2011-2012 Approved Komen Reimbursement Rates

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2011-2012 Approved Komen Reimbursement Rates Powered By Docstoc
					                        2011-2012 Southeast Wisconsin Affiliate of Susan G. Komen for the Cure®
                                    Procedure Reimbursement Rates
                                                                                                            Komen
CPT                                                                                              Medicare    Rate
Code                   Current Procedural Terminology (CPT) Description                           Rate      (175%)

77057   Screening Mammogram, Bilateral (2 view film study of each breast)                         $75.22    $131.64

G0202   Screening Mammogram, Digital Reimbursed at Conventional Mammogram Rate                    $75.22    $131.64

77055   Mammography, Diagnostic Follow-up, Unilateral                                             $78.39    $137.18

        Diagnostic Mammogram (Unilateral), Digital Reimbursed at Conventional Diagnostic
G0206   Mammogram (Unilateral) rate                                                               $78.39    $137.18
77056   Mammography, Diagnostic Follow-up, Bilateral                                              $99.44    $174.02

        Diagnostic Mammogram (Bilateral), Digital Reimbursed at Conventional Diagnostic
G0204   Mammogram (Bilateral) rate                                                                $99.44    $174.02
77031   Stereotactic localization guidance for breast biopsy or needle placement                 $175.41    $306.97
77032   Mammographic guidance for needle placement, breast                                        $55.07    $96.37
        Mammary ductogram or galactogram, single duct, radiological supervision and
77053   interpretation                                                                            $65.73    $115.03
        Mammary ductogram or galactogram, multiple ducts, radiological supervision and
77054   interpretation                                                                            $88.80    $155.40
76098   Radiological examination, surgical specimen                                               $18.17    $31.80
        Ultrasound, breast(s), unilateral or bilateral, B-scan and/or real time with image
76645   documentation                                                                             $82.77    $144.85
76942   Ultrasonic guidance for needle placement, imaging supervision and interpretation         $168.92    $295.61
19000   Puncture aspiration of cyst of breast                                                     $95.59    $167.28
19001   Puncture aspiration of cyst of breast, each additional cyst, used with 19000              $24.37    $42.65
19100   Breast biopsy, percutaneous, needle core, not using imaging guidance                     $116.92    $204.61
19101   Breast biopsy, open, incisional                                                          $266.99    $467.23
        Breast biopsy, percutaneous, needle core, using imaging Breast biopsy, open,
19102   incision guidance                                                                        $193.12    $337.96
        Breast biopsy, percutaneous, automated vacuum assisted or rotating biopsy devise,
19103   using imaging guidance                                                                   $483.64    $846.37
        Excision of cyst, fibroadenoma or other benign or malignant tumor, aberrant breast
19120   tissue, duct lesion, nipple or areolar lesion; open; one or more lesions                 $386.49    $676.36
        Excision of breast lesion identified by preoperative placement of radiological marker;
19125   open; single lesion                                                                      $428.19    $749.33
        Excision of breast lesion identified by preoperative placement of radiological marker,
        open; each additional lesion separately identified by a preoperative radiological
19126   marker                                                                                   $139.52    $244.16
19290   Preoperative placement of needle localization wire, breast                               $142.84    $249.97
19291   Preoperative placement of needle localization wire, breast; each additional lesion        $61.84    $108.22
        Image guided placement, metallic localization clip, percutaneous, during breast
19295   biopsy                                                                                    $78.21    $136.87
10021   Fine needle aspiration (FNA) without imaging guidance                                    $118.70    $207.73
10022   Fine needle aspiration (FNA) with imaging guidance                                       $122.06    $213.61

				
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posted:10/4/2012
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