Reimbursement Rate Reductions Will Be Implemented for Some Texas Medicaid Provider Types Information posted July 29, 2011 Effective for dates of service on or after September 1, 2011, reimbursement rate reductions will be implemented for the services and providers identified below in accordance with the spending reduction plan that was part of House Bill 1, 82 nd Legislature, Regular Session, 2011. These rate reductions will be applied for Texas Medicaid Program as appropriate. The following services or providers are affected by these rate reductions: Comprehensive outpatient rehabilitation facility (CORF) and outpatient rehabilitation facility (ORF) provider types Comprehensive Care Program (CCP) provider types Physical therapist provider types Occupational therapist provider types Early Childhood Intervention (ECI) provider types Children and Pregnant Women (CPW) Program case management provider types Family planning clinic provider types Tuberculosis (TB) clinic provider types Federally qualified health center (FQHC) provider types (Titles V and XX services) Birthing center provider types The following table shows the rate reductions that will be applied to the listed providers. These rate reductions are in addition to any previously implemented rate reductions. Click on the links to view the details. Provider Type Procedure Codes / Services to Receive the Reduction Additional Percent Reduction Total Percent Reduction Effective 9/1/2011 Therapy Services CORF/ORF CORF/ORF therapy services 5% 7% CCP providers CCP therapy services (other than the home setting) 5% 7% CCP providers Speech language therapy services (other than the home setting) 5% 7% Physical therapist Physical therapy services (other than the home setting) 5% 7% Occupational therapist Physical medicine and rehabilitation services (other than the home setting) 5% 7%
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Reimbursement Rate Reductions Will Be Implemented for Some Texas Medicaid Provider Types Information posted July 29, 2011
Effective for dates of service on or after September 1, 2011, reimbursement rate reductions will be implemented for the services and providers identified below in accordance with the spending reduction plan that was part of House Bill 1, 82nd Legislature, Regular Session, 2011. These rate reductions will be applied for Texas Medicaid Program as appropriate.
The following services or providers are affected by these rate reductions:
Comprehensive outpatient rehabilitation facility (CORF) and outpatient rehabilitation facility (ORF) provider types
Comprehensive Care Program (CCP) provider types
Physical therapist provider types
Occupational therapist provider types
Early Childhood Intervention (ECI) provider types
Children and Pregnant Women (CPW) Program case management provider types
Family planning clinic provider types
Tuberculosis (TB) clinic provider types
Federally qualified health center (FQHC) provider types (Titles V and XX services)
Birthing center provider types
The following table shows the rate reductions that will be applied to the listed providers. These rate reductions are in addition to any previously implemented rate reductions. Click on the links to view the details.
Provider Type
Procedure Codes / Services to Receive the Reduction
Additional Percent Reduction
Total Percent Reduction Effective 9/1/2011
Therapy Services
CORF/ORF CORF/ORF therapy services 5% 7%
CCP providers CCP therapy services (other than the home setting)
5% 7%
CCP providers Speech language therapy services (other than the home setting)
5% 7%
Physical therapist
Physical therapy services (other than the home setting)
5% 7%
Occupational therapist
Physical medicine and rehabilitation services (other than the home setting)
5% 7%
Provider Type
Procedure Codes / Services to Receive the Reduction
Additional Percent Reduction
Total Percent Reduction Effective 9/1/2011
ECI* (See note below.)
ECI therapy services (other than the home setting)
5% 7%
(ECI) ECI therapy services procedure codes will be made a benefit effective for dates of service on or after October 1, 2011. The 7 percent rate reduction will be applied at that time.
Note: Therapy services provided in the home and therapies delivered by providers not listed above will continue to receive a 2 percent reduction.
Family Planning
Family planning clinic
Family planning clinic 5% 7%
FQHC All Title V and XX family planning services rendered by FQHC providers
5% 7%
Note: Title XIX services rendered by FQHC providers are not affected by rate reductions at this time.
CPW Program Case Management
CPW Program case management
CPW services 5% 7%
TB Clinic (Individual)
TB clinic (Individual)
TB clinic services 5% 7%
Birthing Center
Birthing center Birthing center services 5% 5%
Pharmacy Dispensing Fee
Pharmacy Provider
Pharmacy Dispensing Fee NA NA
Beginning September 1, 2011, the Online Fee Lookup (OFL) and static fee schedules will reflect these rate reductions.
Therapy Services Rendered by CORF/ORF Providers
TOS Procedure Code
Age Current Rate Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 92506 0-20 $280.00 2.00% 5.00% 7.00% $260.40
1 92506 21-999 $280.00 2.00% 5.00% 7.00% $260.40
1 92507 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 92507 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 92508 0-20 $22.50 2.00% 5.00% 7.00% $20.93
1 92508 21-999 $22.50 2.00% 5.00% 7.00% $20.93
1 92526 0-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97001 0-20 $200.00 2.00% 5.00% 7.00% $186.00
1 97001 21-999 $200.00 2.00% 5.00% 7.00% $186.00
1 97002 0-20 $200.00 2.00% 5.00% 7.00% $186.00
1 97002 21-999 $200.00 2.00% 5.00% 7.00% $186.00
1 97003 0-20 $200.00 2.00% 5.00% 7.00% $186.00
1 97003 21-999 $200.00 2.00% 5.00% 7.00% $186.00
1 97004 0-20 $200.00 2.00% 5.00% 7.00% $186.00
1 97004 21-999 $200.00 2.00% 5.00% 7.00% $186.00
1 97012 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97012 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97014 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97014 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97016 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97016 21-999 $45.00 2.00% 5.00% 7.00% $41.85
Therapy Services Rendered by CORF/ORF Providers
TOS Procedure Code
Age Current Rate Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97018 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97018 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97022 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97022 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97024 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97024 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97026 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97026 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97028 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97028 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97032 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97032 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97033 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97033 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97034 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97034 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97035 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97035 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97036 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97036 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97039 0-20 $45.00 2.00% 5.00% 7.00% $41.85
Therapy Services Rendered by CORF/ORF Providers
TOS Procedure Code
Age Current Rate Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97039 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97110 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97110 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97112 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97112 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97113 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97113 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97116 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97116 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97124 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97124 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97139 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97139 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97140 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97140 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97150 0-20 $22.50 2.00% 5.00% 7.00% $20.93
1 97150 21-999 $22.50 2.00% 5.00% 7.00% $20.93
1 97530 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97530 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97535 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97535 21-999 $45.00 2.00% 5.00% 7.00% $41.85
Therapy Services Rendered by CORF/ORF Providers
TOS Procedure Code
Age Current Rate Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97537 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97537 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97542 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97750 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97750 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97760 0-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97761 0-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97762 0-999 $45.00 2.00% 5.00% 7.00% $41.85
1 97799 0-20 $45.00 2.00% 5.00% 7.00% $41.85
1 97799 21-999 $45.00 2.00% 5.00% 7.00% $41.85
1 S8990 0-999 $59.19 2.00% 5.00% 7.00% $55.05
1 92610 0-999 $280.00 2.00% 5.00% 7.00% $260.40
1 S9152 0-20 $280.00 2.00% 5.00% 7.00% $260.40
1 S9152 21-999 $280.00 2.00% 5.00% 7.00% $260.40
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Therapy Services Rendered by CCP Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 92506 0-20 $210.00 2.00% 5.00% 7.00% $195.30
1 92506 21-999 $210.00 2.00% 5.00% 7.00% $195.30
1 92507 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 92507 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 92508 0-20 $17.50 2.00% 5.00% 7.00% $16.28
1 92508 21-999 $17.50 2.00% 5.00% 7.00% $16.28
1 92526 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 92526 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97001 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97001 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97002 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97002 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97012 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97012 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by CCP Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97016 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97022 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97022 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 0-20 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by CCP Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97036 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97110 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97110 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by CCP Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97535 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97542 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97760 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97761 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97762 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97799 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97799 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 S8990 0-999 $59.19 2.00% 5.00% 7.00% $55.05
1 92610 0-999 $280.00 2.00% 5.00% 7.00% $260.40
1 92630 0-20 $73.89 2.00% 5.00% 7.00% $68.72
1 92630 21-999 $70.37 2.00% 5.00% 7.00% $65.44
1 S9152 0-20 $210.00 2.00% 5.00% 7.00% $195.30
1 S9152 21-999 $210.00 2.00% 5.00% 7.00% $195.30
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Therapy Services Rendered by Physical Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 92506 0-20 $210.00 2.00% 5.00% 7.00% $195.30
1 92506 21-999 $210.00 2.00% 5.00% 7.00% $195.30
1 92507 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 92507 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97001 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97001 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97002 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97002 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97012 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97012 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by Physical Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97022 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97022 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97110 0-20 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by Physical Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97110 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by Physical Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97542 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97760 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97761 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97762 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97799 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97799 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 S8990 0-999 $59.19 2.00% 5.00% 7.00% $55.05
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Therapy Services Rendered by Occupational Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 92506 0-20 $210.00 2.00% 5.00% 7.00% $195.30
1 92506 21-999 $210.00 2.00% 5.00% 7.00% $195.30
1 92507 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 92507 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97001 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97001 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97012 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97012 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97022 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97022 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by Occupational Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97024 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97110 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97110 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 0-20 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by Occupational Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97112 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97542 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 0-20 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by Occupational Therapist Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97750 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97760 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97761 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97762 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 S8990 0-999 $59.19 2.00% 5.00% 7.00% $55.05
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Therapy Services Rendered by ECI Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 92506 0-20 $210.00 2.00% 5.00% 7.00% $195.30
1 92506 21-999 $210.00 2.00% 5.00% 7.00% $195.30
1 92507 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 92507 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97001 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97001 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97002 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97002 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97003 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 0-20 $140.00 2.00% 5.00% 7.00% $130.20
1 97004 21-999 $140.00 2.00% 5.00% 7.00% $130.20
1 97012 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97012 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97014 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97016 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97018 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by ECI Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97022 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97022 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97024 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97026 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97028 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97032 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97033 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97034 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97035 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97036 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97039 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97110 0-20 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by ECI Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97110 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97112 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97113 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97116 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97124 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97139 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97140 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97150 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97530 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97535 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97537 21-999 $35.00 2.00% 5.00% 7.00% $32.55
Therapy Services Rendered by ECI Providers
TOS Procedure Code Age Current Rate
Current % Reduction
Additional % Reduction as of 9/1/2011
Total % Reduction as of 9/1/2011
Rate Effective 9/1/2011
1 97542 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97750 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97760 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97761 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97762 0-999 $35.00 2.00% 5.00% 7.00% $32.55
1 97799 0-20 $35.00 2.00% 5.00% 7.00% $32.55
1 97799 21-999 $35.00 2.00% 5.00% 7.00% $32.55
1 S8990 0-999 $59.19 2.00% 5.00% 7.00% $55.05
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
2 11975 0-999 3.36 $27.276 $91.65 10/1/2010 2.00% 5.00% 7.00% $85.23
2 11976 0-999 3.80 $27.276 $103.65 10/1/2010 2.00% 5.00% 7.00% $96.39
2 11977 0-999 5.97 $27.276 $162.84 10/1/2010 2.00% 5.00% 7.00% $151.44
1 55250 0-20 11.77 $28.640 $337.09 4/1/2010 2.00% 5.00% 7.00% $313.49
1 55250 21-999 11.77 $27.276 $321.04 4/1/2010 2.00% 5.00% 7.00% $298.57
2 55250 0-20 9.64 $28.640 $276.09 10/1/2010 2.00% 5.00% 7.00% $256.76
2 55250 21-999 9.64 $27.276 $262.94 10/1/2010 2.00% 5.00% 7.00% $244.53
2 55450 0-20 9.31 $28.640 $266.64 10/1/2010 2.00% 5.00% 7.00% $247.98
2 55450 21-999 9.31 $27.276 $253.94 10/1/2010 2.00% 5.00% 7.00% $236.16
2 57170 0-20 1.37 $28.640 $39.24 10/1/2010 2.00% 5.00% 7.00% $36.49
2 57170 21-999 1.37 $27.276 $37.37 10/1/2010 2.00% 5.00% 7.00% $34.75
2 58300 0-999 1.43 $27.276 $39.00 10/1/2010 2.00% 5.00% 7.00% $36.27
2 58301 0-999 1.91 $27.276 $52.10 10/1/2010 2.00% 5.00% 7.00% $48.45
2 58340 0-20 1.58 $28.640 $45.25 10/1/2010 2.00% 5.00% 7.00% $42.08
2 58340 21-999 1.58 $27.276 $43.10 10/1/2010 2.00% 5.00% 7.00% $40.08
2 58555 0-20 5.15 $28.640 $147.50 4/1/2010 2.00% 5.00% 7.00% $137.18
2 58555 21-999 5.15 $27.276 $140.47 4/1/2010 2.00% 5.00% 7.00% $130.64
1 58600 0-20 10.02 $28.640 $286.97 10/1/2010 2.00% 5.00% 7.00% $266.88
1 58600 21-999 10.02 $27.276 $273.31 10/1/2010 2.00% 5.00% 7.00% $254.18
2 58611 0-20 2.18 $28.640 $62.44 10/1/2010 2.00% 5.00% 7.00% $58.07
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
2 58611 21-999 2.18 $27.276 $59.46 10/1/2010 2.00% 5.00% 7.00% $55.30
2 58615 0-20 6.70 $28.640 $191.89 10/1/2010 2.00% 5.00% 7.00% $178.46
2 58615 21-999 6.70 $27.276 $182.75 10/1/2010 2.00% 5.00% 7.00% $169.96
8 58660 0-999 $78.64 6/1/2010 2.00% 5.00% 7.00% $73.14
8 58662 0-999 $80.00 6/1/2010 2.00% 5.00% 7.00% $74.40
2 58670 0-20 10.05 $28.640 $287.83 10/1/2010 2.00% 5.00% 7.00% $267.68
2 58670 21-999 10.05 $27.276 $274.12 10/1/2010 2.00% 5.00% 7.00% $254.93
2 58671 0-20 10.04 $28.640 $287.55 10/1/2010 2.00% 5.00% 7.00% $267.42
2 58671 21-999 10.04 $27.276 $273.85 10/1/2010 2.00% 5.00% 7.00% $254.68
2 64435 0-20 3.54 $28.640 $101.39 10/1/2010 2.00% 5.00% 7.00% $94.29
2 64435 21-999 3.54 $27.276 $96.56 10/1/2010 2.00% 5.00% 7.00% $89.80
4 74000 0-20 0.61 $28.640 $17.47 10/1/2010 2.00% 5.00% 7.00% $16.25
4 74000 21-999 0.61 $27.276 $16.64 10/1/2010 2.00% 5.00% 7.00% $15.48
4 74010 0-20 0.95 $28.640 $27.21 10/1/2010 2.00% 5.00% 7.00% $25.31
4 74010 21-999 0.95 $27.276 $25.91 10/1/2010 2.00% 5.00% 7.00% $24.10
4 74740 0-20 1.96 $28.640 $56.13 10/1/2010 2.00% 5.00% 7.00% $52.20
4 74740 21-999 1.96 $27.276 $53.46 10/1/2010 2.00% 5.00% 7.00% $49.72
I 74740 0-20 0.51 $28.640 $14.61 10/1/2010 2.00% 5.00% 7.00% $13.59
I 74740 21-999 0.51 $27.276 $13.91 10/1/2010 2.00% 5.00% 7.00% $12.94
T 74740 0-20 1.45 $28.640 $41.53 10/1/2010 2.00% 5.00% 7.00% $38.62
T 74740 21-999 1.45 $27.276 $39.55 10/1/2010 2.00% 5.00% 7.00% $36.78
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
4 76830 0-20 3.16 $28.640 $90.50 10/1/2010 2.00% 5.00% 7.00% $84.17
4 76830 21-999 3.16 $27.276 $86.19 10/1/2010 2.00% 5.00% 7.00% $80.16
I 76830 0-20 0.94 $28.640 $26.92 10/1/2010 2.00% 5.00% 7.00% $25.04
I 76830 21-999 0.94 $27.276 $25.64 10/1/2010 2.00% 5.00% 7.00% $23.85
T 76830 0-20 2.22 $28.640 $63.58 10/1/2010 2.00% 5.00% 7.00% $59.13
T 76830 21-999 2.22 $27.276 $60.55 10/1/2010 2.00% 5.00% 7.00% $56.31
4 76856 0-20 3.14 $28.640 $89.93 10/1/2010 2.00% 5.00% 7.00% $83.63
4 76856 21-999 3.14 $27.276 $85.65 10/1/2010 2.00% 5.00% 7.00% $79.65
I 76856 0-20 0.94 $28.640 $26.92 10/1/2010 2.00% 5.00% 7.00% $25.04
I 76856 21-999 0.94 $27.276 $25.64 10/1/2010 2.00% 5.00% 7.00% $23.85
T 76856 0-20 2.20 $28.640 $63.01 10/1/2010 2.00% 5.00% 7.00% $58.60
T 76856 21-999 2.20 $27.276 $60.01 10/1/2010 2.00% 5.00% 7.00% $55.81
4 76857 0-20 2.40 $28.640 $68.74 10/1/2010 2.00% 5.00% 7.00% $63.93
4 76857 21-999 2.40 $27.276 $65.46 10/1/2010 2.00% 5.00% 7.00% $60.88
I 76857 0-20 0.52 $28.640 $14.89 10/1/2010 2.00% 5.00% 7.00% $13.85
I 76857 21-999 0.52 $27.276 $14.18 10/1/2010 2.00% 5.00% 7.00% $13.19
T 76857 0-20 1.88 $28.640 $53.84 10/1/2010 2.00% 5.00% 7.00% $50.07
T 76857 21-999 1.88 $27.276 $51.28 10/1/2010 2.00% 5.00% 7.00% $47.69
5 81007 0-999 $3.47 4/1/2011 2.00% 5.00% 7.00% $3.23
5 81099 0-999 $5.01 7/1/1984 2.00% 5.00% 7.00% $4.66
5 86580 0-999 0.21 $27.276 $5.73 4/1/2011 2.00% 5.00% 7.00% $5.33
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
5 86849 0-999 Manually Priced 5/1/1993 2.00% 5.00% 7.00%
Manually Priced
5 86850 0-999 $7.70 4/1/2011 2.00% 5.00% 7.00% $7.16
5 88141 0-999 0.87 $27.276 $23.73 4/1/2011 2.00% 5.00% 7.00% $22.07
5 88302 0-999 1.55 $27.276 $42.28 4/1/2011 2.00% 5.00% 7.00% $39.32
1 90460 0-20 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90461 0-20 $4.00 4/1/2011 2.00% 5.00% 7.00% $3.72
1 90470 8-20 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90470 21-999 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90471 0-20 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90471 21-999 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90472 0-20 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90472 21-999 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90473 0-20 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90473 21-999 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90474 0-20 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90474 21-999 $8.00 4/1/2011 2.00% 5.00% 7.00% $7.44
1 90632 19-20 $45.32 10/1/2010 2.00% 5.00% 7.00% $42.15
1 90632 21-999 $45.32 10/1/2010 2.00% 5.00% 7.00% $42.15
1 90633 19-20 $30.06 4/1/2011 2.00% 5.00% 7.00% $27.96
1 90636 19-20 $96.23 10/1/2010 2.00% 5.00% 7.00% $89.49
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 90636 21-999 $96.23 10/1/2010 2.00% 5.00% 7.00% $89.49
1 90648 19-20 $24.39 4/1/2011 2.00% 5.00% 7.00% $22.68
1 90649 19-20 $139.78 4/1/2011 2.00% 5.00% 7.00% $130.00
1 90649 21-26 $139.78 4/1/2011 2.00% 5.00% 7.00% $130.00
1 90650 9-18 $138.14 7/1/2010 2.00% 5.00% 7.00% $128.47
1 90650 19-26 $138.14 7/1/2010 2.00% 5.00% 7.00% $128.47
1 90650/U1 9-18 $138.14 7/1/2010 2.00% 5.00% 7.00% $128.47
1 90654 19-999 $12.78 1/1/2011 2.00% 5.00% 7.00% $11.89
1 90656 0-999 $11.81 4/1/2010 2.00% 5.00% 7.00% $10.98
1 90656 19-20 $11.81 4/1/2010 2.00% 5.00% 7.00% $10.98
1 90656/U1 0-999 $11.81 4/1/2010 2.00% 5.00% 7.00% $10.98
1 90658 19-20 $10.71 4/1/2010 2.00% 5.00% 7.00% $9.96
1 90658 21-999 $10.71 4/1/2010 2.00% 5.00% 7.00% $9.96
1 90660 19-20 $21.02 4/1/2011 2.00% 5.00% 7.00% $19.55
1 90680 19-20 $74.60 4/1/2009 2.00% 5.00% 7.00% $69.38
1 90681 19-20 $109.95 1/1/2009 2.00% 5.00% 7.00% $102.25
1 90681/U1 0-999 $109.95 1/1/2009 2.00% 5.00% 7.00% $102.25
1 90703 19-20 $22.77 10/1/2010 2.00% 5.00% 7.00% $21.18
1 90703 21-999 $22.77 10/1/2010 2.00% 5.00% 7.00% $21.18
1 90704 19-20 $23.76 4/1/2011 2.00% 5.00% 7.00% $22.10
1 90705 19-20 $18.33 4/1/2011 2.00% 5.00% 7.00% $17.05
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 90706 19-20 $20.43 4/1/2011 2.00% 5.00% 7.00% $19.00
1 90707 19-20 $47.07 10/1/2010 2.00% 5.00% 7.00% $43.78
1 90707 21-999 $47.07 10/1/2010 2.00% 5.00% 7.00% $43.78
1 90710 19-20 $137.90 4/1/2010 2.00% 5.00% 7.00% $128.25
1 90713 19-20 $26.40 4/1/2011 2.00% 5.00% 7.00% $24.55
1 90714 19-20 $18.74 4/1/2011 2.00% 5.00% 7.00% $17.43
1 90714 21-999 $18.74 4/1/2011 2.00% 5.00% 7.00% $17.43
1 90715 19-20 $33.81 10/1/2010 2.00% 5.00% 7.00% $31.44
1 90715 21-999 $33.81 10/1/2010 2.00% 5.00% 7.00% $31.44
1 90716 19-20 $86.41 4/1/2011 2.00% 5.00% 7.00% $80.36
1 90718 19-20 $17.72 4/1/2011 2.00% 5.00% 7.00% $16.48
1 90718 21-999 $17.72 4/1/2011 2.00% 5.00% 7.00% $16.48
1 90721 19-20 $49.24 4/1/2011 2.00% 5.00% 7.00% $45.79
1 90723 19-20 $75.29 8/1/2008 2.00% 5.00% 7.00% $70.02
1 90732 19-20 $40.75 10/1/2010 2.00% 5.00% 7.00% $37.90
1 90732 21-999 $40.75 10/1/2010 2.00% 5.00% 7.00% $37.90
1 90733 19-20 $103.41 10/1/2010 2.00% 5.00% 7.00% $96.17
1 90734 19-20 $110.93 4/1/2011 2.00% 5.00% 7.00% $103.16
1 90740 19-20 $112.50 4/1/2011 2.00% 5.00% 7.00% $104.63
1 90740 21-999 $112.50 4/1/2011 2.00% 5.00% 7.00% $104.63
1 90743 19-20 $22.81 4/1/2011 2.00% 5.00% 7.00% $21.21
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 90744 19-20 $22.82 10/1/2010 2.00% 5.00% 7.00% $21.22
1 90746 19-20 $56.25 4/1/2009 2.00% 5.00% 7.00% $52.31
1 90746 21-999 $56.25 4/1/2009 2.00% 5.00% 7.00% $52.31
1 90747 19-20 $112.50 4/1/2011 2.00% 5.00% 7.00% $104.63
1 90747 21-999 $112.50 4/1/2011 2.00% 5.00% 7.00% $104.63
1 90748 19-20 $46.78 8/1/2008 2.00% 5.00% 7.00% $43.51
1 94774 0-20 $178.14 7/1/2011 2.00% 5.00% 7.00% $165.67
1 94774 21-999 $169.66 7/1/2011 2.00% 5.00% 7.00% $157.78
1 96372 0-20 0.68 $28.640 $19.48 7/1/2011 2.00% 5.00% 7.00% $18.12
1 96372 21-999 0.68 $27.276 $18.55 7/1/2011 2.00% 5.00% 7.00% $17.25
1 99000 0-999 $10.00 4/1/2010 2.00% 5.00% 7.00% $9.30
1 99001 0-999 $10.00 4/1/2010 2.00% 5.00% 7.00% $9.30
1 99201 0-20 0.83 $27.276 $22.64 7/1/2009 2.00% 5.00% 7.00% $21.06
1 99201 21-999 0.83 $27.276 $22.64 7/1/2009 2.00% 5.00% 7.00% $21.06
1 99202 0-20 1.31 $27.276 $35.73 7/1/2009 2.00% 5.00% 7.00% $33.23
1 99202 21-999 1.31 $27.276 $35.73 7/1/2009 2.00% 5.00% 7.00% $33.23
1 99203 0-20 1.77 $27.276 $48.28 9/1/2002 2.00% 5.00% 7.00% $44.90
1 99203 21-999 1.77 $27.276 $48.28 9/1/2002 2.00% 5.00% 7.00% $44.90
1 99204/FP 0-20 2.59 $27.276 $70.64 9/1/2007 2.00% 5.00% 7.00% $65.70
1 99204/FP 21-999 2.59 $27.276 $70.64 9/1/2007 2.00% 5.00% 7.00% $65.70
1 99205 0-20 3.22 $27.276 $87.83 7/1/2009 2.00% 5.00% 7.00% $81.68
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 99205 21-999 3.22 $27.276 $87.83 7/1/2009 2.00% 5.00% 7.00% $81.68
1 99211 0-20 0.43 $27.276 $11.73 7/1/2009 2.00% 5.00% 7.00% $10.91
1 99211 21-999 0.43 $27.276 $11.73 7/1/2009 2.00% 5.00% 7.00% $10.91
1 99212 0-20 0.72 $27.276 $19.64 7/1/2009 2.00% 5.00% 7.00% $18.27
1 99212 21-999 0.72 $27.276 $19.64 7/1/2009 2.00% 5.00% 7.00% $18.27
1 99213 0-20 $29.52 1/18/2002 2.00% 5.00% 7.00% $27.45
1 99213 21-999 $29.52 1/18/2002 2.00% 5.00% 7.00% $27.45
1 99214/FP 0-20 1.52 $27.276 $41.46 9/1/2007 2.00% 5.00% 7.00% $38.56
1 99214/FP 21-999 1.52 $27.276 $41.46 9/1/2007 2.00% 5.00% 7.00% $38.56
1 99215 0-20 2.34 $27.276 $63.83 7/1/2009 2.00% 5.00% 7.00% $59.36
1 99215 21-999 2.34 $27.276 $63.83 7/1/2009 2.00% 5.00% 7.00% $59.36
3 99241 0-999 $44.87 9/1/2007 2.00% 5.00% 7.00% $41.73
3 99241 21-999 $40.47 9/1/2007 2.00% 5.00% 7.00% $37.64
3 99242 0-999 $70.25 9/1/2007 2.00% 5.00% 7.00% $65.33
3 99242 21-999 $63.37 9/1/2007 2.00% 5.00% 7.00% $58.93
3 99243 0-999 $90.77 9/1/2007 2.00% 5.00% 7.00% $84.42
3 99243 21-999 $81.87 9/1/2007 2.00% 5.00% 7.00% $76.14
3 99244 0-999 $127.28 9/1/2007 2.00% 5.00% 7.00% $118.37
3 99244 21-999 $114.80 9/1/2007 2.00% 5.00% 7.00% $106.76
3 99245 0-999 $169.01 9/1/2007 2.00% 5.00% 7.00% $157.18
3 99245 21-999 $152.44 9/1/2007 2.00% 5.00% 7.00% $141.77
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 99354 0-999 $60.51 9/1/2007 2.00% 5.00% 7.00% $56.27
1 99354 21-999 $54.58 9/1/2007 2.00% 5.00% 7.00% $50.76
1 99385 21-999 2.95 $27.276 $80.46 1/1/2010 2.00% 5.00% 7.00% $74.83
1 99386 0-999 3.45 $27.276 $94.10 1/1/2010 2.00% 5.00% 7.00% $87.51
1 99395 21-999 2.56 $27.276 $69.83 1/1/2010 2.00% 5.00% 7.00% $64.94
1 99396 0-999 2.80 $27.276 $76.37 1/1/2010 2.00% 5.00% 7.00% $71.02
9 A4261 0-999 $50.84 10/1/2010 2.00% 5.00% 7.00% $47.28
9 A4264 0-999 $1,230.00 1/1/2010 2.00% 5.00% 7.00% $1,143.90
9 A4266 0-999 $34.11 10/1/2010 2.00% 5.00% 7.00% $31.72
1 A4267 0-999 $0.54 10/1/2010 2.00% 5.00% 7.00% $0.50
1 A4268 0-999 $2.83 10/1/2010 2.00% 5.00% 7.00% $2.63
1 A4269 0-999 $12.26 10/1/2010 2.00% 5.00% 7.00% $11.40
1 A9150/FP 0-999 $14.00 4/1/1995 2.00% 5.00% 7.00% $13.02
1 C9399 0-999 $5.01 7/1/2011 2.00% 5.00% 7.00% $4.66
1 H1010 0-20 0.40 $28.640 $11.46 1/1/2010 2.00% 5.00% 7.00% $10.66
1 H1010 21-999 0.40 $27.276 $10.91 1/1/2010 2.00% 5.00% 7.00% $10.15
1 J1000 0-999 $6.83 4/1/2010 2.00% 5.00% 7.00% $6.35
1 J1055 0-999 $69.87 1/1/2011 2.00% 5.00% 7.00% $64.98
1 J7300 0-999 $419.90 10/1/2008 2.00% 5.00% 7.00% $390.51
1 J7302 0-999 $705.00 10/1/2010 2.00% 5.00% 7.00% $655.65
1 J7303 0-999 $56.85 10/1/2010 2.00% 5.00% 7.00% $52.87
Family Planning Clinics
TOS
Procedure Code/ Modifier
Age Range
Relative Value Unit
Conversion Factor
Current Medicaid Rate
Effective Date
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 J7304 0-999 $21.26 10/1/2010 2.00% 5.00% 7.00% $19.77
1 J7307 0-999 $607.19 10/1/2010 2.00% 5.00% 7.00% $564.69
1 S4993 0-999 $20.88 9/1/2008 2.00% 5.00% 7.00% $19.42
Note: The following rates are for family planning clinic services rendered in the facility setting.
2 36410 0-20 0.25 $28.640 $7.16 4/1/2010 2.00% 5.00% 7.00% $6.66
2 36410 0-20 0.25 $28.640 $7.16 4/1/2010 2.00% 5.00% 7.00% $6.66
2 36410 21-999 0.25 $27.276 $6.82 4/1/2010 2.00% 5.00% 7.00% $6.34
2 36410 21-999 0.25 $27.276 $6.82 4/1/2010 2.00% 5.00% 7.00% $6.34
2 58565 0-20 11.73 $28.640 $335.95 4/1/2010 2.00% 5.00% 7.00% $312.43
2 58565 0-20 11.73 $28.640 $335.95 4/1/2010 2.00% 5.00% 7.00% $312.43
2 58565 0-20 11.73 $28.640 $335.95 4/1/2010 2.00% 5.00% 7.00% $312.43
2 58565 21-999 11.73 $27.276 $319.95 4/1/2010 2.00% 5.00% 7.00% $297.55
2 58565 21-999 11.73 $27.276 $319.95 4/1/2010 2.00% 5.00% 7.00% $297.55
2 58565 21-999 11.73 $27.276 $319.95 4/1/2010 2.00% 5.00% 7.00% $297.55
Note: The following rates are for family planning clinic services rendered in the non-facility setting.
2 36410 0-20 0.52 $28.640 $14.89 4/1/2010 2.00% 5.00% 7.00% $13.85
2 36410 21-999 0.52 $27.276 $14.18 4/1/2010 2.00% 5.00% 7.00% $13.19
2 58565 0-20 45.22 $28.640 $1,295.10 10/1/2010 2.00% 5.00% 7.00% $1,204.44
2 58565 21-999 45.22 $27.276 $1,233.42 10/1/2010 2.00% 5.00% 7.00% $1,147.08
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Children & Pregnant Women Case Management Services (CPW)
TOS Procedure Code Mod 1 Mod 2
Current Medicaid Rate
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
1 G9012 U5 U2 $121.67 2.00% 5.00% 7.00% $115.46
1 G9012 U5 TS $60.84 2.00% 5.00% 7.00% $57.73
1 G9012 $22.81 2.00% 5.00% 7.00% $21.65
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Tuberculosis Clinics
TOS Procedure Code Age Range
Current Medicaid Rate
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
D 71010 0-999 $21.55 2.00% 5.00% 7.00% $20.04
D 71020 0-999 $27.55 2.00% 5.00% 7.00% $25.62
D 71021 0-999 $33.00 2.00% 5.00% 7.00% $30.69
D 71022 0-999 $34.64 2.00% 5.00% 7.00% $32.22
D 71030 0-999 $36.00 2.00% 5.00% 7.00% $33.48
D 71035 0-999 $22.91 2.00% 5.00% 7.00% $21.31
D 81025 0-999 $8.54 2.00% 5.00% 7.00% $7.94
D 86580 0-999 $5.73 2.00% 5.00% 7.00% $5.33
D 86701 0-999 $12.00 2.00% 5.00% 7.00% $11.16
D 86703 0-999 $18.53 2.00% 5.00% 7.00% $17.23
D 89220 0-999 $12.27 2.00% 5.00% 7.00% $11.41
D 96365 0-999 $53.19 2.00% 5.00% 7.00% $49.47
D 96366 0-999 $16.64 2.00% 5.00% 7.00% $15.48
D 96367 0-999 $23.18 2.00% 5.00% 7.00% $21.56
D 96368 0-999 $14.46 2.00% 5.00% 7.00% $13.45
D 96374 0-999 $40.91 2.00% 5.00% 7.00% $38.05
D 96375 0-999 $16.09 2.00% 5.00% 7.00% $14.96
D 99001 0-999 $10.00 2.00% 5.00% 7.00% $9.30
D 99201 0-20 $28.87 2.00% 5.00% 7.00% $26.85
D 99201 21-999 $26.04 2.00% 5.00% 7.00% $24.22
Tuberculosis Clinics
TOS Procedure Code Age Range
Current Medicaid Rate
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
D 99202 0-20 $45.56 2.00% 5.00% 7.00% $42.37
D 99202 21-999 $41.09 2.00% 5.00% 7.00% $38.21
D 99203 0-20 $61.56 2.00% 5.00% 7.00% $57.25
D 99203 21-999 $55.52 2.00% 5.00% 7.00% $51.63
D 99205 0-20 $111.98 2.00% 5.00% 7.00% $104.14
D 99205 21-999 $101.00 2.00% 5.00% 7.00% $93.93
D 99211 0-20 $14.96 2.00% 5.00% 7.00% $13.91
D 99211 21-999 $13.49 2.00% 5.00% 7.00% $12.55
D 99212 0-20 $25.04 2.00% 5.00% 7.00% $23.29
D 99212 21-999 $22.59 2.00% 5.00% 7.00% $21.01
D 99213 0-20 $37.64 2.00% 5.00% 7.00% $35.01
D 99213 21-999 $33.95 2.00% 5.00% 7.00% $31.57
D 99214 0-20 $52.86 2.00% 5.00% 7.00% $49.16
D 99214 21-999 $47.68 2.00% 5.00% 7.00% $44.34
D 99215 0-20 $81.38 2.00% 5.00% 7.00% $75.68
D 99215 21-999 $73.40 2.00% 5.00% 7.00% $68.26
D H0033 0-999 $5.44 2.00% 5.00% 7.00% $5.06
D H0033 0-999 $24.00 2.00% 5.00% 7.00% $22.32
D H0033 0-999 $24.00 2.00% 5.00% 7.00% $22.32
D J0278 0-999 $0.58 2.00% 5.00% 7.00% $0.54
D J1840 0-999 $7.69 2.00% 5.00% 7.00% $7.15
Tuberculosis Clinics
TOS Procedure Code Age Range
Current Medicaid Rate
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
D J1956 0-999 $5.36 2.00% 5.00% 7.00% $4.98
D J2020 0-999 $32.58 2.00% 5.00% 7.00% $30.30
D J2280 0-999 $2.90 2.00% 5.00% 7.00% $2.70
D J3000 0-999 $8.06 2.00% 5.00% 7.00% $7.50
D T1002 0-999 $12.97 2.00% 5.00% 7.00% $12.06
D T1003 0-999 $9.05 2.00% 5.00% 7.00% $8.42
D T1023 0-999 $90.96 2.00% 5.00% 7.00% $84.59
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Birthing Center Services
TOS Procedure Code Age Range Current Rate
Current Percentage Reduction
Additional Percentage Reduction
Total Percent Reduction
Rate Effective 9/1/2011
P 59409 0-999 $546.19 2.00% 5.00% 7.00% $518.88
P 99221 0-999 $69.60 2.00% 5.00% 7.00% $66.12
P S4005 0-999 $152.03 2.00% 5.00% 7.00% $144.43
(TOS) Type of Service. (Age: 0-20) Clients who are 20 years of age and younger. (Age: 21-999) Clients who are 21 years of age and older. (Age: 0-999) Clients of any age.
Pharmacy Dispensing Fee
Component Description Age Range
Current Medicaid Rate
Additional Reduction
Rate Effective 9/1/11
Fixed
A component that provides the base reimbursement to a pharmacy for the cost of dispensing a prescription; it includes reimbursement for professional services costs and overhead costs. 0-999 $7.35 $0.85 $6.50
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