Proposed Outpatient Clinic Fees with Enhanced Care Clinic Adjustment

CHILD and ADULT

Code

Description

Medicare

Medicare

Weighted

Weighted Average

Medicare

Medicare

Fee M.D.

Fee MSW

Average

ECC Fee

Adjusted

ECC Fee

Schedule

Schedule

Fee

25%

Fee

25%

J1630

Injection, haloperidol, up to 5 mg ***

na

-

$2.56

$3.20

$2.56

$3.20

J1631

Injection, haloperidol decanoate, per 50 mg ***

na

-

$5.80

$7.25

$5.80

$7.25

J2680

Injection, fluphenazine decanoate, up to 25 mg ***

na

-

$1.14

$1.43

$1.14

$1.43

M0064

Brief office visit to monitor drug prescriptions *

$29.97

-

$22.81

$28.51

$22.81

$28.51

90801

Psychiatric diagnostic interview examination

$164.74

$123.56

$77.90

$97.38

$85.83

$107.29

90802

Interactive psychiatric diagnostic interview exam

$174.71

$131.03

$87.92

$109.90

$91.02

$113.78

90804

Individual psychotherapy, 20-30 min.s face to face

$70.49

$52.87

$39.03

$48.79

$36.73

$45.91

90805

90804 with medical evaluation and mgmt services

$77.26

-

$48.17

$60.21

$40.25

$50.32

90806

Individual psychotherapy, 45-50 min.s face to face

$106.15

$79.61

$58.10

$72.62

$55.30

$69.13

90807

90806 with medical evaluation and mgmt services *

$112.58

-

$70.53

$88.16

$70.53

$88.16

90808

Individual psychotherapy, 75-80 min.s face to face

$158.17

$118.63

$70.97

$88.72

$82.41

$103.01

90809

90808 with medical evaluation and mgmt services

$163.52

-

$85.59

$106.98

$85.19

$106.49

90810

Interactive psychotherapy, interactive, 20-30 face

$76.07

$57.05

$48.29

$60.36

$39.63

$49.54

90811

90810 with medical evaluation and mgmt services

$85.04

-

$47.50

$59.38

$44.31

$55.38

90812

Interactive psychotherapy, interactive, 45-50 face

$114.47

$85.85

$79.11

$98.89

$59.64

$74.55

90813

90812 with medical evaluation and mgmt services

$119.92

-

$62.77

$78.46

$62.48

$78.10

90814

Individual psychotherapy, 75-80 min.s face to face

$165.61

$124.21

$70.00

$87.50

$86.28

$107.85

90815

90814 with medical evaluation and mgmt services

$170.08

-

$89.02

$111.28

$88.61

$110.77

90846

Family psychotherapy w/o patient

$102.76

$77.07

$59.24

$74.05

$53.54

$66.92

90847

Family psychotherapy w/ patient

$125.29

$93.97

$57.61

$72.01

$65.28

$81.60

90849

Multi-group family psychotherapy

$35.93

$26.95

$29.38

$36.72

$18.72

$23.40

90853

Group psychotherapy other than multiple family *

$35.04

$26.28

$29.49

$36.87

$29.49

$36.87

90857

Interactive Group psychotherapy*

$38.39

$28.79

$32.25

$40.31

$32.25

$40.31

90862

Pharmacological management *

$55.90

-

$42.77

$53.46

$40.71

$50.89

96100

Psychological testing and report, per hour *

$83.71

$62.78

$66.86

$83.58

$67.62

$84.53

96110

Developmental testing and report, limited *

$14.07

$10.55

$11.36

$14.20

$11.36

$14.20

96111

Developmental testing and report, extended *

$155.29

$116.47

$125.43

$156.79

$125.43

$156.79

96117

Neuropsychological testing battery & report, per hour *

$83.71

$62.78

$110.48

$138.10

$67.62

$84.53

99348

Emergency (in-home/community) mental health service **

na

na

$65.00

$81.25

$65.00

$81.25

99349

Mobile Crisis Evaluation Service **

na

na

$115.00

$143.75

$115.00

$143.75

99361

Case Management, 30 min.s **

na

na

$17.50

$21.88

$17.50

$21.88

99362

Case Management, 60 min.s **

na

na

$35.00

$43.75

$35.00

$43.75

NOTE: Medicare Adjusted Fee is 52% of 2005 Medicare Fee

* Not Subject to Percentage of Medicare

** Computed from December RFI Data

*** Rate taken from 2005 CT Medicaid Fee Schedule