ADOPTED - JUNE 28, 2005

Agenda Item No. 10

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO ADJUST THE HEALTH DEPARTMENT’S FEE SCHEDULE

RESOLUTION #05-166

WHEREAS, the Ingham County Board of Commissioners has the authority to establish fees for public health services; and

WHEREAS, the Health Department operates a network of community health centers that have been granted Federally Qualified Health Center status, and as a result the Department is required to pursue maximum payments for services from third party payers and persons with incomes above 200% of the Federal Poverty Level; and

WHEREAS, most health insurers pay the established rate or the charge that is billed, whichever is less; and

WHEREAS, the Federal Government publishes a Medicare Fee Screen and Delta Dental publishes a Prudent Purchaser Arrangement Fee Schedule for General Practitioner; and

WHEREAS, the Community Health Center Board has recommended that the charges for medical services be established at 135% of the published Medicare Fee Screen and that charges for dental services be established at 115% of the Delta Dental Fee Schedule for General Practitioners; and

WHEREAS, the County has a longstanding practice of charging for immunizations at a rate to assure reimbursement of the cost of the immunizing agent; and

WHEREAS, the Health Officer has recommended a number of adjustments in the Health Department’s fee schedules.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners adopts, effective October 1, 2005, the attached fee schedules for services provided by the Ingham County Health Department and the Federally Qualified Health Center it operates.

Fee Schedule for Environmental Services

Medical Fee Schedule

Dental Fee Schedule

Schedule of Other Fees

BE IT FURTHER RESOLVED, that the Board of Commissioners adopts, effective October 1, 2005, the attached discount schedules:

Schedule of Discounts for Medical and Dental Services

Schedule of Discounts for Title X (Family Planning Services)

BE IT FURTHER RESOLVED, that the Health Department shall establish a charge for vaccines based on the cost of the immunizing agent rounded to the nearest whole dollar, effective October 1, 2005.

ADOPTED - JUNE 28, 2005

Agenda Item No. 10

RESOLUTION #05-166

BE IT FURTHER RESOLVED, that the Department shall establish a charge for family planning supplies based on the cost of supplies rounded to the nearest whole dollar, effective October 1, 2005.

HUMAN SERVICES:  Yeas:  Hertel, Weatherwax-Grant, Celentino, Dedden

Nays:  None                         Absent:  Holman, Severino          Approved 6/20/05

FINANCE:  Yeas:  Swope, Hertel, Schor, Dougan

Nays:        None                    Absent:  Thomas, Dedden        Approved 6/22/05

DENTAL SCHEDULE OF CHARGES

The fees charged by the Ingham County Health Department for dental services shall be 115% of the Delta Dental Prudent Purchaser Arrangement Fee Schedule for General Practitioner. 

MEDICAL SCHEDULE OF CHARGES

The fees charged by the Ingham Community Health Centers (Ingham County Health Department) for medical services shall be 135% of the Medicare Fee Screen as published by the Center for Medicaid and Medicare Services (http://www.cms.hhs.gov) by procedural code (HCPCS) and specific to locality (Rest of Michigan). 

For services which do not have a Medicare procedure code, the charge shall be set at 100% of cost.

Proposed FY06 Dental Schedule of Charges – October 1, 2005 – December 31, 2005

ADA Code	Procedure Code	Type of Service	Description of Services	Delta Dental Fee	115% Delta Dental
	D9930	Adjunctive Services - Misc. Services	Complication(post surgical - unusual circumstances)	$       51	$       58
	D9940	Adjunctive Services - Misc. Services	Occlusal guard	$     403	$     464
	D9420	Adjunctive Services - Professional Visits	Hospital Calls	$     250	$     288
	D9110	Adjunctive Services - Unclassified Treatment	Palliative treatment	$       65	$       74
00110	D0150	Diagnostic - Clinical Oral Examinations	Initial Oral Examination	$       36	$       41
00120	D0120	Diagnostic - Clinical Oral Examinations	Periodic (Recall) Oral Examination	$       25	$       29
00130	D0140	Diagnostic - Clinical Oral Examinations	Emergency Oral Examination	$       37	$       42
00210	D0210	Diagnostic – Radiographs	Intraoral-complete series-including BW's	$       72	$       83
00220	D0220	Diagnostic – Radiographs	Intraoral-single, first film	$       13	$       16
00227		Diagnostic – Radiographs	Intraoral-seven films		$          -
00232		Diagnostic – Radiographs	Intraoral-two films		$          -
00233		Diagnostic – Radiographs	Intraoral-three films		$          -
00234		Diagnostic – Radiographs	Intraoral-four films		$          -
00235		Diagnostic – Radiographs	Intraoral-five films		$          -
00272	D0272	Diagnostic – Radiographs	2 Bitewing radiographs	$       19	$       22
00274	D0274	Diagnostic – Radiographs	4 Bitewing radiographs	$       28	$       33
00330	D0330	Diagnostic – Radiographs	Panoramic film	$       70	$       81
	D0230	Diagnostic – Radiographs	Intraoral-periapical, each additional film	$         6	$         7
	D0240	Diagnostic – Radiographs	Intraoral-occlusal film	$       21	$       24
	D0270	Diagnostic – Radiographs	Bitewing - single film	$       13	$       15
03110	D3110	Endodontic - Pulp Capping	Pulp cap-direct (excluding restoration)	$       40	$       46
03220	D3220	Endodontic – Pulpotomy	Vital Pulpotomy	$       96	$     110
	D3221	Endodontic – Pulpotomy	Pulpal Debridement (under age 13)	$       70	$       81
	D3230	Endodontic - Root Canal Therapy	Pulpal therapy, anterior, primary (under age 8)	$     105	$     121
	D3240	Endodontic - Root Canal Therapy	Pupal therapy, posterior, primary (under age 12)	$     105	$     121
	D3310	Endodontic - Root Canal Therapy	Anterior (excluding final restoration)	$     368	$     424
	D3320	Endodontic - Root Canal Therapy	Bicuspid (excluding final restoration)	$     420	$     483
	D3330	Endodontic - Root Canal Therapy	Molar root canal (excluding final restoration)	$     549	$     631
	D3352	Endodontic - Root Canal Therapy	Apexification recalcification-interim medication replacement (under age 13)	$       63	$       72
	D7270	Oral Surgery - Other Surgical Extractions	Tooth replantation and/or stabilization	$     260	$     299
	D7280	Oral Surgery - Other Surgical Extractions	Surg access of exposure impacted/unerupted tooth – simple	$     209	$     240
	D7310	Oral Surgery - Other Surgical Extractions	Alveoplasty per quadrant, in conj with extract.	$     158	$     181
	D7320	Oral Surgery - Other Surgical Extractions	Alveoplasty per quadrant-not in conjunct with extract.	$     189	$     217
	D7510	Oral Surgery - Other Surgical Extractions	Incision and Drainage (introral soft tissue)	$     125	$     144
	D7971	Oral Surgery - Other Surgical Extractions	Excision of pericoronal gingiva	$       60	$       69
07110	D7110	Oral Surgery - Simple Extractons	Single tooth	$       70	$       81
07120	D7120	Oral Surgery - Simple Extractons	Each additional tooth	$       66	$       76
	D7111	Oral Surgery - Simple Extractons	Coronal Remnants - Deciduous tooth	$       75	$       86
	D7140	Oral Surgery - Simple Extractons	Extraction,erupted tooth or exposed root (Elevation and/or forceps removal)	$       74	$       85
07210	D7210	Oral Surgery - Surgical Extractions	Extraction of tooth, erupted	$     140	$     161
07220	D7220	Oral Surgery - Surgical Extractions	Extraction of tooth, soft tissue impaction	$     167	$     192
07230	D7230	Oral Surgery - Surgical Extractions	Extraction of tooth, partial bony impaction	$     220	$     253
	D7240	Oral Surgery - Surgical Extractions	Extraction of tooth, complete bony impaction	$     251	$     289
	D7250	Oral Surgery - Surgical Extractions	Surgical removal of residual tooth (cutting procedure)	$     150	$     173
04340	D4341	Periodontic - Scaling and Root Planing	Perio.Scaling and root planing(per quadrant)	$     138	$     158
	D4355	Periodontic - Scaling and Root Planing	Full mouth debridement (Age 14 & older)	$       60	$       69
01230	D1203	Preventive – Fluoride	Topical application of acidulated phosphate (age 2 through 17)	$       25	$       29
01110	D1110	Preventive – Prophylaxis	Adult Prophylaxis (age 14 and over)	$       48	$       55
01120	D1120	Preventive – Prophylaxis	Child Prophylaxis (age 2-13)	$       35	$       41
01351	D1351	Preventive – Sealants	Sealants, per tooth (ages 5-15 only)	$       25	$       28
01510	D1510	Preventive - Space Maintainers	Fixed, unilateral band type	$     192	$     221
01515	D1515	Preventive - Space Maintainers	Fixed, bilateral band type or palatal/lingual	$     310	$     356
01550	D1550	Preventive - Space Maintainers	Recementation of Spacer	$       37	$       43
DD06930	D6930	Prosthdontics, Fixed - Other Fixed Prosthetic Svcs	Recement bridge	$       92	$     106
	D6740	Prosthdontics, Fixed - Other Fixed Prosthetic Svcs	Porcelain/Ceramic crown	$     543	$     625
05410	D5410	Prosthodontics – Adjustments	Upper denture adjustment	$       44	$       50
05411	D5411	Prosthodontics – Adjustments	Lower denture adjustment	$       46	$       53
05421	D5421	Prosthodontics – Adjustments	Upper partial denture adjustment	$       50	$       57
05422	D5422	Prosthodontics – Adjustments	Lower partial denture adjustment	$       49	$       57
05710	D5710	Prosthodontics - Duplication and Relining	Upper jump, complete denture	$     213	$     245
05711	D5711	Prosthodontics - Duplication and Relining	Lower jump, complete denture	$     278	$     320
05750	D5750	Prosthodontics - Duplication and Relining	Upper relining, complete denture (laboratory)	$     239	$     275
05751	D5751	Prosthodontics - Duplication and Relining	Lower relining, complete denture (laboratory)	$     234	$     269
05760	D5760	Prosthodontics - Duplication and Relining	Upper relining, partial denture (laboratory)	$     218	$     250
05761	D5761	Prosthodontics - Duplication and Relining	Lower relining, partial denture (laboratory)	$     226	$     260
	D5720	Prosthodontics - Duplication and Relining	Rebase maxillary partial denture	$     308	$     354
	D5721	Prosthodontics - Duplication and Relining	Rebase mandibular partial denture	$     308	$     354
	D5730	Prosthodontics - Duplication and Relining	Reline complete maxillary denture (chairside)	$     171	$     197
	D5731	Prosthodontics - Duplication and Relining	Reline complete mandibular denture (chairside)	$     161	$     185
	D5740	Prosthodontics - Duplication and Relining	Reline maxillary partial denture (chairside)	$     170	$     195
	D5741	Prosthodontics - Duplication and Relining	Reline mandibular partial denture (chairside)	$     166	$     191
05820	D5820	Prosthodontics - Other Prosthetic Services	Upper denture,temp(partl-stayplate)Anterior-teeth only	$     270	$     311
05821	D5821	Prosthodontics - Other Prosthetic Services	Lower denture,temp(partl-stayplate)Anterior-teeth only	$     299	$     344
05610	D5510	Prosthodontics - Repairs to Complete Dentures	Repair broken complete denture,no teeth damaged	$       92	$     106
05620	D5520	Prosthodontics - Repairs to Complete Dentures	Repair broken complete denture,replace one tooth	$       80	$       92
05611	D5610	Prosthodontics - Repairs to Partial Dentures	Repair broken partial denture, no teeth damaged	$       99	$     114
05621	D5620	Prosthodontics - Repairs to Partial Dentures	Repair broken partial denture,replace one broken tooth	$     110	$     126
05630	D5630	Prosthodontics - Repairs to Partial Dentures	Replace additional teeth, each tooth	$     130	$     150
05640	D5640	Prosthodontics - Repairs to Partial Dentures	Replace broken tooth on denture, no other repairs	$       77	$       89
05650	D5650	Prosthodontics - Repairs to Partial Dentures	Adding tooth to partial denture to replace extracted	$     116	$     134
05660	D5660	Prosthodontics - Repairs to Partial Dentures	Adding tooth to partial denture to replace extracted	$     145	$     167
05110	D5110	Prosthodontics, Removable  - Complete	Complete Upper	$     697	$     802
05120	D5120	Prosthodontics, Removable  - Complete	Complete Lower	$     696	$     800
05130	D5130	Prosthodontics, Removable  - Complete	Immediate Upper	$     741	$     852
DD05140	D5140	Prosthodontics, Removable  - Complete	Immediate Lower	$     770	$     885
05211	D5211	Prosthodontics, Removable  - Partial	Lower patial, without clasps, acrylic base	$     576	$     662
DD05281	D5281	Prosthodontics, Removable  - Partial	Removable unilateral partial denture,one piece cast, chrome cobalt clasp attachments	$     450	$     518
	D5212	Prosthodontics, Removable  - Partial		$     662	$     761
	D5213	Prosthodontics, Removable  - Partial	Maxilary partial denture,cast metal framework with resin denture bases	$     767	$     882
	D5214	Prosthodontics, Removable  - Partial	Mandibular partial denture,cast metal framework with resin denture bases	$     774	$     890
02110	D2110	Restorative - Amalgam Restorations	Amalgam-one surface, deciduous	$       45	$       51
02120	D2120	Restorative - Amalgam Restorations	Amalgam-two surfaces, deciduous	$       57	$       65
02130	D2130	Restorative - Amalgam Restorations	Amalgam-three surfaces, deciduous	$       72	$       83
02131	D2131	Restorative - Amalgam Restorations	Amalgam-four surfaces, deciduous	$       96	$     110
02140	D2140	Restorative - Amalgam Restorations	Amalgam-one surface, permanent	$       54	$       63
02150	D2150	Restorative - Amalgam Restorations	Amalgam-two surfaces, permanent	$       72	$       83
02160	D2160	Restorative - Amalgam Restorations	Amalgam-three surfaces, permanent	$       89	$     103
02161	D2161	Restorative - Amalgam Restorations	Amalgam-four or more surfaces, permanent	$     105	$     120
02910	D2910	Restorative – Other	Recement inlays	$       61	$       70
02920	D2920	Restorative – Other	Recement crowns	$       57	$       65
02940	D2940	Restorative – Other	Fillings (sedative)	$       58	$       67
	D2930	Restorative – Other	Prefab.Stainless Steel Crown-primary	$     165	$     190
	D2931	Restorative – Other	Prefab.Stainless Steel Crown-primary	$     212	$     244
	D2950	Restorative – Other	Core buildup,including any pins	$     174	$     200
	D2954	Restorative – Other	Prefabricated post and core in addition to crown	$     189	$     217
	D2999	Restorative – Other	Unspecified restorative procedure, by report	$       30	$       34
02330	D2330	Restorative - Resin Restorations	Composite resin-one surface,anterior	$       61	$       70
02331	D2331	Restorative - Resin Restorations	Composite resin-two surfaces,anterior	$       81	$       93
02332	D2332	Restorative - Resin Restorations	Composite resin-three surfaces,anterior	$       98	$     113
02380	D2380	Restorative - Resin Restorations	Composite, one surface, posterior-deciduous	$       57	$       65
02385	D2385	Restorative - Resin Restorations	Composite, one surface, posterior-permanent	$       74	$       85
	D2335	Restorative - Resin Restorations	Resin composite four/+ surfaces, incisal angle (anter.)	$     120	$     138
	D2336	Restorative - Resin Restorations	Resin composite crown, anterior-primary	$     100	$     115
	D2337	Restorative - Resin Restorations	Resin composite crown, anterior-permanent	$     156	$     179
	D2381	Restorative - Resin Restorations	Resin, two surfaces,posterior-primary	$     104	$     120
	D2382	Restorative - Resin Restorations	Resin,three/+ surfaces,posterior-primary	$     154	$     177
	D2386	Restorative - Resin Restorations	Resin, two surfaces,posterior-permanent	$     100	$     115
	D2387	Restorative - Resin Restorations	Resin,three surfaces-posterior-permanent	$     148	$     170
	D2390	Restorative - Resin Restorations	Resin-based composite crown, anterior	$     156	$     179
	D2391	Restorative - Resin Restorations	Resin-based composite, one surface, posterior	$       77	$       89
	D2392	Restorative - Resin Restorations	Resin-based composite, two surfaces, posterior	$     105	$     121
	D2393	Restorative - Resin Restorations	Resin-based composite, three surfaces, posterior	$     155	$     178
	D2394	Restorative - Resin Restorations	Resin-based composite, four or more surfaces, posterior	$     165	$     190
	D2710	Restorative - Single Restorations Only	Crown-Resin (laboratory)	$     534	$     614
	D2740	Restorative - Single Restorations Only	Porcelain/ceramic substrate	$     586	$     674
	D2750	Restorative - Single Restorations Only	Porcelain fused to high noble metal	$     569	$     654
	D2751	Restorative - Single Restorations Only	Porcelain fused to predominantly base metal	$     496	$     571
	D2752	Restorative - Single Restorations Only	Porcelain fused to noble metal	$     537	$     617
	D2790	Restorative - Single Restorations Only	Full cast high noble metal	$     557	$     640
	D2791	Restorative - Single Restorations Only	Full cast predominantly base metal	$     514	$     591
	D2792	Restorative - Single Restorations Only	Full cast noble metal	$     532	$     612

2006 County Fee Analysis – Environmental Health
Human Services Committee
Location			2006
of	Fee	2005	Prop.
Service	Description	Fee	Fee
Env. Health	Fixed Food Service Estab. – Nonprofit	125.00	150.00
Env. Health	Fixed Food Service Estab. – Profit
	Initial License (1)	800.00	800.00
	Initial License incl. Plan Review	966.00	966.00
	Initial Restricted License	260.00	480.00
	Initial License (Mobile)	335.00	340.00
	Multiple facility renewal license	145.00	150.00
	Renewal License
	At least $ 750,000	800.00	800.00
	At least $500,000, less than $750,000 (1)	655.00	655.00
	At least $250,000, less than $500,000 (1)	505.00	505.00
	Less than $250,000 (1)	360.00	360.00
	Seasonal Renewal License
	Seasonal Gross At least $ 750,000	480.00	480.00
	Seasonal at least $500,000, less than $750,000 (1)	393.00	393.00
	Seasonal at least $250,000, less than $500,000 (1)	303.00	303.00
	Seasonal Less than $250,000 (1)	216.00	216.00
	Non Profit	75.00	75.00
Env. Health	Change of Ownership FSE	286.00	286.00
Env. Health	Fixed FSE - Initial License, Nonprofit	195.00	200.00
Env. Health	Initial License - Fee Exempt (plan review only) Govt	166.00	166.00
Env. Health	Initial License - Fee Exempt (plan review only) Schools	0.00	0.00
Env. Health	FSE - Schools/Indigent	0.00	0.00
Env. Health	FSE - Fee Exempt (govt)	0.00	0.00
Env. Health	late renewal  - additional	100.00	100.00
Env. Health	Mobile Home Park Inspections	300.00	325.00
Env. Health	Public Pools Inspection	144.00	166.00
	each additional pool, same location & day	49.00	83.00
Env. Health	Pool Reinspection (after violation)	36.00	83.00
Env. Health	Child & Adult Care Facility Ins. - Full (7)	162.00	162.00
Env. Health	Child & Adult Care Facility Ins. - W & S (7)	102.00	102.00
Env. Health	Child & Adult Care Plan Review	300.00	300.00
Env. Health	STFU (7) - Initial Lic. Incl. Plan Review	260.00	260.00
Env. Health	STFU (7) - in season inspection	90.00	90.00
Env. Health	STFU (7) – Renewal	94.00	94.00
Env. Health	Tattooing Business License (1)	160.00	332.00
	late renewal  - additional	10.00	100.00
Env. Health	Temp FSE - Fee-Exempt	0.00	0.00
Env. Health	Temp FSE - Non-Profit (2)	75.00	80.00
	Ops Began Before Licensing (double)	150.00	160.00
Env. Health	Temp. Food Service Establishment
	Preparation Type (2)	125.00	166.00
	Ops Began Before Licensing (double)	250.00	332.00
	each additional unit after 2, same location	54.00	54.00
Env. Health	Vending (per location, except >10 machines, per loc.)
	1-3 Licensable Mach. in Same Loc.	59.00	60.00
	4-6 Licensable Mach. in Same Loc.	79.00	80.00
	7-10 Licensable Mach. in Same Loc.	104.00	105.00
	Larger Location (First 10 machines)	94.00	105.00
	Larger Location (Add'l Machine > 10)	5.00	5.00
	Min. total for all locations/same operation	180.00	183.00
Env. Health	Water & Sewage	825.00	850.00
Env. Health	Sewage Only (new)	413.00	425.00
Env. Health	Well Only (new)	413.00	425.00
Env. Health	Vacant Land Evaluation (8)	400.00	405.00
Env. Health	Repair - On-Site Sewage (8)	105.00	405.00
Env. Health	Repair – Well	105.00	150.00
Env. Health	Alternative On-site Sewage Plan Review (4)	305.00	310.00
Env. Health	Appeals Board Fee		30.00
Env. Health	Hourly Rate Over Standard Service	72/hr	83/hr
Env. Health	Septic/Well Evaluation		83/hr
Env. Health	Subdivision Evaluation of Preliminary Plat	30.00	166.00
Env. Health	Bathing Area Operational Permit	60.00	166.00
Env. Health	Reinstatement of Bathing Area Permit	11.00	83.00
Env. Health	Sanitary Survey of Proposed Bathing Beach	290.00	332.00
Env. Health	Loan Evaluation - Residential Premises	180.00	225.00
Env. Health	Municipailty Required Eval. of Well/Septic		83.00
Env. Health	Reinstatement of Suspended FSE	424.00	424.00
Env. Health	Surcharge - Failure to submit plans/chg of own	424.00	424.00
Env. Health	Surcharge - Failure to make app. – vending	140.00	140.00
Env. Health	Critical Follow Up Fee	101.00	101.00

Proposed FY06 Title X Schedule of Discounts
Person in Family Unit	Category A	Category B	Category C	Category D	Category E	Category F	Category G	Full Pay
1	< $9,570	$9,571 -$11,963	$11,964 - $14,355	$14,356 - $16748	$16479 - $19140	$19,141 - $21,533	$21,534 - $23,925	> $23,925
2	< $12,830	$12,831 - 16,038	$16,039 -  $19,245	$19,246 - $22,453	$22,454 - $25,660	$25,661 - $28,868	$28,869 - $32,075	> $32,075
3	< $16,090	$16,091 - 20,113	$20,114 - $24,135	$24,136 - $28,158	$28,159 - $32,180	$ 31,181 - $36,203	$36,204 - $40,225	> $40,225
4	< $19,350	$19,351 - $24,188	$24,189 - $29,025	$29,026 - $33,863	$33,864 - $38,700	$38,701 - $43,538	$43,538 - $48,375	> $48,375
5	< $22,610	$22,611 - $28,263	$28,264 - 33,915	$33,916 - $39,568	$39,569 - $45,220	$45,221 - $50,873	$50,874 - $56,525	> $56,525
6	< $25,870	$25,871 - $32,338	$32,338 - $38,805	$38,806 - $45,273	$45,274 - $51,740	$51,741 - $58208	$58,209 - $64,675	> $64,675
7	< $29,130	$29,131 - $36,413	$36,414 - $43,695	$43,696 - $50,978	$50,979 - $58,260	$58,260 - $65,543	$65,544 - $72,825	> $72,825
8	< $32,390	$32,391 - $40,488	$40,489 - $48,585	$48,586 - $56,683	$56,683 - $64,780	$64,781 - $72,878	$72,879 - $80,975	> $80,975
9	<  $35,650	$35,651 - $44,563	$44,564 - $53,475	$53,476 - $62,388	$62,389 - $71,300	$71,301 - $80,213	$80,123 - $89,125	> $89,125
10	< $38,910	$38,911 - $48,638	$48,639 - $58,365	$58,366 - $68,093	$68,093 - $77,820	$77,821 - $87,548	$87,549 - $97,275	> $97,275
Federal Poverty Level	Equal to or less than 100%	101% - 125%	126% - 150%	151% - 175%	176% - 200%	201% - 225%	226% - 250%	Greater than 250%
New Patient Encounter	$              -	$           15	$           20	$           25	$           30	$           35	$           40	Full Charge
Established Patient Encounter	$              -	$           10	$           15	$           20	$           25	$           30	$           35	Full Charge

Proposed FY06 FQHC Schedule of Discounts
Person in Family Unit	Category A	Category B	Category C	Category D	Category E	Full Pay
1	< $9,570	$9,571 -$11,963	$11,964 - $14,355	$14,356 - $16748	$16479 - $19140	> $19,140
2	< $12,830	$12,831 - 16,038	$16,039 -  $19,245	$19,246 - $22,453	$22,454 - $25,660	> $25,660
3	< $16,090	$16,091 - 20,113	$20,114 - $24,135	$24,136 - $28,158	$28,159 - $32,180	> $32,180
4	< $19,350	$19,351 - $24,188	$24,189 - $29,025	$29,026 - $33,863	$33,864 - $38,700	> $38,700
5	< $22,610	$22,611 - $28,263	$28,264 - 33,915	$33,916 - $39,568	$39,569 - $45,220	> $45,220
6	< $25,870	$25,871 - $32,338	$32,338 - $38,805	$38,806 - $45,273	$45,274 - $51,740	> $51,740
7	< $29,130	$29,131 - $36,413	$36,414 - $43,695	$43,696 - $50,978	$50,979 - $58,260	> $58,260
8	< $32,390	$32,391 - $40,488	$40,489 - $48,585	$48,586 - $56,683	$56,683 - $64,780	> $64,780
9	<  $35,650	$35,651 - $44,563	$44,564 - $53,475	$53,476 - $62,388	$62,389 - $71,300	> $71,300
10	< $38,910	$38,911 - $48,638	$48,639 - $58,365	$58,366 - $68,093	$68,093 - $77,820	> $77,820
Federal Poverty Level	Equal to or less than 100%	101% - 125%	126% - 150%	151% - 175%	176% - 200%	Greater than 200%
New Patient Encounter	$           15	$              20	$               25	$              30	$              35	Full Charge
Established Patient Encounter	$           10	$              15	$               20	$              25	$              30	Full Charge

Proposed FY06 Medical Schedule of Charges – October 1, 2005 – December 31, 2005

CPT/Office Code	Type of Service	Description of Service	Medicare Fee	Std Fee
				135% Medicare or Cost
99241	Consultations	Office Consult/Problem Expanded 15 Min	$      49.66	$           67
99242	Consultations	Office Consult/Problem Expanded 30Min	$      91.26	$         123
99243	Consultations	Office Consult/Problem Detailed 40 Min	$    121.60	$         164
99244	Consultations	Office Consult/Problem Detailed 40 Min	$    171.06	$         231
99401	Counseling/Risk Factor Intervention	Individual 15 Min	$      40.59	$           55
99402	Counseling/Risk Factor Intervention	Individual 30 Min	$      68.92	$           93
99403	Counseling/Risk Factor Intervention	Individual 45 Min	$      96.01	$         130
99404	Counseling/Risk Factor Intervention	Individual 60 Min	$    123.25	$         166
99411	Counseling/Risk Factor Intervention	Group 30 Min	$      12.60	$           17
99412	Counseling/Risk Factor Intervention	Group 60 Min	$      18.85	$           25
99420	Counseling/Risk Factor Intervention	Administration and interpretation of HRA	$            -	$           10
99429	Counseling/Risk Factor Intervention	Medical Care Case Management (Unlisted Preventive Service)	$            -	$           95
99499	Counseling/Risk Factor Intervention	Case Management (Unlisted E&M Service)	$            -	$           95
99211	Established Office Visit	Brief @ 5 min	$      20.75	$           28
99212	Established Office Visit	E&M Focused @ 10 min	$      37.79	$           51
99213	Established Office Visit	E&M Expanded @ 15 Min	$      51.41	$           69
99214	Established Office Visit	E&M Detailed @ 30	$      80.83	$         109
99215	Established Office Visit	E&M Moderate @ 45 min	$    118.15	$         160
99391	Established Preventive Services	E&M < 1 Yr	$      76.87	$         104
99392	Established Preventive Services	E&M 1-4 Yrs	$      86.35	$         117
99393	Established Preventive Services	E&M 5-11 Yrs	$      85.29	$         115
99394	Established Preventive Services	E&M 12-17 Yrs	$      94.20	$         127
99395	Established Preventive Services	E&M 18-39 Yrs	$      95.26	$         129
99396	Established Preventive Services	E&M 40-64 Yrs	$    105.44	$         142
99397	Established Preventive Services	E&M ≥ 65Yrs	$    116.14	$         157
99203.01	Family Planning	Initial Exam	$      73.73	$         100
99211.01	Family Planning	Supply Visit	$      20.75	$           28
99212.01	Family Planning	Pill Problem	$      37.79	$           51
99213.02	Family Planning	Problem w/Exam	$      51.41	$           69
99214.01	Family Planning	Annual Exam	$      58.89	$           80
11975	Family Planning: Contraception	Norplant Insert w/Kit	$    115.86	$         156
11976	Family Planning: Contraception	Removal of contraceptive cap	$    140.09	$         189
11977	Family Planning: Contraception	Removal/reinsert contra cap	$    226.27	$         305
57170	Family Planning: Contraception	Diaphram Fitting w/Instrument	$      92.92	$         125
58300	Family Planning: Contraception	IUD Device Insertion	$      95.17	$         128
58301	Family Planning: Contraception	IUD Device Removal	$    103.23	$         139
84703	Family Planning: Contraception	Serum Pregnancy Test	$      10.49	$           14
D96152	Health Education	Diabetes Education, Individual session, per 15 minutes	$            -	$      20.00
S96152	Health Education	Smoking Cessation, Individual session, per 15 minutes	$            -	$      20.00
90471	Immunizations	Administration Fee Injection	$      17.93	$           24
90473	Immunizations	Administration Fee Oral	$      17.93	$           24
251	Internal Code	Physical Exams/ County Pre-employment	$            -	$      60.00
252	Internal Code	Employment/School Physical Exams	$            -	$      60.00
253	Internal Code	Insurance Physical Exams	$            -	$      45.00
260	Internal Code	Immigrant Physical (13 yoa and under)	$            -	$    125.00
261	Internal Code	Immigrant Physical (14 yoa and over)	$            -	$      75.00
	Internal Code	Lab Only	$            -	$        5.00
81000	Laboratory	Urinanalysis with Micro	$        4.43	$             6
81002	Laboratory	Urinanalysis	$        3.57	$             5
81025	Laboratory	Urine Pregnancy Test	$        8.84	$           12
82270	Laboratory	Occult Blood	$        3.64	$             5
82465	Laboratory	Cholesterol, Serum or Whole Blood, Total	$        6.08	$             8
82947	Laboratory	Blood Sugar	$        5.24	$             7
83655	Laboratory	Lead	$      16.91	$           23
83718	Laboratory	High Density Cholesterol	$      11.44	$           15
84703	Laboratory	Chorionic Gonadotropin Assay Pregnancy test	$      10.49	$           14
85018	Laboratory	Hemoglobin	$        3.31	$             4
86403	Laboratory	Strep Screen	$      14.24	$           19
86580	Laboratory	PPD TB Skin Test	$      11.06	$           15
87210	Laboratory	Hanging drop/Micro	$        5.96	$             8
99201	New Office Visit	E&M Focused @ 10 min	$      36.03	$           49
99202	New Office Visit	E&M Expanded @ 15 Min	$      64.04	$           86
99203	New Office Visit	E&M Detailed @ 30	$      95.74	$         129
99204	New Office Visit	E&M Moderate @ 45 min	$    135.51	$         183
99205	New Office Visit	E&M High @ 60 Min	$    171.56	$         232
99381	New Preventive Services	E&M < 1 Yr	$    100.78	$         136
99382	New Preventive Services	E&M 1-4 Yrs	$    108.64	$         147
99383	New Preventive Services	E&M 5-11 Yrs	$    106.52	$         144
99384	New Preventive Services	E&M 12-17 Yrs	$    116.01	$         157
99385	New Preventive Services	E&M 18-39 Yrs	$    116.01	$         157
99386	New Preventive Services	E&M 40-64 Yrs	$    136.53	$         184
99387	New Preventive Services	E&M ≥ 65Yrs	$    147.93	$         200
59025	OB Office Visit	Fetal non-stress test	$      43.63	$           59
59425	OB Office Visit	1st Tri Antepartum Care/4-6 Visits	$    394.78	$         533
59426	OB Office Visit	Antepartum Care 7+ Visits	$    691.05	$         933
59430	OB Office Visit	Postpartum Care Only	$    152.79	$         206
76815	OB Office Visit	Ultrasound, diagnostic; OB, limited	$      89.05	$         120
76818	OB Office Visit	Fetal biophysical profile with non-stress testing	$    118.84	$         160
76830	OB Office Visit	Ultrasound, diagnostic; echography, transvaginal	$      95.24	$         129
99203.01	OB Office Visit	1st Tri Initial 30 Min	$      73.73	$         100
99203.02	OB Office Visit	1st Tri Initial 30 Min	$      73.73	$         100
99203.03	OB Office Visit	1st Tri Initial 30 Min	$      73.73	$         100
99204.01	OB Office Visit	1st Tri Initial 45 Min	$    108.43	$         146
99204.02	OB Office Visit	1st Tri Initial 45 Min	$    108.43	$         146
99204.03	OB Office Visit	1st Tri Initial 45 Min	$    108.43	$         146
99213	OB Office Visit	Established @ 15 Min	$      51.41	$           69
99214	OB Office Visit	Established @ 30 Min	$      58.89	$           80
88142	Other Office Visits	Pap Smear Collection	$            -	$              -
G0101	Other Office Visits	CA screen;pelvic/breast exam (Medicare)	$      36.51	$           49
10060	Procedures	I&D Abscess	$      93.84	$         127
10160	Procedures	Puncture aspiration of abscess, hematoma, bulla or cyst	$    109.86	$         148
11100	Procedures	Biopsy, skin - single lesion	$      77.26	$         104
11101	Procedures	Biopsy, skin - each additional lesion	$      28.37	$           38
11200	Procedures	Removal of skin tags, any area, up to and including 15 lesions	$      68.67	$           93
11400	Procedures	Excision, benign lesion, except skin tag, on trunk, arms or legs: lesion diameter 0.5 cm or less	$    106.30	$         144
11420	Procedures	Excision, benign, lesion, except skin tag, on scalp, neck, hands, feet, genitalia; lesion dia..5 cm or less	$      75.63	$         102
11421	Procedures	lesion diameter .6 to 1.0 cm	$    133.82	$         181
11422	Procedures	lesion diameter 1.1 to 2.0 cm	$    149.62	$         202
11423	Procedures	lesion diameter 2.1 to 3.0 cm	$    178.51	$         241
11424	Procedures	lesion diameter 3.1 to 4.0 cm	$    205.05	$         277
11426	Procedures	lesion diameter over 4.0 cm	$    289.56	$         391
11450	Procedures	Excision for hidradenitis; axillary; with simple or intermediate repair	$    300.11	$         405
11470	Procedures	Excision for hidradenitis; perianal, perineal, or umbilical;    with simple or intermediate repair	$    323.75	$         437
11720	Procedures	Debridement of Nail (s) by any method; one to five	$      26.40	$           36
11740	Procedures	Evacuation of subungual hematoma	$      35.69	$           48
12001	Procedures	Laceration Repair<2.5cm	$    143.34	$         194
12002	Procedures	Laceration Repair 2.6-7.5cm	$    152.67	$         206
12004	Procedures	Laceration Repair 7.6-12.5cm	$    179.23	$         242
16020	Procedures	Dressing (burn)	$      80.34	$         108
17000	Procedures	Wart Removal/Destruction of Lesions = 1	$      58.61	$           79
17003	Procedures	Wart Removal/Destruction of Lesions = 2-14	$      10.13	$           14
17004	Procedures	Wart Removal/Destruction of Lesions = 15 plus	$    194.19	$         262
17110	Procedures	Destruct flat warts, molluscum contagiosum or milia, up to 14 lesions	$      84.54	$         114
17110	Procedures	Wart Destruction 1-15	$      44.20	$           60
17111	Procedures	Destruct flat warts, molluscum contagiosum or milia, 15 plus lesions	$      96.54	$         130
20600	Procedures	Arthrocentesis, aspiration and/or injection; small joint, bursa or cyst	$      51.10	$           69
20605	Procedures	Arthrocentesis, aspiration and/or injec.; intermed. joint, bursa or cyst	$      55.69	$           75
20610	Procedures	Arthrocentesis, aspiration and/or injection; major joint or bursa	$      68.19	$           92
36415	Procedures	Collection of venous blood by venipuncture	$        3.00	$             4
36416	Procedures	Collection of capillary blood specimen (eg, finger, heel, ear stick)	$            -	$              -
51700	Procedures	Bladder irrigation, simple, lavage and/or instillation	$      93.71	$         127
51701	Procedures	Insertion of non-indwelling bladder catheter	$      76.88	$         104
54050	Procedures	Destruction lesion(s) penis (Condyloma) simple; chemical	$    110.04	$         149
54055	Procedures	Cautery Destruction lesion(s) Penis (Electrodesiccation)	$    106.20	$         143
54065	Procedures	Destruction lesion(s) - penis, extenstive; any method	$    192.36	$         260
56420	Procedures	Incision and drainage of Bartholin's gland abcess	$    141.80	$         191
56501	Procedures	Destruction of lesions (s), vulva, simple, any method	$    130.43	$         176
56515	Procedures	Destruction lesion(s) vulva, extensive; any method	$    212.43	$         287
56605	Procedures	Excision, biopsy of vulva or perineum, one lesion	$      86.84	$         117
56606	Procedures	each separate additional lesion	$      42.12	$           57
57061	Procedures	Destruction vaginal lesion(s) simple; any method	$    114.09	$         154
57100	Procedures	Excision, biopsy of vaginal mucosa, simple	$      91.55	$         124
57160	Procedures	Fitting and insertion of pessary support device	$      75.04	$         101
57170	Procedures	Diaphragm Fitting	$      92.92	$         125
57452	Procedures	Colposcopy	$    111.69	$         151
57454	Procedures	Colposcopy with biopsy and/or endocervical curettage	$    162.15	$         219
57455	Procedures	Biopsy of cervix w/scope	$    149.78	$         202
57456	Procedures	Endocerv curettage w/scope	$    140.86	$         190
57500	Procedures	Excision, cervix, biopsy or local excision, single or multiple	$    132.51	$         179
57505	Procedures	Excision, endocervical cutterage	$    102.08	$         138
57510	Procedures	Cautery (Electro/Thermal) - Cervix	$    138.62	$         187
58100	Procedures	Excision, endometrial sampling	$    114.81	$         155
69210	Procedures	Ear Lavage	$      48.17	$           65
78596	Procedures	PFT Pulmonary quantitive differential function study (ventilation/perfusion)	$    335.99	$         454
92541	Procedures	Spontaneous nystagmus test	$      53.72	$           73
92551	Procedures	Audiogram –Screening	$            -	$              -
92552	Procedures	Audiogram –Threshold	$      17.72	$           24
92567	Procedures	Impedance Tympanometry	$      21.76	$           29
93000	Procedures	EKG	$      26.12	$           35
94010	Procedures	Breathing capacity test	$      31.76	$           43
94014	Procedures	Patient recorded spirometry	$      48.19	$           65
94060	Procedures	PFT Bronchospasm evaluation; spirometry, before and after bronchodialator (aerosol or parenteral)	$      53.45	$           72
94150	Procedures	Peak Flow	$        4.28	$             6
94640	Procedures	Nebulizer Tmt (Airway inhalation tx)	$      11.71	$           16
94640	Procedures	Pulmo-Aid Nebulizer	$      11.71	$           16
94760	Procedures	Pulse Oximetry – Single	$        2.56	$             3
94760	Procedures	Noninvasive ear or pulse oximetry for oxygen saturation; single determination	$        2.56	$             3
94761	Procedures	Pulse Oximetry – Multiple	$        5.92	$             8
94761	Procedures	Noninvasive ear or pulse oximetry for oxygen sat.; multiple determinations	$        5.92	$             8
96110	Procedures	Denver Development Test	$      16.69	$           23
98925	Procedures	OMT - quantity 1-2 Body Regions	$      29.47	$           40
98926	Procedures	OMT - quantity 3-4 Body Regions	$      40.79	$           55
98927	Procedures	OMT - quantity 5-6 Body Regions	$      52.30	$           71

County Fee Analysis
Human Services Committee
Location			2006
of	Fee	2005	Prop.
Service	Description	Fee	Fee
Comm. Health	GC Prob Tech (6)	13.50	14.00
Comm. Disease	Continuing Ed. Fee Diseased Control/Imm. (4)	10.00	10.00
Imm. Clinic	INS Vaccination Verification Form (4)	25.00	25.00
Imm. Clinic	Immunization Record Copying Fee (4)	3.00	3.00
Comm. Health	MSS Tran. Bus/Van (5)	21.59	21.97
		(max)	(max)
Comm. Health	MSS - Trans Taxi (5)	21.70	22.08
		(max)
Comm. Health	MSS Trans. Volunteer (5)	0.23	0.24
		per mile	per mile
Comm. Health	ISS Trans. Bus/Van (5)	21.59	21.97
		(max)
Comm. Health	ISS - Trans Taxi (5)	21.70	22.08
		(max)
Comm. Health	ISS Trans. Volunteer (5)	0.23	0.24
		per mile
Comm. Health	Comprehensive Environmental Investigation (5)	200.00	205.00
Comm. Health	Assessment of Home (5)	85.00	85.00
Comm. Health	Emp./School Physical Examinations	65.00	70.00
Comm. Health	Immigration PE's  - Adult (1)	125.00	125.00
Comm. Health	Immigration PE's  - Children (1)	75.00	75.00
Imm. Clinic	International Travel Consultation	30.00	32.00
Imm. Clinic	Influenza (including Administration)	20.00	25.00
Med. Examiner	Cremation Permits	10.00	15.00
Med. Examiner	Autopsy Report Copies (family)	0.00	10.00
Med. Examiner	Autopsy Report Copies (others)	20.00	25.00