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