Exhibit 6 ??? Service Rates, Units, Modalities-Types, and CPT Codes~1.pdf
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- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document is Exhibit 6 - SFY 2025 Services, Rates, Units, Modalities/Types and CPT Codes related to a state and local contract opportunity. It provides a comprehensive list of the services, rates, units, modalities/types, and corresponding CPT codes that will be utilized for the contract period of July 1, 2024 through June 30, 2025. The services detailed include ambulatory withdrawal management, assessments, medication-assisted treatment, case management, therapy, residential treatment, and various laboratory and medical services. The document specifies the service rates, service units, and applicable modalities and procedure codes for each service.
The document outlines the pricing terms and service rates that will be in effect for the contract period. It includes details on a range of services, from ambulatory and residential treatment to medication monitoring and recovery support. The rates are provided at the service level, with specific unit costs and modality types identified. This information is crucial for understanding the pricing structure and service offerings under the state and local contract opportunity.
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Text version
Exhibit 6 - SFY 2025
Services, Rates, Units, Modalities/Types and CPT Codes
Service Rate Unit Modality/Type CPT Code
Ambulatory Withdrawal Management 2 $209.33 per diem Ambulatory H0014 HF
Assessment $28.49 30 minutes Assessment H0001 HF
Bilirubin Panel $2.85 service V or B - Lab 82247
Buprenorphine Maintenance (8mg) $12.03 unit MAT - SxM ZM8G
Buprenorphine/Naloxone Maint. (2mg/0.5mg) $7.66 unit MAT - SxM ZM05
Buprenorphine/Naloxone Maint. (8mg/2mg) $10.40 unit MAT - SxM ZM2G
Case Management - COOC $13.32 15 minutes COOC T2022 HF
Case Management - Vivitrol $13.32 15 minutes V or B T2022 HF
Clinical Consultation $27.75 15 minutes COOC 90887
Cognitive Behavioral Motivational Therapy $25.00 1 hour group MAT IS-Sx ZMTH
Complete Blood Count $4.76 service MAT - Lab 85025
Comprehensive Intake Evaluation $171.99 service COOC 90791
Comprehensive Metabolic Panel $9.99 service V or B - Lab 80053
Continuing Care LOCI $26.43 20 minutes Clinical ZLOCI
Court Liason $6.87 15 minutes Recovery Sup ZCTLI
Crisis Intervention - Individual $15.12 15 minutes COOC S9484 HF
E & M visit - established patient (10 min) 49.91$ 10 minutes Medical Srvcs 99212
E & M visit - established patient (15 min) 81.64$ 15 minutes Medical Srvcs 99213
E & M visit - established patient (25 min) 118.08$ 25 minutes Medical Srvcs 99214
E & M visit - established patient (40 min) 158.24$ 40 minutes Medical Srvcs 99215
E & M visit - new patient (20 min) 82.94$ 20 minutes Medical Srvcs 99202
E & M visit - new patient (30 min) 117.03$ 30 minutes Medical Srvcs 99203
E & M visit - new patient (45 min) 177.73$ 45 minutes Medical Srvcs 99204
E & M visit - new patient (60 min) 224.19$ 60 minutes Medical Srvcs 99205
Family Therapy $113.84 60 minutes Ambulatory 90847 HF
Family Therapy $113.84 60 minutes COOC 90847 HF
Group Therapy $27.48 90 minutes COOC 90853 HF
Group Therapy $27.48 90 minutes Ambulatory 90853 HF
Halfway House $99.43 per diem Residential H2034 HF
Hepatic Function Panel $6.66 service V or B - Lab 80076
Individual Therapy $71.39 30 minutes COOC 90832 HF
Individual Therapy $94.46 45-50 minutes COOC 90834 HF
Individual Therapy $71.39 30 minutes Ambulatory 90832 HF
Individual Therapy $94.46 45-50 minutes Ambulatory 90834 HF
Revised 04/08/24
Effective 07/01/24
Exhibit 6 - SFY 2025
Services, Rates, Units, Modalities/Types and CPT Codes
Service Rate Unit Modality/Type CPT Code
Inpatient Withdrawal Management $475.42 per diem Residential H0010 HF
Intensive Outpatient $109.38 bundle per diem Ambulatory H0015 HF
Long Term Residential - Tier 2 $161.33 per diem Residential H0026T2 HF
Mantoux Tuberculin Test $10.57 service Clinical 86580
Medication Monitoring $47.54 15 minutes COOC 90862 HF
Medication Monitoring - MAT $47.54 15 minutes V or B Z3353
Methadone - Outpatient Phase I $91.07 Weekly bundle Ambulatory H0020 HF26 I
Methadone - Outpatient Phase II $91.07 Weekly bundle Ambulatory H0020 HF26 II
Methadone - Outpatient Phase III $91.07 Weekly bundle Ambulatory H0020 HF26 III
Methadone - Outpatient Phase IV $91.07 Weekly bundle Ambulatory H0020 HF26 IV
Methadone - Outpatient Phase V $91.07 Weekly bundle Ambulatory H0020 HF26 V
Methadone - Outpatient Phase VI $91.07 Weekly bundle Ambulatory H0020 HF26 VI
Methodone Maintenance $4.05 unit MAT IS-M H0020 HF
Oral Swab $8.46 service Clinical ZSWB
Partial Care $78.23 bundle per diem Ambulatory H2036 HF
Psychiatric Evaluation $437.76 service COOC 90792
Psychoeducational Group Services $6.61 90 minutes Ambulatory Z3355
Quantitative Syphilis Test $2.85 service V or B - Lab 86593
Recovery Mentor $10.00 15 minutes Recovery Sup ZRMEN
Recovery Support Care Management $26.40 15 minutes Recovery Sup H0023 HF
Recovery Support Care Management - ISI $26.40 15 minutes Pre-Admission ISICARM
Short Term Residential $244.78 per diem Residential H0018 HF
Transferase, Alanine Amino Panel (ALT) $2.85 service V or B - Lab 84460
Transferase, Aspartate Amino Panel (AST) $2.85 service V or B - Lab 84450
Transportation - mileage $0.33 per mile Recovery Sup ZMIL
Transportation - staff time $9.30 per hour Recovery Sup ZTRAV
Urine - Routine & Microscopic Analysis $1.14 service OPR only 81000
Urine Drug Screen - Presumptive Testing $8.46 service Clinical H0003HF
Urine Preg Test Visual Color Comp $2.85 service V or B 81025
Vivitrol Medication and Injection $1,232.34 injection V or B ZVIV
Revised 04/08/24
Effective 07/01/24
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