|
90785 Interactive Complexity
|
Professional
|
$60.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
490785
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$5.64
|
| Rate for Payer: Humana Commercial |
$6.29
|
| Rate for Payer: Humana Commercial |
$5.80
|
| Rate for Payer: Humana Commercial |
$6.76
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$5.80
|
| Rate for Payer: Humana Medicare |
$6.76
|
| Rate for Payer: Magellan Medicaid |
$5.37
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$5.37
|
| Rate for Payer: Prime Health Services Workers Comp |
$22.74
|
| Rate for Payer: Sunshine Health FHK |
$5.37
|
| Rate for Payer: Sunshine Health Medicaid |
$5.37
|
| Rate for Payer: Sunshine Health Medicaid |
$4.30
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$10.43
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$9.78
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$9.13
|
|
|
Add to CCM initiation visit (care plan formulation) (G0506)
|
Professional
|
$186.00
|
|
|
Service Code
|
CPT G0506
|
| Hospital Charge Code |
74G0506
|
| Min. Negotiated Rate |
$30.65 |
| Max. Negotiated Rate |
$100.77 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$43.07
|
| Rate for Payer: Behavioral Services Network Medicare |
$43.07
|
| Rate for Payer: Carelon Medicare |
$43.07
|
| Rate for Payer: Lucet Commercial |
$38.76
|
| Rate for Payer: Lucet Commercial |
$36.61
|
| Rate for Payer: Lucet Commercial |
$32.30
|
| Rate for Payer: Molina Complete Care Medicare |
$43.07
|
| Rate for Payer: Prime Health Services Workers Comp |
$100.77
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$43.07
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$35.02
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$30.65
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$32.84
|
|
|
Alcohol and/or Drug Screening - H0049
|
Professional
|
$25.00
|
|
|
Service Code
|
CPT H0049
|
| Hospital Charge Code |
104H0049
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$24.94 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.83
|
| Rate for Payer: Carelon Medicaid |
$17.08
|
| Rate for Payer: Magellan Medicaid |
$17.93
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.93
|
| Rate for Payer: Molina Complete Care Marketplace |
$17.08
|
| Rate for Payer: Sunshine Health FHK |
$17.93
|
| Rate for Payer: Sunshine Health Medicaid |
$14.34
|
| Rate for Payer: Sunshine Health Medicaid |
$17.93
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$24.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$23.38
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$21.82
|
|
|
Clubhouse Services
|
Professional
|
$24.00
|
|
|
Service Code
|
CPT H2030
|
| Hospital Charge Code |
135H2030
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$5.29
|
| Rate for Payer: Carelon Medicaid |
$5.00
|
| Rate for Payer: Magellan Medicaid |
$5.04
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$5.04
|
| Rate for Payer: Molina Complete Care Marketplace |
$5.04
|
| Rate for Payer: Sunshine Health FHK |
$5.04
|
| Rate for Payer: Sunshine Health Medicaid |
$5.04
|
| Rate for Payer: Sunshine Health Medicaid |
$4.03
|
|
|
Clubhouse Services - H2030
|
Professional
|
$5.29
|
|
|
Service Code
|
CPT H2030
|
| Hospital Charge Code |
136H2030
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$5.29
|
| Rate for Payer: Carelon Medicaid |
$5.00
|
| Rate for Payer: Magellan Medicaid |
$5.04
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$5.04
|
| Rate for Payer: Molina Complete Care Marketplace |
$5.04
|
| Rate for Payer: Sunshine Health FHK |
$5.04
|
| Rate for Payer: Sunshine Health Medicaid |
$5.04
|
| Rate for Payer: Sunshine Health Medicaid |
$4.03
|
|
|
Comprehensive Behavioral Health Assessment
|
Professional
|
$72.00
|
|
|
Service Code
|
CPT H0031 HA
|
| Hospital Charge Code |
90H0031
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$12.12 |
| Rate for Payer: Carelon Medicaid |
$12.12
|
|
|
Comprehensive Behavioral Health Assessment
|
Professional
|
$48.92
|
|
|
Service Code
|
CPT H0031
|
| Hospital Charge Code |
89H0031
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.80
|
| Rate for Payer: Carelon Medicaid |
$15.00
|
| Rate for Payer: Magellan Medicaid |
$17.90
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.90
|
| Rate for Payer: Sunshine Health FHK |
$17.90
|
| Rate for Payer: Sunshine Health Medicaid |
$17.90
|
| Rate for Payer: Sunshine Health Medicaid |
$14.32
|
|
|
CVD risk reduction, annually, 15 mins (G0446)
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT G0446
|
| Hospital Charge Code |
72G0446
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$41.22 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$22.33
|
| Rate for Payer: Behavioral Services Network Medicare |
$22.33
|
| Rate for Payer: Carelon Medicare |
$22.33
|
| Rate for Payer: Lucet Commercial |
$16.75
|
| Rate for Payer: Lucet Commercial |
$20.10
|
| Rate for Payer: Lucet Commercial |
$18.98
|
| Rate for Payer: Molina Complete Care Medicare |
$22.33
|
| Rate for Payer: Prime Health Services Workers Comp |
$41.22
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$22.33
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$17.03
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$18.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$15.90
|
|
|
Depression, annually (G0444)
|
Professional
|
$55.00
|
|
|
Service Code
|
CPT G0444
|
| Hospital Charge Code |
70G0444
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$8.84
|
| Rate for Payer: Behavioral Services Network Medicare |
$8.84
|
| Rate for Payer: Carelon Medicare |
$8.84
|
| Rate for Payer: Lucet Commercial |
$6.63
|
| Rate for Payer: Lucet Commercial |
$7.51
|
| Rate for Payer: Lucet Commercial |
$7.96
|
| Rate for Payer: Molina Complete Care Medicare |
$8.84
|
| Rate for Payer: Prime Health Services Workers Comp |
$30.04
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$8.84
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$7.19
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.29
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.74
|
|
|
Group Therapy 90853
|
Professional
|
$46.35
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
2990853
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$21.91
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$23.72
|
| Rate for Payer: Behavioral Services Network Medicare |
$23.72
|
| Rate for Payer: Carelon Commercial/Medicare |
$35.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$23.72
|
| Rate for Payer: Humana Commercial |
$34.23
|
| Rate for Payer: Humana Commercial |
$31.78
|
| Rate for Payer: Humana Commercial |
$29.34
|
| Rate for Payer: Humana Medicare |
$29.34
|
| Rate for Payer: Humana Medicare |
$31.78
|
| Rate for Payer: Humana Medicare |
$34.23
|
| Rate for Payer: Lucet Commercial |
$17.79
|
| Rate for Payer: Lucet Commercial |
$20.16
|
| Rate for Payer: Lucet Commercial |
$21.35
|
| Rate for Payer: Magellan Medicaid |
$20.87
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$20.87
|
| Rate for Payer: Molina Complete Care Medicare |
$23.72
|
| Rate for Payer: Prime Health Services Workers Comp |
$42.92
|
| Rate for Payer: Sunshine Health FHK |
$20.87
|
| Rate for Payer: Sunshine Health Medicaid |
$16.70
|
| Rate for Payer: Sunshine Health Medicaid |
$20.87
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$23.72
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$18.09
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$16.88
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$19.30
|
|
|
Group Therapy H2019HQ
|
Professional
|
$6.73
|
|
|
Service Code
|
CPT H2019
|
| Hospital Charge Code |
125H2019
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.80
|
| Rate for Payer: Carelon Medicaid |
$15.00
|
| Rate for Payer: Magellan Medicaid |
$17.90
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.90
|
| Rate for Payer: Sunshine Health FHK |
$17.90
|
| Rate for Payer: Sunshine Health Medicaid |
$14.32
|
| Rate for Payer: Sunshine Health Medicaid |
$17.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$38.65
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$36.23
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$33.82
|
|
|
Group Therapy H2019HQ
|
Professional
|
$7.07
|
|
|
Service Code
|
CPT H2019 HQ
|
| Hospital Charge Code |
126H2019
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$7.07
|
| Rate for Payer: Carelon Medicaid |
$6.67
|
| Rate for Payer: Magellan Medicaid |
$6.73
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$6.73
|
| Rate for Payer: Sunshine Health FHK |
$6.73
|
| Rate for Payer: Sunshine Health Medicaid |
$6.73
|
| Rate for Payer: Sunshine Health Medicaid |
$5.38
|
|
|
Individual and Family Therapy 16-37 Min
|
Professional
|
$75.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
1790832
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$121.42 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$62.04
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$67.46
|
| Rate for Payer: Behavioral Services Network Medicare |
$67.46
|
| Rate for Payer: Carelon Commercial/Medicare |
$45.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$40.00
|
| Rate for Payer: Carelon Medicare |
$67.46
|
| Rate for Payer: Humana Commercial |
$80.21
|
| Rate for Payer: Humana Commercial |
$74.05
|
| Rate for Payer: Humana Commercial |
$86.38
|
| Rate for Payer: Humana Medicare |
$74.05
|
| Rate for Payer: Humana Medicare |
$80.21
|
| Rate for Payer: Humana Medicare |
$86.38
|
| Rate for Payer: Lucet Commercial |
$50.60
|
| Rate for Payer: Lucet Commercial |
$60.71
|
| Rate for Payer: Lucet Commercial |
$57.34
|
| Rate for Payer: Magellan Medicaid |
$59.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$59.09
|
| Rate for Payer: Molina Complete Care Medicare |
$67.46
|
| Rate for Payer: Prime Health Services Workers Comp |
$121.42
|
| Rate for Payer: Sunshine Health FHK |
$59.09
|
| Rate for Payer: Sunshine Health Medicaid |
$59.09
|
| Rate for Payer: Sunshine Health Medicaid |
$47.27
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$67.46
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$48.01
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$54.86
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$51.44
|
|
|
Individual and Family Therapy 38-52 Min
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
1990834
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$160.02 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$81.85
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$89.06
|
| Rate for Payer: Behavioral Services Network Medicare |
$89.06
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$89.06
|
| Rate for Payer: Humana Commercial |
$95.86
|
| Rate for Payer: Humana Commercial |
$111.83
|
| Rate for Payer: Humana Commercial |
$103.84
|
| Rate for Payer: Humana Medicare |
$111.83
|
| Rate for Payer: Humana Medicare |
$103.84
|
| Rate for Payer: Humana Medicare |
$95.86
|
| Rate for Payer: Lucet Commercial |
$80.15
|
| Rate for Payer: Lucet Commercial |
$66.80
|
| Rate for Payer: Lucet Commercial |
$75.70
|
| Rate for Payer: Magellan Medicaid |
$77.95
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$77.95
|
| Rate for Payer: Molina Complete Care Medicare |
$89.06
|
| Rate for Payer: Prime Health Services Workers Comp |
$160.02
|
| Rate for Payer: Sunshine Health FHK |
$77.95
|
| Rate for Payer: Sunshine Health Medicaid |
$62.36
|
| Rate for Payer: Sunshine Health Medicaid |
$77.95
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$89.06
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$67.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$72.43
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$63.38
|
|
|
Individual and Family Therapy 38-52 Mins
|
Professional
|
$68.59
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
2090834
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$160.02 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$81.85
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$89.06
|
| Rate for Payer: Behavioral Services Network Medicare |
$89.06
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$89.06
|
| Rate for Payer: Humana Commercial |
$103.84
|
| Rate for Payer: Humana Commercial |
$95.86
|
| Rate for Payer: Humana Commercial |
$111.83
|
| Rate for Payer: Humana Medicare |
$111.83
|
| Rate for Payer: Humana Medicare |
$103.84
|
| Rate for Payer: Humana Medicare |
$95.86
|
| Rate for Payer: Lucet Commercial |
$66.80
|
| Rate for Payer: Lucet Commercial |
$75.70
|
| Rate for Payer: Lucet Commercial |
$80.15
|
| Rate for Payer: Magellan Medicaid |
$77.95
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$77.95
|
| Rate for Payer: Molina Complete Care Medicare |
$89.06
|
| Rate for Payer: Prime Health Services Workers Comp |
$160.02
|
| Rate for Payer: Sunshine Health FHK |
$77.95
|
| Rate for Payer: Sunshine Health Medicaid |
$62.36
|
| Rate for Payer: Sunshine Health Medicaid |
$77.95
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$89.06
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$67.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$72.43
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$63.38
|
|
|
Individual and Family Therapy 53-999 Mins
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
2390837
|
| Min. Negotiated Rate |
$91.94 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$120.67
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$131.49
|
| Rate for Payer: Behavioral Services Network Medicare |
$131.49
|
| Rate for Payer: Carelon Medicare |
$131.49
|
| Rate for Payer: Humana Commercial |
$152.31
|
| Rate for Payer: Humana Commercial |
$140.59
|
| Rate for Payer: Humana Commercial |
$164.02
|
| Rate for Payer: Humana Medicare |
$152.31
|
| Rate for Payer: Humana Medicare |
$164.02
|
| Rate for Payer: Humana Medicare |
$140.59
|
| Rate for Payer: Lucet Commercial |
$118.34
|
| Rate for Payer: Lucet Commercial |
$111.77
|
| Rate for Payer: Lucet Commercial |
$98.62
|
| Rate for Payer: Magellan Medicaid |
$114.92
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$114.92
|
| Rate for Payer: Molina Complete Care Medicare |
$131.49
|
| Rate for Payer: Prime Health Services Workers Comp |
$235.96
|
| Rate for Payer: Sunshine Health FHK |
$114.92
|
| Rate for Payer: Sunshine Health Medicaid |
$91.94
|
| Rate for Payer: Sunshine Health Medicaid |
$114.92
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$131.49
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$106.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.25
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$93.57
|
|
|
Individual and Family Therapy 53+ Min
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
2290837
|
| Min. Negotiated Rate |
$91.94 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$120.67
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$131.49
|
| Rate for Payer: Behavioral Services Network Medicare |
$131.49
|
| Rate for Payer: Carelon Medicare |
$131.49
|
| Rate for Payer: Humana Commercial |
$152.31
|
| Rate for Payer: Humana Commercial |
$140.59
|
| Rate for Payer: Humana Commercial |
$164.02
|
| Rate for Payer: Humana Medicare |
$152.31
|
| Rate for Payer: Humana Medicare |
$164.02
|
| Rate for Payer: Humana Medicare |
$140.59
|
| Rate for Payer: Lucet Commercial |
$111.77
|
| Rate for Payer: Lucet Commercial |
$118.34
|
| Rate for Payer: Lucet Commercial |
$98.62
|
| Rate for Payer: Magellan Medicaid |
$114.92
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$114.92
|
| Rate for Payer: Molina Complete Care Medicare |
$131.49
|
| Rate for Payer: Prime Health Services Workers Comp |
$235.96
|
| Rate for Payer: Sunshine Health FHK |
$114.92
|
| Rate for Payer: Sunshine Health Medicaid |
$91.94
|
| Rate for Payer: Sunshine Health Medicaid |
$114.92
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$131.49
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$93.57
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.25
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$106.94
|
|
|
Individual and Family Therapy 90832
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
1890832
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$121.42 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$62.04
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$67.46
|
| Rate for Payer: Behavioral Services Network Medicare |
$67.46
|
| Rate for Payer: Carelon Commercial/Medicare |
$45.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$40.00
|
| Rate for Payer: Carelon Medicare |
$67.46
|
| Rate for Payer: Humana Commercial |
$80.21
|
| Rate for Payer: Humana Commercial |
$86.38
|
| Rate for Payer: Humana Commercial |
$74.05
|
| Rate for Payer: Humana Medicare |
$80.21
|
| Rate for Payer: Humana Medicare |
$74.05
|
| Rate for Payer: Humana Medicare |
$86.38
|
| Rate for Payer: Lucet Commercial |
$57.34
|
| Rate for Payer: Lucet Commercial |
$60.71
|
| Rate for Payer: Lucet Commercial |
$50.60
|
| Rate for Payer: Magellan Medicaid |
$59.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$59.09
|
| Rate for Payer: Molina Complete Care Medicare |
$67.46
|
| Rate for Payer: Prime Health Services Workers Comp |
$121.42
|
| Rate for Payer: Sunshine Health FHK |
$59.09
|
| Rate for Payer: Sunshine Health Medicaid |
$59.09
|
| Rate for Payer: Sunshine Health Medicaid |
$47.27
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$67.46
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$51.44
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$54.86
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$48.01
|
|
|
Individual and Family Therapy 90834
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
2190834
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$160.02 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$81.85
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$89.06
|
| Rate for Payer: Behavioral Services Network Medicare |
$89.06
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Medicare |
$89.06
|
| Rate for Payer: Humana Commercial |
$103.84
|
| Rate for Payer: Humana Commercial |
$111.83
|
| Rate for Payer: Humana Commercial |
$95.86
|
| Rate for Payer: Humana Medicare |
$111.83
|
| Rate for Payer: Humana Medicare |
$95.86
|
| Rate for Payer: Humana Medicare |
$103.84
|
| Rate for Payer: Lucet Commercial |
$75.70
|
| Rate for Payer: Lucet Commercial |
$80.15
|
| Rate for Payer: Lucet Commercial |
$66.80
|
| Rate for Payer: Magellan Medicaid |
$77.95
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$77.95
|
| Rate for Payer: Molina Complete Care Medicare |
$89.06
|
| Rate for Payer: Prime Health Services Workers Comp |
$160.02
|
| Rate for Payer: Sunshine Health FHK |
$77.95
|
| Rate for Payer: Sunshine Health Medicaid |
$62.36
|
| Rate for Payer: Sunshine Health Medicaid |
$77.95
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$89.06
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$67.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$72.43
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$63.38
|
|
|
Individual and Family Therapy 90837
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
2490837
|
| Min. Negotiated Rate |
$91.94 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$120.67
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$131.49
|
| Rate for Payer: Behavioral Services Network Medicare |
$131.49
|
| Rate for Payer: Carelon Medicare |
$131.49
|
| Rate for Payer: Humana Commercial |
$152.31
|
| Rate for Payer: Humana Commercial |
$164.02
|
| Rate for Payer: Humana Commercial |
$140.59
|
| Rate for Payer: Humana Medicare |
$164.02
|
| Rate for Payer: Humana Medicare |
$140.59
|
| Rate for Payer: Humana Medicare |
$152.31
|
| Rate for Payer: Lucet Commercial |
$118.34
|
| Rate for Payer: Lucet Commercial |
$111.77
|
| Rate for Payer: Lucet Commercial |
$98.62
|
| Rate for Payer: Magellan Medicaid |
$114.92
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$114.92
|
| Rate for Payer: Molina Complete Care Medicare |
$131.49
|
| Rate for Payer: Prime Health Services Workers Comp |
$235.96
|
| Rate for Payer: Sunshine Health FHK |
$114.92
|
| Rate for Payer: Sunshine Health Medicaid |
$91.94
|
| Rate for Payer: Sunshine Health Medicaid |
$114.92
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$131.49
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.25
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$106.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$93.57
|
|
|
Individual and Family Therapy H2019HR
|
Professional
|
$22.96
|
|
|
Service Code
|
CPT H2019 HR
|
| Hospital Charge Code |
128H2019
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$22.96
|
| Rate for Payer: Carelon Medicaid |
$18.33
|
| Rate for Payer: Magellan Medicaid |
$21.87
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$21.87
|
| Rate for Payer: Molina Complete Care Marketplace |
$22.96
|
| Rate for Payer: Sunshine Health FHK |
$21.87
|
| Rate for Payer: Sunshine Health Medicaid |
$17.50
|
| Rate for Payer: Sunshine Health Medicaid |
$21.87
|
|
|
Individual and Family Therapy H2019HR
|
Professional
|
$21.87
|
|
|
Service Code
|
CPT H2019
|
| Hospital Charge Code |
127H2019
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.80
|
| Rate for Payer: Carelon Medicaid |
$15.00
|
| Rate for Payer: Magellan Medicaid |
$17.90
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.90
|
| Rate for Payer: Sunshine Health FHK |
$17.90
|
| Rate for Payer: Sunshine Health Medicaid |
$17.90
|
| Rate for Payer: Sunshine Health Medicaid |
$14.32
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$33.82
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$38.65
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$36.23
|
|
|
Intensive Team Case Management
|
Professional
|
$12.07
|
|
|
Service Code
|
CPT T1017
|
| Hospital Charge Code |
177T1017
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Carelon Medicaid |
$12.00
|
|
|
Intensive Team Case Management
|
Professional
|
$36.00
|
|
|
Service Code
|
CPT T1017 HK
|
| Hospital Charge Code |
178T1017
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: Carelon Medicaid |
$12.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$12.07
|
|
|
IOP Per Diem
|
Professional
|
$390.00
|
|
|
Service Code
|
CPT S9480
|
| Hospital Charge Code |
137S9480
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$46.89 |
| Rate for Payer: Humana Commercial |
$43.53
|
| Rate for Payer: Humana Commercial |
$46.89
|
| Rate for Payer: Humana Commercial |
$40.18
|
|
