ADOPTED - JULY 24, 2001
Agenda Item No. 32
Introduced by the Human Services and Finance Committees of the:
INGHAM COUNTY BOARD OF COMMISSIONERS
RESOLUTION TO AUTHORIZE A NEW CLINICAL SERVICES FEE SCHEDULE
RESOLUTION #01-232
WHEREAS, the Michigan Public Health Code provides the Board of Commissioners with the authority to establish fees for services provided by the Health Department; and
WHEREAS, the Board of Commissioners periodically adjusts the fee schedule for clinical services provided by the Health Department; and
WHEREAS, the State of Michigan Medical Services Administration (Medicaid Agency) is implementing a Uniform Billing Project effective August 1, 2001 which is intended to bring the Michigan Medicaid Program into compliance with the Federal Health Insurance Portability and Accountability Act of 1996; and
WHEREAS, Ingham County will have to change its fee schedule in order to comply with the Uniform billing Project, by adding and deleting some categories of services; and
WHEREAS, the Health Officer has recommended that the Board of Commissioners adopt a new Clinical Services Fee Schedule, leaving in place the existing sliding fee schedule based on ability to pay.
THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners hereby adopts the attached Clinical Services Fee Schedule for services provided by the Ingham County Health Department, to be effective August 1, 2001.
HUMAN SERVICES: Human Services will meet 7/23/01
FINANCE: Yeas: Czarnecki, Hertel, Schafer, Swope, Lynch, Krause Nays: None
Absent: Minter Approved 7/18/01
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Effective August 1, 2001 | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
Office Visits - New Patients | ||||
99205 | New - Level 5-Comprehensive-High Complexity | $110.00 | ||
99204 | New - Level 4-Comprehensive-Moderate Complexity | $90.00 | ||
99203 | New - Level 3-Detailed-Low Complexity | $65.00 | ||
99202 | New - Level 2-Expanded Focus | $45.00 | ||
99201 | New - Level 1-Problem Focused - Straight Forward | $40.00 | ||
99387 | New - 65 years and over | $90.00 | ||
99386 | New - 40 through 64 years | $80.00 | ||
99385 | New - Well Child - 18 through 39 years | $70.00 | ||
99384 | New - Well Child - 12 through 17 years | $70.00 | ||
99383 | New - Well Child - 5 through 11 years | $70.00 | ||
99382 | New - Well Child - 1 through 4 years | $70.00 | ||
99381 | New - Well Child - under 1 year | $70.00 | ||
Office Visits - Established Patients | ||||
99215 | Revisit - Level 5-Comprehensive-High Complexity | $75.00 | ||
99214 | Revisit - Level 4-Detailed-Moderate Complexity | $50.00 | ||
99213 | Revisit - Level 3-Expanded-Low Complexity | $35.00 | ||
99212 | Revisit - Level 2-Problem Focused - Straight Forward | $25.00 | ||
99211 | Revisit - Level 1-Straight Forward | $25.00 | ||
99397 | Revisit - 65 years and over | $70.00 | ||
99396 | Revisit - 40 through 64 years | $65.00 | ||
99395 | Revisit - Well Child - 18 through 39 years | $60.00 | ||
99394 | Revisit - Well Child - 12 through 17 years | $60.00 | ||
99393 | Revisit - Well Child - 5 through 11 years | $60.00 | ||
99392 | Revisit - Well Child - 1 through 4 years | $60.00 | ||
99391 | Revisit - Well Child - under 1 year | $60.00 | ||
99402 | Preventative Medicine Counseling - 30 min. | ** | ||
99401 | Preventative Medicine Counseling - 15 min. | ** | ||
Other Office Visits | ||||
Agency PEs/County Pre-Employ PE's | $30.00 | |||
Insurance PEs | $45.00 | |||
Immigration PE's | $70.00 | |||
Employment/School PE's | $40.00 | |||
Travel Consultation | $25.00 | |||
Lab/Injection Only | $5.00 | |||
Laboratory | ||||
82947 | Blood sugar | $5.00 | ||
87210 | Hanging drop | $5.00 | ||
83655 | Lead | $15.00 | ||
85018 | Hemoglobin | $5.00 | ||
82270 | Occult Blood | $5.00 | ||
86403 | Strep Screen | $6.00 | ||
84703 | UCG | $6.00 | ||
81002 | Urinalysis | $3.00 | ||
81000 | UA with Micro | $3.00 | ||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
Procedures | ||||
92551 | Audiogram -Screening | $20.00 | ||
92552 | Audiogram -Threshold | $20.00 | ||
11100 | Biopsy, skin - single lesion | $55.00 | ||
11101 | Biopsy, skin - each additional lesion | $25.00 | ||
57510 | Cautery (Electro/Thermal) - Cervix | $115.00 | ||
54050 | Destruction (lesion(s) penis (Condyloma) simple; chemical | |||
54055 | Cautery Destruction lesion(s) Penis (Electro desiccation) | $165.00 | ||
57061 | Destruction vaginal lesion(s) simple; any method | $80.00 | ||
54065 | Destruction lesion(s), penis, extensive; any method | $170.00 | ||
56515 | Destruction lesion(s) vulva, extensive; any method | $105.00 | ||
57452 | Colposcopy | $60.00 | ||
57454 | Colposcopy with biopsy and/or endocervical curettage | $70.00 | ||
11720 | Debridement of Nail(s) by any method; one to five | $20.00 | ||
56501 | Destruction of lesion(s), vulva, simple, any method | $90.00 | ||
96110 | Denver Development Test | $35.00 | ||
69210 | Ear Irrigation | $10.00 | ||
93000 | EKG | $30.00 | ||
11740 | Evacuation of subungual hematoma | $25.00 | ||
11400 | Excision, benign lesion, except skin tag, on trunk, arms | $80.00 | ||
or legs: lesion diameter 0.5 cm or less | ||||
11420 | Excision, benign lesion, except skin tag, on scalp, | $70.00 | ||
neck, hands, feet, genitalia; lesion dia. .5 cm or less | ||||
11421 | lesion diameter .6 to 1.0 cm | $90.00 | ||
11422 | lesion diameter 1.1 to 2.0 cm | $100.00 | ||
11423 | lesion diameter 2.1 to 3.0 cm | $115.00 | ||
11424 | lesion diameter 3.1 to 4.0 cm | $130.00 | ||
11426 | lesion diameter over 4.0 cm | $175.00 | ||
11450 | Excision for hidradenitis; axillary; with simple or intermediate repair | $95.00 | ||
11470 | Excision for hidradenitis; perianal, perineal, or umbilical; | $110.00 | ||
with simple or intermediate repair | ||||
57500 | Excision, cervix, biopsy or local excision, single or multiple | $55.00 | ||
57505 | Excision, endocervical cutterage | $70.00 | ||
58100 | Excision, endometrial sampling | $45.00 | ||
57100 | Excision, biopsy of vaginal mucosa, simple | $55.00 | ||
56605 | Excision, biopsy of vulva or perineum, one lesion | $65.00 | ||
56606 | each separate additional lesion | $50.00 | ||
57160 | Fitting and insertion of pessary support device | $50.00 | ||
10060 | Incision and drainage of abcess, simple, or single | $60.00 | ||
56420 | Incision and drainage of Bartholin's gland abcess | $60.00 | ||
92567 | Impedance Tympanometry | $20.00 | ||
98925 | OMT - quantity 1-2 Body regions | $20.00 | ||
98926 | OMT - quantity 3-4 Body regions | $25.00 | ||
98927 | OMT - quantity 5-6 Body regions | $35.00 | ||
78596 | Pulmonary Function Study | $205.00 | ||
94640 | Pulmo-Aid Nebulizer | $25.00 | ||
11200 | Removal of skin tags, any area, up to and including 15 lesions | $45.00 | ||
X0055 | Suture Removal | $15.00 | ||
17000 | Wart Removal/Destruction of Lesions = 1 | $40.00 | ||
17003 | Wart Removal/Destruction of Lesions = 2-14 | $10.00 | ||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
17004 | Wart Removal/Destruction of Lesions = 15 plus | $120.00 | ||
17110 | Destruct flat warts, molluscum contagiosumor milia, up to 14 lesions | $40.00 | ||
17111 | Destruct flat warts, molluscum contagiosumor milia, 15 plus lesions | $50.00 | ||
86580 | TB Skin Test | $7.00 | ||
16020 | Dressing, burn | $10.00 | ||
76830 | Ultrasound, diagnostic; echography, transvaginal | $60.00 | ||
36415 | Venipucture, routine or finger/heel/ear stick for | $5.00 | ||
collection of specimen(s) | ||||
Injections | ||||
J1100 | Decadron | $6.00 | ||
J3301 | Kanalog -10, -40 | $8.00 | ||
J0696 | Rocephin Injection 250 mg (each 250 mg. dosage) | $13.00 | ||
J2920 | Solu-Medrol | $10.00 | ||
J3420 | Vitamin B-12 | $7.00 | ||
LEAD POISONING INVESTIGATION FEES | ||||
300025 | Initial Environment Assessment | $100.00 | ||
300026 | Follow-Up Environmental Visit | $100.00 | ||
300027 | Nursing Assessment/Education | $85.00 | ||
MATERNAL AND INFANT SUPPORT SERVICES | ||||
Z0001 | Clinic | $80.00 | ||
Z0004/Z0020 | Home | $105.00 | ||
Z0002/Z0022 | Clinic | $75.00 | ||
Z0003/Z0021 | Home | $95.00 | ||
Z0005 | Education | $40.00 | ||
PRENATAL FEES | ||||
X4855 | First Visit | $75.00 | ||
X4855 | Revisit | $75.00 | ||
X4854 | Package Price | $700.00 | ||
59025 | Fetal non-stress test | $25.00 | ||
76818 | Fetal biophysical profile, with non-stress testing | $65.00 | ||
76815 | Diagnostic Ultrasound, OB, limited | $55.00 | ||
59430 | Postpartum care only | $85.00 | ||
FAMILY PLANNING | ||||
Office Visits | ||||
89005 | New Physical Exam (See preventative med. codes 99383-99387) | $50.00 | ||
89027 | Annual Physical (See preventative med. codes 99393-99397 | $35.00 | ||
89025 | Medical Revisit (See office procedure codes 99211-99213) | $15.00 | ||
89020 | Counseling Visit (See preventative med. codes 99401-99402 | $10.00 | ||
89049 | Lab Only | $6.00 | ||
|
||||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
Procedures | ||||
57170 | Diaphragm Fit | $14.00 | ||
58300 | IUD Insertion | $60.00 | ||
58301 | IUD Removal | $14.00 | ||
11975 | Norplant Insertion | $150.00 | ||
11976 | Norplant Removal | $150.00 | ||
Laboratory | ||||
85018QW | Hemoglobin | $5.00 | ||
VDRL | $5.00 | |||
81002 | Urinalysis | $3.00 | ||
81000 | Urine Micro | $3.00 | ||
84703QW | Pregnancy Test | $6.00 | ||
87210 | Hanging drop/Micro | $5.00 | ||
Cytology/Pap | $8.00 | |||
Contraceptive Supplies | ||||
Z8500 | Birth Control Pills | $6.50 | ||
Z8506 | Plan B (Emergency Contraceptive) | ** | ||
Z8510 | Diaphragm | $10.00 | ||
Z8511 | Condoms (Male) | $0.60 | ||
Z8512 | Condoms (Female) | ** | ||
Z8513 | Foam/Jelly/Cream/Film | $4.50 | ||
Z8585 | Lunelle Injection | ** | ||
J7300 | IUD | $125.00 | ||
A4260 | Norplant | $400.00 | ||
Vaginal Contraceptive Film | $1.80 | |||
J1055 | Depo Provera | $30.00 | ||
Sponge | $10.00 | |||
Pharmaceutical Supplies | ||||
Z8051 | Amoxicillin, 250 mg. | $5.00 | ||
Z8052 | Amoxicillin, 500 mg. | $5.00 | ||
89851 | Ampicillin, 250 mg. | $5.00 | ||
89852 | Ampicillin, 500 mg. | $5.00 | ||
89858 | Bactrim | $5.00 | ||
Z8060 | Diflucan, 150 mg. 1 tab | ** | ||
Z8061 | Erythromycin, 250 mg. | $5.00 | ||
Z8062 | Erythromycin, 500 mg. | $7.00 | ||
Z8092 | Floxin 400 mg. (single dose) | $5.00 | ||
Floxin (14 day) | $45.00 | |||
Z8090 | Flagyl, 4 tabs | ** | ||
Z8091 | Flagyl (Metronidzaole) 14 tabs | $7.00 | ||
Gantricin | $10.00 | |||
Gynazole | $20.00 | |||
89862 | Mycelex G Cream | $15.00 | ||
Z8063 | Keflex 250 mg | $7.00 | ||
Z8064 | Keflex 500 mg | $7.00 | ||
| ||||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
Z8082 | Monistat 7 inserts | $21.00 | ||
Macrodantin | $40.00 | |||
Z8059 | Probenecid 500 mg | $5.00 | ||
J0696 | Rocephin Injection 250 mg | $11.00 | ||
Z8066 | Suprax 400 mg. 1 cap | ** | ||
Z8067 | Suprax 400 mg. 10 caps | ** | ||
Z8005 | Terazol Cream | $14.00 | ||
89850 | Tetracycline 250 mg | $3.00 | ||
89854 | Tetracycline 500 mg | $3.00 | ||
Z8070 | TMP-SMZ-DS 28 tabs | ** | ||
Z8076 | Zithromax, 250 mg 6 caps | ** | ||
Z8077 | Zithromax, 1 gm Suspension | ** | ||
Z8074 | Vibramycin (Doxycline) | $5.00 |
** No Medicaid Fee published yet, set fees to the next highest $5.00 increment when Medicaid fees are published
Update 6/28/01;7/02/01;7/05/01