HomeMy WebLinkAboutC.054.93010_0175TflBABYLO\F(Meditaidl
511000
511000
\A
R
Initial Maternity Care Cnordmallon
;;00
6000
;;00
60 00
Subsequent month
"0 00
2000
MCC Nome Visit
00
; g 00
Mo\\' Brief), 'sit
S; 00
S; 00
Mo\\Standard Visit
$ I00 00
hyo\\ E tended Visit
Age S•i 1 years
ADULT
SS9 00
SS9 00
�HEkLTHTB
Treatment (Medicaid)
S11500
Con
Age 18-39 years
Medicnidi
1 TRAM AIITTED DISEASE. ---
SSO 00
S8000
EXU..k
10
S14500
Initial visit-
HI\' caseNlanagement (Unit rate t> min )
Age 65 years &over
s.,FN AT ASI �!cnid
Maternal .Assessment
S6000
6000
SO 00
60 00
Post Partum Home Visit •
Post Panum Home Visit . Newborn .Assessment
88 00
88 00
Maternhc Home Visit
Age under i year
$ 70 00
ORENS RVICE- O IID/NA-f10N1 M_...-edicaid)-
S8900
58900
Primary Service COOrd. -
Aae 1-4 years
Sliding Fee Scale is utilized in Child Health Clinics
autornaticaliy be implemented in the County fee
All State adjustments made to Medicaid charges will
schedule
CPT COU-
RV
SEICE
FEES
Prev mixt Visits (New)
Age under 1 year
$ 80.00
99381
$ 90.00
Age 1.4 years
99382
$ I00 00
99383
Age S•i 1 years
Age 12-17 years
$11000
99384
S11500
99385
Age 18-39 years
Age 40.64 years
S13000
99386
S14500
99387
Age 65 years &over
preventivpEisit3
LKILabliLh-10
Age under i year
$ 70 00
99391
$ 75.00
99392
Aae 1-4 years
Age 5-1I years
$ 85 00
99393
S 100 00
Age I2-17 years
99394
S10000
99395
Age 18-39 years
Age 40-64 years
SIU 00
99396
S 130 00
99397
Age 65 years &over
Eval/NIi [ Visits (Mewl
Minima!
$ 50.00
99201
Limited
S65 00
99202
Expanded
$ 85.00
99203
Detailed
$125.00
99204
Comprehensive
$155.00
99205
5