Rate Codes Carved Out of APGs

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