consultation See Footnote (10)(10)Yes <br />Fine needle aspiration biopsy without imaging guidance, first lesion 10021 92.90$ Yes <br /> Each additional lesion 10004 47.99$ Yes <br />Fine needle aspiration biopsy including ultrasound guidance, first lesion 10005 123.55$ Yes <br /> Each additional lesion 10006 55.99$ Yes <br />Punch biopsy of skin (including simple closure when performed), single lesion 11104 114.70$ Yes <br /> Each additional lesion 11105 54.60$ Yes <br />11106 142.37$ Yes <br /> Each additional lesion 11107 65.30$ Yes <br />Puncture aspiration of cyst of breast 19000 91.89$ Yes <br />Puncture aspiration of cyst of breast, each additional cyst, used with 19000 19001 24.31$ Yes <br />Breast biopsy, with placement of localization device and imaging of 19081 453.59$ Yes <br /> biopsy specimen, percutaneous; stereotactic guidance; first lesion (5) <br /> Each additional lesion (5) 19082 347.59$ Yes <br />Breast biopsy, with placement of localization device and imaging of 19083 451.72$ Yes <br /> biopsy specimen, percutaneous; ultrasound guidance; first lesion (5) <br /> Each additional lesion (5)19084 342.03$ Yes <br />Breast biopsy, percutaneous, needle core, not using imaging guidance 19100 135.56$ Yes <br />Breast biopsy, open, incisional 19101 298.85$ Yes <br />North Carolina Breast and Cervical Cancer Control Program <br />Breast Cancer Screening and Diagnostic Procedures <br />2024 Services Fee Schedule (1) <br />For the Period 01/01/2024 through 12/31/2024 <br />Screening digital breast tomosynthesis, bilateral (2) <br />Incisional biopsy of skin (e.g., wedge; including simple closure when <br />performed), single lesion <br />Screening <br />Follow-Up <br />Created: 12/28/2023 <br />Diagnostic digital breast tomosynthesis, unilateral or bilateral (3) <br />Screening mammography, bilateral, includes CAD <br />Exhibit BDocusign Envelope ID: E3FD8286-9BF1-4ABB-A975-EA9FB3BD2524