Preschool/School Supportive Health Services Program
SSHSP Billing Codes, Handout 5 - August 2018
(posted 5/22/19)
SSHSP providers must use this select list of Current Procedural Terminology (CPT) codes to bill Medicaid for SSHSP services. This handout contains CPT codes for the following SSHSP services that can be billed to Medicaid:
| Click on one of these links to go directly to the CPT codes. | |
| Psychological Evaluation | Psychological Counseling |
| Speech Therapy | Audiological Evaluation |
| Physical Therapy | Occupational Therapy |
| Medical/Medical Specialist Evaluation | Skilled Nursing |
| Special Transportation | |
Effective September 1, 2009, all SSHSP services will be reimbursed using an encounter-based claiming methodology, based on fees established by the Department of Health.
CPT codes are numbers assigned to services practitioners may provide to a patient including medical, surgical and diagnostic services. CPT codes are then used by insurers to identify the service provided and ultimately the reimbursement rates. Since CPT codes are used nationally, they ensure uniformity, while adding a level of precision. CPT codes are developed, maintained and copyrighted by the American Medical Association (AMA). As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes are discarded. Thousands of codes are in use, (over 14,000) and are updated annually. Development and maintenance of these codes is overseen by editorial boards at the AMA. DOH in coordination with SED has developed a list (just over 100 codes) that is available for SSHSP claiming.
CPT codes are either timed or untimed. Timed codes require the entry of units. When the practitioner chooses a code, the number of units must also be indicated. For example, if the physical therapist provided a service (CPT code 97140) and the session lasted 30 minutes, two units would be billed. Untimed codes are used on a one-per-session/per day basis. With one exception, providers should not report more than one physical medicine and rehabilitation therapy service for the same 15-minute time period. The only exception involves a “supervised modality” defined by CPT codes 97010-97028 which may be reported for the same 15-minute time period as other therapy services. For more information on the use of CPT codes and the claiming parameters, please contact your individual professional organizations.
SSHSP Billing Codes, Handout 5 - August 2018 |
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| SERVICE TYPE | CPT CODE | RATE CODE | DESCRIPTION | SESSION TIME/UNITS | PAYMENT RATE |
| Psychological Evaluation | 90791 | 2000 | PSYCHIATRIC DIAGNOSTIC EXAMINATION | 1 per session | $136.52 |
| Psychological Evaluation | 90792 | 2001 | PSYCHIATRIC DIAGNOSTIC EXAMINATION WITH MEDICAL SERVICES | 1 per session | $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 | 60 minutes | $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 minutes | $114.07 |
| Psychological Evaluation | 96110 | 2004 | DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE SCREEN), WITH INTERPRETATION AND REPORT | 1 per session | $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 | 1 per session | $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'S OR PHYSICIAN'S TIME, BOTH FACE-TO-FACE TIME WITH THE PATIENT AND TIME INTERPRETING TEST RESULTS AND PREPARING THE REPORT | 60 minutes | $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 | 60 minutes | $102.68 |
| Psychological Counseling | 90832 | 2008 | PSYCHOTHERAPY, 30 MINUTES WITH PATIENT | 30 minutes | $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) | 30 minutes | $69.20 |
| Psychological Counseling | 90834 | 2010 | PSYCHOTHERAPY, 45 MINUTES WITH PATIENT | 45 minutes | $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) | 45 minutes | $87.33 |
| Psychological Counseling | 90837 | 2012 | PSYCHOTHERAPY, 60 MINUTES WITH PATIENT | 60 minutes | $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) | 60 minutes | $115.26 |
| Psychological Counseling | 90785 | 2014 | INTERACTIVE COMPLEXITY (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) | 1 per session | $14.42 |
| Psychological Counseling | 90847 | 2020 | FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT) | 1 per session | $110.80 |
| Psychological Counseling | 90853 | 2021 | GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP) | 1 per session | $26.69 |
| Speech | 92521 | 2023 | EVALUATION OF SPEECH FLUENCY (E.G., STUTTERING, CLUTTERING) | 1 per evaluation | $118.04 |
| Speech | 92522 | 2052 | EVALUATION OF SPEECH SOUND PRODUCTION (E.G., ARTICULATION, PHONOLOGICAL PROCESS, APRAXIA, DYSARTHRIA) | 1 per evaluation | $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) | 1 per evaluation | $208.58 |
| Speech | 92524 | 2054 | BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE | 1 per evaluation | $94.21 |
| Speech | 92507 | 2024 | TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSING DISORDER; INDIVIDUAL | 1 per session | $83.63 |
| Speech | 92508 | 2025 | TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSINGDISORDER; GROUP, 2 OR MORE INDIVIDUALS | 1 per session | $24.43 |
| Speech | 92520 | 2026 | LARANGEAL FUNCTION STUDIES (I.E. AERODYNAMIC TESTING AND ACOUSTIC TESTING) | 1 per session | $81.71 |
| Speech | 92526 | 2027 | TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING | 1 per session | $91.24 |
| Speech | 92597 | 2028 | EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC DEVICE TO SUPPLEMENT ORAL SPEECH | 1 per session | $77.02 |
| Speech | 92626 | 2029 | EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR | 60 minutes |
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| Speech | 92627 | 2030 | EVALUATION OF AUDITORY REHABILITATION STATUS; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) | 15 minutes | $23.66 |
| Audio Evaluation | 92550 | 2031 | TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS | 1 per session | $22.58 |
| Audio Evaluation | 92552 | 2032 | PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY | 1 per session | $34.36 |
| Audio Evaluation | 92553 | 2033 | PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE | 1 per session | $40.90 |
| Audio Evaluation | 92555 | 2034 | SPEECH AUDIOMETRY THRESHOLD | 1 per session | $25.51 |
| Audio Evaluation | 92556 | 2035 | SPEECH AUDIOMETRY WITH SPEECH RECOGNITION | 1 per session | $41.28 |
| Audio Evaluation | 92557 | 2036 | COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND 92556 COMBINED) | 1 per evaluation | $40.25 |
| Audio Evaluation | 92565 | 2037 | STENGER TEST, PURE TONE | 1 per session | $17.05 |
| Audio Evaluation | 92567 | 2038 | TYMPANOMETRY (IMPEDANCE TESTING) | 1 per session | $15.47 |
| Audio Evaluation | 92568 | 2039 | ACOUSTIC REFLEX TESTING, THRESHOLD | 1 per session | $16.93 |
| Audio Evaluation | 92570 | 2040 | ACOUSTIC IMMITTANCE TESTING, INCLUDES TYMPANOMETRY (IMPEDANCE TESTING), ACOUSTIC REFLEX THRESHOLD TESTING, AND ACOUSTIC REFLEX DECAY TESTING | 1 per session | $34.20 |
| Audio Evaluation | 92571 | 2041 | FILTERED SPEECH TEST | 1 per session | $29.74 |
| Audio Evaluation | 92572 | 2042 | STAGGERED SPONDAIC WORD TEST | 1 per session | $34.48 |
| Audio Evaluation | 92576 | 2043 | SYNTHETIC SENTENCE IDENTIFICATION TEST | 1 per session | $39.74 |
| Audio Evaluation | 92577 | 2044 | STENGER TEST, SPEECH | 1 per session | $16.66 |
| Audio Evaluation | 92579 | 2045 | VISUAL REINFORCEMENT AUDIOMETRY (VRA) | 1 per session | $48.50 |
| Audio Evaluation | 92582 | 2046 | CONDITIONING PLAY AUDIOMETRY | 1 per session | $72.95 |
| Audio Evaluation | 92583 | 2047 | SELECT PICTURE AUDIOMETRY | 1 per session | $54.75 |
| Audio Evaluation | 92585 | 2048 | AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERVOUS SYSTEM; COMPREHENSIVE | 1 per session | $146.76 |
| Audio Evaluation | 92586 | 2049 | AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERVOUS SYSTEM; LIMITED | 1 per session | $94.11 |
| Audio Evaluation | 92587 | 2050 | EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT OR DISTORTION PRODUCTS) | 1 per session | $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) | 1 per evaluation | $35.35 |
| Audio Evaluation | 92620 | 2056 | EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; INITIAL 60 MINUTES | 60 minutes | $100.63 |
| Audio Evaluation | 92621 | 2057 | EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; EACH ADDITIONAL 15 MINUTES | 15 minutes | $23.61 |
| Physical Therapy | 97161 | 2058 | PHYSICAL THERAPY EVALUATION LOW COMPLEXITY | 1 per evaluation | $87.12 |
| Physical Therapy | 97162 | 2079 | PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY | 1 per evaluation | $87.12 |
| Physical Therapy | 97163 | 2101 | PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY | 1 per evaluation | $87.12 |
| Physical Therapy | 97164 | 2059 | PHYSICAL THERAPY RE-EVALUATION | 1 per evaluation | $58.87 Back to Top |
| Occupational or Physical Therapy | 97010 | 2060 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD PACKS | 1 per session | $6.20 |
| Occupational or Physical Therapy | 97012 | 2061 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL | 1 per session | $17.29 |
| Occupational or Physical Therapy | 97014 | 2062 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED) | 1 per session | $16.90 |
| Occupational or Physical Therapy | 97016 | 2063 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES | 1 per session | $20.90 |
| Occupational or Physical Therapy | 97018 | 2064 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH | 1 per session | $11.92 |
| Occupational or Physical Therapy | 97022 | 2065 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL BATH | 1 per session | $25.53 |
| Occupational or Physical Therapy | 97024 | 2066 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY (EG, MICROWAVE) | 1 per session | $7.30 |
| Occupational or Physical Therapy | 97026 | 2067 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED | 1 per session | $6.53 |
| Occupational or Physical Therapy | 97028 | 2068 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET | 1 per session | $8.03 |
| Occupational or Physical Therapy | 97032 | 2069 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL) EACH 15 MINUTES | 15 minutes | $20.36 |
| Occupational or Physical Therapy | 97033 | 2070 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES | 15 minutes | $23.42 |
| Occupational or Physical Therapy | 97034 | 2071 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES | 15 minutes | $19.29 |
| Occupational or Physical Therapy | 97035 | 2072 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND THERAPY, EACH 15 MINUTES | 15 minutes | $13.52 |
| Occupational or Physical Therapy | 97036 | 2073 | APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES | 15 minutes | $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 | 15 minutes | $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 | 15 minutes | $36.22 |
| Occupational or Physical Therapy | 97113 | 2076 | THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES | 15 minutes | $46.12 |
| Occupational or Physical Therapy | 97116 | 2077 | THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING) | 15 minutes | $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) | 15 minutes | $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 | 15 minutes | $31.91 |
| Physical Therapy | 97150 | 2081 | THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS) | 1 per session | $18.35 |
| Occupational Therapy | 97165 | 2082 | OCCUPATIONAL THERAPY EVALUATION LOW COMPLEXITY | 1 per evaluation | $99.43 Back to Top |
| Occupational Therapy | 97166 | 2105 | OCCUPATIONAL THERAPY EVALUATION MODERATE COMPLEXITY | 1 per evaluation | $99.43 |
| Occupational Therapy | 97167 | 2106 | OCCUPATIONAL THERAPY EVALUATION HIGH COMPLEXITY | 1 per evaluation | $99.43 |
| Occupational Therapy | 97168 | 2083 | OCCUPATIONAL THERAPY RE-EVALUATION | 1 per evaluation | $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 | 15 minutes | $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 | 15 minutes | $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 | 15 minutes | $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 | 15 minutes | $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 | 15 minutes | $32.37 |
| Occupational or Physical Therapy | 97542 | 2089 | WHEELCHAIR MANAGEMENT (EG, ASSESSMENT, FITTING, TRAINING), EACH 15 MINUTES | 15 minutes | $32.75 |
| Occupational Therapy | 97150 | 2100 | THERAPEUTIC PROCEDURE(S), GROUP 2 OR MORE INDIVIDUALS) | 1 per session | $18.35 |
| Occupational or Physical Therapy | 97760 | 2107 | ORTHOTIC(S) MANAGEMENT AND TRAINING (INCLUDING ASSESSMENT AND FITTING WHEN NOT OTHERWISE REPORTED), UPPER EXTREMITY(IES), LOWER EXTREMITY(IES) AND/OR TRUNK, INITIAL ORTHOTIC(S) ENCOUNTER, EACH 15 MINUTES | 15 minutes | $40.83 |
| Occupational or Physical Therapy | 97761 | 2108 | PROSTHETIC(S) TRAINING, UPPER AND/OR LOWER EXTREMITY(IES), INITIAL PROSTHETIC(S) ENCOUNTER, EACH 15 MINUTES | 15 minutes | $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)/PROSTHETIC(S) ENCOUNTER, EACH 15 MINUTES | 15 minutes | $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. | Approximately 10 minutes | $47.28Back to Top |
| 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. | Approximately 20 minutes | $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. | Approximately 30 minutes | $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. | Approximately 45 minutes | $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. | Approximately 60 minutes | $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. | Approximately 5 minutes | $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. | Approximately 10 minutes | $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. | Approximately 15 minutes | $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. | Approximately 25 minutes | $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. | Approximately 40 minutes | $154.26 |
| Skilled Nursing | T1002 | 2102 | RN SERVICES, UP TO 15 MINUTES | 15 minutes | $9.25 |
| Skilled Nursing | T1003 | 2103 | LPN/LVN SERVICES, UP TO 15 MINUTES | 15 minutes | $8.00 |
| Transportation | T2003 | 2104 | NON-EMERGENCY TRANSPORTATION; ENCOUNTER/TRIP | 1 per one-way trip | See Handout 6 |
Last Updated:
May 22, 2019ate -->