Innovations

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					                               State Service Rates FY 12/13
                                                                                              Effective
                                                                                                          End Date
Code    Mod                                    Description                           Unit       Date                    Rate
H2014         Developmental Therapy Professional - Individual                       15 min    7/1/2012    6/30/2013     $8.39
H2014 HM Developmental Therapy Paraprofessional - Individual                        15 min    7/1/2012    6/30/2013     $6.01
H2014 HQ Developmental Therapy Professional - Group                                 15 min    7/1/2012    6/30/2013     $2.78
H2014 U1 Developmental Therapy Paraprofessional - Group                             15 min    7/1/2012    6/30/2013     $2.01
H2034    SA Halfway House                                                           per day   7/1/2012    6/30/2013    $46.28
YA213    Community Respite                                                          per day   7/1/2012    6/30/2013   $214.38
YA232    Room & Board - Level III (1-4 Beds) (Current DSS Rate)                     per day   7/1/2012    6/30/2013    $20.10
YA233         Room & Board - Level III (5+ Beds) (Current DSS Rate)                 per day   7/1/2012    6/30/2013    $20.10
YA234         Room & Board - Level II (Age 5 or less) (Current DSS Rate $365/mo)    per day   7/1/2012    6/30/2013    $13.00
YA235         Room & Board - Level II (Age 6-12 less) (Current DSS Rate $415/mo )   per day   7/1/2012    6/30/2013    $14.66
YA236         Room & Board - Level II (Age 13+) (Current DSS Rate $465/mo)          per day   7/1/2012    6/30/2013    $16.33
YA237         Room & Board - Level IV (1-4 Beds) (Current DSS Rate)                 per day   7/1/2012    6/30/2013    $20.10
YA238         Room & Board - Level IV (5+ beds) (Current DSS Rate)                  per day   7/1/2012    6/30/2013    $20.10
YA263         Therapeutic Leave Room & Board - Level III (1-4 Beds)                 per day   7/1/2012    6/30/2013    $20.10
YA264         Therapeutic Leave Room & Board - Level III (5+ Beds)                  per day   7/1/2012    6/30/2013    $20.10
YA265         Therapeutic Leave Room & Board - Level II (Age 5 or less)             per day   7/1/2012    6/30/2013    $13.00
YA266         Therapeutic Leave Room & Board - Level II (Age 6-12)                  per day   7/1/2012    6/30/2013    $14.66
YA267         Therapeutic Leave Room & Board - Level II (Age 13+)                   per day   7/1/2012    6/30/2013    $16.33
YA268         Therapeutic Leave Room & Board - Level IV (1-4 Beds)                  per day   7/1/2012    6/30/2013    $20.10
YA269         Therapeutic Leave Room & Board - Level IV (5+ Beds)                   per day   7/1/2012    6/30/2013    $20.10
YA308         OPC: Peer Support - Individual                                        15 min    7/1/2012    6/30/2013     $8.14
YA309         OPC: Peer Support - Group                                             15 min    7/1/2012    6/30/2013     $2.71
YA323         FC: Assertive Engagement                                              15 min    7/1/2012    6/30/2013    $15.00
YA341         Assertive Engagement                                                  15 min    7/1/2012    6/30/2013    $15.00
YA344         FC: Peer Support                                                      15 min    7/1/2012    6/30/2013     $9.95
YA356         OPC: Assertive Engagement                                             15 min    7/1/2012    6/30/2013    $15.00
YA370         Specialized summer Program (WM)                                       15 min    7/1/2012    6/30/2013     $3.77
YA378         Wellness and Living Skills Education                                  15 min    7/1/2012    6/30/2013     $5.36
YM050         Personal Care                                                         15 min    7/1/2012    6/30/2013     $3.36
YM100         Day Supports - Group                                                  15 min    8/15/2012   6/30/2013     $3.64
YM101         Day Supports - Individual                                             15 min    8/15/2012   6/30/2013     $6.13
YM107         Residential Supports - Level 2                                        per day   8/15/2012   6/30/2013   $124.96
YM108         Residential Supports - Level 3                                        per day   8/15/2012   6/30/2013   $144.19
YM109         Residential Supports - Level 4                                        per day   8/15/2012   6/30/2013   $163.41
YM110         Specialized Consultative Services                                     15 min    8/15/2012   6/30/2013    $25.00
YM112         Supported Employment - Individual                                     15 min    8/15/2012   6/30/2013     $7.39
YM113         Community Networking                                                  15 min    8/15/2012   6/30/2013     $5.35
YM116         Community Guide                                                       per day   8/15/2012   6/30/2013   $150.00
YM550         Adaptive Behavioral Training                                          15 min    7/1/2012    6/30/2013     $5.79
YM645         Supported Employment - Long Term Follow-up (Non-MR/MI)                15 min    7/1/2012    6/30/2013    $11.21
YM811         Supervised Living - 1 Resident                                        per day   7/1/2012    6/30/2013   $116.15
YM812         Supervised Living - 2 Resident                                        per day   7/1/2012    6/30/2013   $116.15
YM813         Supervised Living - 3 Resident                                        per day   7/1/2012    6/30/2013   $116.15
YM814         Supervised Living - 4 Resident                                        per day   7/1/2012    6/30/2013    $93.17
YM815         Supervised Living - 5 Resident                                        per day   7/1/2012    6/30/2013    $77.67
YM816         Supervised Living - 6 Resident                                        per day   7/1/2012    6/30/2013    $68.83
YP010         Hourly Respite - Individual                                           15 min    7/1/2012    6/30/2013     $5.00
YP011         Hourly Respite - Group                                                15 min    7/1/2012    6/30/2013     $1.67
YP020         Personal Assistance                                                   15 min    7/1/2012    6/30/2013     $4.46
YP340         Mandated Team Eval                                                    15 min    7/1/2012    6/30/2013    $22.66
                               State Service Rates FY 12/13
                                                                                   Effective
                                                                                               End Date
Code    Mod                                  Description                  Unit       Date                    Rate
YP610         Developmental Day Activities                               15 min    7/1/2012    6/30/2013     $4.74
YP620         ADVP                                                       15 min    7/1/2012    6/30/2013     $1.13
YP630         Supported Employment - Individual                          15 min    7/1/2012    6/30/2013    $11.21
YP640         Supported Employment - Group                               15 min    7/1/2012    6/30/2013     $2.53
YP650         Community Rehabilitation Program (Sheltered Workshop)      15 min    7/1/2012    6/30/2013     $3.71
YP660         Day Activity                                               15 min    7/1/2012    6/30/2013     $3.75
YP710         Supervised Living Low                                      per day   7/1/2012    6/30/2013    $23.14
YP720         Supervised Living Moderate                                 per day   7/1/2012    6/30/2013    $32.00
YP730         Respite Care - Community Facility                          per day   7/1/2012    6/30/2013   $113.00
YP740         Family Living Low                                          per day   7/1/2012    6/30/2013    $21.73
YP750         Family Living Moderate                                     per day   7/1/2012    6/30/2013    $30.76
YP760         Group Living Low                                           per day   7/1/2012    6/30/2013    $28.92
YP770         Group Living Moderate                                      per day   7/1/2012    6/30/2013    $41.05
YP780         Group Living High                                          per day   7/1/2012    6/30/2013    $66.11
YP790         Detox - Social Setting                                     per day   7/1/2012    6/30/2013   $118.42
YP830         Alcohol and/or Drug Assessment                             15 min    7/1/2012    6/30/2013    $22.00
YP831         Behavioral Health Counseling                               15 min    7/1/2012    6/30/2013    $22.00
YP832         Behavioral Health Counseling - Group Therapy               15 min    7/1/2012    6/30/2013     $8.11
YP833         Behavioral Health Counseling - Family Therapy w/ Client    15 min    7/1/2012    6/30/2013    $22.00
YP834         Behavioral Health Counseling - Family Therapy w/o Client   15 min    7/1/2012    6/30/2013    $22.00
YP835         Alcohol and/or Drug Group Counseling                       15 min    7/1/2012    6/30/2013     $8.11
YP851         Public Psychiatry - Administrative Functions               15 min    7/1/2012    6/30/2013    $25.00
YP852         Public Psychiatry - Consultation/Service Functions         15 min    7/1/2012    6/30/2013    $35.00
SF001         Piedmont - Residential Supports Level 1 - State Funded     per day   7/1/2012    6/30/2013    $85.00
SF002         Piedmont - Residential Supports Level 2 - State Funded     per day   7/1/2012    6/30/2013   $108.12
SF003         Piedmont - Residential Supports Level 3 - State Funded     per day   7/1/2012    6/30/2013   $127.84
SF020         Piedmont - Day Supports - State Funded                     15 min    7/1/2012    6/30/2013     $6.47
SF025         Piedmont - Day Supports Group Setting - State Funded       15 min    7/1/2012    6/30/2013     $3.84
             Innovations Service Rates FY 12/13
                                                                       Effective
Code Mod                         Description                  Unit       Date      End Date      Rate         Limitation
H2011      Primary Crisis Response                           15 min    7/1/2012    6/30/2013     $8.14
H2015      Community Networking                              15 min    7/1/2012    6/30/2013     $5.35
H2015 HQ   Community Networking - Group                      15 min    7/1/2012    6/30/2013     $2.98
H2015 U1   Community Networking - Classes/conferences                  7/1/2012    6/30/2013   Invoice   $1,000 per waiver year
H2016      Residential Supports Level 1                      per day   7/1/2012    6/30/2013    $86.51
H2016      Residential Supports Level 1 - AFL                per day   7/1/2012    6/30/2013    $91.51
H2016 HI   Residential Supports Level 4                      per day   7/1/2012    6/30/2013   $163.41
H2016 HI   Residential Supports Level 4 - AFL                per day   7/1/2012    6/30/2013   $168.41
H2025      Supported Employment Services - Individual        15 min    7/1/2012    6/30/2013     $7.39
H2025 HQ   Supported Employment Services - Group             15 min    7/1/2012    6/30/2013     $1.90
S5110      Natural Supports Education                        15 min    7/1/2012    6/30/2013     $8.53
S5111      Natural Supports Education - Conference                     7/1/2012    6/30/2013   Invoice   $1,000 per waiver year
S5125      Personal Care                                     15 min    7/1/2012    6/30/2013     $3.54
S5150      Respite Care - Community Individual               15 min    7/1/2012    6/30/2013     $3.54
S5150 HQ   Respite Care - Community Group                    15 min    7/1/2012    6/30/2013     $2.69
S5150 US   Respite Care - Community Facility                 per day   7/1/2012    6/30/2013   $240.00
S5165      Home Modifications                                          7/1/2012    6/30/2013   Invoice   $20,000 over five years
T1005 TD   Respite Care Nursing - RN                         15 min    7/1/2012    6/30/2013     $8.82
T1005 TE   Respite Care Nursing - LPN                        15 min    7/1/2012    6/30/2013     $8.82
T1015      Intensive In Home Support                         15 min    7/1/2012    6/30/2013     $4.74
T1999      Individual Goods and Services                               7/1/2012    6/30/2013   Invoice   $2,000 per waiver year
T2013      In Home Skill Building - Individual               15 min    7/1/2012    6/30/2013     $5.35
T2013 HQ   In Home Skill Building - Group                    15 min    7/1/2012    6/30/2013     $2.98
T2014      Residential Supports Level 2                      per day   7/1/2012    6/30/2013   $124.96
T2014      Residential Supports Level 2 - AFL                per day   7/1/2012    6/30/2013   $129.96
T2016 HI   Residential Supports Level 5                      per day   7/1/2012    6/30/2013   $200.00
T2016 HI   Residential Supports Level 5 - AFL                per day   7/1/2012    6/30/2013   $205.00
T2020      Residential Supports Level 3                      per day   7/1/2012    6/30/2013   $144.19
T2020      Residential Supports Level 3 - AFL                per day   7/1/2012    6/30/2013   $149.19
T2021      Day Supports - Individual                         15 min    7/1/2012    6/30/2013     $6.13
T2021 HQ   Day Supports - Group                              15 min    7/1/2012    6/30/2013     $3.64
T2025      Specialized Consultative Services                 15 min    7/1/2012    6/30/2013    $25.00
T2025 HO   Specialized Consultative Services - BCBA          15 min    7/1/2012    6/30/2013    $25.00
T2025 U1   Financial Supports                                monthly   7/1/2012    6/30/2013   $199.00
T2025 U2   FM Supplies                                                 7/1/2012    6/30/2013   Invoice
T2025 U3   Crisis Behavioral Consultation                    15 min    7/1/2012    6/30/2013    $18.75
T2027      Day Supports - Developmental Day                  15 min    7/1/2012    6/30/2013     $6.13
T2028      Communication Device - Purchase                             7/1/2012    6/30/2013   Invoice   $15,000 over five years
T2029      Assistive Technology - Equipment and Supplies               7/1/2012    6/30/2013   Invoice   $15,000 over five years
T2034      Out of Home Crisis                                per day   7/1/2012    6/30/2013   $235.00
T2038      Community Transition Supports                     1 time    7/1/2012    6/30/2013   Invoice          $5,000 one time
T2039      Vehicle Adaptations                                         7/1/2012    6/30/2013   Invoice   $20,000 over five years
T2041      Community Guide                                   monthly   7/1/2012    6/30/2013   $150.00
T2041 U1   Community Guide Training for Employer of Record   15 min    7/1/2012    6/30/2013    $11.75                 30 hours
V5336      Communication Device - Repairs                              7/1/2012    6/30/2013   Invoice
                          B3 Service Rates FY 12/13
                                                                                    Effective
Code       Mod Mod                        Description                  Unit           Date      End Date       Rate      Limitation
H0038                Peer Support                                     15 min        7/1/2012    12/31/2012     $9.36
H0038      U4        Peer Support                                     15 min        7/1/2012    11/30/2012     $9.36
H0038      U4        Peer Support                                     15 min        12/1/2012   6/30/2013     $12.00
H0038      HQ        Peer Support Group                               15 min        7/1/2012    12/31/2012     $2.71
H0038      HQ   U4   Peer Support Group                               15 min        7/1/2012    6/30/2013      $2.71
H0043 **             Community Transition                             1 Time        7/1/2012    12/31/2012   Invoice $5,000 one time
H0043 ** U4          Community Transition                             1 Time        7/1/20/12   6/30/2013    Invoice $5,000 one time
H0045                Individual Respite                               15 min        7/1/2012    12/31/2012     $3.88
H0045      U4        Individual Respite                               15 min        7/1/2012    6/30/2013      $3.88
H0045      HQ        Group Respite                                    15 min        7/1/2012    12/31/2012     $3.00
H0045      HQ   U4   Group Respite                                    15 min        7/1/2012    6/30/2013      $3.00
H2023 **             Initial Individual Supported Employmemt          15 min        7/1/2012    12/31/2012    $11.21
H2023 ** U4          Initial Individual Supported Employmemt          15 min        7/1/2012    6/30/2013     $11.21
H2023 ** HQ          Initial Group Supported Employmemt               15 min        7/1/2012    12/31/2012     $2.53
H2023 ** HQ     U4   Initial Group Supported Employmemt               15 min        7/1/2012    6/30/2013      $2.53
H2026 **             Maintenance Individual Supported Employment      15 min        7/1/2012    12/31/2012    $11.21
H2026 ** U4          Maintenance Individual Supported Employment      15 min        7/1/2012    6/30/2013     $11.21
H2026 ** HQ          Maintenance Group Supported Employment           15 min        7/1/2012    12/31/2012     $1.27
H2026 ** HQ     U4   Maintenance Group Supported Employment           15 min        7/1/2012    6/30/2013      $1.27
S5151                Respite Care - Community Facility               per day        7/1/2012    6/30/2013    $240.09
T1019                Individual Support                               15 min        7/1/2012    12/31/2012     $6.50
T1019      U4        Individual Support                               15 min        7/1/2012    11/30/2012     $6.50
T1019      U4        Individual Support                               15 min        12/1/2012   6/30/2013     $12.00
T2041      U4        Community Guide                                 monthly        7/1/2012    6/30/2013    $150.00
99241      U4        Psychiatric Consultation - approx 15 min      per time limit   7/1/2012    6/30/2013     $55.00
99242      U4        Psychiatric Consultation - approx 30 min      per time limit   7/1/2012    6/30/2013     $90.00
99244      U4        Psychiatric Consultation - approx 60 min      per time limit   7/1/2012    6/30/2013    $168.00



                      ** DD Consumers only
                 Medicaid HCSPCS MH/DD/SA Service Rates FY 12/13
                                                                                                            Effective
Code Mod Mod                                     Description                                    Unit          Date      End Date      Rate
H0001          Behavioral Health Assessment                                                    15 min       7/1/2012    6/30/2013    $22.00
H0002          GAIN Assessment                                                                 15 min       7/1/2012    6/30/2013    $22.00
H0004          Behavioral Health Counseling and Therapy                                        15 min       7/1/2012    6/30/2013    $22.00
H0004 HQ       DMH Outpatient Treatment Program                                                15 min       7/1/2012    6/30/2013     $8.11
H0004 HR       DMH Outpatient Tx Family Therapy with Client                                    15 min       7/1/2012    6/30/2013    $22.00
H0004 HS       DMH Outpatient Tx Family Therapy without Client                                 15 min       7/1/2012    6/30/2013    $22.00
H0005          Alcohol and/or Drug Services;Group Counseling by Clinician                      15 min       7/1/2012    6/30/2013     $8.11
H0010          Non-Hospital Medical Detoxification                                            per diem      7/1/2012    6/30/2013   $367.57
H0012 HB       Non-Hospital Community Residential Treatment - Adult                           per diem      7/1/2012    6/30/2013   $155.81
H0013          Medically Monitored Community Residential Treatment                            per diem      7/1/2012    6/30/2013   $265.25
H0014          Ambulatory Detoxification                                                       15 min       7/1/2012    6/30/2013    $21.25
H0015          Substance Abuse Intensive Outpatient Program                                   per diem      7/1/2012    6/30/2013   $148.52
               Behavioral Health Long Term Residential (HRI Level III-4 beds or less) for
                                                                                                            7/1/2012    6/30/2013
H0019          providers who have been credentialed to provide the new staffing pattern       per diem                              $252.38
               Behavioral Health Long Term Residential (HRI Level III-5 beds or more) for
                                                                                                            7/1/2012    6/30/2013
H0019          providers who have been credentialed to provide the new staffing pattern       per diem                              $205.64
H0019          Behavioral health Long Term Residential (HRI Level IV)                         per diem      7/1/2012    6/30/2013   $342.15
H0020          Alcohol and/or Drug Services; methadone administration                         per event     7/1/2012    6/30/2013    $19.17
H0031          Mental Health Assessment                                                        15 min       7/1/2012    6/30/2013    $22.00
H0035          DMH Partial Hospitalization Per Diem - Child/Adults                            per diem      7/1/2012    6/30/2013   $121.69
H0040          Assertive Community Treatment Team (ACTT)                                    (4 per month)   7/1/2012    6/30/2013   $323.98
H0046          Mental Health Services, Not Otherwise Specified (HRI Level I-Foster Care)      per diem      7/1/2012    6/30/2013    $75.00
H2011 HF       Mobile Crisis Management (MH/SA)                                                15 min       7/1/2012    6/30/2013    $34.37
H2012 HA       Child and Adolescent Day Treatment                                             per hour      7/1/2012    6/30/2013    $31.25
H2015 HT       Community Support Team (MH/SA)                                                  15 min       7/1/2012    6/30/2013    $16.52
H2017          DMH Psychosocial Rehabilitation (PSR)                                           15 min       7/1/2012    6/30/2013     $2.90
H2020          Therapeutic Behavioral Services (HRI Level II-Group Homes)                     per diem      7/1/2012    6/30/2013   $136.04
H2022          Intensive In-Home Services                                                     per diem      7/1/2012    6/30/2013   $258.20
H2033          Multi-Systemic Therapy (MST)                                                    15 min       7/1/2012    6/30/2013    $37.32
H2035          SA Comprehensive Outpatient Treatment Program                                  per hour      7/1/2012    6/30/2013    $46.28
S5145          Foster Care, Therapeutic, Child (HRI Level II - Therapeutic Foster Care)       per diem      7/1/2012    6/30/2013    $95.40
S9484          Crisis Intervention (Facility Based Crisis)                                    per hour      7/1/2012    6/30/2013    $18.78
S9484 HA       Facility Based Crisis Program - Children and Adolescents                       per hour      7/1/2012    6/30/2013    $18.78
T1023          Diagnostic Assessment (MH/SA)                                                   event        7/1/2012    6/30/2013   $261.13

H2036          Medically Supervised or ADATC Detoxification/Crisis Stabilization              per diem      7/1/2012    6/30/2013
               (Per diem rate will be determined by individual provider)
             MH/DD/SA CPT Fee Schedules
                         FY 12/13                                                                          Licensed     LCSW, LPC Certified Clinical Certified Nurse    Physician     Physician        LPA          LCAS
                                                                                                         Psychologist    & LMFT       Nurse Specialist  Practitioner    Assistant
                                                                                                         Fee Schedule Fee Schedule     Fee Schedule    Fee Schedule Fee Schedule Fee Schedule Fee Schedule Fee Schedule
                                                                               Effective                  Provider       Provider       Provider         Provider        Provider     Provider       Provider      Provider
 Code Mod                    Description                             Unit        Date       End Date     Specialty 109 Specialty 110   Specialty 111   Specialty 112   Specialty 999 Specialty 001 Specialty 128 Specialty 129
90785+    Interactive Complexity Add-on                         per time limit 1/1/2013     6/30/2013             $3.96         $2.97            $3.37           $3.37          $3.37         $3.96         $2.97         $2.97
 90791    Psychiatric Diagnostic Evaluation                      per event     1/1/2013     6/30/2013          $125.39        $94.04           $119.80         $119.80       $119.80       $140.94        $94.04        $94.04
                                                                 per event
90792       Psychiatric Diagnostic Evaluation w/ medical svc                     1/1/2013    6/30/2013                                        $134.56         $134.56       $134.56        $158.30
90801       Per Clinical Intake                                  per event       7/1/2012   12/31/2012         $140.94       $105.71          $119.80         $119.80       $119.80        $158.30       $105.71        $105.71
90802       Interactive Evaluation                               per event       7/1/2012   12/31/2012         $149.73       $112.30          $127.27         $127.27       $127.27        $149.73       $112.30        $112.30
90804       Individual Therapy (20-30 min)                      per time limit   7/1/2012   12/31/2012          $60.48        $45.36           $51.41          $51.41        $51.41         $60.48        $45.36         $45.36
90805       Individual Therapy (20-30 min) MD                   per time limit   7/1/2012   12/31/2012                                                         $63.04        $63.04         $73.48
90806       Individual Therapy (45-50 min)                      per time limit   7/1/2012   12/31/2012          $91.07        $68.30           $77.41          $77.41        $77.41         $91.07        $68.30         $68.30
90807       Individual Therapy (45-50 min) MD                   per time limit   7/1/2012   12/31/2012                                                         $88.99        $88.99        $103.58
90808       Individual Therapy (75+ min)                        per time limit   7/1/2012   12/31/2012         $135.95       $101.96          $115.55         $115.55       $115.55        $135.95       $101.96        $101.96
90809       Individual Therapy (75+ min) MD                     per time limit   7/1/2012   12/31/2012                                                                      $118.50        $139.41
90810       Interactive Therapy (30 min)                        per time limit   7/1/2012   12/31/2012          $65.34        $49.00           $55.54          $55.54        $55.54         $65.34        $49.00         $49.00
90811       Interactive Therapy (30 min) MD                     per time limit   7/1/2012   12/31/2012                                                         $62.12        $62.12         $72.20
90812       Interactive Therapy (50 min)                        per time limit   7/1/2012   12/31/2012          $98.01        $73.51           $83.31          $83.31        $83.31         $98.01        $73.51         $73.51
90813       Interactive Therapy (50 min) MD                     per time limit   7/1/2012   12/31/2012                                                         $87.84        $87.84        $102.30
90814       Interactive Therapy (80 min)                        per time limit   7/1/2012   12/31/2012         $142.22       $106.67          $120.89         $120.89       $120.89        $142.22       $106.67        $106.67
90815       Interactive Therapy (80 min) w/eval & mgmt svcs     per time limit   7/1/2012   12/31/2012                                                        $124.58       $124.58        $144.97
90816       Individual Therapy (30 min)                         per time limit   7/1/2012   6/30/2013           $60.93        $45.70           $51.79          $51.79        $51.79         $60.93        $45.70         $45.70
90817       Individual Therapy (30 min) MD Inpt, res setting    per time limit   7/1/2012   6/30/2013                                                                        $55.89         $65.75
90818       Individual Therapy (50 min) Inpt, res setting       per time limit   7/1/2012   6/30/2013           $91.82        $68.87           $78.05          $78.05        $78.05         $91.82        $68.87         $68.87
90819       Individual Therapy (50 min) MD Inpt, res setting    per time limit   7/1/2012   6/30/2013                                                                        $81.17         $95.49
90821       Individual Therapy (80 min)                         per time limit   7/1/2012   6/30/2013          $136.72       $102.54          $116.22         $116.22       $116.22        $136.72       $102.54        $102.54
            Individual Therapy (80 min) w/eval & mgmt svcs;
90822                                                           per time limit 7/1/2012     6/30/2013
            Inpt res setting                                                                                                                                                $118.30        $139.18
90823       Interactive Therapy (30 min)                        per time limit 7/1/2012     6/30/2013           $65.55        $49.17           $55.72          $55.72        $55.72         $65.55        $49.17         $49.17
            Interactive Therapy (30 min) w/eval & mgmt svcs;
90824                                                           per time limit 7/1/2012     6/30/2013
            Inpt res setting                                                                                                                                                 $60.32         $70.97
90826       Interactive Therapy (50 min)                        per time limit 7/1/2012     6/30/2013           $97.37        $73.02           $82.76          $82.76        $82.76         $97.37        $73.02         $73.02
            Interactive Therapy (50 min) w/eval & mgmt svcs;
90827                                                           per time limit 7/1/2012     6/30/2013
            Inpt res setting                                                                                                                                                 $85.61        $100.72
90828       Interactive Therapy (80 min)                        per time limit 7/1/2012     6/30/2013          $142.34       $106.75          $120.99         $120.99       $120.99        $142.34       $106.75        $106.75
            Interactive Therapy (80 min) w/eval & mgmt svcs;
90829                                                           per time limit 7/1/2012     6/30/2013
            Inpt res setting                                                                                                                                                $122.75        $144.41
 90832      Psychotherapy, 16 - 37 mins                         per time limit   1/1/2013   6/30/2013           $52.24        $39.18           $51.41          $51.41        $51.41         $60.48        $39.18         $39.18
90833+      Psychotherapy, 16 - 37 mins with E/M svc            per time limit   1/1/2013   6/30/2013                                          $29.67          $29.67        $29.67         $34.91
 90834      Psychotherapy, 38 - 52 mins                         per time limit   1/1/2013   6/30/2013           $78.36        $58.77           $77.41          $77.41        $77.41         $91.07        $58.77         $58.77
90836+      Psychotherapy, 38 - 52 mins with E/M svc            per time limit   1/1/2013   6/30/2013                                          $48.21          $48.21        $48.21         $56.72
 90837      Psychotherapy, 53+ mins                             per time limit   1/1/2013   6/30/2013           $99.42        $74.57           $96.48          $96.48        $96.48        $113.51        $74.57         $74.57
90838+      Psychotherapy, 53+ mins with E/M svc                per time limit   1/1/2013   6/30/2013                                          $77.85          $77.85        $77.85         $91.59
 90839      Psychotherapy for Crisis, 30 - 74 mins              per time limit   1/1/2013   6/30/2013          $125.28        $93.96          $106.49         $106.49       $106.49        $125.28        $93.96         $93.96
            Psychotherapy for Crisis, each add'l 30 mins
90840+                                                          per time limit
            beyond initial 74 mins, up to two add-ons                            1/1/2013    6/30/2013         $105.47        $79.10           $89.65          $89.65        $89.65        $105.47        $79.10         $79.10
90846       Family Therapy w/o Patient                           per event       7/1/2012   6/30/2013           $88.34        $66.25           $75.09          $75.09        $75.09         $88.34        $66.25         $66.25
90847       Family Therapy w/ Patient                            per event       7/1/2012   6/30/2013          $107.88        $80.91           $91.70          $91.70        $91.70        $107.88        $80.91         $80.91
90849       Group Therapy                                        per event       7/1/2012   6/30/2013           $30.65        $22.98           $26.05          $26.05        $26.05         $30.65        $22.98         $22.98
90853       Group Therapy                                        per event       7/1/2012   6/30/2013           $29.75        $22.31           $25.29          $25.29        $25.29         $29.75        $22.31         $22.31
90857       Interactive Group Psychotherapy                      per event       7/1/2012   12/31/2012          $32.52        $24.39           $27.64          $27.64        $27.64         $32.52        $24.39         $24.39
90862       Medication Check-Individual                          per event       7/1/2012   12/31/2012                                                         $56.15        $56.15         $74.86
90870       Special Therapy                                      per event       7/1/2012   6/30/2013                                                                                       $79.23
90772       Therapeutic, prophylactic or diagnostic injection    per event       7/1/2012   6/30/2013                                                                                       $16.62
96101       Psychological Testing                                per hour        7/1/2012   6/30/2013           $89.65                                                                      $89.65        $67.23         $67.23
96105       Aphasia assessment w/interp & report                 per hour        7/1/2012   6/30/2013                         $47.07
96110       Development Testing                                  per event       7/1/2012   6/30/2013           $10.11         $7.58                                                        $10.11         $7.58          $7.58
96111       Development Testing                                  per hour        7/1/2012   6/30/2013          $132.53        $99.40                                                       $132.53        $99.40         $99.40
96116       Neurobehavioral Status Exam                          per hour        7/1/2012   6/30/2013           $98.60                                                                      $98.60        $73.95         $73.95
96118       Neuropsychological Testing                           per hour        7/1/2012   6/30/2013          $117.15                                                                     $117.15        $87.86         $87.86
96372       Therapeutic, prophylactic or diagnostic injection    per event       7/1/2012   6/30/2013                                                                                       $16.62
H0001    Behavioral Health Assessment                        15 min   7/1/2012   6/30/2013   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00
H0004    Behavioral Health Counseling and Therapy            15 min   7/1/2012   6/30/2013   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00
H0004 HQ DMH Outpatient Treatment Group                      15 min   7/1/2012   6/30/2013    $8.11    $8.11    $8.11    $8.11    $8.11    $8.11    $8.11    $8.11
H0004 HR DMH Outpatient Tx Family Therapy w/ Client          15 min   7/1/2012   6/30/2013   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00
H0004 HS DMH Outpatient Tx Family Therapy w/o Client         15 min   7/1/2012   6/30/2013   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00
         Alcohol and/or Drug Services; group Counseling by
H0005                                                        15 min   7/1/2012   6/30/2013
         Clinician                                                                            $8.11    $8.11    $8.11    $8.11    $8.11    $8.11    $8.11    $8.11
H0031    Mental Health Assessment                            15 min   7/1/2012   6/30/2013   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.00
                EM & ER Service Rates FY 12/13
                                                                                                                    CNP         PA
                                                                                                       Physican Provider     Provider
                                                                                                       Provider
                                                                                   Effective           Speciality Speciality Speciality
Code                              Description                           Unit         Date    End Date     001        112        999
90865   narcosynthesis for psychiatric diagnostic and therapeutic    per event     7/1/2012 6/30/2013    $111.98      $95.18     $95.18
95970   electronic analysis of implanted neurostimulator pulse       per event     7/1/2012 6/30/2013      $18.37     $15.61     $15.61
95971   electronic analysis of implanted neurostimulator pulse       per event     7/1/2012 6/30/2013      $33.21     $28.23     $28.23
95972   electronic analysis of implanted neurostimulator pulse      per time limit 7/1/2012 6/30/2013      $63.09     $53.63     $53.63
95973   electronic analysis of implanted neurostimulator pulse      per time limit 7/1/2012 6/30/2013      $37.56     $31.93     $31.93
95974   electronic analysis of implanted neurostimulator pulse      per time limit 7/1/2012 6/30/2013    $123.81    $105.24     $105.24
95975   electronic analysis of implanted neurostimulator pulse      per time limit 7/1/2012 6/30/2013      $71.24     $60.55     $60.55
95978   electronic analysis of implanted neurostimulator pulse      per time limit 7/1/2012 6/30/2013    $145.28    $123.49     $123.49
95979   electronic analysis of implanted neurostimulator pulse      per time limit 7/1/2012 6/30/2013      $68.29     $58.05     $58.05
96125   standardized cognitive performance testing (eg, ross        per time limit 7/1/2012 6/30/2013      $67.13     $57.06     $57.06
96150   h & b assess, 15 min face to face with pt, initial          per time limit 7/1/2012 6/30/2013      $18.96     $16.12     $16.12
96151   h & b assess, 15 min face to face with pt, reassessment     per time limit 7/1/2012 6/30/2013      $18.34     $15.59     $15.59
96152   h & b assess, 15 min face to face with pt, indiviaual       per time limit 7/1/2012 6/30/2013      $78.38     $66.62     $66.62
96372   injection (specify substance or drug) subcutaneous or        per event     7/1/2012 6/30/2013      $17.04     $14.48     $14.48
96373   injection (specify substance or drug) intra-arterial         per event     7/1/2012 6/30/2013      $14.63     $12.44     $12.44
96374   injection (specify substance or drug) intravenous push       per event     7/1/2012 6/30/2013      $43.61     $37.07     $37.07
96375   therapeutic, prophylactic, or diagnostic injection (specify  per event     7/1/2012 6/30/2013      $18.91     $16.07     $16.07
99201   ov new pt, minor - phys time approx 10 min                  per time limit 7/1/2012 6/30/2013      $21.46     $18.24     $18.24
99202   ov new pt, moderate - phys time approx 20 min               per time limit 7/1/2012 6/30/2013      $41.38     $35.17     $35.17
99203   ov new pt, moderate -phys time approx 30 min                per time limit 7/1/2012 6/30/2013      $62.45     $53.08     $53.08
99204   ov new pt, complex - phys time approx 45 min                per time limit 7/1/2012 6/30/2013    $104.87      $89.14     $89.14
99205   ov new pt, severe - phys time approx 60 min                 per time limit 7/1/2012 6/30/2013    $136.47    $116.00     $116.00
99211   ov estab pt, minimal w/wo phys, time approx 5 min           per time limit 7/1/2012 6/30/2013       $7.94      $6.75      $6.75
99212   ov estab pt, minor - phys time approx 10 min                per time limit 7/1/2012 6/30/2013      $21.14     $17.97     $17.97
99213   ov estab pt, moderate - phys time approx 15 min             per time limit 7/1/2012 12/31/2012     $41.37     $35.16     $35.16
99213   ov estab pt, moderate - phys time approx 15 min             per time limit 1/1/2013 6/30/2013      $74.86     $63.63     $63.63
99214   ov estab pt, severe - phys time approx 25 min               per time limit 7/1/2012 12/31/2012     $64.00     $54.40     $54.40
99214   ov estab pt, severe - phys time approx 25 min               per time limit 1/1/2013 6/30/2013      $85.00     $72.25     $72.25
99215   ov estab pt, severe phys time approx 40 min                 per time limit 7/1/2012 6/30/2013      $90.87     $77.24     $77.24
99217   observation care discharge day management                    per event     7/1/2012 6/30/2013      $61.32     $52.12     $52.12
99218   initial observation care, per day, low complexity             per day      7/1/2012 6/30/2013      $57.84     $49.16     $49.16
99219   initial observation care, per day, moderate complexity        per day      7/1/2012 6/30/2013      $95.78     $81.41     $81.41
99220   initial observation care, per day, high complexity            per day      7/1/2012 6/30/2013    $134.33    $114.18     $114.18
99221   Initial hospital care, minor, phys                            per day      7/1/2012 6/30/2013      $62.60        N/A        N/A
99222   Initial hospital care, moderate, phys                         per day      7/1/2012 6/30/2013    $103.86         N/A        N/A
99223   initial hosp care, severe - phys time approx 70 min           per day      7/1/2012 6/30/2013    $166.89    $141.86     $141.86
99231   subsequent hosp care, stable - phys time approx 15 min      per time limit 7/1/2012 6/30/2013      $34.30     $29.16     $29.16
99232   subsequent hosp care, moderate - phys time approx 25        per time limit 7/1/2012 6/30/2013      $61.81     $52.54     $52.54
99233   subsequent hosp care, complex - phys time approx 35 min per time limit 7/1/2012 6/30/2013          $88.53     $75.25     $75.25
99234   observation or inpatient hospital care, for the evaluation   per event     7/1/2012 6/30/2013    $117.16      $99.59     $99.59
99235   observation or inpatient hospital care, for the evaluation   per event     7/1/2012 6/30/2013    $153.91    $130.82     $130.82
99236   observation or inpatient hospital care, for the evaluation   per event     7/1/2012 6/30/2013    $191.29    $162.60     $162.60
99238   hospital discharge day management; 30 min or less           per time limit 7/1/2012 6/30/2013      $61.11     $51.94     $51.94
99239   hospital discharge day management; more than 30 min         per time limit 7/1/2012 6/30/2013      $88.81     $75.49     $75.49
99241   outpt. consult, minor - phys time approx 15 min             per time limit 7/1/2012 6/30/2013      $27.57     $23.43     $23.43
99242   outpt. consult, moderate - phys time approx 30 min          per time limit 7/1/2012 6/30/2013      $58.18     $49.45     $49.45
99243   outpt. consult, severe - phys time approx 40 min            per time limit 7/1/2012 6/30/2013      $81.09     $68.93     $68.93
99244   outpt. consult, severe - phys time approx 60 min            per time limit 7/1/2012 6/30/2013    $128.77    $109.45     $109.45
99245   outpt. consult, severe - phys time approx 80 min            per time limit 7/1/2012 6/30/2013    $160.63    $136.54     $136.54
99251   initial inpt consult - phys time approx 20 min              per time limit 7/1/2012 6/30/2013      $40.82     $34.70     $34.70
99252   initial inpt consult - phys time approx 40 min              per time limit 7/1/2012 6/30/2013      $63.26     $53.77     $53.77
99253   initial inpt consult - phys time approx 55 min              per time limit 7/1/2012 6/30/2013      $96.03     $81.63     $81.63
99254   initial inpt consult - phys time approx 80 min              per time limit 7/1/2012 6/30/2013    $138.89    $118.06     $118.06
99255   initial inpt consult - phys time approx 110 min             per time limit 7/1/2012 6/30/2013    $169.23    $143.85     $143.85
99281   er visit, minor                                              per event     7/1/2012 6/30/2013      $17.03     $14.48     $14.48
99282   er visit, low severity                                       per event     7/1/2012 6/30/2013      $33.13     $28.16     $28.16
99283   er visit, moderate severity                                  per event     7/1/2012 6/30/2013      $51.35     $43.65     $43.65
99284   er visit, high severity                                      per event     7/1/2012 6/30/2013      $96.14     $81.72     $81.72
99285   er visit for the evaluation and mgmt of a patient,           per event     7/1/2012 6/30/2013    $142.93    $121.49     $121.49
                 EM & ER Service Rates FY 12/13
                                                                                                                              CNP         PA
                                                                                                                 Physican Provider     Provider
                                                                                                                 Provider
                                                                                         Effective               Speciality Speciality Speciality
Code                               Description                              Unit           Date      End Date       001        112        999
99304   initial nursing facility care, per day, for evaluation & mgmt     per day        7/1/2012    6/30/2013       $74.00     $62.90     $62.90
99305   initial nursing facility care, per day, for evaluation & mgmt     per day        7/1/2012    6/30/2013     $103.46      $87.94     $87.94
99306   initial nursing facility care, per day, for evaluation & mgmt     per day        7/1/2012    6/30/2013     $132.95    $113.01     $113.01
99307   subsequent nursing facility care, per day, evaluation and         per day        7/1/2012    6/30/2013       $36.52     $31.04     $31.04
99308   subsequent nursing facility care, per day, evaluation and         per day        7/1/2012    6/30/2013       $55.83     $47.46     $47.46
99309   subsequent nursing facility care, per day, evaluation and         per day        7/1/2012    6/30/2013       $74.06     $62.95     $62.95
99310   subsequent nursing facility care, per day, evaluation and         per day        7/1/2012    6/30/2013     $109.51      $93.08     $93.08
99315   nursing facility discharge day management; 30 min or less       per time limit   7/1/2012    6/30/2013       $53.43     $45.42     $45.42
99316   nursing facility discharge 30 min or less more than 30 min      per time limit   7/1/2012    6/30/2013       $69.81     $59.34     $59.34
99318   evaluation and mgmt of a patient involving annual nursing       per time limit   7/1/2012    6/30/2013       $77.42     $65.81     $65.81
99324   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013       $49.64     $42.19     $42.19
99325   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013       $72.30     $61.46     $61.46
99326   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013     $119.54    $101.61     $101.61
99327   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013     $155.92    $132.53     $132.53
99328   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013     $183.55    $156.02     $156.02
99334   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013       $51.16     $43.49     $43.49
99335   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013       $79.25     $67.36     $67.36
99336   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013     $111.60      $94.86     $94.86
99337   domiciliary or rest home visit evaluation and mgmt of a         per time limit   7/1/2012    6/30/2013     $160.35    $136.30     $136.30
99341   home visit for the evaluation and mgmt of a new patient         per time limit   7/1/2012    6/30/2013       $49.64     $42.19     $42.19
99342   home visit for the evaluation and mgmt of a new patient         per time limit   7/1/2012    6/30/2013       $72.30     $61.46     $61.46
99343   home visit for the evaluation and mgmt of a new patient         per time limit   7/1/2012    6/30/2013     $116.43      $98.97     $98.97
99344   home visit for the evaluation and mgmt of a new patient         per time limit   7/1/2012    6/30/2013     $152.86    $129.93     $129.93
99345   home visit for the evaluation and mgmt of a new patient         per time limit   7/1/2012    6/30/2013     $183.86    $156.28     $156.28
99347   home visit for the evaluation and mgmt of established           per time limit   7/1/2012    6/30/2013       $48.44     $41.17     $41.17
99348   home visit for the evaluation and mgmt of established           per time limit   7/1/2012    6/30/2013       $73.14     $62.17     $62.17
99349   home visit for the evaluation and mgmt of established           per time limit   7/1/2012    6/30/2013     $106.51      $90.53     $90.53
99350   home visit for the evaluation and mgmt of established           per time limit   7/1/2012    6/30/2013     $148.49    $126.22     $126.22
99354   prolonged physician service in office or outpatient setting     per time limit   7/1/2012    6/30/2013       $80.13     $68.11     $68.11
99355   prolonged physician service in office or outpatient setting     per time limit   7/1/2012    6/30/2013       $79.28     $67.39     $67.39
99356   prolonged physician service in inpatient setting, requiring     per time limit   7/1/2012    6/30/2013       $77.23     $65.65     $65.65
99357   prolonged physician service in inpatient setting, requiring     per time limit   7/1/2012    6/30/2013       $77.76     $66.10     $66.10
Q3014   telehealth originating site facility fee                                         7/1/2012    6/30/2013       $21.25     $21.25     $21.25

				
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