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 />(12)Code 99459 may only be reimbursed if cervical cytology (Pap) or HPV test is conducted during pelvic exam. <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 />Codes 19281-19286 are for image guidance placement of a localization device without image-guided biopsy. These codes should <br />not be used in conjunction with 19081-19084. <br />HPV DNA testing is not a reimbursable test for women under 30 years of age; 87626 cannot be reimbursed along with 87624 <br />or 87625. <br />Fee is calculated using (Base Units + Time [in units]) x Conversion Factor = Anesthesia Fee Amount. Go to <br />https://www.cms.gov/medicare/payment/fee-schedules/physician/anesthesiologists-center for updated base rates and conversion <br />List separately in addition to 77065 or 77066. <br />List separately in addition to code for primary procedure 77067. <br />The National Breast & Cervical Cancer Early Detection Program (NBCCEDP) allows telehealth visits using regular office visit <br />codes through the end of December 2025. 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 />visits will be based upon guidance we receive from NBCCEDP. By law, NC BCCCP can only cover Medicare-approved and <br />allowable procedures. <br />NOTES: <br />Codes 19081-19084 are to be used for breast biopsies that include image guidance, placement of a localization device, and <br />imaging of specimen. They should not be used in conjunction with 19281-19286. <br />Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C