BCCCNP Service CPT Code FY 2019 Rate Oct 1, 2018 Dec 31, 2018

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Cody Ball
5 years ago
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1 Screening Mammogram (Bilateral); including CAD 2 Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic Mammogram (Unilateral);

(any reporting system) requiring interpretation by physician 7 Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; manual screening under physician

1 1 Screening Mammogram (Bilateral); including CAD 2 Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic Mammogram (Unilateral); including CAD 4 Diagnostic Mammogram (Bilateral); including CAD 5 Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ diagnostic mammography (77065 & 77066))** 6 Pap test, (any reporting system) requiring interpretation by physician 7 Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision Service CPT Code Oct 1, 2018 Dec 31, Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; manual screening and rescreening under physician supervision 9 Pap test, slides, (Bethesda System); manual screening under physician supervision 10 Pap test, slides, (Bethesda System); manual screening and rescreening under physician supervision 11 Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision 12 Pap test (any reporting system) collected in preservative fluid, automated thin layer preparation; screening by automated system and manual rescreening or review, under physician supervision TC TC TC TC G0279 G0279-TC G or G or G0123 $ $81.32 $30.08 $47.61 $21.48 $26.13 $ $76.93 $30.08 $ $97.98 $37.67 $47.61 $21.48 $26.13 Jan 01, current $ $93.70 $37.82 $53.43 $23.70 $29.73 $ $88.62 $40.78 $ $ $50.24 $53.43 $23.70 $29.73 $27.27 $31.11 $23.43 $ $23.43 $ $12.22 $ $12.22 $ $24.72 $ or G0145 $30.49 $ HPV Typing, High-risk types $40.60 $37.04 FY19 ~ Updated 01/10/ Effective 01/01/2019

2 Service CPT Code Oct 1, 2018 Dec 31, 2018 Jan 01, current 14 HPV Typing, Types 16 and 18 ONLY $40.60 $ Consultation / Risk Assessment, Breast or Cervical Office Visit, New Patient Full Exam min yo yr Office Visit, New Patient Partial Exam min min $36.74 $36.74 $45.00 $ Office Visit, Established Patient Full Exam min min yo yo Office Visit, Established Patient Partial Exam min min $16.60 $16.60 $22.00 $ Urine test; pregnancy ~ To be billed with colposcopy services only $7.32 $ Colposcopy ** Cannot be billed with pathology 88305/88307** TC $91.06 $78.16 $ $ 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** TC $ $ $ $ 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 24 Colposcopy with Endocervical Curettage (Colp w/ ECC) ** Cannot be billed in conjunction with 57505** ** Cannot be billed with Level V pathology 88307** 25 Endocervical Curettage (not part of D & C) Fine Needle Aspiration biopsy without imaging guidance; Fine Needle Aspiration of Superficial Breast Tissue, Using Imaging Guidance (replaced by ) 27 Fine Needle Aspiration biopsy without imaging guidance; Each additional lesion 28 Fine Needle Aspiration biopsy including ultrasound guidance; 29 Fine Needle Aspiration biopsy including ultrasound guidance; Each additional lesion TC TC TC TC TC TC TC $ $94.32 $ $87.77 $84.62 $77.04 $ $61.14 $ $58.06 $ $ $ $ $ $97.41 $97.89 $58.26 Discontinued 12/31/2018 $53.40 $45.27 $ $75.25 $60.69 $51.21 FY19 ~ Updated 01/10/ Effective 01/01/2019

3 Service CPT Code Oct 1, 2018 Dec 31, Fine Needle Aspiration biopsy including fluoroscopic guidance; TC 31 Fine Needle Aspiration biopsy including fluoroscopic guidance; Each additional lesion TC 32 Fine Needle Aspiration biopsy including CT guidance; TC 33 Fine Needle Aspiration biopsy including CT guidance; Each additional lesion TC 34 Fine Needle Aspiration biopsy including MRI guidance; TC 35 Fine Needle Aspiration biopsy including fluoroscopic guidance; Each additional lesion TC 36 Fine Needle Aspiration (FNA), Breast Cyst $ TC $ Fine Needle Aspiration (FNA), Each Additional Cyst $ TC $ 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 stereotactic guidance 39 Each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19081) 40 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 41 Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19083) 42 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 TC TC TC TC TC 43 Each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19085) 44 Breast Biopsy, Needle Core, Not Using Imaging Guidance TC TC 45 Breast Biopsy, Incisional TC $ $ $ $73.81 $ $ $ $69.52 $ $ $ $81.10 $ $62.70 $ $ Jan 01, current $ $96.67 $ $62.92 $ $ $ $85.40 TBD TBD $ $45.63 $27.44 $22.35 $ $ $ $87.57 $ $ $ $81.63 $ $ $ $94.26 $ $76.43 $ $ FY19 ~ Updated 01/10/ Effective 01/01/2019

4 46 Breast Biopsy, Excisional ** Anesthesia reimbursement available TC 47 Breast Biopsy, Excision of Single Lesion Identified by Radiological Marker TC ** Anesthesia reimbursement available 48 Breast Biopsy, Excision of Each Additional Lesion TC 49 Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first TC lesion, including mammographic guidance 50 Each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure); (Use in conjunction with 19281) 51 Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance 52 Each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure); (Use in conjunction with 19283) 53 Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance 54 Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure); (Use in conjunction with 19285) 55 Placement of breast localization device(s) (e.g. clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance 56 Each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure); (Use in conjunction with 19287) TC TC TC TC TC TC TC $ $ $ $ $ $ $ $89.63 $ $45.54 $ $89.93 $ $45.83 $ $76.50 $ $38.80 $ $ $ $56.75 $ $ $ $ $ $ $ $ $ $51.97 $ $ $ $54.29 $ $89.38 $ $44.81 $ $ $ $ Radiological Examination, Surgical Specimen TC $13.78 $6.78 $7.00 $16.45 $8.37 $8.08 FY19 ~ Updated 01/10/ Effective 01/01/2019

5 58 Breast Ultrasound, Complete 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. 59 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. 60 Ultrasound; Axilla (--- no longer Nurse Consultant approved) 61 Ultrasonic Guidance/Breast Needle Biopsy, Radiologic Supervision/Interpretation 62 Surgical Pathology, Breast or Cervical Biopsy - Level IV (one unit) TC (2 units or -50 modifier) TC (2 line items) L TC2L L (one unit) TC (2 units or -50 modifier) TC (2 line items) L TC2L L TC TC TC $87.48 $56.43 $31.05 $ $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. $30.69 $9.41 $21.28 $49.71 $22.19 $27.51 $59.36 $25.28 $34.09 $ $67.29 $36.45 $ $ $54.68 $77.81 ea. $50.47 ea. $27.34 ea. $85.09 $51.03 $34.06 $ $76.55 $51.09 $63.82 ea. $38.28 ea. $25.55 ea. $56.00 $31.39 $24.61 $55.73 $23.94 $31.79 $67.03 $29.02 $38.01 FY19 ~ Updated 01/10/ Effective 01/01/2019

6 63 Surgical Pathology, Breast or Cervical Biopsy - Level V **Cannot bill with 57505, 57452, 57454, or 57456** 64 Pathology consultation during surgery, first tissue block, with frozen section(s), single specimen 65 Pathology consultation during surgery, each additional tissue block, with frozen section(s) 66 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 67 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure (88341)) 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 TC TC TC TC TC TC TC $ $ $75.16 $86.15 $31.92 $54.23 $38.01 $11.17 $26.84 $73.52 $48.83 $24.68 $86.52 $55.59 $30.93 $ $75.57 $40.06 $ $83.14 $42.51 $ $ $83.16 $94.53 $31.73 $62.80 $51.83 $30.94 $20.90 $89.17 $60.61 $28.56 $ $67.29 $35.63 $ $80.49 $42.45 $ $81.51 $45.53 FY19 ~ Updated 01/10/ Effective 01/01/2019

7 70 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s), first evaluation episode 71 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s), each separate additional evaluation episode (bill in conjunction w/ 88172) 72 Cytopathology, evaluation of fine needle aspirate; interpretation and Report 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 $47.50 $16.13 $31.37 $ $65.01 $60.93 $55.29 $31.17 $24.12 $55.16 $18.87 $36.29 $28.84 $6.77 $22.07 $ $77.34 $70.66 Discontinued 12/31/ Patient Navigation G9012 $55.00 $55.00 Service CPT Code FY19 74 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 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 s are based on a flat fee. Only one unit is reimbursable as indicated on the rate schedule AA AD QK QX QY QZ $94.84 $56.91 $47.42 $47.42 $47.42 $94.84 FY19 ~ Updated 01/10/ Effective 01/01/2019

BCCCNP Service CPT Code FY 2019 Rate Oct 1, 2018 Dec 31, 2018

BCCCNP Service CPT Code FY 2019 Rate Oct 1, 2018 Dec 31, 2018 1 Screening Mammogram (Bilateral); including CAD Service CPT Code 77067 77067-TC 77067-26 $111.40 $81.32 $30.08 $131.51 $93.70 $37.82 * Note: Breast tomosynthesis, unilateral (77061) and bilateral (77062)