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 Breast and cervical cancer screening OR cervical cancer screening only. Standard of care practice as per clinic, education of breast and cervical cancer (symptoms, dense breast tissue, mammogram and pap screening, HPV, etc.), appointment for mammogram scheduled, voucher faxed to facility and B&C and copy given to patient. |
99204/05 | $120.00 |
| Established Patient; expanded history, exam, straightforward decision-making; 20 min. Breast cancer screening. Standard of care practice as per clinic, education of breast and cervical cancer (symptoms, dense breast tissue, mammogram and pap screening, HPV, etc.), appointment for mammogram scheduled, voucher faxed to facility and B&C and copy given to patient. |
99213 | $85.00 |
| Established Patient; expanded history, exam, straightforward decision-making; 30 min. Breast and cervical cancer screening OR cervical cancer screening only. Standard of care practice as per clinic, education of breast and cervical cancer (symptoms, dense breast tissue, mammogram and pap screening, HPV, etc.), appointment for mammogram scheduled, voucher faxed to facility and B&C and copy given to patient. |
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. Office visit for establish patient - problem focus face to face for discussion of dense breast tissue within a month after mammogram appointment. |
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 |