ALAY Fee Schedule DOC Final.xlsx
XLSX spreadsheet 21 KB Posted
- Contract number
- 410036-W17-ELB5714-GEN-35
- Issued by
- Wisconsin
About this file
This document is a fee schedule outlining behavioral health and medical services pricing between Alay Health Team and the DOC (Department of Corrections). The fee schedule appears to be part of a contract negotiation or agreement establishing discounted rates for healthcare services to be provided within a correctional facility setting.
The contract covers a comprehensive range of behavioral health and medical services including psychiatric diagnostic evaluations, various forms of psychotherapy (individual, group, family), crisis intervention, evaluation and management services, substance abuse screening and counseling, laboratory services, and telehealth services. The pricing structure shows Alay Health Team's standard charges alongside significantly discounted DOC rates, with reductions typically ranging from 50-80% off standard pricing. For example, a 60-minute psychotherapy session is discounted from $325 to $124.31, and psychiatric diagnostic evaluations are reduced from $285-$425 to $124.99-$140. The fee schedule includes CPT codes, HCPCS codes, and various service categories spanning mental health treatment, medical evaluations, drug testing, and administrative services, indicating a comprehensive healthcare services contract designed to serve the correctional population's medical and behavioral health needs.
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Other files
| File | Type | Posted |
|---|---|---|
| 5714 35 Ren Alay Vivit.pdf | ||
| 5714 35 Contract Alay Opioid.pdf |
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Text version
Sheet1
| CPT Code | Code Description | Alay Health Team Charge | DOC Proposed Discounted Rate |
| 90791 | Psychiatric Diagnostic Evaluation without Medical Services | $ 285.00 | $ 124.99 |
| 90792 | Psychiatric Diagnostic Evaluation with Medical Services | $ 425.00 | $ 140.00 |
| 90832 | Psychotherapy, 30 Min | $ 175.00 | $ 75.00 |
| 90833 | 30 min Psychotherapy add on code | $ 225.00 | $ 65.00 |
| 90834 | Psychotherapy, 45 Min. | $ 300.00 | $ 83.00 |
| 90836 | 45 min psychotherapy add on code | $ 300.00 | $ 82.00 |
| 90837 | Psychotherapy, 60 Min. | $ 325.00 | $ 124.31 |
| 90838 | 60 min psychotherapy add on code | $ 375.00 | $ 107.12 |
| 90839 | Psychotherapy for crisis, first 60 min. | $ 200.00 | $ 129.64 |
| 90840 | Psychotherapy for crisis, add on | $ 50.00 | $ 62.16 |
| 90845 | Psychoanalysis | $ 135.71 | $ 89.14 |
| 90846 | Family Psychotherapy, without pt present | $ 250.00 | $ 100.20 |
| 90847 | Family/Couple Psychotherapy | $ 250.00 | $ 104.18 |
| 90849 | Mulit Family Group Psytx | $ 107.14 | $ 30.92 |
| 90853 | Group Psychotherapy | $ 175.00 | $ 24.91 |
| 90785 | Interactive complexity Add On code | $ 150.00 | $ 14.05 |
| 99201 | EM of new patient (10 minutes) | $ 175.00 | $ 32.29 |
| 99202 | EM of new patient (20 minutes) | $ 200.00 | $ 60.84 |
| 99203 | E&M of new patient, Presenting problem(s) are moderate severity (30 minutes) | $ 285.00 | $ 92.86 |
| 99204 | E&M of new patient, Presenting problem(s) are moderate to high severity (45 minutes) | $ 350.00 | $ 157.70 |
| 99205 | E&M of new patient, Presenting problem(s) are moderate to high severity (60 minutes) | $ 400.00 | $ 204.93 |
| 99211 | Office/other OP visit for eval. & mgt. of an established patient that may not require the presence of a physician (5 min) | $ 150.00 | $ 55.00 |
| 99212 | E&M of an established patient, (10 minutes) | $ 175.00 | $ 65.00 |
| 99213 | E&M of an established patient, (15 minutes) | $ 200.00 | $ 70.00 |
| 99214 | E&M of an established patient. Presenting problem(s) are moderate to high severity (25 minutes) | $ 275.00 | $ 105.00 |
| 99215 | E&M of an established patient. Presenting problem(s) are moderate to high severity (40 minutes) | $ 325.00 | $ 110.00 |
| 87180 | Culture Screening | $ 35.00 | $ 15.00 |
| 90865 | Narcosynthesis | $ 192.86 | |
| 90885 | Psy Evaluation of Records | $ 150.00 | $ 50.00 |
| 90887 | Consultation with Family | $ 75.00 | $ 95.00 |
| 90889 | Preparation of Reports of patient's psychiatric status, history | $ 125.00 | $ 90.00 |
| 96372 | Intramuscular Injections | $ 100.00 | $ 35.00 |
| 99000 | handling of a specimen for transfer | $ 71.43 | $ 20.00 |
| 99082 | Unusual Travel (15 min units) | $ 25.00 | $ 20.00 |
| 99199 | no show | $ 128.57 | $ 75.00 |
| 99354 | prolonged e/m 30-74 minutes beyond | $ 142.86 | $ 114.29 |
| 99355 | prolonged e/m reported for each 15/30 period over | $ 257.14 | $ 205.71 |
| 99406 | tobacco cessation counseling | $ 28.57 | $ 22.86 |
| 99407 | smoking cessation counseling | $ 50.00 | $ 40.00 |
| 99408 | alcohol and/or substance use screening | $ 57.14 | $ 45.71 |
| 99409 | alcohol and/or substance evaluation and management | $ 100.00 | $ 80.00 |
| 99420 | administer and interpret health risk assessment | $ 28.57 | $ 22.86 |
| 99420 | Health Risk Analysis/Assessment | $ 35.71 | $ 28.57 |
| G0396 | structured assessment alcohol and drug | $ 64.29 | $ 51.43 |
| G0397 | structured assessment for alcohol and drug use | $ 128.57 | $ 102.86 |
| G0442 | Annual Alcohol Misuse Screening, 15 minutes | $ 35.71 | $ 28.57 |
| G0443 | Brief face-to-face behavioral counseling for Alcohol Misuse, 15 minutes | $ 57.14 | $ 45.71 |
| G0459 | telehealth pharmaceutical management | $ 150.00 | $ 120.00 |
| G0477QW | multi panel drug test cup | $ 178.57 | $ 142.86 |
| H0049 | alcohol and drug screening | $ 42.86 | $ 34.29 |
| H0050 | brief 15 minute alcohol and drug screening | $ 85.71 | $ 68.57 |
| No Show | $ 100.00 | $ 75.00 | |
| Q3014 | tele health originating fee | $ 75.00 | $ 35.00 |
| RHC | Rural Health | $ 107.14 | $ 85.71 |
| S9529 | routine veinipuncture for collection of specimin | $ 92.86 | $ 74.29 |
| 36415 | Veinipuncture | $ 92.86 | $ 74.29 |
| 80300 | Urine Drug Tox 6-7 panel collection | $ 145.00 | $ 116.00 |
| 99051 | After customary service hours (after 5pm weekdays and weekend hours) | $ 75.00 | $ 60.00 |
Sheet2
Sheet3
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