Y22-115_Exhibit_4_Ryan_White_Part_A_OAHS_Fee_Schedule.pdf
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- Solicitation number
- Y22-115
- Issued by
- Orange County, Orlando City, Florida
About this file
The document is the Ryan White Part A Program OAHS (Outpatient Ambulatory Health Services) Fee Schedule for the period of March 1, 2021 to February 28, 2022, issued by Orange County, Florida for HIV healthcare services. The fee schedule provides a comprehensive list of medical service rates for various healthcare procedures, including new and established patient visits, physicals, virtual check-ins, women's health services, immunizations, chest X-rays, EKGs, in-house labs, and other medical procedures. The document details specific CPT (Current Procedural Terminology) codes with corresponding rates for services ranging from office visits to specialized medical treatments.
The fee schedule presents a detailed pricing structure for HIV-related healthcare services, with rates varying from as low as $3.38 for a urinalysis to $575.85 for lymph node abscess drainage. The pricing appears to be part of the Ryan White Part A Program, which is a federal program designed to provide HIV-related healthcare services to low-income individuals. The rates cover a wide spectrum of medical services, including preventive care, diagnostic procedures, vaccinations, and specialized treatments. The document serves as a critical reference for healthcare providers involved in delivering HIV-related medical services under this program, offering clear guidance on reimbursement rates for various medical interventions.
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RYAN WHITE PART A PROGRAM OAHS FEE SCHEDULE
March 1, 2021 - February 28, 2022
CPT Code DESCRIPTION
RATE FOR
New Patient
99201 OV NEW PROBLEM FOCUSED $75.05
99202 OV NEW EXPANDED PROBLEM FOCUSED $119.63
99203 OV NEW DETAILED LOW $184.86
99204 OV NEW COMPREHENSIVE MODERATE $277.08
99205 OV NEW COMPREHENSIVE HIGH $366.24
Established Patients
99211 OV EST MIN VISIT MD $36.35
99212 OV EST PROBLEM FOCUSED VISIT $91.38
99213 OV EST EXPANDED PROBLEM FOCUS $149.66
99214 OV EST DETAILED VISIT $212.55
99215 OV EST COMPREHENSIVE VISIT $297.62
99385 PERIODIC COMPREHENSIVE RE-EVAL (NEW. Pt. 18-39) $160.82
99386 PERIODIC COMPREHENSIVE RE-EVAL (NEW. Pt. 40-64) $194.40
99395 PERIODIC COMPREHENSIVE RE-EVAL (EST. Pt. 18-39) $160.82
99396 PERIODIC COMPREHENSIVE RE-EVAL (EST. Pt. 40-64) $160.86
Physicals
G0402 INITIAL PREVENTIVE PHYSICAL EXAMINIATION (IPPE) $274.28
G0438 ANNUAL WELLNESS VISIT INCLUDES PPPS (New) $273.74
G0439 SUBSEQUENT ANNUAL WELLNESS VISIT INCLUDES PPPS (Established) $216.03
Virtual Check-In & E-Visits
G2012 BRIEF CHECK-IN BY MD/QHP $23.99
G2010 REMOTE IMAGE SUBMIT BY PT $19.70
99421 OL DIG E/M SVC 5-10 MIN $24.53
99422 OL DIG E/M SVC 11-20 MIN $49.05
99423 OL DIG E/M SVC 21+ MIN $77.24
99441 PHONE E/M PHYS/QHP 5-10 MIN $91.38
99442 PHONE E/M PHYS/QHP 11-20 MIN $150.47
99443 PHONE E/M PHYS/QHP 21-30 MIN $213.38
98966 HC PRO PHONE CALL 5-10 MIN $22.91
98967 HC PRO PHONE CALL 11-20 MIN $44.24
98968 HC PRO PHONE CALL 21-30 MIN $64.71
G2061 QUAL NONMD EST PT 5-10M $20.09
G2062 QUAL NONMD EST PT 11-20M $35.51
G2063 QUAL NONMD EST PT 21>MIN $55.59
Women Health
G0101 PAP, PELVIC AND BREAST EXAM (WELL WOMEN EXAM) $64.49
Q0091 PAP SMEAR AND PELVIC EXAM $70.08
Immunizations
90460 MENINGOCOCCAL VAC. (MenACWY-CRM MENVEO) $27.18
90471 IMMUNIZATION ADMIN. 1 VACCINE/OAMC $27.18
90472 IMMUNIZATION ADMIN. EACH ADDITIONAL VACCINE $20.69
90632 HEP. A VACCINE , ADULT DOSAGE, INTRAMUSCULAR $91.05
90636 TWINRIX VACCINE $174.00
90648 HAEMOPHILUS INFLUENZAE TYPE B $35.12
90651 GARDASIL 9 VACCINE $320.00
CPT Code DESCRIPTION
RATE FOR
90656 INFLUENZA VACCINE $29.66
90662 FLUZONE HIGH DOSE AGE 65+ $91.47
90670 PNEUMOCOCCAL CONJUGATE VACCINE, INTRAMUSCULAR $345.21
90674 INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4) $43.85
90686 INFLUENZA VIRUS VACCINE QUADRIVALENT (IIV4) $29.37
90707 MEASLES, MUMPS AND RUBELLA VACCINE $70.61
90714 TETANUS VACCINE $38.06
90715 TDAP VACCINE, 7 YEARS OR OLDER, INTRAMUSCULAR $51.09
90716 VARICELLA IMMUNIZATION (VARIVAX) $122.51
90732 PNEUMO POLYSACCHARIDE VACCINE 2 YEARS>, INTRAMC. $179.88
90734 MENINGOCOCCAL VAC. (MenACWY-D MENACTRA) $190.43
90736 HZV VACCINE LIVE SUBQ (HERPES ZOSTER VACCINE) $310.08
90740 HEPATITIS B 40 mg. $211.14
90746 HEPATITIS B VACCINE, ADULT, INTRAMUSCULAR $104.48
90750 SHINGRIX VACCINE $247.50
90756 INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4) ABX FREE $41.55
G0008 ADMIN. INFLUENZA VIRUS VAC $27.18
G0009 ADMIN. PNEUMOCOCCAL VAC $27.18
G0010 ADMIN. HEPATITIS B VAC $27.18
Q2035 AFLURIA VACC, 3 YRS AND OLDER $27.36
Q2036 FLULAVAL VACC, 3 YRS AND OLDER $12.87
Q2037 FLUVIRIN VACC, 3 YRS AND OLDER $26.54
Q2038 FLUZONE VACC, 3 YRS AND OLDER $18.06
Chest-X-ray
71046 CHEST-X-RAY $53.96
EKG
93000 EKG W-INTERPRETATION AND REPORT $24.26
93005 EKG ROUTINE ECG WITH AT LEAST 12 LEADS $10.49
In House Labs
81003 URINALYSIS AUTOMATED, WITHOUT MICROSCOPY $3.38
81025 URINE PREGNANCY TEST $12.92
82272 STOOL FOR OCCULT BLOOD GUAIAC $6.35
82948 BLOOD GLUCOSE $7.56
85018 HEMOGLOBIN (HGB) $3.56
86481 T-SPOT TUBERCULOSIS TEST $150.00
87430 RAPID STRWP STRPTOCOCCUS, GROUP A $25.22
Other
10040 INCISION AND DRAINAGE ACNE SURGERY $189.36
10060 INCISION AND DRAINAGE OF ABCESS $202.31
10061 INCISION AND DRAINAGE MULTIPLE ABCESS $350.78
10120 FOREIGN BODY REMOVAL SKIN $249.84
10180 INCISION DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION $438.83
11000 DEBRIDEMET EXTENSIVE INFECTED SKIN $94.25
11042 EXCISION OR DEBRIDEMENT SKIN,SUBCUTAN TISSUE $212.31
11100 BIOPSY OF SKIN, SUBCUTANEOUS $173.42
11101 BIOPSY OF SKIN (MORE THAN ONE) $54.84
CPT Code DESCRIPTION
RATE FOR
11400 EXCISION BENIGN LESION HALF CM OR LESS TRUNK $209.76
11401 EXCISION BENIGN LESION DIAMETER HALF CM TO CM $256.25
11402 EXCISION BENIGN LESION 1 TO 2 CM TRUNK $283.76
11403 EXCISION BENIGN LESION 2 TO 3 $327.90
11406 EXCISION BENIGN LESION 4 CM TRUNK $537.57
11420 EXCISION BENIGN LESION HALF CM OR LESS NOT TRUNK $210.75
11422 EXCISION BENIGN LESION 1 TO 2 CM NOT TRUNK $298.01
11426 EXCISION BENIGN LESION 4 CM NOT TRUNK $566.70
11601 EXCISION MALIGNANT LESION DIAMETER HALF CM TO CM $379.97
11621 EXCISION MALIGNANT LESION HALF CM OR LESS NOT TRUNK $381.08
11640 EXCISION MALIGNANT LESION HALF CM OR LESS DIAMITE $337.70
11642 EXCISION MALIGNANT LESION 1 TO 2 CM DIAMITE $444.80
11730 AVULSION OF NAIL PLATE PARTIAL OR COMPLETE SIMPLE SINGLE $190.40
11750 EXCISION OF NAIL AND NAIL MATRIX $265.32
17000 DESTRUCTION BENIGN OR PREMALIGNANT LESION $107.18
17003 DESTRUCTION BENIGN OR PREMALIGNANT LESIONS 2 - 14 $10.34
17004 DESTRUCTION BENIGN OR PREMALIGNANT LESIONS 15 OR MORE $268.88
17110
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,
CHEMOSURGERY, SURGICAL CURETTEMENT), OF $182.94
30300 FOREIGN BODY REMOVAL NOSE $333.44
36415 DRAWING FEE/VENIPUNCTURE $4.50
38300 DRAINAGE LYMPH NODE ABCESS $575.85
87210 WET MOUNT INFECTIOUS AGENT $8.73
87220 KOH SLIDE/TISSUE EXAM $6.41
94010 LHP PULMONARY TESTING BREATHING CAPACITY $47.34
94060 LHP PULMONARY TESTING THORACIC GAS VOLUME $73.83
94664 NEBULIZER $26.60
94750
PULMONARY COMPLIANCE STUDY (EG, PLETHYSMOGRAPHY, VOLUME AND
PRESSURE MEASUREMENTS) $140.01
94760
LHP NONINVASIVE EAR OR PULSE OXIMETERY FOR O2 SAT SINGLE
DETERMINATION $4.05
94761
LHP NONINVASIVE EAR OR PULSE OXIMETERY FOR O2 SAT MULT
DETERMINATION $6.20
96368 INFUSION CONCURRENT THERAPEUTIC $33.63
96372 ADMIN OF INJECTION $22.89
J0561 BICILLIN 100,000 UNITS LIMIT 24 UNITS $22.65
J0696 INJECTION ROCEPHIN 250 MG (PER UNIT) $0.84
J1050 DEPO PROVERA (PER UNIT) $0.86
J1071 TESTOSTERONE (PER UNIT) (NEEDS PRIOR APROVAL) $0.05
J3420 INJECTION B-12 (1000 MCG VIAL) $2.76
File details come from the government source that posted it. Updated .