Medicaid Reimbursement Survey, 2010/11. North Carolina

Transcription

1 Medicaid Reimbursement Survey, 2010/11 North Carolina

2 North Carolina /11 AAP Medicaid Reimbursement Survey Survey Summary As part of its effort to monitor the impact of the Medicaid program on pediatrics, the American Academy of Pediatrics (AAP) conducts its Medicaid Reimbursement Survey periodically. The Survey, which collects state-administered fee-for-service program payment rates for commonly reported pediatric Current Procedural Terminology/CPT codes and dental codes, was most recently mailed to State Medicaid Directors in the 50 states and the District of Columbia between July 2010 and February 2011 to request payment rates effective July 1, 2010, the beginning of the fiscal year for most states. As of publication of this report, 46 states have responded to the survey. Tennessee, which does not have a state-administered fee-for-service Medicaid program, is not included in this report series. This and earlier AAP Medicaid Reimbursement Survey reports can be found at URL: In this Report... This report provides state-reported fees paid for pediatric services represented by over 200 CPT and dental codes used by state-administered fee-for-service Medicaid programs to reimburse providers. Medicaid fees are compared to Medicare where available, or to other benchmark fees (such as prices listed in the Clinical Diagnostic Lab Fee Schedule, or prices based on the Ingenix Essential RBRVS) where Medicare comparisons are unavailable. Codes are selected for inclusion in the survey based on (i) utilization, and (ii) importance to Academy priorities, such as Bright Futures and the pediatric medical home. Also included in this report are summary updates on Medicaid managed care (MMC) enrollment, state-monitoring of MMC physician reimbursement, coverage of Bright Futures benefits, availability of enhanced payment for pediatric services, availability of pediatric medical home program and provider payment, availability of Pediatric Primary Care Case Management (PCCM) program and provider payment, and reimbursement of pediatricians for providing certain mental and preventive oral health services to children.

3 North Carolina /11 AAP Medicaid Reimbursement Survey Caveats and Notes Medicaid fees shown in this report represent fee-for-service payments reported by states for state-administered Medicaid programs at the time of the study. The rates are subject to change. Nationally, the majority of children enrolled in Medicaid programs are enrolled in managed care plans, which may or may not benchmark provider payment rates to fees shown in this report. Depending on managed care penetration levels, the impact of state-administered fee-for-service Medicaid payment rates varies by state. Unless noted otherwise, non-facility rates and enhanced payment rates for pediatric services, where available and reported by the state, are included in this report. Medicare rates in this report are (a) based on non-facility Medicare payment published by the Centers for Medicare and Medicaid Services for 2011, and (b) adjusted with Geographic Practice Cost Index (GPCIs) published by CMS. Certain codes, including not not limited to and , are assigned RVUs but not covered by Medicare. CPT is a trademark of the American Medical Association. Dental codes (CDT Codes) are copyright 2006 American Dental Association. Reprinted with permission. Contact Information Contact Suk-fong Tang, Department of Practice, for comments on this report. Contact Dan Walter, Division of State Government Affairs, for Medicaid questions and advocacy advice. Contact Elizabeth Sobczyk, Division of Pediatric Practice, for pediatric immunization questions and advocacy advice. Contact the Division of Health Care Finance and Quality Improvement at dhcfqi@aap.org for information on child health financing or RBRVS. Suggested Citation 2010/11 AAP Medicaid Reimbursement Survey. American Academy of Pediatrics. Elk Grove Village, Illinois. Available for download at the AAP Website, at URL:

4 North Carolina /11 AAP Medicaid Reimbursement Survey Abbreviations AAP: American Academy of Pediatrics BC: Billed amount / billed charges BI / BR/ IC/ MP/ PR: By invoice/ by report/ individual consideration/manually priced/per review, i.e., Carrier will establish payment amounts for these services on a case-by-case basis following review of documentation, such as an operative report. BO: Bundled with other services, i.e., Payment for covered services is always bundled into payment for other services not specified. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. CMS: Centers for Medicare and Medicaid Services FFS: Discounted fee-for-service IER: RVUs not published for this code in the Medicare RBRVS; values are based on the Ingenix Essential RBRVS. Ratio (percentage listed under %Medicare column) represents Medicaid payment as a percentage of the rate calculated using the RVUs published in the Ingenix Essential RBRVS. LFS: Amount per Clinical Diagnostic Lab Fee Schedule. Ratio (percentage listed under %Medicare column) represents Medicaid payment as a percentage of the mount listed for the state in the Clinical Diagnostic Lab Fee Schedule. NA: Not applicable NC: Not covered NIS: Not priced by the current Physician Fee Schedule, or RVUs not included in RBRVS NL: Payment information specific to procedure code not listed on state Medicaid website or physician fee schedule. Note: absence of such information from fee schedule often indicates that the service is either not covered, or covered under alternate code(s). NP: Information not provided by state in returned AAP survey OM: Other method used P2010: 2010 pricing; code replaced prior to publication of this report QMB: Qualified Medicare Beneficiary RBRVS: Resource-Based Relative Value Scale, the physician payment schedule for Medicare RNE: Rate not established RVU(s): Relative Value Unit(s), the numeric value of the resources needed to provide services according to the Resource-Based Relative Value Scale UCF: Usual and customary fees VFC: Vaccines for Children Program. Providers are typically paid a vaccine administration fee for administering vaccines made available free of charge through VFC programs.

5 List of CPT and Dental Codes Included in Report Service Type Code Description Page# Preventive New patient, under 1 year 1 Medicine New patient, 1 through 4 years 1 Services New patient, 5 through 11 years New patient, 12 though 17 years New patient, 18 though 39 years Established patient, under 1 year Established patient, 1 through 4 years Established patient, 5 through 11 years Established patient, 12 though 17 years Established patient, 18 though 39 years Individual counseling, 15 min Individual counseling, 30 min Individual counseling, 45 min Individual counseling, 60 min Group health education Preventive counseling group - 30 min Preventive counseling group - 60 min Health risk assessment test Basic life and/or disability evaluation 1 Home Services Office and Other Outpatient Services Work related or medical disability evaluation New patient, problem focused New patient, expanded New patient, detailed New patient, moderate complexity New patient, high complexity Established patient, problem focused Established patient, expanded Established patient, detailed Established patient, comprehensive New patient, problem-focused New patient, expanded New patient, low complexity New patient, moderate complexity New patient, high complexity Established patient, nurse only Established patient, problemfocused Established patient, low complexity Established patient, moderate complexity Established patient, high complexity Screening test, hearing evaluation Tympanometry, hearing evaluation Screening test, visual acuity Developmental testing; limited Ocular photoscreening 2 Service Type Code Description Page# Newborn Care Initial newborn care Subsequent newborn care Admit and discharge on same day Physician attendance at delivery Newborn resuscitation Circumcision w/ regional block 2 Immunizations One immunization administration, physician counseling < 8 yrs Each additional immunization administration, physician counseling < 8 yrs One immunization administration, oral or intranasal, physician counseling < 8 yrs Each additional immunization administration, oral or intranasal, physician counseling < 8 yrs One immunization administration Each additional immunization administration One immunization administration, oral or intranasal Each additional administration, oral or intranasal Immune admin H1N1 im/nasal Hemophilus Influenza B Hpv vaccine 4 valent im Hpv vaccine 2 valent im Influenza virus (6-35 months) Influenza virus (3+ years) Influenza virus, intranasal use Flu vacc pandemic H1N Pneumococcal vacc 7 val im Pneumococcal vacc 13 val im Rotavirus DTaP (< 7 years) DTP DT (< 7 years) Measles-Mumps-Rubella IPV Tdap Varicella Td (³ 7 years) DTaP-HIB DTaP-HepB-IPV Meningococcal vaccine im Hepatitis B, (pediatric/adolescent age) 3 Evaluation and Observation care discharge, day Management management Initial observation care, low severity Initial observation care, intermediate severity Initial observation care, high severity Prolonged service outpatient, 1st hour, face-to-face 3

6 List of CPT and Dental Codes Included in Report (Continued) Service Type Code Description Page# Evaluation and Management Same as 99354, each additional 30 min 3 (continued) Prolonged service, inpatient, 1st hour, face-to-face Same as 99356, each additional 30 min Prolonged service, 1st hour, nonface-to-face Same as 99358, each additional 30 min Medical team conference by hc pro(face-to-face), 30 min Team conf w/o patient by physicians Team conf w/o pat by hc pro, 30 min Care plan oversight, min/mo Same as 99339, 30 min or more Home health care supervision, min/mo Same as 99374, 30 min or more Hospice care supervision, min Same as 99377, 30 min or more Nursing facility supervision, min Same as 99379, 30 min or more Phone e/m by phys 5-10 min Phone e/m by phys min Phone e/m by phys min 4 Non-physician Provider (NPP) Services Hospital Care Online e/m by physician Health and Behavior assessment Health and Behavior intervention same as above, group same as above, patient present same as above, patient not present Medical Nutrition Therapy, individual, initial Medical Nutrition Therapy, individual, follow-up Medical Nutrition Therapy, group, 30 min Telephone assessment / management, 5-10 min Telephone assessment / management, min Telephone assessment / management, min On-line assessment and management service Initial hospitalization, per day, low complexity Initial hospitalization, per day, moderate complexity Initial hospitalization, per day, high complexity Subsequent hospitalization, per day, low complexity Subsequent hospitalization, per day, mod Complexity 5 Service Type Code Description Page# Hospital Care (Continued) Subsequent hospitalization, per day, high complexity Hospital discharge, day management, =<30 min Hospital discharge, day management, > 30 min 5 Consultation Office consultation, problem focused Office consultation, expanded Office consultation, low complexity Office consultation, moderate complexity Office consultation, high complexity Initial inpatient consultation, low severity problem Same as above, moderate severity problem 5 Pathology and Laboratory Mental Health Allergy/ Immunology Cardiology Same as above, moderate to high severity problem Urinalysis, non-automated with microscopy Urinalysis, non-automated without microscopy Tuberculosis, intradermal Throat culture Rapid Streptococcus screen Psychiatric diagnostic interview examination Individual psychotherapy, min face-to-face Individual psychotherapy, min face-to-face Individual psychotherapy, min face-to-face Pharmacologic management Developmental testing, extended Consultation with family Preparation of report Percutaneous tests with allergenic extracts Percutaneous tests, sequential and incremental Intracutaneous tests, with biologicals Intracutaneous tests, with allergenic extracts Allergen immunotherapy, single injection Allergen immunotherapy, two or more injections Tube thoracostomy, includes water seal Cardiopulmonary resuscitation Transthoracic echocardiography Echocardiography, real-time w/ image documentation Doppler echocardiograph Right heart catheterization Left heart catheterization 6

7 List of CPT and Dental Codes Included in Report (continued) Service Type Code Description Page# Service Type Code Description Page# Critical Care Intubation, endotracheal 6 Neonatal and Initial pediatric critical care ( Insertion of non-tunneled center Pediatric yrs) 7 venous cathether; < 5 yrs 6 Critical Care Subsequent pediatric critical care Insertion of peripherally inserted (continued) (2-5 yrs) 7 CVC; under 5 years Initial neonatal critical care Arterial puncture, diagnostic Arterial line placement Critical care, first hour 6 Emergency Care Gastrointestinal Ophthalmology Otolaryngology Neonatal and Pediatric Critical Care Critical care, additional 30 min Simple surgical removal of foreign body Simple surgical repair of facial wounds ( cm) Venipuncture necessitating physician skill; < 3 yrs Venipuncture necessitating physician skill; >= 3 yrs Routine venipuncture Finger, heel, ear stick Lumbar puncture, diagnostic Moderate sedation by same phys < 5 yrs Moderate sedation by same phys 5 yrs Moderate sedation by same phys add-on Moderate sedation diff phys < 5 yrs Moderate sedation diff phys 5 yrs Moderate sedation diff phys addon ED visit, problem focused ED visit, expanded ED visit, detailed Upper gastrointestinal endoscopy with biopsy Colonoscopy with biopsy Sigmoidoscopy with biopsy Strabismus surgery, horizontal Strabismus surgery, vertical Nasolacrimal probing Tonsillectomy/adenoidectomy, under 12 years Tonsillectomy/adenoidectomy, over 12 years Tympanostomy and tubes Umbilical vein catheterization Umbilical artery catheterization Initial pediatric critical care (29d- 24m) Subsequent pediatric critical care (29d-24m) 7 Initial and Continuing Intensive Care Services Subsequent neonatal critical care Initial neonatal intensive care Subsq intensive care, < 1500 gm Subsq intensive care, gm Subsq intensive care, gm 7 Pulmonology Bronchoscopy Thoracentesis for aspiration Spirometry, including graphic record Inhalation treatment Continuous inhalation treatment, first hour Same as 94644, each additional hour Demonstration/evaluation 8 Radiology Frontal chest x-ray 8 Plastic Cleft lip repair 8 Surgery Cleft palate repair 8 Surgery Extensive clubfoot release Appendectomy Bilateral inguinal hernia, 6 mos to < 5 years 8 Urology and Dialysis Dental Services Bilateral inguinal hernia, 5 years or over Renal biopsy; percutaneous, by trocar or needle ESRD services; yrs, 4+ physician visits/mo Same as above, 2-3 physician visits/mo Same as above, 1 physician visits/mo Same as above, home dialysis for full month Same as above, for dialysis per day Peritoneal dialysis 8 D0120 Periodic exam 9 D1203 Topical fluoride treatment, child 9 D1120 Prophylaxis, child 9 D2150 Amalgam two surfaces, primary or permanent 9 D2330 Resin-based composite one surface anterior 9 D1351 Sealant, per tooth 9 D2930 Stainless steel crown on a primary tooth 9 D3220 Pulpotomy 9 D7140 Extraction 9 D0145 Caries Risk Assessment 9

8 AAP Medicaid Reimbursement Survey: North Carolina 2010/11 Medicaid Payments for Commonly Reported Pediatric CPT Codes Preventive Medicine Services New Patient, under 1 year New Patient, 1 through 4 years New Patient, 5 through 11 years New Patient, 12 through 17 years New Patient, 18 through 39 years Established Patient, under 1 year Established Patient, 1 through 4 years Established Patient, 5 through 11 years Established Patient, 12 through 17 years Established Patient, 18 through 39 years Individual Counseling, 15 min Individual Counseling, 30 min Individual Counseling, 45 min Individual Counseling, 60 min Group health education Preventive counseling group, 30 min Preventive counseling group, 60 min Health risk assessment test Basic life and/or disability evaluation Work related or medical disability evaluation Home Services Individual Counseling, 15 min Individual Counseling, 30 min Individual Counseling, 45 min Individual Counseling, 60 min New patient, high complexity Established patient, problem focused Established patient, expanded Established patient, detailed Established patient, comprehensive $90.84 $98.90 $98.24 $ $ $77.01 $85.29 $84.97 $93.35 $93.35 $35.25 $60.32 $84.48 $ NIS $15.11 $19.81 $9.68 NIS NIS $53.18 $77.28 $ $ $ $52.84 $80.05 $ $ TM

9 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 2 of 9) Office and Other Outpatient Services New Patient, office visit New Patient, expanded office visit New Patient, low complexity New Patient, moderate complexity New Patient, high complexity Established Patient, office visit Established Patient, expanded office visit Established Patient, low complexity Established Patient, moderate complexity Established Patient, high complexity Screening test, hearing evaluation Tympanometry, hearing evaluation Screening test, visual acuity Developmental testing; limited $40.04 $68.73 $99.68 $ $ $19.06 $40.04 $66.83 $99.54 $ $10.99 $14.85 $2.51 $ Ocular photoscreening Newborn Care Initial newborn care Subsequent newborn care Admit and discharge on same day Physician attendance at delivery Newborn resuscitation Circumcision w/regionl block Immunizations Immunization administration of vaccines provided by VFC One immunization admin, phys counseling < 8 yrs Each additional immunization administration, physician counseling < 8 yrs One immunization administration, oral or intranasal, physician counseling < 8 yrs Each additional immunization administration, oral or intranasal, physician counseling < 8 yrs One immunization administration Each additional immunization administration $26.65 $56.54 $30.45 $77.56 $70.16 $ $ NA $20.61 (P2010) $10.50 (P2010) $14.01 (P2010) $10.16 (P2010) $22.31 $11.19 NA

10 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 3 of 9) Immunizations (Continued) One immunization administration, oral or intranasal Each additional administration, oral or intranasal Immune admin H1N1 im/nasal, incl counseling Hemophilus Influenza B Hpv vaccine 4 valent im Hpv vaccine 2 valent im Influenza virus (6-35 months) Influenza virus (3+ years) Influenza virus, intranasal use Flu vacc pandemic H1N Pneumococcal vacc 7 val im Pneumococcal vacc 13 val im Rotavirus DTaP (< 7 years) DTP DT (< 7 years) Measles, mumps, rubella IPV Tdap Varicella Td (>= 7 years) DTaP, HIB DTaP-HepB-IPV Meningococcal vaccine im Hepatitis B, (pediatric/adolescent age) Evaluation and Management Observation care discharge, day management Initial observation care, low severity Payment rates, if shown, apply where service recipient is not eligible for free vaccine provided by VFC (Vaccine for Children program), such as when recipient is 19 or older Initial observation care, intermediate severity Initial observation care, high severity Prolonged service, outpatient, 1st hour, face-to-face Same as 99354, each additional 30 min Prolonged service, inpatient, 1st hour, face-to-face Same as 99356, each additional 30 min Prolonged service, 1st hour, non face-to-face Same as 99358, each additional 30 min $22.31 $11.19 $20.07 Medicare reimburses for vaccine products using 106% of the product's average sale price (ASP) $67.47 $62.91 $ $ $92.95 $91.98 $85.37 $85.37 $ $50.89

11 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 4 of 9) Evaluation and Management (Continued) Medical team conference by hc pro(face-to-face), 30 min Team conf w/o patient by physicians Team conf w/o patient by hc pro, 30 min Care plan oversight, min/mo Same as 99339, 30 minutes or more per month Home health care supervision, min/mo Same as 99374, 30 min or more per month Hospice care supervision, min Same as 99377, 30 min or more Nursing facility supervision, min Same as 99379, 30 min or more Phone e/m by physician 5-10 min Phone e/m by physician min Phone e/m by physician min Online e/m by physician $41.06 $54.28 $35.48 $73.96 $ $66.68 $ $66.68 $ $66.68 $ $13.61 $25.82 $38.35 $29.73 (IER) Non-physician Provider (NPP) Services Health and Behavior assessment, by NPP $ Health and Behavior intervention, by NPP $ same as above, group $ same as above, patient present $ same as above, patient not present $ Medical Nutrition Therapy, by NPP, individual, initial $ Medical Nutrition Therapy, by NPP, individual, follow-up $ Medical Nutrition Therapy, by NPP, group, 30 min $ Telephone assessment/management, by NPP, 5-10 min $ Same as above, min $ Same as above, min $ On-line assessment and management service, by NPP $20.27 (IER) Medical Home and Primary Care Case Management: Program Availability and Provider Payment Summary

12 AAP Medicaid Reimbursement Survey Report, 2010/11 North Carolina, Continued (page 5 of 9) Hospital Care Initial hosptialization, per day, low complexity $ Initial hosptialization, per day, moderate complexity $ Initial hosptialization, per day, high complexity $ Subsequent hosptialization, per day, low complexity $ Same as above, moderate complexity $ Same as above, high complexity $ Hospital discharge, day management, <= 30 min $ Hospital discharge, day management, >30 min $99.00 Consultations Office consultation, problem focused $ Office consultation, expanded Office consultation, low complexity Office consultation, moderate complexity $84.57 $ $ Office consultation, high complexity $ Initial inpatient consultation, low severity problem $ Same as above, moderate severity problem $ Same as above, moderate to high severity problem $ Pathology and Laboratory Urinalysis, non-automated with microscopy $4.45 (LFS) Urinalysis, non-automated without microscopy $3.60 (LFS) Tuberculosis, intradermal $ Throat culture $8.12 (LFS) Rapid Streptococcus screen $16.12 (LFS) Mental Health Psychiatric diagnostic interview examination $ Individual psychotherapy, min face-to-face $ Individual psychotherapy, min face-to-face $ Individual psychotherapy, min face-to-face $ Pharmacological management $ Developmental testing, extended $ Consultation with family $ Preparation of report $64.67 (IER) Medicaid Reimbursement for Mental Health Services Provided by Pediatricians:

13 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 6 of 9) Specialty Care Codes Allergy/Immunology Percutaneous tests with allergenic extracts Percutaneous tests, sequential and incremental Intracutaneous tests, with biologicals Intracutaneous tests with allergenic extracts Allergenic immunotherapy, single injection Allergen immunotherapy, two or more injections $6.11 $17.72 $13.80 $7.09 $9.68 $11.97 Cardiology Tube thoracostomy, includes water seal Cardiopulmonary resuscitation Transthoracic echocardiography Echocardiography, real-time with image documentation Doppler echocardiograph Right heart catheterization Left heart catheterization Critical Care Intubuation, endotracheal Insertion of non-tunneled CVC~ ; <5 yrs old Insertion of peripherally inserted CVC~; <5 yrs old Arterial puncture, diagnostic Arterial line placement Critical care, first hour Critical care, additional 30 minutes Emergency Care Simple surgical removal of foreign body Simple surgical repair of facial wound( cm) Venipuncture necessitating physician skill, < 3 yrs, Venipuncture necessitating physician skill, >= 3 years Routine venipuncture Finger, heel, ear stick Lumbar puncture, diagnostic Moderate sedation by same physician < 5 yrs Moderate sedation by same physician 5 yrs Moderate sedation by same physician add-on $ $ $ $ $60.66 $ (P2010) $ (P2010) $ $ $ $29.81 $49.48 $ $ $ $ $28.06 $17.56 $3.00 NIS $ $61.02 (IER) $73.23 (IER) $20.27 (IER)

14 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 7 of 9) Emergency Care (Continued) Moderate sedation diff physician < 5 yrs Moderate sedation diff physician 5 yrs Moderate sedation diff physician add-on ED visit, problem focused ED visit, expanded ED visit, detailed Gastrointestinal Upper gastrointestinal endoscopy with biopsy Colonoscopy with biopsy Sigmoidoscopy with biopsy Ophthalmology Strabismus surgery, horizontal Strabismus surgery, vertical Nasolacrimal probing $55.85 (IER) $45.72 (IER) $20.27 (IER) $39.31 $59.53 $ $ $ $ $ $ $ Otolaryngology Tonsillectomy/adenoidectomy, under 12 years Tonsillectomy/adenoidectomy, 12 years or over Tympanostomy and tubes Neonatal and Pediatric Critical Care Umbilical vein catheterization Umbilical artery catheterization Initial pediatric critical care (29d-24m) Subsequent pediatric critical care (29d-24m) Initial pediatric critical care (2-5 yrs) Subsequent pediatric critical care (2-5 yrs) Initial neonatal critical care Subsequent neonatal critical care Initial and Continuing Intensive Care Services Initial neonatal intensive care Subsq intensive care, < 1500 gm Subsq intensive care, gm Subsq intensive care, gm $ $ $ $ $72.85 $ $ $ $ $ $ $ $ $ $114.83

15 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 8 of 9) Pulmonology Bronchoscopy Thoracentesis for aspiration Spriometry, including graphic record Inhalation treatmen Continuous inhalation treatment, first ho Same as 94644, each additional hour Demonstration/evaluation $ $ $33.95 $15.23 $38.39 $13.92 $15.23 Radiology Frontal chest x-ray Plastic Surgery Cleft lip repair Cleft palate repair Surgery Extensive clubfoot release Appendectomy Bilateral inguinal hernia, 6 mos to under 5 yrs Bilateral inguinal hernia, 5 years or over Urology and Dialysis Renal biopsy ESRD services for yrs, 4+ physician visits/mo Same as above, 2-3 physician visits/mo Same as above, 1 physician visits/mo Same as above, home dialysis for full month Same as above, dialysis for day Peritoneal dialysis $22.88 $ $ $ $ $ $ $ $ $ $ $ $ $76.34

16 AAP Medicaid Reimbursement Survey Report, 2010/11 - North Carolina, Continued (page 9 of 9) Dental and Oral Health Services Dental codes (CDT Codes) are copyright 2006 American Dental Association. D Periodic exam D Topical fluoride treatment, child D Prophylaxis, child D Amalgam two surfaces, primary or permanent D Resin-based composite one surface anterior D Sealant, per tooth D Stainless steel crown on a primary tooth D Pulpotomy D Extraction D Caries Risk Assessment NIS Medicaid Reimbursement for Preventive Oral Health Services Performed by Non-dental Medical Providers