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2025 Office Fee <br />Code Fee Allowed <br />Clinical breast examination N/A Yes <br />77063 48.21$ No <br />77063TC 21.57$ <br />77063-26 26.64$ <br />77067 116.72$ No <br />77067TC 82.88$ <br />77067-26 33.83$ <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 114.35$ No <br />77065TC 78.61$ <br />77065-26 35.75$ <br />Diagnostic mammography, bilateral, includes CAD 77066 144.16$ No <br />77066TC 100.17$ <br />77066-26 43.99$ <br />G0279 40.72$ No <br />G0279TC 14.08$ <br />G0279-26 26.64$ <br />Ultrasound, complete examination of breast including axilla,76641 92.98$ No <br /> unilateral (4)76641TC 60.42$ <br />76641-26 32.56$ <br />Ultrasound, limited examination of breast including axilla, 76642 77.29$ No <br /> unilateral (4)76642TC 46.94$ <br />76642-26 30.34$ <br />Surgical evaluation/Consultation See Footnote (10)(10)Yes <br />Fine needle aspiration biopsy without imaging guidance, first lesion 10021 91.66$ Yes <br /> Each additional lesion 10004 48.74$ Yes <br />Fine needle aspiration biopsy including ultrasound guidance, first lesion 10005 121.66$ Yes <br /> Each additional lesion 10006 55.46$ Yes <br />Punch biopsy of skin (including simple closure when performed), single lesion 11104 111.67$ Yes <br /> Each additional lesion 11105 53.89$ Yes <br />11106 138.80$ Yes <br /> Each additional lesion 11107 63.69$ Yes <br />Puncture aspiration of cyst of breast 19000 88.16$ Yes <br />Puncture aspiration of cyst of breast, each additional cyst, used with 19000 19001 24.03$ Yes <br />Breast biopsy, with placement of localization device and imaging of 19081 441.20$ Yes <br /> biopsy specimen, percutaneous; stereotactic guidance; first lesion (5) <br /> Each additional lesion (5) 19082 334.48$ Yes <br />Breast biopsy, with placement of localization device and imaging of 19083 436.21$ Yes <br /> biopsy specimen, percutaneous; ultrasound guidance; first lesion (5) <br /> Each additional lesion (5)19084 327.95$ Yes <br />Breast biopsy, percutaneous, needle core, not using imaging guidance 19100 131.79$ Yes <br />Breast biopsy, open, incisional 19101 288.23$ Yes <br />North Carolina Breast and Cervical Cancer Control Program <br />Breast Cancer Screening and Diagnostic Procedures <br />2025 Services Fee Schedule (1) <br />For the Period 01/01/2025 through 12/31/2025 (Revision #3) <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: 01/14/2025; Revised 04/16/2025 <br />Diagnostic digital breast tomosynthesis, unilateral or bilateral (3) <br />Screening mammography, bilateral, includes CAD <br />Exhibit BDocusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C