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Home My WebLink AboutC.054.93010_1182MEDICAID DIFFERENCE CPT CODE SERVICE DESCRIPTION FEES FY 2002-2003 41112003 ICUID & MED. Laboratory $19.00 $5.48 $13.52 82947 Glucose $25.00 $6.64 $18.36 82950 1 hour Glucola $55.00 $17.99 $37.01 82951 GIT (3 ht) $15.00 $5.48 $9.52 82952 GTT Specimen 4 $3.31 $11.69 85013 Hematocrit $15.00 $15.00 $3.57 $11.43 81002 Urine Dipstick $19.00 $4.43 $14.57 81000 Urine with micro Pvt. Lab/cannot charge $11.28 S 11 2, 87086 Urine colony count $8.84 $1.16 81025 Pregnancy test (urine) $10.00 $5.33 $12.67 97210 Wet Prep $18,00 $36.00 $12.03 $23,97 87070 GC culture $18.00 $6,08 SIL92 82465 Cholesterol $19.00 $5.96 $13A4 87205 Gram Stains $40.00 not given 89320 is 16.84 89300 Semen Analysis $44.00 $8.85 $35.15 87164 Darkfield Pvt. Lab/cannot charge $5.96 S196 86592 Star RPR $12.00 not given we use G0001 F/MEDICAID 36415 Venipuncture/stick $13.00 not given not reimburs. Medicaid 99000 Handling fee $12.00 $4.14 $7.86 G0001 Medicaid Venipuncture Office Procedure $134.00 $133.94 $0,06 54050 Wart Treatment/Male $127.96 $6.14 56501 Wart Treatment/Female $134.00 $77.59 $92.41 76815 Ultrasound $170.00 $35.10 $89,90 59025 Non -Stress test $125.00 $91.74 $418.26 59412 Cephalic Version/Exterral $510.00 $116.58 $93.42 11976 Norplant Removal $210.00 $83.17 $128.83 58300 IUD Insertion $212.00 $95.86 $1.14 58301 IUD Removal $97,00 $984 $0.16 99070 IUD Supply $10.00 $77.62 $14.39 57170 Diaphragm Fitting $9100 $66.00 $48.00 96110 Denver Developmental $114.00 $9.31 $12.69 92551 Audiometry $22.00 $40.38 $21.62 69210 Ear Irrigation $62.00 MEDICAID DIFFERENCE FEES FY 4/112003 ICHD & MED. Proposed CPT CODE SERVICE DESCRIPTION EP Modifier Fee Change Immunizations/Injections 2002-2003 $3.79 $6.21 90782 Therapeutic/diag. Admin- Fee $10,00 11 -1 $20.00 $7.00 90471 Admin. single vaccine $5,00 $6.71 $4.76 $0.24 90472 Admin. 2+ vaccines $5.00 $4.11 $18.89 90788 Admin. antibiotics $23.00 $110.23 $037 90384 RHO Gain $111,00 $43.29 $1,71 J1055 Depo-Provera $45.00 90716 Adult Varicella $60.00 not given 90707 Adult MMR $40,00 not given 90733 Adult Meningitis $68.00 not given 42 $64.00 90746 Adult Hepatitis B $60.00 $63.42 $0.69 90632 Adult Hepatitis A $55.00 $54.31 $27.18 $2.82 90633 Ped/Adol. Hepatitis A $30-00 $7.13 -So'l { $8.00 90658 influenza Vaccine $7.00 $18.00 $11.79 $6.21 90732 Pneumonia Vaccine 86580 PPD (TB Skin Test) $19.00 not given 90669 Prevnar - private stock $71.00 not given 90713 Polio - private stock $26.00 not given