Reimbursement

Ultrasound & Stereotactic Rotational Biopsy Systems
2007 Billing & Payment Information
2007 APC & Physician Payment Levels Effective January 1, 2007
2007 Ambulatory Surgery Center Payment Levels Effective April 1, 2004

PHYSICIAN OFFICE BILLING (Includes Professional Services and Technical Components) Physician Owned Breast Centers, Offices, Clinics or Imaging Centers (Non-ASC Facility)

CPT	Description	2007 National Average Medicare Fee Schedule Allowed Amount¹
19103	Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance	$554.44
19102	Biopsy of breast; percutaneous, needle core, using imaging guidance	$212.98
76942	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	$157.65
77032	Mammographic Guidance for Needle Placement, Breast	$70.11
77031	Stereotactic Localization Guidance	$306.21
76645	Ultrasound, breast(s) (unilateral or bilateral), B-scan and/or real time with image documentation	$75.04
76098	Radiological examination, surgical specimen	$22.74
19295	Image guided placement, metallic loc. clip, percutaneous, during breast biopsy	$97.78

HOSPITAL OUTPATIENT AND AMBULATORY SURGICAL CENTER BILLING Hospital Owned Breast Centers, Radiology Departments, Imaging Centers

Rev Code	Description	HCPCS	APC	Status Indicator	2007 APC Medicare Allowed Amount²
402³	Ultrasonic Guidance⁴ - echo guide for biopsy	76942	0268	S	$73.04
402	Upright Mammography	77032	0263	X	$104.23
402	Stereotactic Image Guidance	77031	0264	X	$181.86
402	Diagnostic Echo Breast	76645	0265	S	$60.99
402	Radiological Exam, Specimen	76098	0260	X	$43.60
401	Unilateral Mammogram-Post Procedure	77055	-	A	Payment method other than OPPS
310/312	Pathology Lab – Surg. Path IV	88305	0343	X	$32.03
49x -or-	Ambulatory Surgery -or-	19103	0658	T	$395.77
49x	Ambulatory Surgery -or-	19102	0005	T	$240.00
51x	Clinic Services – Breast Biopsy (Marker)	19295	0657	S	$106.76

NON HOSPITAL ASC & INDEPENDENT DIAGNOSTIC TESTING FACILITY (IDTF) BILLING

CPT	Description	2007 Medicare Fee Schedule National Average Allowed Amount⁵
19103	Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance	$355.97
19102	Biopsy of breast; percutaneous, needle core, using imaging guidance	$240.00
19295	Image guided placement, metallic localization clip, percutaneous, during breast biopsy	$106.76
76942-TC	Ultrasonic Guidance - Technical Component⁶	$125.44
77032-TC	Mammographic Guidance for Needle Placement, Breast – Technical Component	$43.58
77031-TC	Stereotactic Localization Guidance – Technical Component	$229.66
76645-TC	Ultrasound, breast(s) (unilateral or bilateral), B-scan and/or real time with image documentation – Technical Component	$49.27
77055-TC	Unilateral Mammogram – Technical Component	$54.19
76098-TC	Radiological Exam, Specimen – Technical Component	$15.16

PHYSICIAN BILLING Professional Services Only

CPT	Description	2007 National Average Medicare Fee Schedule Allowed Amount⁷
19103	Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance	$195.93
19102	Biopsy of breast; percutaneous, needle core, using imaging guidance	$105.36
76645-26	Ultrasound, breast(s) (unilateral or bilateral), B-scan and/or real time with image documentation – Professional Component	$25.77
76942-26	Ultrasonic Guidance - Professional Component⁶	$34.87
77031-26	Stereotactic Localization Guidance – Professional Component	$82.62
77032-26	Mammographic Guidance for Needle Placement, Breast – Professional Component	$26.53
76098-26	Radiological Exam, Specimen – Professional Component	$8.34
19295	Image guided placement, metallic localization clip, percutaneous, during breast biopsy	$76.93

1 Physicians should refer to their local contractor for their geographic payments.
2 Hospital outpatient departments and clinics should refer to their provider intermediary manuals for geographic specific payment.
3 Revenue codes are required on the UB-92 billing form to represent the type of service provided. Most but not all revenue codes require corresponding HCPCS or CPT codes.
4 Medicare lists ultrasonic guidance for breast biopsy as an interventional radiology procedure. Interventional procedures are coded into separate procedural components using surgical CPT codes (19000 series) and radiological codes (70000 series). Consult your local payors about their coding policies.
5 CMS 1506FC Addendum AA 2007 ASC Update of HCPCS Codes and Payment for Ambulatory Surgical Centers.
6 ASCs that are enrolled as IDTFs can bill the technical component for image guidance. (Federal Register, 6/12/1998, p. 32296)
7 Physicians should refer to their provider carrier manuals for geographic specific payment.

DISCLAIMER – The information contained in this document is provided as representative examples of reimbursement in this category. It is intended to assist providers in accurately obtaining reimbursement for health care services. It is not intended to increase or maximize reimbursement by any payor. Providers should consult their payor organizations with regard to local reimbursement policies. The information provided in this document is for information purposes only and represents no statement, promise or guarantee by Encapsule Medical Devices, Inc. All CPT and APC codes are supplied for information purposes only and represent no statement; promise or guarantee by Encapsule Medical Devices, Inc. that these codes will be appropriate or that reimbursement will be made. CPT codes and descriptions are copyrights of the American Medical Associations. CPT does not include fee schedules, relative values or related ratings. The source for this information is the Center for Medicare and Medicaid Services. The content provided by the Center for Medicare and Medicaid Services is updated frequently. It is the responsibility of the service provider to confirm the appropriate coding required by their local Medicare carriers, fiscal intermediaries and commercial payors.