Mental Hygiene Services Fees
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
Fees Effective 4/1/2024
Rates currently pending State Plan Amendment 24-0052 approval by the Centers for Medicare and Medicaid Services and New York State Division of the Budget approval.
- Fee Comparisons is also available in Portable Document Format (PDF)
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees | |||||||||
---|---|---|---|---|---|---|---|---|---|
Fees Effective 4/1/2024 | |||||||||
Procedure Codes | Authorized Provider Types | IPSIDD Max Units | Regional Fees* | ||||||
Procedure Code | Note Below | CPT Descprition | Locality 1 | Locality 2 | Locality 3 | Locality 4 | Locality 99 | ||
90791 | Psy dx evaluation | LP (0580)/ LCSW (0560) | 1 | $183.96 | $186.28 | $174.41 | $186.69 | $166.31 | |
90832 | Psytx, 30 min | LP (0580)/ LCSW (0560) | 1 | $110.32 | $111.65 | $104.67 | $111.91 | $100.02 | |
90834 | Psytx, 45 min | LP (0580)/ LCSW (0560) | 1 | $147.07 | $148.66 | $139.64 | $149.04 | $133.72 | |
90837 | Psytx, 60 min | LP (0580)/ LCSW (0560) | 1 | $203.75 | $206.17 | $193.37 | $206.70 | $184.85 | |
90846 | Family psytx w/o patient | LP (0580) / LCSW (0560) | 1 | $110.31 | $111.51 | $104.71 | $111.79 | $100.24 | |
90847 | Family psytx w/patient | LP (0580) / LCSW (0560) | 1 | $220.67 | $223.51 | $209.30 | $224.05 | $199.68 | |
90853 | Group psychotherapy | LP (0580) / LCSW (0560) | 1 | $57.04 | $57.77 | $54.06 | $57.88 | $51.55 | |
92507 | Speech/hearing therapy | SLP (0623) | 1 | $118.39 | $120.61 | $111.24 | $120.50 | $103.76 | |
92508 | Speech/hearing therapy | SLP (0623) | 1 | $34.60 | $35.33 | $32.41 | $35.26 | $29.99 | |
92521 | Eval of Speech Fluency | SLP (0623) | 1 | $160.91 | $164.29 | $151.05 | $164.10 | $140.34 | |
92522 | Eval of Speech Sound Production | SLP (0623) | 1 | $160.91 | $164.28 | $151.06 | $164.07 | $140.35 | |
92523 | Eval of Speech Sound Production with eval of language comprehension and expression | SLP (0623) | 1 | $160.96 | $164.70 | $150.92 | $164.47 | $139.63 | |
92524 | Behavioral and qualitative analysis of voice and resonance | SLP (0623) | 1 | $160.91 | $165.34 | $150.71 | $165.10 | $138.61 | |
92526 | Oral function therapy | SLP (0623) | 1 | $118.47 | $120.77 | $111.20 | $120.61 | $103.44 | |
92606 | Use of non-speech device | SLP (0623) | 1 | $118.66 | $121.17 | $111.09 | $120.89 | $102.67 | |
92609 | Use of speech device service | SLP (0623) | 1 | $118.66 | $121.17 | $111.09 | $120.89 | $102.67 | |
92610 | Evaluate swallowing function | SLP (0623) | 1 | $118.50 | $121.04 | $111.12 | $120.85 | $102.97 | |
96112 | (C) | Devel tst phys/qhp 1st hr | LP (0580) / LCSW (0560) | 1 | $147.53 | $150.31 | $139.15 | $150.40 | $130.73 |
96113 | (C) | Devel tst phys/qhp ea addl | LP (0580) / LCSW (0560) | 1 | $73.77 | $75.17 | $69.58 | $75.21 | $65.37 |
96130 | (C) | Psycl tst eval phys/qhp 1st | LP (0580) / LCSW (0560) | 1 | $73.57 | $74.44 | $69.79 | $74.62 | $66.67 |
96136 | (C) | Psycl/nrpsyc tst phy/qhp 1st | LP (0580) / LCSW (0560) | 1 | $147.13 | $148.87 | $139.56 | $149.23 | $133.33 |
96137 | (C) | Psycl/nrpsyc tst phy/qhp ea | LP (0580) / LCSW (0560) | 1 | $73.57 | $74.44 | $69.79 | $74.62 | $66.67 |
96138 | (C) | Psycl/nrpsyc tech 1st | LP (0580) / LCSW (0560) | 1 | $149.03 | $153.54 | $138.26 | $152.77 | $124.51 |
96139 | (C) | Psycl/nrpsyc tst tech ea | LP (0580) / LCSW (0560) | 1 | $74.52 | $76.78 | $69.14 | $76.39 | $62.27 |
97110 | Therapeutic exercises, 15 min | OT (0621) / PT (0622) | 3 | $43.00 | $44.02 | $40.23 | $43.92 | $38.32 | |
97112 | Neuromuscular reeducation, 15 min | OT (0621) / PT (0622) | 3 | $43.23 | $44.11 | $40.48 | $44.02 | $37.64 | |
97113 | Aquatic therapy/exercises, 15 min | OT (0621) / PT (0622) | 3 | $43.38 | $44.43 | $40.44 | $44.27 | $36.97 | |
97116 | Gait training therapy, 15 min | OT (0621) / PT (0622) | 3 | $43.24 | $44.12 | $40.53 | $44.04 | $37.55 | |
97124 | Massage therapy, 15 min | OT (0621) / PT (0622) | 3 | $43.29 | $44.44 | $40.43 | $44.32 | $37.01 | |
97129 | (B) | Ther ivntj 1st 15 min | OT (0621) / PT (0622) / SLP (0623) | 1 | $43.16 | $43.90 | $40.59 | $43.85 | $37.97 |
97130 | (B) | Ther ivntj ea addl 15 min | OT (0621) / PT (0622) / SLP (0623) | 2 | $43.16 | $43.90 | $40.59 | $43.85 | $37.97 |
97140 | Manual therapy, 15 min | OT (0621) / PT (0622) | 3 | $43.24 | $44.08 | $40.54 | $43.99 | $37.62 | |
97150 | Group therapeutic procedures | OT (0621) / PT (0622) | 1 | $43.16 | $43.99 | $40.55 | $43.96 | $37.82 | |
97161 | (A) | Pt evaluation, low complexity | PT (0622) | 1 | $97.08 | $99.00 | $91.16 | $98.89 | $84.83 |
97162 | (A) | Pt evaluation, med complexity | PT (0622) | 1 | $129.44 | $132.00 | $121.55 | $131.85 | $113.11 |
97163 | (A) | Pt evaluation, high complexity | PT (0622) | 1 | $161.80 | $165.00 | $151.93 | $164.81 | $141.39 |
97164 | (A) | PT re-evaluation, re-defined | PT (0622) | 1 | $97.21 | $99.30 | $91.07 | $99.12 | $84.25 |
97165 | (A) | Ot evaluation, low complexity | OT (0621) | 1 | $87.52 | $89.55 | $81.93 | $89.36 | $75.56 |
97166 | (A) | Ot evaluation, med complexity | OT (0621) | 1 | $116.70 | $119.40 | $109.22 | $119.15 | $100.73 |
97167 | (A) | Ot evaluation, high complexity | OT (0621) | 1 | $145.87 | $149.24 | $136.53 | $148.93 | $125.92 |
97168 | (A) | OT re-evaluation, re-defined | OT (0621) | 1 | $87.71 | $89.85 | $81.85 | $89.55 | $74.96 |
97530 | Therapeutic activities, 15 min | OT (0621) / PT (0622) | 3 | $43.30 | $44.23 | $40.51 | $44.11 | $37.35 | |
97533 | Sensory integration, 15 min | OT (0621) / PT (0622) / SLP (0623) | 3 | $43.22 | $44.02 | $40.55 | $43.96 | $37.75 | |
97535 | Self care mngment training, 15 min | OT (0621) / PT (0622) | 3 | $43.29 | $44.20 | $40.51 | $44.10 | $37.40 | |
97537 | Community/work reintegration, 15 min | OT (0621) / PT (0622) | 3 | $44.02 | $44.85 | $41.32 | $44.78 | $34.54 | |
97542 | Wheelchair mngment training, 15 min | OT (0621) / PT (0622) | 8 | $46.60 | $47.50 | $43.73 | $47.42 | $40.65 | |
97755 | Assistive technology assess, 15 min | OT (0621) / PT (0622) | 6 | $43.14 | $43.92 | $40.58 | $43.90 | $37.95 | |
* Locality Breakdown Locality 1 - Manhattan Locality 2 - Bronx, Brooklyn, Nassau, Rockland, Staten Island, Suffolk, Westchester Locality 3 - Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, Ulster Locality 4 - Queens Locality 99 - Remainder of State |
|||||||||
Authorized Provider Types OT Occupational Therapist (PCOS: 0621) PT Physical Therapist (PCOS: 0622) SLP Speech and Lang Pathologist (PCOS: 0623) LP Licensed Psychologist (PCOS: 0580) LCSW Licensed Clinical Social Worker (PCOS: 0560) |
|||||||||
(A) Effective 1/1/2017, the American Medical Association (AMA) replaced procedure codes 97001, 97002, 97003, 97004 with eight new procedure codes.
|