|
MH Office Visit - Est. Pt. (High Complexity 99215)
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
6699215
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$89.72
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$141.34
|
| Rate for Payer: Behavioral Services Network Medicare |
$141.34
|
| Rate for Payer: Carelon Medicare |
$141.34
|
| Rate for Payer: Humana Commercial |
$182.70
|
| Rate for Payer: Humana Commercial |
$196.76
|
| Rate for Payer: Humana Medicare |
$196.76
|
| Rate for Payer: Humana Medicare |
$182.70
|
| Rate for Payer: Lucet Commercial |
$106.00
|
| Rate for Payer: Lucet Commercial |
$120.14
|
| Rate for Payer: Lucet Commercial |
$127.21
|
| Rate for Payer: Magellan Medicaid |
$85.45
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$85.45
|
| Rate for Payer: Molina Complete Care Medicare |
$141.34
|
| Rate for Payer: Prime Health Services Workers Comp |
$278.85
|
| Rate for Payer: Sunshine Health FHK |
$85.45
|
| Rate for Payer: Sunshine Health Medicaid |
$85.45
|
| Rate for Payer: Sunshine Health Medicaid |
$68.36
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$141.34
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$114.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$107.76
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.58
|
|
|
MH Office Visit - Est. Pt. (Minimal 99211)
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4599211
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.48
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$8.53
|
| Rate for Payer: Behavioral Services Network Medicare |
$8.53
|
| Rate for Payer: Carelon Medicare |
$8.53
|
| Rate for Payer: Humana Commercial |
$27.66
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.25
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| Rate for Payer: Magellan Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care Medicare |
$8.53
|
| Rate for Payer: Prime Health Services Workers Comp |
$34.95
|
| Rate for Payer: Sunshine Health FHK |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$14.08
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$8.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.50
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
|
|
MH Office Visit - Est. Pt. (Minimal 99211)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
146T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Office Visit - Est. Pt. (Minimal 99211) - 304
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
147T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Office Visit - Est. Pt. (Straightforward Complexity 99212)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
148T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Office Visit - Est. Pt. (Straightforward Complexity 99212)
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
5699212
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$86.66 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$29.55
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$34.73
|
| Rate for Payer: Behavioral Services Network Medicare |
$34.73
|
| Rate for Payer: Carelon Medicare |
$34.73
|
| Rate for Payer: Humana Commercial |
$55.80
|
| Rate for Payer: Humana Commercial |
$60.09
|
| Rate for Payer: Humana Medicare |
$60.09
|
| Rate for Payer: Humana Medicare |
$55.80
|
| Rate for Payer: Lucet Commercial |
$26.05
|
| Rate for Payer: Lucet Commercial |
$29.52
|
| Rate for Payer: Lucet Commercial |
$31.26
|
| Rate for Payer: Magellan Medicaid |
$28.14
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$28.14
|
| Rate for Payer: Molina Complete Care Medicare |
$34.73
|
| Rate for Payer: Prime Health Services Workers Comp |
$86.66
|
| Rate for Payer: Sunshine Health FHK |
$28.14
|
| Rate for Payer: Sunshine Health Medicaid |
$22.51
|
| Rate for Payer: Sunshine Health Medicaid |
$28.14
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$34.73
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$28.24
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$24.71
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$26.48
|
|
|
MH Office Visit - New Pt. Detailed (Low Complexity 99203)
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
3499203
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$172.60 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$88.45
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$81.01
|
| Rate for Payer: Behavioral Services Network Medicare |
$81.01
|
| Rate for Payer: Carelon Medicare |
$81.01
|
| Rate for Payer: Humana Commercial |
$138.94
|
| Rate for Payer: Humana Commercial |
$149.63
|
| Rate for Payer: Humana Medicare |
$149.63
|
| Rate for Payer: Humana Medicare |
$138.94
|
| Rate for Payer: Lucet Commercial |
$72.91
|
| Rate for Payer: Lucet Commercial |
$68.86
|
| Rate for Payer: Lucet Commercial |
$60.76
|
| Rate for Payer: Magellan Medicaid |
$84.24
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$84.24
|
| Rate for Payer: Molina Complete Care Medicare |
$81.01
|
| Rate for Payer: Prime Health Services Workers Comp |
$172.60
|
| Rate for Payer: Sunshine Health FHK |
$84.24
|
| Rate for Payer: Sunshine Health Medicaid |
$84.24
|
| Rate for Payer: Sunshine Health Medicaid |
$67.39
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$81.01
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$65.88
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$57.64
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$61.76
|
|
|
MH Office Visit - New Pt. Detailed (Low Complexity 99203)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
154T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Office Visit - New Pt. (High Complexity 99205)
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
4099205
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$342.51 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$174.78
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$178.78
|
| Rate for Payer: Behavioral Services Network Medicare |
$178.78
|
| Rate for Payer: Carelon Medicare |
$178.78
|
| Rate for Payer: Humana Commercial |
$262.57
|
| Rate for Payer: Humana Commercial |
$282.77
|
| Rate for Payer: Humana Medicare |
$282.77
|
| Rate for Payer: Humana Medicare |
$262.57
|
| Rate for Payer: Lucet Commercial |
$160.90
|
| Rate for Payer: Lucet Commercial |
$151.96
|
| Rate for Payer: Lucet Commercial |
$134.08
|
| Rate for Payer: Magellan Medicaid |
$166.46
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$166.46
|
| Rate for Payer: Molina Complete Care Medicare |
$178.78
|
| Rate for Payer: Prime Health Services Workers Comp |
$342.51
|
| Rate for Payer: Sunshine Health FHK |
$166.46
|
| Rate for Payer: Sunshine Health Medicaid |
$166.46
|
| Rate for Payer: Sunshine Health Medicaid |
$133.17
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$178.78
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$145.39
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.22
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.30
|
|
|
MH Office Visit - New Pt. (High Complexity 99205)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
151T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Office Visit - New Pt. (Low Complexity 99202)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
152T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
MH Office Visit - New Pt. (Low Complexity 99202)
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3199202
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$110.83 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$57.30
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$46.61
|
| Rate for Payer: Behavioral Services Network Medicare |
$46.61
|
| Rate for Payer: Carelon Medicare |
$46.61
|
| Rate for Payer: Humana Commercial |
$102.26
|
| Rate for Payer: Humana Commercial |
$94.95
|
| Rate for Payer: Humana Medicare |
$102.26
|
| Rate for Payer: Humana Medicare |
$94.95
|
| Rate for Payer: Lucet Commercial |
$34.96
|
| Rate for Payer: Lucet Commercial |
$39.62
|
| Rate for Payer: Lucet Commercial |
$41.95
|
| Rate for Payer: Magellan Medicaid |
$54.57
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$54.57
|
| Rate for Payer: Molina Complete Care Medicare |
$46.61
|
| Rate for Payer: Prime Health Services Workers Comp |
$110.83
|
| Rate for Payer: Sunshine Health FHK |
$54.57
|
| Rate for Payer: Sunshine Health Medicaid |
$54.57
|
| Rate for Payer: Sunshine Health Medicaid |
$43.66
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$46.61
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$37.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$33.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$35.54
|
|
|
MH Office Visit - New Pt. (Moderate Complexity 99204)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
153T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
MH Office Visit - New Pt. (Moderate Complexity 99204)
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3799204
|
| Min. Negotiated Rate |
$93.53 |
| Max. Negotiated Rate |
$259.28 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$132.54
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$131.44
|
| Rate for Payer: Behavioral Services Network Medicare |
$131.44
|
| Rate for Payer: Carelon Medicare |
$131.44
|
| Rate for Payer: Humana Commercial |
$228.62
|
| Rate for Payer: Humana Commercial |
$212.28
|
| Rate for Payer: Humana Medicare |
$228.62
|
| Rate for Payer: Humana Medicare |
$212.28
|
| Rate for Payer: Lucet Commercial |
$118.30
|
| Rate for Payer: Lucet Commercial |
$98.58
|
| Rate for Payer: Lucet Commercial |
$111.72
|
| Rate for Payer: Magellan Medicaid |
$126.23
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$126.23
|
| Rate for Payer: Molina Complete Care Medicare |
$131.44
|
| Rate for Payer: Prime Health Services Workers Comp |
$259.28
|
| Rate for Payer: Sunshine Health FHK |
$126.23
|
| Rate for Payer: Sunshine Health Medicaid |
$126.23
|
| Rate for Payer: Sunshine Health Medicaid |
$100.98
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$131.44
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$106.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.22
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$93.53
|
|
|
MH-related medical srvs: medical procedures-MH - 99211
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4799211
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.48
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$8.53
|
| Rate for Payer: Behavioral Services Network Medicare |
$8.53
|
| Rate for Payer: Carelon Medicare |
$8.53
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Commercial |
$27.66
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Lucet Commercial |
$7.25
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| Rate for Payer: Magellan Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care Medicare |
$8.53
|
| Rate for Payer: Prime Health Services Workers Comp |
$34.95
|
| Rate for Payer: Sunshine Health FHK |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$14.08
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$8.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.50
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
|
|
MH Related Medical Svcs: Medical Procedures
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4699211
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.48
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$8.53
|
| Rate for Payer: Behavioral Services Network Medicare |
$8.53
|
| Rate for Payer: Carelon Medicare |
$8.53
|
| Rate for Payer: Humana Commercial |
$27.66
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.25
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| Rate for Payer: Magellan Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care Medicare |
$8.53
|
| Rate for Payer: Prime Health Services Workers Comp |
$34.95
|
| Rate for Payer: Sunshine Health FHK |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$14.08
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$8.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.50
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
|
|
MH Related Medical Svs Medical Procedures T1015HE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT T1015 HE
|
| Hospital Charge Code |
156T1015
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$10.59
|
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Magellan Medicaid |
$10.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$10.09
|
| Rate for Payer: Sunshine Health FHK |
$10.09
|
| Rate for Payer: Sunshine Health Medicaid |
$8.07
|
| Rate for Payer: Sunshine Health Medicaid |
$10.09
|
|
|
MH Related Medical Svs Medical Procedures T1015HE
|
Professional
|
Both
|
$10.09
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
155T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Single Panel Drug Test T1015HF
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT T1015 HF
|
| Hospital Charge Code |
158T1015
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$10.59
|
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Magellan Medicaid |
$10.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$10.09
|
| Rate for Payer: Sunshine Health FHK |
$10.09
|
| Rate for Payer: Sunshine Health Medicaid |
$8.07
|
| Rate for Payer: Sunshine Health Medicaid |
$10.09
|
|
|
MH Single Panel Drug Test T1015HF
|
Professional
|
Both
|
$10.09
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
157T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
MH Substance Test T1015HF
|
Professional
|
Both
|
$10.09
|
|
|
Service Code
|
CPT T1015 HF
|
| Hospital Charge Code |
160T1015
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$10.59
|
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Magellan Medicaid |
$10.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$10.09
|
| Rate for Payer: Sunshine Health FHK |
$10.09
|
| Rate for Payer: Sunshine Health Medicaid |
$8.07
|
| Rate for Payer: Sunshine Health Medicaid |
$10.09
|
|
|
MH Substance Test T1015HF
|
Professional
|
Both
|
$10.09
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
159T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
MH Treatment Plan - New and Established Patient
|
Professional
|
Both
|
$97.86
|
|
|
Service Code
|
CPT H0032
|
| Hospital Charge Code |
98H0032
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$102.75
|
| Rate for Payer: Carelon Medicaid |
$97.00
|
| Rate for Payer: Magellan Medicaid |
$97.86
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$97.86
|
| Rate for Payer: Molina Complete Care Marketplace |
$97.86
|
| Rate for Payer: Sunshine Health FHK |
$97.86
|
| Rate for Payer: Sunshine Health Medicaid |
$78.29
|
| Rate for Payer: Sunshine Health Medicaid |
$97.86
|
|
|
MH Treatment Plan Review H0032TS
|
Professional
|
Both
|
$48.93
|
|
|
Service Code
|
CPT H0032
|
| Hospital Charge Code |
99H0032
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$102.75
|
| Rate for Payer: Carelon Medicaid |
$97.00
|
| Rate for Payer: Magellan Medicaid |
$97.86
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$97.86
|
| Rate for Payer: Molina Complete Care Marketplace |
$97.86
|
| Rate for Payer: Sunshine Health FHK |
$97.86
|
| Rate for Payer: Sunshine Health Medicaid |
$78.29
|
| Rate for Payer: Sunshine Health Medicaid |
$97.86
|
|
|
MH Treatment Plan Review H0032TS
|
Professional
|
Both
|
$51.38
|
|
|
Service Code
|
CPT H0032 TS
|
| Hospital Charge Code |
100H0032
|
| Min. Negotiated Rate |
$39.14 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$51.38
|
| Rate for Payer: Carelon Medicaid |
$48.50
|
| Rate for Payer: Magellan Medicaid |
$48.93
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$48.93
|
| Rate for Payer: Sunshine Health FHK |
$48.93
|
| Rate for Payer: Sunshine Health Medicaid |
$39.14
|
| Rate for Payer: Sunshine Health Medicaid |
$48.93
|
|
