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Fee Schedules and Rates

The following contains Current Dental Terminology, Fourth Edition (CDT), copyright © 2010 American Dental Association (ADA).  All rights reserved. CDT is a trademark of the ADA. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. U.S. Government Rights. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago, Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.” The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement below by checking the checkbox and clicking on the button labeled “I ACCEPT”. If you do not agree to the terms and conditions, you may not access the following data. Instead, you must click below on the button labeled “I DO NOT ACCEPT” and return to the homepage.
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Below are the fee schedules and rates listed by codes for particular provider or facility types.

Envision

Fee Schedules File Type File Type Effective Date
Ambulance PDF Excel July 1, 2015
Anesthesia Base Unit PDF Excel July 1, 2015
Ambulatory Surgical Center Fee Schedule for DOS PDF Excel October 1, 2015
Billing Guidelines for Psychiatry and Psychiatric Nurse Practitioners for Mental Health/Psychiatry Services PDF July 1, 2015
Billing Guidelines for Therapeutic and Evaluative Mental Health Services for Expanded EPSDT (T&E) PDF July 1, 2015
Billing Guidelines for Community/Private Mental Health Centers (CMHC/PMHC) PDF July 1, 2015
Dental Fees – Outpatient Hospital PDF Excel Jan. 1, 2015
Dental Fees – Professional Services PDF Excel Jan. 1, 2015
Durable Medical Equipment (DME), Orthotic, Prosthetic PDF Excel July 1, 2015
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) PDF July, 1, 2009
Hearing PDF Excel July 1, 2015
Intellectual and Developmental Disabilities (ID/DD) waiver PDF Jan. 1, 2009
Increased Primary Care Provider PDF Excel July 1, 2015
Medical Supply PDF Excel July 1, 2015
Medical Supply Codes – Manually Priced PDF Excel July 1, 2015
Outpatient Prospective Payment System (OPPS) Medicaid PDF Excel July 1, 2015
PASRR Administrative Services PDF
Pathology Laboratory PDF Excel July 1, 2015
Physician Administered Drug PDF Excel Jan. 1, 2016
Radiology PDF Excel July 1, 2015
Vision PDF Excel July 1, 2015

 

Prescribed Pediatric Extended Care

Code/Modifier Description of Service Maximum Fee
T1025 (code) Full day PPEC services
(over four hours, up to 12 hours per day)
$240 per day
T1026 (code) Partial day PPEC services
(four hours or less per day, billed in units of one hour)
$30 per hour
UC (modifier) Transportation provided by PPEC center $35 per day

 

Calendar Year 2016[/tcol]
Rates Effective Date
End-Stage Renal Disease Jan. 1, 2015
Jan. 1, 2016
End-Stage Renal Disease bundled list Jan. 1, 2015
Jan. 1, 2016
Federally Qualified Health Center (FQHC) Calendar Year 2015
Calendar Year 2016
Home Health Fiscal Year 2016
Hospice FY 2016 Rates by County Effective: Jan. 1, 2016
Hospice FY 2016 Rates by County Effective: Oct. 1, 2015
Psychiatric Residential Treatment Facilities (PRTF) Calendar Year 2015
Rural Health Clinics (RHC) Calendar Year 2015
Calendar Year 2016
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) Calendar Year 2015
Calendar Year 2016
MS Dept. of Health Clinic July 1, 2011
Nursing Facilities 2015 First Quarter
2015 Second Quarter
2015 Third Quarter
2015 Fourth Quarter
2016 First Quarter

 

 Code descriptions on the various fee schedules available below are incomplete. Providers must use current CPT, HCPCS, CDT and ICD9 books for correct coding.

 

Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS Apply.

CPT only copyright 2014 American Medical Association. All rights reserved.