North Carolina. North Carolina South Atlantic US Medicare

Transcription

1 TM 1998 reimbursement rates for commonly used CPT codes North Carolina EPSDT - Preventive Medicine Services New Patient, under 1 year $76.68 $57.40 $45.87 $ New Patient, 1 through 4 years $76.68 $53.83 $47.32 $ New Patient, 5 through 11 years $76.68 $54.23 $48.58 $ New Patient, 12 through 17 years $76.68 $60.31 $52.48 $ New Patient, 18 through 39 years $76.68 $68.15 $53.58 $ Established Patient, under 1 year Established Patient, 1 to 4 yrs Established Patient, 5 to 11 yrs Established Patient, 12 to 17 yrs Established Patient, 18 to 39 yrs $76.68 $50.78 $40.08 $75.77 $76.68 $52.08 $42.10 $88.09 $76.68 $53.01 $43.41 $88.09 $76.68 $59.88 $47.01 $ $76.68 $63.40 $47.15 $ Individual Counseling, 15 min NP NE $23.93 $ Individual Counseling, 30 min NP NE $37.07 $67.46 EPSDT - Evaluation and Management New Patient, office visit $25.33 $26.67 $25.68 $ New Patient, expanded office visit $41.13 $36.28 $35.89 $ New Patient, low complexity $57.57 $46.35 $46.87 $ New Patient, intermediate complexity $85.90 $67.44 $66.06 $ New Patient, high complexity $ $83.64 $94.53 $ Established Patient, office visit Established Patient, expanded office visit Established Patient, low complexity Established Patient, intermediate complexity Established Patient, high complexity Screening test, hearing evaluation Tympanometry, hearing evaluation $11.11 $11.14 $14.26 $14.16 $22.42 $21.33 $23.18 $27.61 $32.30 $28.11 $32.30 $39.42 $49.27 $57.40 $43.54 $59.39 $78.05 $61.07 $63.20 $93.67 $9.36 $10.02 $12.12 $15.47 $12.10 $12.75 $20.54 OM Other method, NC Not covered, Not applicable, NP not provided by state.

2 EPSDT - Newborn Care Initial newborn care Subsequent newborn care Admit and discharge on same day $75.66 $60.77 $63.90 $86.69 $40.02 $31.17 $32.47 $45.81 $93.24 $69.76 $74.90 $ Immunizations DPT DT Measles, mumps, rubella Oral polio Varicella Td Influenza virus Hemophilus Influenza B DTaP, HIB Hepatitis B, under 11 years Hepatitis B, 11 through 19 years Unlisted immunization procedure Therapeutic or diagnostic injection Evaluation and Management $12.88 $15.21 $9.00 $18.84 $17.86 $16.74 $11.39 $10.01 $19.73 $23.22 $9.23 $7.76 $10.60 $9.11 $15.31 $12.92 $9.76 $13.87 $16.92 $15.64 $17.99 $17.78 $19.33 $9.01 $7.15 $5.04 $ Observation care discharge $55.43 $44.51 $40.23 $ Initial care, low severity $60.39 $49.14 $45.54 $ Initial care, intermediate severity $98.28 $78.25 $70.01 $ Initial care, high severity Prolonged service, 1 hr, face-to-face $ $ $88.96 $ $78.05 $63.02 $61.43 $ Team medical conference Telephone call for consultation Supervision of home health care patient Newborn Care NC NC NC $26.89 $27.96 $4.75 $5.09 $44.36 $ Physician attendance at delivery Newborn resuscitation Circumcision $93.24 $70.60 $ $ $ $ $73.74 $61.50 $ OM Other method, NC Not covered, Not applicable, NP not provided by state. Page 2 of 6

3 Hospital Care Initial observation, moderate complexity $98.28 $78.25 $68.97 $ Initial observation, high complexity $ $ $89.40 $ Initial hosptialization, low complexity $60.10 $45.75 $45.10 $ Initial hosptialization, intermediate complexity $97.99 $70.57 $70.04 $ Initial hosptialization, high complexity $ $89.54 $87.14 $ Subsequent hosptialization, low complexity Subsequent hosptialization, intermediate Subsequent hosptialization, high complexity $31.37 $23.80 $25.42 $36.57 $46.57 $33.62 $34.51 $53.64 $65.04 $48.27 $50.31 $ Hospital discharge, under 30 min $55.14 $40.85 $38.75 $63.24 Consultations Office visit, straightforward decision $63.76 $50.42 $51.46 $ Office visit, low complexity $83.07 $63.86 $65.66 $ Office visit, intermediate complexity $ $89.38 $87.76 $ Office visit, high complexity $ $ $ $ Initial inpatient visit, moderate complexity $ $88.43 $87.42 $ Initial inpatient visit, high complexity $ $ $ $ Pathology and Laboratory Urinalysis, non-automated $4.37 $3.69 $ Urinalysis, automated $4.37 $3.75 $ Bone marrow aspiration $53.77 $46.62 $43.58 $ Tuberculosis, intradermal $7.31 $5.55 $7.34 $ Streptococcus screen $13.05 $11.67 $ Throat or nose culture $10.68 $8.62 $9.39 Psychiatry Diagnostic interview examination $ $79.28 $71.13 $ OM Other method, NC Not covered, Not applicable, NP not provided by state. Page 3 of 6

4 Allergy/Immunology Percutaneous tests with allergenic extracts $2.77 $2.23 $2.28 $ Percutaneous tests, sequential and incremental $8.01 $6.25 $5.31 $ Intracutaneous tests, with biologicals $8.01 $6.38 $5.26 $ Intracutaneous tests with allergenic extracts $4.24 $3.58 $3.42 $ Allergenic immunotherapy, single injection $11.11 $8.71 $7.60 $ Allergen immunotherapy, two or more injections $14.33 $11.47 $10.31 $18.34 Cardiology Thoracostomy tube $ $ $ $ Cardiopulmonary resuscitation $ $ $ $ Transthoracic echocardiography $ $ $ $ Echocardiography, real-time with $ $ $ $ image documentation Doppler echocardiography $76.06 $63.22 $81.89 $ Right heart catheterization $ $ $ $ Left heart catheterization $1, $ $ $ Critical Care Intubuation, endotracheal $ $85.07 $81.47 $ Place catheter, percutaneous, < 2yrs old $72.16 $59.94 $80.01 $ Place catheter, percutaneous, > 2yrs old $72.95 $64.11 $79.24 $ Arterial puncture, diagnostic $18.39 $15.41 $17.72 $ Arterial line placement $56.89 $46.69 $53.58 $ Evaluation and management, first hour $ $ $ $ Evaluation and management, add. 30 minutes $80.95 $56.53 $57.52 $91.86 Emergency Care Simple surgical removal of foreign body $51.02 $42.81 $40.62 $ Simple surgical repair of facial wound $ $ $ $ Venipuncture, under 2 years $8.35 $8.90 $13.49 $ Venipuncture, over 2 years $12.30 $11.80 $15.36 $ Venipuncture for specimen collection $3.57 $2.41 $ Lumbar puncture, diagnostic $56.63 $46.26 $51.02 $66.26 OM Other method, NC Not covered, Not applicable, NP not provided by state. Page 4 of 6

5 Emergency Care, cont Visit, low complexity Visit, intermediate complexity Visit, high complexity North Carolina $28.58 $24.63 $24.96 $33.55 $53.35 $41.06 $38.28 $61.16 $81.73 $61.57 $55.32 $93.48 Gastrointestinal Upper gastrointestinal endoscopy with biopsy Esophagomyotomy (Heller) thoracic approach Otolaryngology Tonsillectomy/adenoidectomy, under 12 years Tonsillectomy/adenoidectomy, over 12 years Tympanostomy and tubes $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Perinatal Pediatrics (neonatal intensive care) Umbilical vein catheterization $44.00 $35.07 $42.32 $ Umbilical artery catheterization $58.27 $47.03 $60.60 $ Inital NICU care $ $ $ $ Subsequent NICU, unstable neonate $ $ $ $ Subsequent NICU, stable $ $ $ $ Plastic Surgery Cleft lip repair $ $ $ $ Cleft palate repair $ $ $ $ Pulmonology Bronchoscopy $ $ $ $ Thoracentesis $75.17 $60.92 $65.99 $ Spriometry, including graphic record $25.87 $21.74 $26.35 $32.50 OM Other method, NC Not covered, Not applicable, NP not provided by state. Page 5 of 6

6 Radiology Frontal chest x-ray $21.65 $16.68 $18.98 $26.97 Surgery Extensive clubfoot release $ $ $ $ Appendectomy $ $ $ $ Bilateral inguinal hernia, under 5 years $ $ $ $ Bilateral inguinal hernia, over 5 years $ $ $ $ Urology and Dialysis Renal biopsy $ $ $ $ ESRD (end stage renal dis $ $ $ $ ESRD, 2 through 11 years $ $ $ $ ESRD, 12 through 19 years $ $ $ $ Peritoneal dialysis $77.95 $64.55 $70.43 $92.59 OM Other method, NC Not covered, Not applicable, NP not provided by state. Page 6 of 6