Rate Codes Carved Out of APGs
- Also available in Excel Format (XLS) and Portable Document Format (PDF)
Rate Code |
Rate Code Description | Notes |
---|---|---|
1226 | FITTING OF SPECTACLES, MONOFOCAL, BIFOCAL, MULTIFOCAL | No longer carved out -Subsumed into APGs as of 1/1/2011 |
1227 | FITTING OF SPECTACLES & EYEGLASS MATERIALS | No longer carved out -Subsumed into APGs as of 1/1/2011 |
1228 | Comprehensive Wheelchair Evaluation and Management | Rate Code effective 10/1/2009 |
1381 | SBHC Flu Seasonal Vaccines - Administration Only | Rate Code effective 9/1/2009 |
1382 | SBHC Flu H1N1 Vaccine - Administration Only | Rate Code effective 9/1/2009 |
1383 | SBHC Pneumo, Vaccines - Administration Only | Rate Code effective 9/1/2009 |
1604 | MOMS HEALTH SUPPORTIVE SERVICES | |
1813 | TB/HIV COUNSELING W/O TESTING - MC CLIENT | |
1814 | STD/HIV COUNSELING W/O TESTING - MC CLIENT | |
1815 | TB/HIV COUNSELING & TESTING - MC CLIENT | |
1816 | STD/HIV COUNSELING & TESTING - MC CLIENT | |
1817 | TB/HIV POST TEST NEGATIVE - MC CLIENT | |
1818 | STD/HIV POST TEST NEGATIVE - MC CLIENT | |
1819 | TB/HIV POST TEST POSITIVE - MC CLIENT | |
1820 | STD/HIV POST TEST POSITIVE - MC CLIENT | |
1850 | DAY HEALTH CARE SERVICE (HIV) | |
2887 | CHILD REHABILITATION | |
2961 | AIDS CLINIC, THERAPEUTIC VISIT | |
3107 | MONTHLY DIALYSIS SVCS - MEDICARE CROSSOVER | No longer carved out -Subsumed into APGs as of 1/1/2012 |
3138 | NEWBORN HEARING SCRNG SVC - 1ST/INITIAL STAGE | Rate Code set to $0 effective 12/1/2009 |
3141 | SCREENING FOR ORTHODONTIC TREATMENT | Rate Code set to $0 effective 9/5/2012 |
3142 | D & T CS/MMIS TC INTAKE EXAM MANAGED CARE | |
3257 | SBHC - Individual Brief Psychotherapy 20-30 min w/ Patient | Rate Code effective 9/1/2009 |
3258 | SBHC - Individual Comprehensive Psychotherapy 45-50 min w/ Patient | Rate Code effective 9/1/2009 |
3259 | SBHC - Family Psychotherapy with or w/o Patient present | Rate Code effective 9/1/2009 |
3260 | SBHC-Individ LMHC/LMFT Service 20-30 min w/patient | Rate Code effective 3/1/2023 |
3261 | SBHC-Individ LMHC/LMFT Service 45-50 min w/patient | Rate Code effective 3/1/2023 |
3262 | SBHC-Fam Srvcs LMHC/LMFT with or w/o p/t present | Rate Code effective 3/1/2023 |
4011 | FQHC GROUP PSYCHOTHERAPY | Carved out for all FQHCs |
4012 | FQHC OFF-SITE SERVICES | Carved out for all FQHCs |
4013 | FQHC INDIVIDUAL THRESHOLD VISIT[1] | Carved out only for FQHCs that opted out of APGs |
4222 | Individ LMHC/LMFT Services 20-30 min w/patient | Rate Code effective 3/1/2023 |
4223 | Individ LMHC/LMFT Services 45-50 min w/patient | Rate Code effective 3/1/2023 |
4224 | Family Srvcs LMHC/LMFT with or w/o p/t present | Rate Code effective 3/1/2023 |
4257 | Clinics - Individual Brief Psychotherapy 20-30 min w/ Patient | Rate Code effective 9/1/2009 |
4258 | Clinics - Individual Comprehensive Psychotherapy 45-50 min w/ Patient | Rate Code effective 9/1/2009 |
4259 | Clinics - Family Psychotherapy with or w/o Patient present | Rate Code effective 9/1/2009 |
5246 | Collaborative Care Monthly Case Payment - Year 1 | Rate Code effective 1/1/2015 |
5247 | Collaborative Care Monthly Case Payment - Year 2 | Rate Code effective 1/1/2015 |
5248 | Collaborative Care retainage - Year 1 | Rate Code effective 1/1/2015 |
5249 | Collaborative Care retainage - Year 2 | Rate Code effective 1/1/2015 |
5301 | MEDICAL EVALUATION SSHSP | |
5312 | TB/DIRECTLY OBSERVED THERAPY - DNST LVL 1 | |
5313 | TB/DIRECTLY OBSERVED THERAPY - DNST LVL 2 | |
5317 | TB/DIRECTLY OBSERVED THERAPY - UPST LVL 1 | |
5318 | TB/DIRECTLY OBSERVED THERAPY - UPST LVL 2 | |
5388 | PRESCHOOL SUPPORTIVE HEALTH PROGRAM - IEP | |
5389 | SCHOOL-AGE SUPPORTIVE HEALTH PROGRAM - IEP |