FY 2016 BCCCNP Unit Cost Reimbursement Rate Schedule

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1 Unit Cost Reimbursement Schedule 1 Screening Mammogram (Bilateral) Service CPT Code FY16 2 Digital Screening Mammogram (Bilateral) 3 Diagnostic Mammogram (Unilateral) 4 Digital Diagnostic Mammogram (Unilateral) 5 Diagnostic Mammogram (Bilateral) 6 Digital Diagnostic Mammogram (Bilateral) 7 Pap test, cervical or vaginal (any reporting system), requiring interpretation by physician 8 Pap test, cervical or vaginal (any reporting system), preparation; manual screening under physician supervision 9 Pap test, cervical or vaginal (any reporting system), preparation; manual screening and rescreening under physician supervision 10 Pap test, slides, cervical or vaginal (Bethesda System); manual screening under physician supervision TC G0202 G0202-TC G TC G0206 G0206-TC G TC G0204 G0204-TC G $80.86 $45.12 $35.74 $ $95.67 $35.39 $88.08 $52.34 $35.74 $ $90.51 $35.39 $ $68.85 $44.32 $ $ $ $ $ $ $14.38 FY16 11 Pap test, slides, cervical or vaginal (Bethesda System); manual screening and rescreening under physician supervision 12 Pap test, cervical or vaginal (any reporting system), preparation; screening by automated system, under physician supervision $ $29.08 FY16 1 2/01/2016

2 Unit Cost Reimbursement Schedule Service CPT Code FY16 13 Pap test, cervical or vaginal (any reporting system), $35.87 preparation; screening by automated system and manual rescreening or review, under physician supervision 14 Screening Pap test, cervical or vaginal (any reporting G0123 $27.57 system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision 15 Screening Pap test, cervical or vaginal (any reporting G0124 $32.08 system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician 16 Screening Pap test, cervical or vaginal (any reporting G0145 $35.87 system), collected in preservative 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 (Code ADDED effective DOS 01/01/16) $ Consultation Visit, Breast or Cervical min $ min $ 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 24 Urine test; pregnancy To be billed in conjunction with 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** $34.40 $ min $ $ TC TC $ $94.49 $ $ FY16 $43.22 $43.22 $19.53 $19.53 FY16 2 2/01/2016

3 Unit Cost Reimbursement Schedule Service CPT Code FY $ 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** 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) (eg, clip, metallic pellet), when performed, TC and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic 35 Each additional lesion, including stereotactic (Use 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 37 Each additional lesion, including ultrasound (Use 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 39 Each additional lesion, including magnetic resonance (List separately in addition to code for TC TC TC TC TC $ $ $ $93.00 $ $71.93 $ $68.30 $ $45.36 $27.46 $22.65 $ $ $ $86.83 FY16 $ $ $ $ $ $81.79 (Use in conjunction with 19085) 34-39: Do not report in conjunction with , 76098, 76942, for same lesion $1, $ $ $ $98.21 $95.41 FY16 3 2/01/2016

4 Unit Cost Reimbursement Schedule Service CPT Code FY16 40 Breast Biopsy, Needle Core, Not Using Imaging $ Guidance TC $ 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) (eg, clip, percutaneous; first lesion, including mammographic 46 Each additional lesion, including mammographic (List separately in addition to code for (Use in conjunction with 19281) 47 Placement of breast localization device(s) (eg, clip, percutaneous; first lesion, including stereotactic 48 Each additional lesion, including stereotactic (Use in conjunction with 19283) 49 Placement of breast localization device(s) (eg, clip, percutaneous; first lesion, including ultrasound 50 Each additional lesion, including ultrasound (Use in conjunction with 19285) 51 Placement of breast localization device(s) (eg clip, percutaneous; first lesion, including magnetic resonance 52 Each additional lesion, including magnetic resonance (List separately in addition to code for TC TC TC TC TC TC TC TC TC $ $ $ $ $53.58 $ $ $ $53.92 $ $90.00 $ $45.65 FY16 $ $ $ $ $69.41 $66.77 (Use in conjunction with 19287) 45-52: Do not report in conjunction with , 76942, and/or for same lesion. For surgical specimen radiography, use FY16 4 2/01/2016

5 Unit Cost Reimbursement Schedule Service CPT Code FY16 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. 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 TC TC (one unit) TC (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 $16.21 $7.98 $8.23 $ $ $76.85 $ $69.19 $37.57 $ $ $56.36 $80.07 ea. $51.90 ea. $28.18 ea. $88.11 $53.03 $35.08 $ $79.55 $52.62 $66.09 ea. $39.78 ea. $26.31 ea. $59.84 $26.21 $33.63 FY16 FY16 5 2/01/2016

6 Unit Cost Reimbursement Schedule Service CPT Code FY16 58 Surgical Pathology, Breast or Cervical Biopsy - Level IV 59 Surgical Pathology, Breast or Cervical Biopsy - Level V **Cannot bill in conjunction with 57505, 57452, 57454, 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) 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 64 Cytopathology, Evaluation of Fine Needle Aspirate to determine Specimen Adequacy 65 Cytopathology, Interpretation and Report TC TC TC TC TC TC TC TC $71.45 $32.74 $38.71 $ $ $85.13 $ $37.55 $63.80 $44.72 $13.14 $31.58 $65.79 $44.09 $21.70 $88.21 $51.99 $36.22 $55.88 $18.98 $36.90 $ $76.48 $71.68 FY16 FY16 6 2/01/2016

7 Unit Cost Reimbursement Schedule Service CPT Code FY16 66 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 $63.25 $34.80 $ Patient Navigation G9012 $ 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 $88.74 $53.24 FY16 $ $66.95 c. Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals QK $44.37 $55.79 d. CRNA service: with medical direction by a physician QX $44.37 $55.79 e. Anesthesiologist medically directs one CRNA QY $44.37 $55.79 f. CRNA service: (supervised) without medical direction by a physician QZ $88.74 $ s are based on a flat fee. Only one unit is reimbursable as indicated on the rate schedule. FY16 7 2/01/2016

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