CPT Codes and Reimbursement Rates
Updated March 2026
Services and Payment for Screening-Based Services
The following table sets forth the amounts the Utah Breast & Cervical Cancer Screening Program will pay for services rendered to clients from March 1, 2026 through February 28, 2027.
| Service (Office Visits) | 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 | $57.21 |
| Service (Laboratory Services) | CPT Code | Rate |
|---|---|---|
| Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System, manual screening under physician supervision | 88164 | $18.54 |
| Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System, manual screening, and rescreening under physician supervision | 88165 | $42.22 |
| Cytopathology (liquid-based Pap test) cervical or vaginal, collected in preservative fluid, automated thin layer preparation, manual screening under physician supervision | 88142 | $20.26 |
| Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation, manual screening rescreening, under physician supervision | 88143 | $23.04 |
| Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation, screening by automated system, under physician supervision | 88174 | $25.37 |
| Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation, screening by automated system and manual rescreening under physician supervision | 88175 | $26.61 |
| Human Papillomavirus, high-risk types | 87624 | $35.09 |
| Human Papillomavirus, types 16 and 18 only | 87625 | $40.55 |
| Human Papillomavirus, reported high-risk types separately and pooled | 87626 | $70.20 |
| Hospital 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) |
| Complete Ultrasound, Unilateral | 76641 | $95.54 ($62.47 and $33.08) |
| Limited Ultrasound, Unilateral | 76642 | $79.74 ($48.97 and $30.78) |
| Screening digital breast tomosynthesis, unilateral and bilateral | 77063 | $49.18 ($21.98 and $27.20) |
| Diagnostic digital breast tomosynthesis, unilateral and bilateral | G0279 | $39.13 ($11.93 and $27.20) |
| Radiological examination surgical specimen (preapproval) | 76098 | $41.06 ($26.67 and $14.39) |
| Ultrasonic guidance for needle placement, imaging supervision interp. (preapproval) | 76942 | $61.53 ($30.75 and $30.77) |
| Cytopathology, evaluation of FNA; immediate cytohistologic study to determine adequacy of specimen(s), first evaluation episode | 88172 | $52.18 ($19.77 and $32.41) |
| Cytopathology, evaluation of FNA; immediate cytohistologic study to determine adequacy of specimen(s), each additional evaluation episode | 88177 | $28.12 ($19.96 and $8.16) |
| Cytopathology, evaluation of FNA; interpretation and report | 88173 | $159.33 ($64.24 and $95.09) |
| Surgical pathology, gross & microscopic examination | 88305 | $67.37 ($34.42 and $32.95) |
| Surgical pathology, gross & microscopic examination; requiring microscopic evaluation of surgical margins | 88307 | $264.23 ($74.96 and $189.27) |
| Pathology consultation during surgery, first tissue block, with frozen section(s), single specimen | 88311 | $93.65 ($56.61 and $37.03) |
| Pathology consultation during surgery, each additional tissue block, with frozen section | 88332 | $51.37 ($28.46 and 22.91) |
| Immunohisto/cytochemistry, per specimen | 88341 | $89.63 ($26.21 and $63.42) |
| Immunohisto/cytochemistry, per specimen, each additional | 88342 | $104.94 ($32.12 and $72.83) |
| Morphometric analysis, tumor immunohistochemistry, per specimen; manual (preapproval) | 88360 | $114.66 ($38.38 and $76.28) |
| Morphometric analysis, tumor immunohistochemistry, per specimen; using cumputer assisted technology (preapproval) | 88361 | $109.53 ($39.84 and $69.69) |
| Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; first lesion | 19081 | $455.54 ($135.92 and $319.62) |
| Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; each additional lesion | 19082 | $344.59 ($68.29 and $276.30) |
| Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; ultrasound guidance; first lesion | 19083 | $452.67 ($128.34 and $324.33) |
| Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; ultrasound guidance; each additional lesion | 19084 | $338.75 ($64.03 and $274.72) |
| 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) |
| Placement of breast localization device, percutaneous; ultrasound guidance; first lesion | 19285 | $332.43 ($70.58 and $261.85) |
| Placement of breast localization device, percutaneous; ultrasound guidance; each additional lesion | 19286 | $270.92 ($35.45 and $235.47) |
| Placement of breast localization device, percutaneous; magnetic resonance guidance; first lesion | 19287 | $567.93 ($104.20 and $463.73) |
| Placement of breast localization device, percutaneous; magnetic resonance guidance; each additional lesion | 19288 | $431.85 ($52.57 and $379.28) |
| Mammary ductogram or galactogram, single duct (preapproval, high risk only) | 77053 | $50.58 ($16.37 and $34.21) |
| MRI, breast, without contrasts unilateral (preapproval, high risk only) | 77046 | $203.01 ($64.89 and $138.12) |
| MRI, breast, without contrasts, bilateral (preapproval, high risk only) | 77047 | $206.44 ($71.77 and $134.66) |
| MRI, breast, including CAD with and without contrasts, unilateral (preapproval, high risk only) | 77048 | $317.87 ($94.99 and $222.88) |
| MRI, breast, including CAD with and without contrasts, bilateral (preapproval, high risk only) | 77049 | $323.57 ($103.83 and $219.74) |
| Outpatient Surgical Breast Biopsy - Flat Rate (preapproval) | 19120/19125 | $1,250.00 |
| Anesthesia for procedures on the integumentary system, anterior trunk, not otherwise specified | 00400 | Base Units (3) + Time Units (Minutes/15 X Conversation Factor ($20.60) |
| Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified | 00940 | Base Units (3) + Time Units (Minutes/15 X Conversation Factor ($20.60) |
| Moderate anesthesia, 10-22 minutes for individuals 5 years and older | 99156 | $69.92 |
| Moderate anesthesia for each additional 15 minutes | 99157 | $53.17 |
| Surgeon/OBGYN Services | CPT Code | Rate |
|---|---|---|
| Fine needle aspiration without imaging guidance, first lesion (Surgeon only) | 10021 | $96.63 |
| Fine needle aspiration with imaging guidance, each additional lesion (Surgeon only) | 10004 | $51.30 |
| Fine needle aspiration biopsy including ultrasound guidance, first lesion (Surgeon only) | 10005 | $126.94 |
| Fine needle aspiration biopsy including ultrasound guidance, each additional lesion (Surgeon only) | 10006 | $58.32 |
| Fine needle aspiration biopsy including fluoroscopic guidance, first lesion (Surgeon only) | 10007 | $326.85 |
| Fine needle aspiration biopsy including fluoroscopic guidance, each additional lesion (Surgeon only) | 10008 | $134.90 |
| Fine needle aspiration biopsy including CT guidance, first lesion (Surgeon only) | 10009 | $391.84 |
| Fine needle aspiration biopsy including CT guidance, each additional lesion (Surgeon only) | 10010 | $223.97 |
| Placement of soft tissue localization device | 10035 | $327.73 |
| Placement of soft tissue localization device, each additional lesion | 10036 | $274.66 |
| Puncture aspiration of cyst of breast | 19000 | $35.71 (facility) |
| Puncture aspiration of cyst of breast, each additional | 19001 | $17.71 (facility) |
| Biopsy of breast, needle core | 19100 | $60.15 (facility) |
| Incisional biopsy of breast | 19101 | $208.66 (facility) |
| Excision of cyst, fibroadenoma, or other benign or malignant tumor aberrant breast tissue, duck lesion or nipple lesion (Surgeon only) | 19120 | $548.30 |
| Excision of Breast lesion identified by preoperative placement of radiological marker, open; single lesion (Surgeon only) | 19125 | $607.56 |
| Excision of breast lesion identified by preop placement of rad marker, open | 19126 | $140.03 |
| Needle biopsy of axillary lymph node | 38505 | $162.99 |
| Colposcopy without biopsy (surgical procedure only) (OB/GYN only) | 57452 | $120.61 |
| Colposcopy with biopsy and/or endocervical curettage (surgical procedure only) (OB/GYN only) | 57454 | $160.03 |
| Colposcopy of the cervix, with biopsy (OB/GYN only) | 57455 | $154.72 |
| Colposcopy with endocervical curettage (OB/GYN only) | 57456 | $144.74 |
| Biopsy, single or multiple, or local excision of lesion, with or w/out fulguration (separate procedure) (OB/GYN only) | 57500 | $144.28 |
| Excision, endocervical curettage (not done as part of dilation & curettage) (OB/GYN only) | 57505 | $142.06 |
| Endometrial Sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation (OB/GYN only) | 58100 | $94.38 |
| Endometrial sampling (biopsy) performed in conjunction with colposcopy (OB/GYN only) | 58110 | $49.34 |
| Colposcopy of the cervix with loop electrode biopsy of the cervix (OB/GYN only) | 57460* | $295.28 |
| Colposcopy with loop electrode conization of the cervix (OB/GYN only) | 57461* | $334.26 |
| Conization of cervix, with or without fulguration, with or without dilation and curettage, cold knife or laser (OB/GYN only) | 57520* | $345.70 |
| Loop electrode excision (OB/GYN only) | 57522* | $288.85 |
| New patient - office visit 15-29 minute face to face (Surgeon and OB/GYN only) | 99202-BC | $72.41 |
| New patient - office visit 30-44 minute face to face (Surgeon and OB/GYN only) | 99203-BC | $113.50 |
| New patient - office visit 45-59 minute face to face (Surgeon and OB/GYN only) | 99204-BC | $171.59 |
| New patient - office visit 60-74 minute face to face (Surgeon and OB/GYN only) | 99205-BC | $229.11 |
| Established patient - office visit 5 minute face to face (Surgeon and OB/GYN only) | 99211-BC | $23.27 |
| Established patient - office visit 10-19 minute face to face (Surgeon and OB/GYN only) | 99212-BC | $57.21 |
| Established patient - office visit 20-29 minute face to face (Surgeon and OB/GYN only) | 99213-BC | $91.96 |
| Established patient - office visit 30-39 minute face to face (Surgeon and OB/GYN only) | 99214-BC | $131.12 |
| Pelvic examination (list separately, in addition to primary procedure). This provides fees for the cost of pelvic examination packs and in-room chaperones. This is only allowed when pelvic exam is done in order to do a Pap or HPV test | 99459 | $16.33 |