1 Screening Mammogram (Bilateral) 1a. ** NEW **- 01/01/2017- ** Replaces 77057** Screening Mammogram (Bilateral) 2 Digital Screening Mammogram (Bilateral) Service CPT Code 2a. Screening Breast Tomosynthesis (Bilateral) Effective 10/26/2016 ** Can only be paid w/ screening mammography (G0202))** 3 Diagnostic Mammogram (Unilateral) 3a. ** NEW **- 01/01/2017- ** Replaces 77055** Diagnostic Mammogram (Unilateral) 4 Digital Diagnostic Mammogram (Unilateral) 5 Diagnostic Mammogram (Bilateral) 5a. ** NEW **- 01/01/2017- ** Replaces 77056** Diagnostic Mammogram (Bilateral) 77057 77057-TC 77057-26 ** NEW ** 77067 77067-TC 77067-26 G0202 G0202-TC G0202-26 77063 77063-TC 77063-26 77055 77055-TC 77055-26 ** NEW ** 77065 77065-TC 77065-26 G0206 G0206-TC G0206-26 77056 77056-TC 77056-26 ** NEW ** 77066 77066-TC 77066-26 $80.86 $45.12 $35.74 $131.06 $95.67 $56.01 $25.27 $30.74 DEL $88.08 $52.34 $35.74 $125.90 $90.51 017 $113.17 $68.85 $44.32 DELETED 01/01/2017 --- see 1a. $131.06 $95.67 $131.06 $95.67 $56.01 $25.27 $30.74 DELETED 01/01/2017 --- see 3a. $125.90 $90.51 $125.90 $90.51 DELETED 01/01/2017 --- see 5a. $159.59 $115.27 $44.32 1 02/01/2017
6 Digital Diagnostic Mammogram (Bilateral) FY 2017 Service CPT Code 6a. Diagnostic Breast Tomosynthesis (Bilateral) Effective 10/26/2016 ** Can only be w/ Dig Dx mammography (G0204 & G0206))** 7 Pap test, (any reporting system) requiring interpretation by physician 8 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 10 Pap test, slides, (Bethesda System); manual screening under physician supervision 11 Pap test, slides, (Bethesda System); manual screening and rescreening under physician supervision 12 Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision 13 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 14 Screening Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision 15 Screening Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician 16 Screening Pap test, (any reporting system) collected in preservative fluid, automated thin layer preparation, screening by automated system and manual rescreening under physician supervision G0204 G0204-TC G0204-26 G0279 G0279-TC G0279-26 $159.59 $115.27 $44.32 $56.01 $25.27 $30.74 $159.59 $115.27 $44.32 $56.01 $25.27 $30.74 88141 $32.08 $32.08 88142 $27.57 $27.57 88143 $27.57 $27.57 88164 $14.38 $14.38 88165 $14.38 $14.38 88174 $29.08 $29.08 88175 $35.87 $35.87 G0123 $27.57 $27.57 G0124 $32.08 $32.08 G0145 $35.87 $35.87 17 HPV Typing, High-risk types 87624 $47.76 $47.76 18 HPV Typing, Types 16 and 18 ONLY 87625 $47.76 $47.76 2 02/01/2017
Service CPT Code 19 Consultation Visit, Breast or Cervical 99204 45 min $107.34 $107.34 99205 60 min $107.34 $107.34 20 Office Visit, New Patient Full Exam 99203 30 min $107.34 $107.34 99385 18-39 yo $107.34 $107.34 99386 40-64 yr $107.34 $107.34 99387 65 + $107.34 $107.34 21 Office Visit, New Patient Partial Exam 99201 10 min $43.22 $43.22 99202 20 min $43.22 $43.22 22 Office Visit, Established Patient Full Exam 99213-15 min $72.20 $72.20 99214 25 min $72.20 $72.20 99215 40 min $72.20 $72.20 99395 18-39 yo $72.20 $72.20 99396 40-64 yo $72.20 $72.20 99397 65 + $72.20 $72.20 23 Office Visit, Established Patient Partial Exam 99211 5 min $19.53 $19.53 99212 10 min $19.53 $19.53 24 Urine test; pregnancy ~ To be billed in conjunction with 81025 $8.61 $8.61 colposcopy services 25 Colposcopy ** Cannot be billed with pathology 88305/88307** 26 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** 28 Colposcopy with Endocervical Curettage (Colp w/ ECC) ** Cannot be billed in conjunction with 57505** ** Cannot be billed with Level V pathology 88307** 57452 57452-TC 57454 57454-TC 57455 57455-TC 57456 57456-TC 29 Endocervical Curettage (not part of D & C) 57505 57505-TC $110.31 $94.49 $155.18 $139.36 $144.82 $113.88 $136.16 $105.89 $102.28 $93.00 $107.13 $91.95 $150.65 $135.46 $140.03 $110.97 $131.98 $103.26 $99.55 $90.63 30 Fine Needle Aspiration of Superficial Breast Tissue, Not Using Imaging Guidance 10021 10021-TC 31 Fine Needle Aspiration of Superficial Breast Tissue, 10022 Using Imaging Guidance 10022-TC 32 Fine Needle Aspiration (FNA), Breast Cyst 19000 19000-TC 33 Fine Needle Aspiration (FNA), Each Additional Cyst 19001 19001-TC $126.25 $71.93 $141.20 $68.30 $112.42 $45.36 $27.46 $22.65 $126.25 $71.93 $141.20 $68.30 $112.42 $45.36 $27.46 $22.65 3 02/01/2017
Service CPT Code 34 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance 35 Each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) (Use 19082 in conjunction with 19081) 36 Biopsy, breast, with placement of breast localization device(s) (eg, 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 19084 in conjunction with 19083) 38 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance 19081 19081-TC 19082 19082-TC 19083 19083-TC 19084 19084-TC 19085 19085-TC 39 Each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) (Use 19086 in conjunction with 19085) 40 Breast Biopsy, Needle Core, Not Using Imaging Guidance 19100 19086 19086-TC 19100-TC 41 Breast Biopsy, Incisional 19101 19101-TC 42 Breast Biopsy, Excisional 19120 ** Anesthesia reimbursement available 19120-TC $705.83 $173.71 $580.25 $86.83 $681.51 $167.03 $559.09 $81.79 $1,046.34 $192.93 $826.96 $95.41 $152.16 $73.76 $354.14 $228.87 $519.46 $440.12 $705.83 $173.71 $580.25 $86.83 $681.51 $167.03 $558.09 $81.79 $1,038.23 $192.93 $826.96 $95.41 $152.16 $73.76 $354.14 $228.87 $519.46 $440.12 43 Breast Biopsy, Excision of Single Lesion Identified by Radiological Marker ** Anesthesia reimbursement available 19125 19125-TC 44 Breast Biopsy, Excision of Each Additional Lesion 19126 19126-TC 45 Placement of breast localization device(s) (eg, clip, metallic 19281 pellet, wire/needle, radioactive seeds), percutaneous; first 19281-TC lesion, including mammographic guidance 46 Each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure) (Use 19282 in conjunction with 19281) 19282 19282-TC $577.09 $490.50 $175.09 $175.09 $244.19 $105.45 $166.03 $53.58 $577.09 $490.50 $175.09 $175.09 $244.19 $105.45 $166.03 $53.58 4 02/01/2017
Service CPT Code 47 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance 48 Each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) (Use 19284 in conjunction with 19283) 49 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance 50 Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use 19286 in conjunction with 19285) 51 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance 52 Each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) (Use 19288 in conjunction with 19287) 53 Radiological Examination, Surgical Specimen 54 Magnetic Resonance Guidance for Needle Placement, Radiologic Supervision Interpretation 55 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. 19283 19283-TC 19284 19284-TC 19285 19285-TC 19286 19286-TC 19287 19287-TC 19288 19288-TC 76098 76098-TC 76098-26 77021 77021-TC 77021-26 (one unit) 76641 76641-TC 76641-26 (2 units or -50) 76641 76641-TC 76641-26 (2 line items) 76641-2L 76641-TC2L 76641-262L $270.86 $105.80 $206.14 $53.92 $522.11 $90.00 $457.06 $45.65 $872.99 $134.07 $702.30 $66.77 $16.21 $7.98 $8.23 $400.17 $323.32 $76.85 $106.76 $69.19 $37.57 $160.14 $103.79 $56.36 $80.07 ea. $51.90 ea. $28.18 ea. $270.86 $105.80 $206.14 $53.92 $522.11 $90.00 $457.06 $45.65 $872.99 $134.07 $702.30 $66.77 $16.21 $7.98 $8.23 DELETED 01/01/2017 $102.92 $66.39 $36.53 $154.36 $99.58 $54.78 $77.18 ea. $49.79 ea. $27.39 ea. 5 02/01/2017
Service CPT Code 56 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. 57 Ultrasonic Guidance/Breast Needle Biopsy, Radiologic Supervision/Interpretation 58 Surgical Pathology, Breast or Cervical Biopsy - Level IV 59 Surgical Pathology, Breast or Cervical Biopsy - Level V **Cannot bill with 57505, 57452, 57454, 57455 or 57456** 60 Pathology consultation during surgery, first tissue block, with frozen section(s), single specimen 61 Pathology consultation during surgery, each additional tissue block, with frozen section(s) (one unit) 76642 76642-TC 76642-26 (2 units or -50) 76642 76642-TC 76642-26 (2 line items) 76642-2L 76642-TC2L 76642-262L 76942 76942-TC 76942-26 88305 88305-TC 88305-26 88307 88307-TC 88307-26 88331 88331-TC 88331-26 88332 88332-TC 88332-26 $88.11 $53.03 $35.08 $132.17 $79.55 $52.62 $66.09 ea. $39.78 ea. $26.31 ea. $59.84 $26.21 $33.63 $71.45 $32.74 $38.71 $308.60 $223.47 $85.13 $101.35 $37.55 $63.80 $44.72 $13.14 $31.58 $84.94 $50.87 $34.07 $127.40 $76.30 $51.10 $63.70 ea. $38.15 ea. $25.55 ea. $58.48 $26.11 $32.37 $69.84 $29.74 $40.10 $269.30 $180.87 $88.42 $94.31 $30.07 $64.24 $44.72 $13.14 $31.58 6 02/01/2017
Service CPT Code 62 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 63 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure) 64 Cytopathology, Evaluation of Fine Needle Aspirate to determine Specimen Adequacy 65 Cytopathology, Interpretation and Report 88341 88341-TC 88341-26 88342 88342-TC 88342-26 88172 88172-TC 88172-26 88173 88173-TC 88173-26 $89.29 $61.59 $27.70 $105.71 $69.49 $36.22 $55.88 $18.98 $36.90 $148.16 $76.48 $71.68 $86.49 $57.45 $29.04 $101.79 $65.40 $36.39 $55.88 $18.98 $36.90 $148.16 $76.48 $71.68 66 Cytopathology, Selective Cellular Enhancement Technique with Interpretation (e.g., Liquid Based Slide Preparation Method), EXCEPT CERVICAL OR VAGINAL 88112 88112-TC 88112-26 $71.00 $42.55 $28.45 $65.05 $36.67 $28.38 **Cannot bill in conjunction with 88173** 67 Patient Navigation G9012 $60.00 $60.00 7 02/01/2017
Service CPT Code 68 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 00400-AA 00400-AD $111.58 $66.95 $111.58 $66.95 c. Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals 00400-QK d. CRNA service: with medical direction by a physician 00400-QX e. Anesthesiologist medically directs one CRNA f. CRNA service: (supervised) without medical direction by a physician 00400-QY 00400-QZ $111.58 $111.58 Rates are based on a flat fee. Only one unit is reimbursable as indicated on the rate schedule. 8 02/01/2017