Allowable CPT Codes

CPT Codes and Reimbursement Rates

Updated March 2026

The following table sets forth the amounts the Utah Breast & Cervical Cancer Screening Program will pay for services rendered to clients from March 1, 2025 through February 28, 2026.

 

Services and Payment for Clinic-Based ServicesAllowable CPT Codes CPT Code Rate
New Patient; expanded history, exam, straightforward decision making; 20 minutes 99203 $85.00
New Patient; expanded history, exam, straightforward decision making; 30 minutes 99204/05 $120.00
Established Patient; expanded history, exam, straightforward decision-making; 20 min. 99213 $85.00
Established Patient; expanded history, exam, straightforward decision-making; 30 min. 99214 $120.00
Established Patient; evaluation and management, may not require presence of physician; 5 min. 99211 $21.00
Established Patient; history, exam, straightforward decision-making; 10 min. 99212 $52.82
Services and Payment for Screening-Based Services CPT Code Rate
Screening Mammography Bilateral, includes CAD 77067 $120.09 ($85.70 and $34.39)
Diagnostic mammography, unilateral, includes CAD 77065 $117.98 ($80.99 and $36.99)
Diagnostic mammography, bilateral, includes CAD 77066 $149.42 ($103.90 and $45.52)
Screening digital breast tomosynthesis, unilateral and bilateral (in addition to 77067) 77063 $49.18 ($21.98 and $27.20)
Diagnostic digital breast tomosynthesis, unilateral and bilateral (in addition to 77065 or 77066) G0279 $39.13 ($11.93 and $27.20)
*Radiological examination surgical specimen 76098 $41.06 ($26.67 and $14.39)
Complete Ultrasound, Unilateral 76641 $95.54 ($62.47 and $33.08)
Limited Ultrasound, Unilateral 76642 $79.74 ($48.97 and $30.78)
*Ultrasonic guidance for needle placement, imaging supervision interp 76942 $61.53 ($30.75 and $30.77)
*Aspiration of Cyst of Breast 19000 $91.91/$35.71
*Aspiration of Cyst of Breast, additional 19001 $25.56/$17.71
*Biopsy of breast, needle core (surgical procedure only) 19100 $155.59/$60.15
*Incisional Biopsy of breast 19101 $334.56/$208.66
*Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion, open; 1 or more lesions 19120 $548.30
Excisional Biopsy, Facility only (Agreement between B&C & Provider-Flat rate) 19120 $1,250.00
Excision of Breast lesion identified by preoperative placement of radiological marker, open; single lesion 19125 $607.56
Excisional Biopsy, Facility only (Agreement between B&C & Provider-Flat rate) 19125 $1,250.00
Excision of breast lesion identified by preoperative placement of radiological marker, open; each addt’l lesion separately identified by a preoperative radiological marker) 19126 $140.03
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; first lesion 19081 $455.54 ($319.62 and $135.92)
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; each additional lesion 19082 $$344.59 ($276.30 and $68.29)/td>
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; ultrasound guidance; first lesion 19083 $452.67 ($324.33 and $128.34)
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; ultrasound guidance; each additional lesion 19084 $338.75 ($274.72 and $64.03)
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; magnetic resonance guidance; first lesion 19085 $682.28 ($533.43 and $148.85)
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; magnetic resonance guidance; each additional lesion 19086 $523.24 ($448.97 and $74.27)
Placement of breast localization device, percutaneous; mammographic guidance; first lesion 19281 $224.36 ($142.54 and $81.82)
Placement of breast localization device, percutaneous; mammographic guidance; each additional lesion 19282 $156.64 ($115.86 and $40.78)
Placement of breast localization device, percutaneous; stereotactic guidance; first lesion 19283 $238.78 ($156.05 and $82.73)
Placement of breast localization device, percutaneous; stereotactic guidance; each additional lesion 19284 $172.61 ($130.93 and $41.68)
Cytopathology, evaluation of FNA; immediate cytohostologic study to determine adequacy of specimen(s), first evaluation episode 88172 $52.50
Cytopathology, evaluation of FNA; immediate cytohostologic study to determine adequacy of specimen(s), each additional evaluation episode 88177 $27.77
Cytopathology, evaluation of FNA; interpretation and report 88173 $158.13
Surgical pathology, gross & microscopic examination 88305 $66.51
Surgical pathology, gross & microscopic examination; requiring microscopic evaluation of surgical margins 88307 $262.98