MARCH 27, 2001
Agenda Item No. 16
Introduced by the Human Services and Finance Committees of the:
INGHAM COUNTY BOARD OF COMMISSIONERS
RESOLUTION TO ADJUST THE HEALTH DEPARTMENT'S CLINICAL FEE SCHEDULE
RESOLUTION #01-89
WHEREAS, the Board of Commissioners has the authority to establish fees for services provided by the Health Department, such authority being established in the Public Health Code; and
WHEREAS, the Board of Commissioners has established a number of fee schedules for services provided by the Health Department; and
WHEREAS, the Board of Commissioners has established a fee schedule for clinical services; and
WHEREAS, the Department attempts to maintain a fee schedule that assures the maximum collection of fees from first and third parties and the Department charges for clinical services on a sliding fee schedule, based on the patient's ability to pay, with most persons falling in the no pay range; and
WHEREAS, the Health Officer has recommended that a number of the fees in the Clinical Fee Schedule be adjusted to reflect the increase in costs and the increase in the Medicaid fee screen for services.
THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners adopts a new Clinical Fee Schedule, which is attached to the resolution.
BE IT FURTHER RESOLVED, that the new Clinical Fee Schedule will become effective on April 1, 2001.
HUMAN SERVICES COMMITTEE: Yeas: Czarnecki, Dedden, Hertel, Celentino
Nays: Severino Absent: None Approved 3/19/01
FINANCE: Yeas: Czarnecki, Hertel, Schafer, Minter, Swope, Krause
Nays: None Absent: Lynch Approved 3/21/01
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Summary of Changes | ||||
Procedure | Current | Proposed | ||
Code | Explanation of Services | Fee | Fee | |
Office Visits - New Patients | ||||
99205 | New - Level 5-Comprehensive-High Complexity | $70.00 | $110.00 | |
99204 | New - Level 4-Comprehensive-Moderate Complexity | $55.00 | $90.00 | |
99203 | New - Level 3-Detailed-Low Complexity | $40.00 | $65.00 | |
99202 | New - Level 2-Expanded Focus | $40.00 | $45.00 | |
99385 | New - Well Child - 18 + years | $60.00 | $70.00 | |
99384 | New - Well Child - 12 through 17 years | $60.00 | $70.00 | |
99383 | New - Well Child - 5 through 11 years | $60.00 | $70.00 | |
99382 | New - Well Child - 1 through 4 years | $60.00 | $70.00 | |
99381 | New - Well Child - under 1 year | $60.00 | $70.00 | |
Office Visits - Established Patients | ||||
99215 | Revisit - Level 5-Comprehensive-High Complexity | $50.00 | $75.00 | |
99214 | Revisit - Level 4-Comprehensive-Moderate Complexity | $35.00 | $50.00 | |
99213 | Revisit - Level 3-Detailed-Low Complexity | $25.00 | $35.00 | |
99395 | Revisit - Well Child - 18 + years | $50.00 | $60.00 | |
99394 | Revisit - Well Child - 12 through 17 years | $50.00 | $60.00 | |
99393 | Revisit - Well Child - 5 through 11 years | $50.00 | $60.00 | |
99392 | Revisit - Well Child - 1 through 4 years | $50.00 | $60.00 | |
99391 | Revisit - Well Child - under 1 year | $50.00 | $60.00 | |
Other Office Visits | ||||
Marriage License Consults (Single) | $15.00 | |||
Marriage License Consults (Double) | $20.00 | |||
Laboratory | ||||
Clinitest | $5.00 | |||
Diastix | $5.00 | |||
83655 | Lead | $15.00 | ||
86308 | Mono Spot | $5.00 | ||
85651 | Sed. Rate | $5.00 | ||
86403 | Strep Screen | $5.00 | $6.00 | |
80001 | K+ | $15.00 | ||
Procedures | ||||
Allergy Injection | $5.00 | |||
11100 | Biopsy, skin - single lesion | $55.00 | ||
11101 | Biopsy, skin - each additional lesion | $25.00 | ||
54510 | Cautery (Chem.) - Cervix | $10.00 | $115.00 | |
57055 | Cautery (Elec.) - Destruction lesion | $10.00 | $60.00 | |
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 | ||
11710 | 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 | ||||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Summary of Changes | ||||
Procedure | Current | Proposed | ||
Code | Explanation of Services | Fee | Fee | |
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 | $95.00 | ||
intermediate repair | ||||
11470 | Excision for hidradenitis; perianal, perineal, or umbilical; | $110.00 | ||
with simple or intermediate repair | ||||
57500 | Excision, cervix, biopsy or local excision, single or | $55.00 | ||
multiple | ||||
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 | $20.00 | $60.00 | |
56420 | Incision and drainage of Bartholin's gland abcess | $60.00 | ||
98925 | OMT - quantity 1-2 | $20.00 | ||
98926 | OMT - quantity 3-4 | $25.00 | ||
98927 | OMT - quantity 5-6 | $35.00 | ||
11200 | Removal of skin tags, any area, up to and including | $45.00 | ||
15 lesions | ||||
17000 | Wart Removal/Destruction of Lesions = 1 | $15.00 | $40.00 | |
17003 | Wart Removal/Destruction of Lesions = 2-14 | $15.00 | $10.00 | |
86580 | TB Skin Test | $5.00 | $7.00 | |
76830 | Ultrasound, diagnostic; echography, transvaginal | $60.00 | ||
36415 | Venipuncture, routine or finger/heel/ear stick for | $5.00 | ||
collection of specimen(s) | ||||
Injections | ||||
J1100 | Decadron | $5.00 | $6.00 | |
J3301 | Kanalog -10, -40 | $5.00 | $8.00 | |
J0696 | Rocephin Injection 250 mg (each 250 mg. dosage) | $5.00 | $13.00 | |
J2920 | Solu-Medrol | $5.00 | $10.00 | |
J3420 | Vitamin B-12 | $5.00 | $7.00 | |
LEAD POISONING INVESTIGATION FEES | ||||
300027 | Nursing Assessment/Education | $75.00 | $85.00 | |
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Summary of Changes | ||||
Procedure | Current | Proposed | ||
Code | Explanation of Services | Fee | Fee | |
MATERNAL AND INFANT SUPPORT SERVICES | ||||
First Visit/Assessment | $80.00 | |||
Z0001 | Clinic | $80.00 | ||
Z0004/Z0020 | Home | $105.00 | ||
Revisit | $70.00 | |||
Z0002/Z0022 | Clinic | $75.00 | ||
Z0003/Z0021 | Home | $95.00 | ||
PRENATAL FEES | ||||
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 | $45.00 | $50.00 | |
89027 | Annual Physical | $32.00 | $35.00 | |
89025 | Medical Revisit | $14.00 | $15.00 | |
89020 | Counseling Visit | $8.50 | $10.00 | |
Laboratory | ||||
88534 | VDRL | $3.50 | $5.00 | |
Contraceptive Supplies | ||||
89815 | IUD | $90.00 | $125.00 | |
89816 | Sponge | $6.00 | $10.00 | |
Pharmaceutical Supplies | ||||
Gynazole - 1 | $ 20.00 | |||
89867 | Rocephin Injection 250 mg | $10.00 | $13.00 | |
89868 | Terazol Cream | $7.00 | $14.00 |
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
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 | $40.00 | ||
99385 | New - Well Child - 18 + 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 - Extablished Patients | ||||
99215 | Revisit - Level 5-Comprehensive-High Complexity | $75.00 | ||
99214 | Revisit - Level 4-Comprehensive-Moderate Complexity | $50.00 | ||
99213 | Revisit - Level 3-Detailed-Low Complexity | $35.00 | ||
99212 | Revisit - Level 2-Expanded Focus | $25.00 | ||
99211 | Revisit - Level 1-Problem Focused | $25.00 | ||
99395 | Revisit - Well Child - 18 + 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 | ||
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 | Hematocrit/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 | ||
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 | ||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
57510 | Cautery (Chem.) - Cervix | $115.00 | ||
54055 | Cautery (Elec.) - Destruction lesion | $60.00 | ||
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 | ||
11710 | 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 | $95.00 | ||
intermediate repair | ||||
11470 | Excision for hidradenitis; perianal, perineal, or umbilical; | $110.00 | ||
with simple or intermediate repair | ||||
57500 | Excision, cervix, biopsy or local excision, single or | $55.00 | ||
multiple | ||||
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 | $20.00 | ||
98926 | OMT - quantity 3-4 | $25.00 | ||
98927 | OMT - quantity 5-6 | $35.00 | ||
94640 | Pulmo-Aid Nebulizer | $25.00 | ||
11200 | Removal of skin tags, any area, up to and including | $45.00 | ||
15 lesions | ||||
X0055 | Suture Removal | $15.00 | ||
17000 | Wart Removal/Destruction of Lesions = 1 | $40.00 | ||
17003 | Wart Removal/Destruction of Lesions = 2-14 | $10.00 | ||
86580 | TB Skin Test | $7.00 | ||
Dressing | $10.00 | |||
76830 | Ultrasound, diagnostic; echography, transvaginal | $60.00 | ||
36415 | Venipucture, routine or finger/heel/ear stick for | $5.00 | ||
collection of specimen(s) | ||||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
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 | ||||
First Visit/Assessment | ||||
Z0001 | Clinic | $80.00 | ||
Z0004/Z0020 | Home | $105.00 | ||
Revisit | ||||
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 | $50.00 | ||
89027 | Annual Physical | $35.00 | ||
89025 | Medical Revisit | $15.00 | ||
89020 | Counseling Visit | $10.00 | ||
89049 | Lab Only | $6.00 | ||
Procedures | ||||
84710 | Diaphragm Fit | $14.00 | ||
89028 | IUD Insertion | $60.00 | ||
89050 | IUD Removal | $14.00 | ||
89031 | Norplant Insertion | $150.00 | ||
89032 | Norplant Removal | $150.00 | ||
INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE | ||||
Procedure | ||||
Code | Explanation of Services | FEE | ||
Laboratory | ||||
88368 | Hematocrit | $5.00 | ||
88534 | VDRL | $5.00 | ||
88701 | Urinalysis | $3.00 | ||
88703 | Urine Micro | $3.00 | ||
88775 | UCG/ICON | $6.00 | ||
88881 | Hanging drop/Micro | $5.00 | ||
88920 | Cytology/Pap | $8.00 | ||
Contraceptive Supplies | ||||
89800 | Birth Control Pills | $6.50 | ||
89810 | Diaphragm | $10.00 | ||
89811 | Condoms | $0.60 | ||
89812 | Foam/Jelly/Cream | $4.50 | ||
89815 | IUD | $125.00 | ||
89817 | Norplant | $400.00 | ||
Vaginal Contraceptive Film | $1.80 | |||
89818 | Depo Provera | $30.00 | ||
89816 | Sponge | $10.00 | ||
Pharmaceutical Supplies | ||||
89855 | Amoxicillin, 250 mg. | $5.00 | ||
89856 | Amoxicillin, 500 mg. | $5.00 | ||
89851 | Ampicillin, 250 mg. | $5.00 | ||
89852 | Ampicillin, 500 mg. | $5.00 | ||
89858 | Bactrim | $5.00 | ||
89860 | Erythromycin, 250 mg. | $5.00 | ||
89861 | Erythromycin, 500 mg. | $7.00 | ||
89825 | Floxin (single dose) | $5.00 | ||
Floxin (14 day) | $45.00 | |||
89820 | Flagyl (Metronidzaole) | $7.00 | ||
Gantricin | $10.00 | |||
Gynazole - 1 | $20.00 | |||
89862 | Mycelex G Cream | $15.00 | ||
89864 | Keflex 250 mg | $7.00 | ||
89865 | Keflex 500 mg | $7.00 | ||
Monistat | $7.00 | |||
89866 | Macrodantin | $40.00 | ||
89859 | Probenecid 500 mg | $5.00 | ||
89867 | Rocephin Injection 250 mg | $11.00 | ||
Suprax | $5.00 | |||
89868 | Terazol Cream | $14.00 | ||
89850 | Tetracycline 250 mg | $3.00 | ||
89854 | Tetracycline 500 mg | $3.00 | ||
89869 | Vibramycin (Doxycline) | $5.00 |