Medicaid in Education Alert
New York State Department of Health (DOH), Office of Health Insurance Programs (OHIP)
New York State Education Department (NYSED)
Preschool/School Supportive Health Services Program (SSHSP)
Medicaid in Education

Issue #18-03

To: All SSHSP Medicaid Providers
From: NYS DOH OHIP SSHSP &
NYSED Medicaid in Education Unit
Date: June 29, 2018
Subject: Encounter-based Rate Changes for School Supportive Health
Services Program

The purpose of this Alert is to inform SSHSP providers of changes to the encounter-based fee-for-service rates. In 2010 SSHSP encounter-based rates were benchmarked at 75% of the 2010 Mid-Hudson region Medicare rates. The Department of Health received approval from CMS to increase most of the SSHSP rates to 100% of the 2017 Mid-Hudson region Medicare rates. This does not apply to special transportation and skilled nursing services. The new rates will be retroactive for dates of service on and after July 1, 2017.

The Department of Health is now loading updated rates to enrolled SSHSP provider files. It is anticipated that providers will receive written notification that the new rates have been loaded to their enrollment file within the next two weeks. SSHSP providers will not have to resubmit already paid claims. Existing paid claims, for services rendered on and after July 1, 2017, will automatically be reprocessed by eMedNY when the new rates are loaded, the resulting payments should be released on or about 8/1/18.

Providers may receive remittance advice information in one of three formats:
  • The electronic HIPAA 835/820 transaction
  • PDF Remittance Advice
  • Paper Remittance Advice

Remittance Advices contain a maximum of ten thousand (10,000) claim lines; any overflow will generate a separate 835 and a separate check.

Providers who submit claims under multiple ETINs will receive a separate remittance advice for each ETIN, regardless of advice format.

When previously paid claims are adjusted by a Retroactive Rate Adjustment ("Retro"), the following values are returned in the 835 Remittance Advice:
  • A RETROACTIVE RATE REVERSAL is communicated by a Remittance Advice Reason Code (RARC) value of N689 (ALERT: REVERSAL DUE TO RETROACTIVE RATE CHANGE). The CLP segment contains 22 (Reversal) in CLP02.
  • A RETROACTIVE RATE CORRECTION is communicated by a Remittance Advice Reason Code (RARC) value of N419 (RETROACTIVE RATE ADJUSTMENT). The CLP segment contains 1 (Processed as Primary) in CLP02.

Additional information about Medicaid Remittance can be found online at: https://www.emedny.org/ProviderManuals/AllProviders/General_Remittance_Guidelines.pdf

SSHSP Billing Codes, Handout 5, is being revised. Attached to this Alert is a table showing the prior rates and the new rates. Once the rates are loaded in eMedNY another Medicaid Alert will be issued with the revised Handout 5.

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or at SSHSP@health.ny.gov, the NYS Education Department, Medicaid Unit at medined@nysed.gov, or your local Regional Technical Support and Assistance Contact.

SERVICE TYPE CPT Code Rate Code DESCRIPTION Old Rate
(end 06/30/17)		 New Rate
(eff. 07/01/17)
Psychological Evaluation 90791 2000 PSYCHIATRIC DIAGNOSTIC EXAMINATION $116.57 $136.52
Psychological Evaluation 90792 2001 PSYCHIATRIC DIAGNOSTIC EXAMINATION WITH MEDICAL SERVICES $95.16 $153.77
Psychological Evaluation 96101 2002 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI, RORSCHACH, WAIS), PER HOUR OF THE PSYCHOLOGIST'S OR PHYSICIAN'S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT $63.53 $83.45
Psychological Evaluation 96105 2003 ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPORT, PER HOUR $60.13 $114.07
Psychological Evaluation 96110 2004 DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE SCREEN), WITH INTERPRETATION AND REPORT $5.76 $8.71
Psychological Evaluation 96111 2005 DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE AND/OR COGNITIVE FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS) WITH INTERPRETATION AND REPORT $99.66 $138.87
Psychological Evaluation 96116 2006 NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDGMENT, EG, ACQUIRED KNOWLEDGE, ATTENTION, LANGUAGE, MEMORY, PLANNING AND PROBLEM SOLVING, AND VISUAL SPATIAL ABILITIES), PER HOUR OF THE PSYCHOLOGIST'SOR PHYSICIAN'S TIME, BOTH FACE-TO-FACE TIME WITH THE PATIENT AND TIME INTERPRETING TEST RESULTS AND PREPARING THE REPORT $70.38 $97.15
Psychological Evaluation 96118 2007 NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), PER HOUR OF THE PSYCHOLOGIST'S OR PHYSICIAN'S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT $77.81 $102.68
Psychological Counseling 90832 2008 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT $48.30 $66.28
Psychological Counseling 90833 2009 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICES (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) $31.82 $69.20
Psychological Counseling 90834 2010 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT $61.83 $88.15
Psychological Counseling 90836 2011 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) $51.63 $87.33
Psychological Counseling 90837 2012 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT $90.44 $132.29
Psychological Counseling 90838 2013 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) $83.48 $115.26
Psychological Counseling 90785 2014 INTERACTIVE COMPLEXITY (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) $3.66 $14.42
Psychological Counseling 90847 2020 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT) $82.97 $110.80
Psychological Counseling 90853 2021 GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP) $24.50 $26.69
Speech 92521 2023 EVALUATION OF SPEECH FLUENCY (E.G., STUTTERING, CLUTTERING) $89.16 $118.04
Speech 92522 2052 EVALUATION OF SPEECH SOUND PRODUCTION (E.G., ARTICULATION, PHONOLOGICAL PROCESS, APRAXIA, DYSARTHRIA) $72.25 $97.67
Speech 92523 2053 EVALUATION OF SPEECH SOUND PRODUCTION (E.G., ARTICULATION, PHONOLOGICAL PROCESS, APRAXIA, DYSARTHRIA); WITH EVALUATION OF LANGUAGE COMPREHENSION AND EXPRESSION (E.G., RECEPTIVE AND EXPRESSIVE LANGUAGE) $150.31 $208.58
Speech 92524 2054 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE $75.70 $94.21
Speech 92507 2024 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSING DISORDER; INDIVIDUAL $50.57 $83.63
Speech 92508 2025 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSINGDISORDER; GROUP, 2 OR MORE INDIVIDUALS $24.85 $24.43
Speech 92520 2026 LARANGEAL FUNCTION STUDIES (I.E. AERODYNAMIC TESTING AND ACOUSTIC TESTING) $48.07 $81.71
Speech 92526 2027 TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING $77.73 $91.24
Speech 92597 2028 EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC DEVICE TO SUPPLEMENT ORAL SPEECH $82.17 $77.02
Speech 92626 2029 EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR $62.56 $95.73
Speech 92627 2030 EVALUATION OF AUDITORY REHABILITATION STATUS; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $15.11 $23.66
Audio Evaluation 92550 2031 TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS $15.95 $22.58
Audio Evaluation 92552 2032 PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY $17.42 $34.36
Audio Evaluation 92553 2033 PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE $22.37 $40.90
Audio Evaluation 92555 2034 SPEECH AUDIOMETRY THRESHOLD; $12.47 $25.51
Audio Evaluation 92556 2035 SPEECH AUDIOMETRY WITH SPEECH RECOGNITION $19.17 $41.28
Audio Evaluation 92557 2036 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND 92556 COMBINED) $31.49 $40.25
Audio Evaluation 92565 2037 STENGER TEST, PURE TONE $9.55 $17.05
Audio Evaluation 92567 2038 TYMPANOMETRY (IMPEDANCE TESTING) $12.12 $15.47
Audio Evaluation 92568 2039 ACOUSTIC REFLEX TESTING, THRESHOLD $12.85 $16.93
Audio Evaluation 92570 2040 ACOUSTIC IMMITTANCE TESTING, INCLUDES TYMPANOMETRY (IMPEDANCE TESTING), ACOUSTIC REFLEX THRESHOLD TESTING, AND ACOUSTIC REFLEX DECAY TESTING $24.29 $34.20
Audio Evaluation 92571 2041 FILTERED SPEECH TEST $13.05 $29.74
Audio Evaluation 92572 2042 STAGGERED SPONDAIC WORD TEST $18.29 $34.48
Audio Evaluation 92576 2043 SYNTHETIC SENTENCE IDENTIFICATION TEST $17.42 $39.74
Audio Evaluation 92577 2044 STENGER TEST, SPEECH $11.88 $16.66
Audio Evaluation 92579 2045 VISUAL REINFORCEMENT AUDIOMETRY (VRA) $33.58 $48.50
Audio Evaluation 92582 2046 CONDITIONING PLAY AUDIOMETRY $33.74 $72.95
Audio Evaluation 92583 2047 SELECT PICTURE AUDIOMETRY $25.88 $54.75
Audio Evaluation 92585 2048 AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THECENTRAL NERVOUS SYSTEM; COMPREHENSIVE $78.87 $146.76
Audio Evaluation 92586 2049 AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THECENTRAL NERVOUS SYSTEM; LIMITED $48.32 $94.11
Audio Evaluation 92587 2050 EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT OR DISTORTION PRODUCTS) $27.62 $22.96
Audio Evaluation 92588 2051 EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON OF TRANSIENT AND/OR DISTORTION PRODUCT OTOACOUSTIC EMISSIONS AT MULTIPLE LEVELS AND FREQUENCIES) $47.63 $35.35
Audio Evaluation 92620 2056 EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; INITIAL 60 MINUTES $59.40 $100.63
Audio Evaluation 92621 2057 EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; EACH ADDITIONAL 15 MINUTES $13.62 $23.61
Physical Therapy 97161 2058 PHYSICAL THERAPY EVALUATION LOW COMPLEXITY $54.81 $87.12
Physical Therapy 97162 2079 PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY $54.81 $87.12
Physical Therapy 97163 2101 PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY $54.81 $87.12
Physical Therapy 97164 2059 PHYSICAL THERAPY RE-EVALUATION $29.74 $58.87
Occupational or Physical Therapy 97010 2060 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD PACKS $3.91 $6.20
Occupational or Physical Therapy 97012 2061 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL $11.45 $17.29
Occupational or Physical Therapy 97014 2062 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED) $10.70 $16.90
Occupational or Physical Therapy 97016 2063 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES $12.45 $20.90
Occupational or Physical Therapy 97018 2064 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH $6.53 $11.92
Occupational or Physical Therapy 97022 2065 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL BATH $14.51 $25.53
Occupational or Physical Therapy 97024 2066 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY (EG, MICROWAVE) $4.49 $7.30
Occupational or Physical Therapy 97026 2067 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED $3.91 $6.53
Occupational or Physical Therapy 97028 2068 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET $5.04 $8.03
Occupational or Physical Therapy 97032 2069 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL) EACH 15 MINUTES $12.92 $20.36
Occupational or Physical Therapy 97033 2070 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES $20.18 $23.42
Occupational or Physical Therapy 97034 2071 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES $12.11 $19.29
Occupational or Physical Therapy 97035 2072 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND THERAPY, EACH 15 MINUTES $9.20 $13.52
Occupational or Physical Therapy 97036 2073 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES $21.25 $35.30
Occupational or Physical Therapy 97110 2074 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE, RANGE OF MOTION AND FLEXIBILITY $22.19 $34.68
Occupational or Physical Therapy 97112 2075 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE, COORDINATION, KINESTHETIC SENSE, POSTURE, AND/OR PROPRIOCEPTION FOR SITTING AND/OR STANDING ACTIVITIES $23.29 $36.22
Occupational or Physical Therapy 97113 2076 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES $28.04 $46.12
Occupational or Physical Therapy 97116 2077 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING) $19.65 $30.05
Occupational or Physical Therapy 97124 2078 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT (STROKING, COMPRESSION, PERCUSSION) $17.99 $27.85
Occupational or Physical Therapy 97140 2080 MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTION), 1 OR MORE REGIONS, EACH 15 MINUTES $20.77 $31.91
Physical Therapy 97150 2081 THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS) $14.33 $18.35
Occupational Therapy 97165 2082 OCCUPATIONAL THERAPY EVALUATION LOW COMPLEXITY $59.11 $99.43
Occupational Therapy 97166 2105 OCCUPATIONAL THERAPY EVALUATION MODERATE COMPLEXITY $59.11 $99.43
Occupational Therapy 97167 2106 OCCUPATIONAL THERAPY EVALUATION HIGH COMPLEXITY $59.11 $99.43
Occupational Therapy 97168 2083 OCCUPATIONAL THERAPY RE-EVALUATION $34.98 $66.06
Occupational or Physical Therapy 97530 2084 THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER (USE OF DYNAMIC ACTIVITIES TO IMPROVE FUNCTIONAL PERFORMANCE), EACH 15 MINUTES $23.96 $37.27
Occupational or Physical Therapy 97532 2085 DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING (INCLUDES COMPENSATORY TRAINING), DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER, EACH 15 MINUTES $19.00 $28.04
Occupational or Physical Therapy 97533 2086 SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, DIRECT (ONE-ON-ONE) PATIENT CONTACT BY THE PROVIDER, EACH 15 MINUTES $20.75 $31.12
Occupational or Physical Therapy 97535 2087 SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (adl) AND COMPENSATORY TRAINING, MEAL PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY DEVICES/ADAPTIVE EQUIPMENT) DIRECT ONE-ON-ONE CONTACT BY THE PROVIDER, EACH 15 MINUTES $23.94 $37.37
Occupational or Physical Therapy 97537 2088 COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK ENVIRONMENT/MODIFICATION ANALYSIS, WORK TASK ANALYSIS, USE OF ASSISTIVE TECHNOLOGY DEVICE/ADAPTIVE EQUIPMENT), DIRECT ONE-ON-ONE CONTACT BY PROVIDER, EACH 15 MINUTES $21.32 $32.37
Occupational or Physical Therapy 97542 2089 WHEELCHAIR MANAGEMENT (EG, ASSESSMENT, FITTING, TRAINING), EACH 15 MINUTES $21.61 $32.75
Occupational Therapy 97150 2100 THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS) $14.33 $18.35
Occupational or Physical Therapy 97760 2107 ORTHOTIC(S) MANAGEMENT AND TRAINING (INCLUDING ASSESSMENT AND FITTING WHEN NOT OTHERWISE REPORTED), UPPER EXTREMITY(S), LOWER EXTREMITY(S) AND/OR TRUNK, INITIAL ORTHOTIC(S) ENCOUNTER, EACH 15 MINUTES $25.61 $40.83
Occupational or Physical Therapy 97761 2108 PROSTHETIC(S) TRAINING, UPPER AND/OR LOWER EXTREMITY(S), INITIAL PROSTHETIC(S) ENCOUNTER, EACH 15 MINUTES $22.70 $35.45
Occupational or Physical Therapy 97763 2109 ORTHOTIC(S)/PROSTHETIC(S) MANAGEMENT AND/OR TRAINING, UPPER EXTREMITY(IES), LOWER EXTREMITY(IES), AND/OR TRUNK, SUBSEQUENT ORTHOTIC(S)/PROSTETIC(S) ENCOUNTER, EACH 15 MINUTES $28.07 $51.91
Medical Evaluation 99201 2090 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; STRAIGHT FORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE SELF LIMITED OR MINOR. PHYSICIANS TYPICALLY SPEND 10 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $30.45 $47.28
Medical Evaluation 99202 2091 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; STRAIGHT FORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE LOW TO MODERATE SEVERITY. PHYSICIANS TYPICALLY SPEND 20 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $52.51 $80.15
Medical Evaluation 99203 2092 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL DECISION MAKING OF LOW COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE OF MODERATE SEVERITY. PHYSICIANS TYPICALLY SPEND 30 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $75.88 $116.10
Medical Evaluation 99204 2093 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE MODERATE TO HIGH SEVERITY. PHYSICIANS TYPICALLY SPEND 45 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $117.17 $175.57
Medical Evaluation 99205 2094 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE MODERATE TO HIGH SEVERITY. PHYSICIANS TYPICALLY SPEND 60 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $147.11 $220.99
Medical Evaluation 99211 2095 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN ESTABLISHED PATIENT, THAT MAY NOT REQUIRE THE PRESENCE OF A PHYSICIAN, USUALLY THE PRESENTING PROBLEM(S) ARE MINIMAL. TYPICALLY, 5 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES. $15.08 $21.67
Medical Evaluation 99212 2096 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; STRAIGHT FORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE SELF LIMITED OR MINOR. PHYSICIANS TYPICALLY SPEND 10 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $30.45 $46.77
Medical Evaluation 99213 2097 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; MEDICAL DECISION MAKING OF LOW COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE LOW TO MODERATE SEVERITY. PHYSICIANS TYPICALLY SPEND 15 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $51.05 $78.02
Medical Evaluation 99214 2098 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE MODERATE TO HIGH SEVERITY. PHYSICIANS TYPICALLY SPEND 25 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $76.46 $114.57
Medical Evaluation 99215 2099 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE MODERATE TO HIGH SEVERITY. PHYSICIANS TYPICALLY SPEND 40 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. $102.91 $154.26
Last Updated: July 30, 2018