$ $97.98 $ a. Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram a. Global. $47.61 b. Technical/Facility Only

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Archibald Maxwell
6 years ago
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Diagnostic Mammogram (Bilateral) 6 Digital Diagnostic Mammogram (Bilateral) 77067 77067-TC 77067-26 G0202 G0202-TC G0202-26 77063 77063-TC 77063-26 77065 77065-TC 77065-26 G0206 G0206-TC G0206-26

1 1 Screening Mammogram (Bilateral) 2 Digital Screening Mammogram (Bilateral) 2a. Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic Mammogram (Unilateral) 4 Digital Diagnostic Mammogram (Unilateral) 5 Diagnostic Mammogram (Bilateral) 6 Digital Diagnostic Mammogram (Bilateral) TC G0202 G0202-TC G TC TC G0206 G0206-TC G TC $ $81.32 ** Discontinued as of 01/01/2018 ** G0204 G0204-TC G $ $81.32 $47.61 $21.48 $26.13 $ $76.93 ** Discontinued as of 01/01/2018 ** $ $76.93 $ $97.98 $37.67 ** Discontinued as of 01/01/2018 ** $ $97.98 $ a. Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram G0279 $47.61 G0279-TC $21.48 G $26.13 ** Can only be paid w/ diagnostic mammography (77065 & 77066))** 7 Pap test, (any reporting system) requiring interpretation by physician $ Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 9 Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; manual screening and rescreening under physician supervision $ $23.43 FY /01/2018

2 10 Pap test, slides, (Bethesda System); manual screening under $12.22 physician supervision 11 Pap test, slides, (Bethesda System); manual screening and $12.22 rescreening under physician supervision 12 Pap test, (any reporting system) collected in preservative fluid, $24.72 automated thin layer preparation; screening by automated system, under physician supervision 13 Pap test (any reporting system) collected in preservative fluid, $30.49 automated thin layer preparation; screening by automated system and manual rescreening or review, under physician supervision 14 Screening Pap test, (any reporting system) collected in preservative G0123 $23.43 fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision 15 Screening Pap test, (any reporting system) collected in preservative G0124 $27.27 fluid, automated thin layer preparation, requiring interpretation by physician 16 Screening Pap test, (any reporting system) collected in preservative G0145 $30.49 fluid, automated thin layer preparation, screening by automated system and manual rescreening under physician supervision 17 HPV Typing, High-risk types $ HPV Typing, Types 16 and 18 ONLY $ Consultation Visit, Breast or Cervical min min 20 Office Visit, New Patient Full Exam min yo yr Office Visit, New Patient Partial Exam min $ min 22 Office Visit, Established Patient Full Exam min min min yo yo Office Visit, Established Patient Partial Exam min $36.74 $ min $ Urine test; pregnancy ~ To be billed in conjunction with colposcopy services $ Colposcopy ** Cannot be billed with pathology 88305/88307** TC $91.06 $78.16 FY /01/2018

3 57454 $ TC $ Colposcopy with Biopsy of the Cervix and Endocervical Curettage (Colp Bx & ECC) ** Cannot be billed in conjunction with 57505** ** Cannot be billed with Level V pathology 88307** 27 Colposcopy with Biopsy of the Cervix (Colp w/ Bx) ** Cannot be billed in conjunction with 57505** ** Cannot be billed with Level V pathology 88307** TC 28 Colposcopy with Endocervical Curettage (Colp w/ ECC) ** Cannot be billed in conjunction with 57505** ** Cannot be billed with Level V pathology 88307** 29 Endocervical Curettage (not part of D & C) TC TC 30 Fine Needle Aspiration of Superficial Breast Tissue, Not Using Imaging Guidance TC 31 Fine Needle Aspiration of Superficial Breast Tissue, Using Imaging Guidance TC 32 Fine Needle Aspiration (FNA), Breast Cyst TC 33 Fine Needle Aspiration (FNA), Each Additional Cyst TC 34 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy TC specimen, when performed, percutaneous; first lesion, including stereotactic guidance 35 Each additional lesion, including stereotactic guidance (List (Use in conjunction with 19081) 36 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance 37 Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19083) 38 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance 39 Each additional lesion, including magnetic resonance guidance (List (Use in conjunction with 19085) TC TC TC TC TC 40 Breast Biopsy, Needle Core, Not Using Imaging Guidance TC FY /01/2018 $ $94.32 $ $87.77 $84.62 $77.04 $ $61.14 $ $58.06 $95.56 $38.56 $23.34 $19.25 $ $ $ $73.81 $ $ $ $69.52 $ $ $ $81.10 $ $62.70

4 41 Breast Biopsy, Incisional TC $ $ Breast Biopsy, Excisional ** Anesthesia reimbursement available TC $ $ Breast Biopsy, Excision of Single Lesion Identified by Radiological Marker TC $ $ ** Anesthesia reimbursement available 44 Breast Biopsy, Excision of Each Additional Lesion $ Placement of breast localization device(s) (e.g., clip, metallic pellet, mammographic guidance 46 Each additional lesion, including mammographic guidance (List (Use in conjunction with 19281) 47 Placement of breast localization device(s) (e.g., clip, metallic pellet, stereotactic guidance 48 Each additional lesion, including stereotactic guidance (List (Use in conjunction with 19283) 49 Placement of breast localization device(s) (e.g., clip, metallic pellet, ultrasound guidance 50 Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19285) 51 Placement of breast localization device(s) (e.g. clip, metallic pellet, magnetic resonance guidance 52 Each additional lesion, including magnetic resonance guidance (List (Use in conjunction with 19287) 53 Radiological Examination, Surgical Specimen TC TC TC TC TC TC TC TC TC TC $ $ $89.63 $ $45.54 $ $89.93 $ $45.83 $ $76.50 $ $38.80 $ $ $ $56.75 $13.78 $6.78 $7.00 FY /01/2018

5 54 Breast Ultrasound, Complete exam, including axilla, UNI-Lateral (one unit) TC $87.48 $56.43 $31.05 BI-Lateral reporting: Provider will receive 150% of the payment for a single side (unilateral) if the code is reported with modifier -50, or modifiers RT and LT, or with two units of service. 55 Breast Ultrasound, Limited exam, including axilla, UNI-Lateral BI-Lateral reporting: Provider will receive 150% of the payment for a single side (unilateral) if the code is reported with modifier -50, or modifiers RT and LT, or with two units of service. 56 Ultrasonic Guidance/Breast Needle Biopsy, Radiologic Supervision/Interpretation 57 Surgical Pathology, Breast or Cervical Biopsy - Level IV 58 Surgical Pathology, Breast or Cervical Biopsy - Level V **Cannot bill with 57505, 57452, 57454, or 57456** (2 units or -50) TC (2 line items) L TC2L L (one unit) TC (2 units or -50) TC (2 line items) L TC2L L TC TC TC $ $84.64 $46.56 $65.60 ea. $42.32 ea. $23.28 ea. $72.20 $43.24 $28.96 $ $64.86 $43.44 $54.15 ea. $32.43 ea. $21.72 ea. $49.71 $22.19 $27.51 $59.36 $25.28 $34.09 $ $ $75.16 FY /01/2018

6 59 Pathology consultation during surgery, first tissue block, with frozen section(s), single specimen 60 Pathology consultation during surgery, each additional tissue block, with frozen section(s) 61 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 62 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure) 63 Cytopathology, Evaluation of Fine Needle Aspirate to determine Specimen Adequacy 64 Cytopathology, Interpretation and Report 65 Cytopathology, Selective Cellular Enhancement Technique with Interpretation (e.g., Liquid Based Slide Preparation Method), EXCEPT CERVICAL OR VAGINAL **Cannot bill in conjunction with 88173** TC TC TC TC TC TC $86.15 $31.92 $54.23 $38.01 $11.17 $26.84 $73.52 $48.83 $24.68 $86.52 $55.59 $30.93 $47.50 $16.13 $31.37 $ $65.01 $ TC $55.29 $31.17 $ Patient Navigation G9012 $55.00 FY /01/2018

7 67 Anesthesia Payable w/ Excisional Breast Biopsies ONLY (*19120 & *19125) a. Anesthesia services performed personally by anesthesiologist b. Medical supervision by a physician: more than four concurrent anesthesia procedures AA AD $94.84 $56.91 c. Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals d. CRNA service: with medical direction by a physician e. Anesthesiologist medically directs one CRNA f. CRNA service: (supervised) without medical direction by a physician Rates are based on a flat fee. Only one unit is reimbursable as indicated on the rate schedule. 68 Morphometric analysis, tumor immunohistochemistry (eg, Her- 2/neu, estrogen receptor/progesterone receptor), quantitative or semi quantitative, per specimen, each single antibody stain procedure; manual 69 Morphometric analysis, tumor immunohistochemistry (eg, Her- 2/neu, estrogen receptor/progesterone receptor), quantitative or semi quantitative, per specimen, each single antibody stain procedure; manual; using computer-assisted technology QK QX QY QZ N E W TC $47.42 $47.42 $47.42 $94.84 Effective DOS 02/01/2018 N E W TC $ $75.57 $40.06 Effective DOS 02/01/2018 $ $83.14 $42.51 FY /01/2018

BCCCNP Service CPT Code FY19 Rate. $ $97.98 $ Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram a. Global

BCCCNP Service CPT Code FY19 Rate. $ $97.98 $ Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram a. Global 1 Screening Mammogram (Bilateral) 2 Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic Mammogram (Unilateral) 4 Diagnostic Mammogram