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Home My WebLink About20132260.tiffRESOLUTION RE: APPROVE REVISIONS TO FEE SCHEDULE FOR FEES COLLECTED BY THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with revisions to the fee schedule for fees collected by the Weld County Department of Public Health and Environment, and WHEREAS, after study and review, the Board deems it advisable to approve the proposed revisions, effective upon date of approval, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the revised fee schedule for fees collected by the Weld County Department of Public Health and Environment, as attached hereto, be, and hereby are, approved, effective immediately. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 12th day of August, A.D., 2013. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: Weld County Clerk to the Board ounty Attorney Date of signaturAUG 2 0 2013 EXCUSED William F. Garcia. Chair arbara Kirkmey-r cc:/ -0'L 8/a9//3 2013-2260 HL0003 TO: Memorandum William F. Garcia, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health and Environment DATE: August 8, 2013 SUBJECT: 2013 Mid -Year Fee Increase Request The Department of Public Health and Environment is requesting authorization for mid -year fee schedule revisions in the Public Health Services and Environmental Health Services divisions. Attached for Board review and approval are the full fee schedules of both divisions reflecting the proposed adjustments. The requested changes are justified below. 4. PHS Fee Schedule Revision Justification On July 1, 2013, Medicaid revised their reimbursement schedules. With the Board's approval, the Health Department would like to bring its fee schedule into alignment with what Medicaid is willing to reimburse for certain medical services that are currently provided by the Health Department. In doing so several services will be reimbursed at a higher rate, resulting in greater revenue for Weld County, thus reducing the local taxpayers' costs in providing these essential services in the community. EHS Fee Schedule Revision Justification Body Art Fee: The implementation of a new body art fee is proposed to allow the Department to collect fees prior to doing work. In the past, we have conducted work for which we received no compensation because the facility operator decided not to open the establishment. The fee is consistent with other programs such as the food program. Ambulance Fees: The ambulance fees are being adjusted to reflect time spent conducting activities related to the service. The Ambulance "service" fee is being reduced because little staff time is spent in processing these applications. The Ambulance "unit" fee is being increased because a significant amount of time is spent reviewing, inspecting, and processing these permits. We are currently recovering approximately 12% of our costs. The adjusted fees will allow for collection of approximately 35% of our costs. The fees have not been adjusted since at least 1997. In April of this year an informal survey was conducted to determine what other counties are charging for similar services. Attached is a summary of those results. I recommend approval of the mid -year fee increases. 2013-2260 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH ENVIRONMENT Page 1 PUBLIC HEALTH SERVICES - 2013 SLIDING FEE SCHEDULE Revised 7/11/2013 HOUSEHOLD CODE SIZE Procedure Code Procedure VISITS New Client 99201 Focused - nurse visit* 99202 Expanded* 99203 Detailed* 99204 Comprehensive" Established Client 99211 Nurse Visit* 99212 Focused* 99213 Expanded* _ 63.75 85.00 99214 Detailed'0.00, 33.50 67.00I 100.50 134.00 IHome Visits 99341 New Client Focused 79.00'.. 79.00. 79.00 79.00, 79.00 99342 New Client - Expanded 79.00 79.00 79.00 _ 79.00 79.00 99347 Est. Client - Focused 79.00 79.00 79.00 79.00 79.00 99348 Est. Client - Expanded Code Code': Code Code Code 1 2 3 4 5 0.00 10.50 21.00 31.50'' 42.00'' 0.00 0.00 0.001 25.25 50.50 - 75.75 101.00 33.00. 66.00 99.00 132.00. 49.25 98.50 147.75. 197.00, r 0.00' 9.75, 19.5O 29.25' 39.00' 0.00 16.50 33.00 49.50 66.00 Preventive Medicine Counseling 99401 Individual - 15 min* 99402 Individual - 30 min* 99403 Individual - 45 min* I Travel Visits 99404 ! Individual Initial Visit - 60 99401W Return Visit 99412 Group Initial Visit - 60 Preventive Medicine 99384 I New Client 12-17 years old* 99385 New Client 18-39 years old* 99386 New Client 40-64 years old* 99394 Est. Client 12-17 years old* 99395 Est. Client 18-39 years old* 99396 Est. Client 40-64 years old* Additional Codes 0071W Community Education 1 hr. 0069W Travax Printout 69006 NHV Mother - Task Care Mgmt. T1017 NHV Child - Task Care Mgmt. 0072W !Swift Annual FP STI Exam pre -pay 99499 TB Consultation PROCEDURES 56420 Bartholin Cyst 11100 Biopsy of skin, single 57500 Cervical Lesion Biopsy 0116W Chest X -Ray (Prepay) 67452 Colposcopy w/o Biopsy ** 57454 '.Colposcopy with Biopsy ** 57511 Cryocautery cervix- initial or repeat 7000 Cryotherapy first lesion "* 17003 Cryotherapy 2-14 lesions** 17004 Cryotherapy 15 + lesions ** 56501 Destruction Lesion Vulva 57170 Diaphragm/Cervical Cap Fitting * 58100 Endometrial biopsy w/wo Biopsy 79.00 79.00 79.00 79.00 79 00, 0.00 10.50 21.00 31.50 42.00' 0.00 13.00 26.00 39.00 52.00 0.00 14.75, 29.50 44.25 59.00 66.001 42.00 42.00 66.001 42.00 42.00 66.00 66.00 66.00 42.00 42.00 42.00 42.00 42.00 42.00 0.001 33.0O. 66.00 99.001 132.00! 0.00' 33.00 66.00 99.00'1 132.00'. 0.00 35.50 71.00 106.50 142.00 _ 0.00 21.25 42.50 63.75 85.00 0.00. 21,25 42.50 63.75 85.00 0.00 23.501 47.00 70.50 94.00 r 64.00 64.00 64.00 64.00 64.00 8.00 8.00 8.00 8.00 8.00 12.00 12.00 12.00 12.00 12.00 12.0012.00 12.00 12.00 12 00! 311.00 311.00 311.00 311.001 311.001 ' 60.00 60.00 60.00' 60.00' 60.00'' 37.00 37.00 37.00 37.00 37.0O 30 00 30.001,. 30.00 30.00 30.00 _-_- 28 00, 28.00, 28.00 28.00 00 33.0O 33.00' 33.001 33.00 33.00 57.00 57.00 57.0O 57.00 57.00 92.00, 92.00 92.00 92.00 92.00 102.00: 102.00', 102.00 102.00' 102.00 102.00 102.001_ 102.00 102.00 : 102.00'1 27.00 27.00'' 27.00' 27.00 27.00'. 27.00 27.00 27.0O 27.00 27.0O 27.00 27.00 27.00 27.00 27.00 91 00 --- 9 -_ , 91.00 1.0 0 00'.. 20.25 40.50 60.75' 81.00 45.001 45.00 45.00'', 45.00 45.00', WELD COUNTY DEPARTMENT OF PUBLIC HEALTH ENVIRONMENT PUBLIC HEALTH SERVICES - 2013 SLIDING FEE SCHEDULE Page 2 Revised 7/11/2013 ProcedureCode Code Code l Code Code' _ Code IProcedure 1i 2 31 4i 5 58110. EndometYal biopsy with Colposcopy _ 58.00' 58.00'1 58.00'.. 58.001 - 58.00' Essureb referral*** 0.00 0.00, 0.00 0.00! 0.00 11400 Excisions, benign lesion 79.00 79.00 79.00 79.00' 79.00' 11981 Implanon Insertion 0.00 42.25 84.50 126.75 169.00 10060 Incision & drainage of abcess, single or simple 32.00. 32.00 32.00 32.00 32.00 58300 Insertion _ * -.— -- 1 2. 170.00. 57460 LEEP with biopsy _.. 139.00' 139.0011 139.00 139.00 139.001 57461 I 32.00 32.00 32.00 32.001 32.001 88305 I 93.001 93.00, 88305W Leve4Surg al Pe hoiogyal h2ndgsitelst site 9100. 93.001 8 each add'! [ 293.001 293.00 293.00 - 293. O 293 00, seoz5 'Non Stress Test Interp 0.00 0.00 0.00 0.00, 0.00, 11976 Removal, implant contraceptive (Implanon) 0.00 50.25 100.50 150.75 201.00 11983 Removal implant, with reinsertion 0.00 77.25 154.50 231.75 309.00 58301 Removal IUD* - _ 0.00 _ 34.00 68,00 102.00 136.00 A4550 I Surgical Tray 61.00.61.00; 61.00 61.00, 61.00, Shaving of epidermal lesion, single on trunk, 11300 arms or legs, .5cm 38.00 38.001 38.001 38.00 38.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg. 10* _ 0.00 1.50 3.00 0052W Cycle Beads* 0.00 2.75 5.50 A4266 Diaphragm* 0.00 6.50 13.00 A4269 Foam Contraception* -0.00 2.75 5.50 47307 .implanon/Nexplanon ! 0.00 165.00 330.00, J7302 IUD Mirena 1 0.00 176.00', 352.00' J7300 !IUD 41055 Medroxyprogesterone roresterone 150m IM De o * I1- 0.00. 154.50,' 302.50 Pa ragard 9 9 ( P ) 9.00 J7303 Nuva Ring 0.00 7.75 15.50 S4993 Oral Contraceptives* 0.00 5.75 11.50 0068W Seasonale 0.00 15.00 30.00 0065W Today's Sponge 0.00 1.00 2.00 LAB 82947 Assay, body fluid, glucose, (FBS)* 85025 CBC w/diff 85027 CBC w/o Diff 87491 Chlamydia PCR* 87491NS Chlamydia PCR* - full fee 0090W Court Ordered Lab Draw 83001 FSH 87591 Gonorrhea PCR* - 87591Ns Gonorrhea PCR* - full fee 82948 Glucose Random 82951 Glucose Tolerance Test 2 hr (GTT) 87205 Gram Stain 84702 HCG Quantitative - Serum Pregnancy Test 84703 HCG Qualitative - Serum Pregnancy Test 86708 Hep B Surface Antibody 87250 Herpes Culture 86695 Herpes Select Type I (89999A33) 86696 Herpes Select Type II (89999A33) 85018 HGB - (Finger Stick)* 86703 HIV Screen, ELIS A 87621 HPV High Risk 0081W HPV, High Risk w/ repeat pap (labcorp use) 484006W Immunohistochemical Stain 83002 LH 80061W Lipid Panel - SFS* 80061N Lipid Panel 80076 Liver Panel 80048 Metabolic Panel 0.00 4.25; 8.50 18.001 18.00' 18.00 16.001 16.00. 16.00 0.00 11.00 22.00 25.00 25.00 25.00 15.00 15.00 15.00 33.00 33.00 33.00 0.001 1100, 22.00 25.001 25.00 25.00 7.001 7.00, 7.00 22.00 22.00; ---22.00 24.00' 24.001 24.00'. 38.00' 38.00 38.00 38.00 38.00 38.00 21.00 21.00. 21.00 66.00 66.00' 66.00 64.00 64.001 _ 64.00 64 001 64.00_1 64.00' 0.00 3.25 6.50 21.001 21.00', 21.001 66.00 66.00 66.00 1_04.00 104.00 104.00 94.00 94.00 94.00 33.00 33.00 33.00 0.00 8.50 _ 17.00 34.00 34.00 34.00' 27.00 27.00 27.0011 28.001 28.00'. 28.00, 4.50 6.00 8.25 11.00 19.50 26.00 8.25 11.00. 495.00 660.00 528.001 704.00, 453.751 605.00k 13.50 18.001 23.25 31.00' 17.25 23.00 45.00 60.00 3.00 4.00 12.75; 17.00, 18.001 18.001 16.001, 16.00! 33.001 44.00, 25.00'. 44.00 15.00 15.00 33.00 33.00 33.001 44.00! 25.001 44.001 7.001 7.00''. 22.00 22.00 24.00 24.00 38.00 38.00 38.00 38.00 21.00 21.00 66.00 66.00 64.00, 64.00'. 64.001 64.001 9.75! 13.001 21.00. 21.00' 66.00, 66.00', 104.00 104.00 94.00 94.00 33.00 33.00 25.501 34.00'' 34.00 34.00 27.00 27.00. 28.00 28.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH ENVIRONMENT Page 3 PUBLIC HEALTH SERVICES - 2013 SLIDING FEE SCHEDULE Revised 7/11/2013 Procedure Code Procedure Code Code Code: Code' Code'. 1 2 3 4 5 82274 Occult Blood Test, Fecal, IA 0.00 6.50 13.00 19.50 26.00 88142 Pap - p 20.00 30.00, 40.00 - 00806 Pt neathin* prep 111. 0 00,1 10 00!, 44 00 40.00 40.001 34.001 86592 ' RPR/S hillis test 20 00 20.00. 20.00 20.00 24 00, Pap, P I YP � 20.00 84480 T3 43.00 43.00 43.00 43.00 43.00 84436 T4 7.00 7.00 7.00 7.00 7.00 87798 omonas vaginalis - amplified 0_ 10.00 10.00 10 00! 10.00 -' 80003!TSH _ I 31.00! 31.00 31.00!1 31.00 31.00I _.. 86480 Tuberculosis Test-Quantiferon (IGRA) 82.00 82.001 82.00' 82.00! 82.001 81001 Urinalysis, complete with micro ex _ 6.00 6.00' 6.00 6.00' 6.00 81002 Urinalysis, w/o scope (UA) _- 9.00 9.00 9.00 9.00 9.00 87086 Urine Culture, Comprehensive 10.00. 10.00 10.00. 10.00 10.00 81025 I Urine Preganancy Test* _.' 0.00_ 3 00 6.001 9.00 12.001 36415 I Venipuncture5.001 5.00', 5.00 5.00. 5.00 36415W !Veni uncture with sliding fee lab 0.00. 1.25' 2.50, 3.75! 5.00 87210 Wet Prep 21.00 21.00 21.00 : 21.00 21.00 MEDICINES and TREATMENTS 0036W Aldarra cream con w Amoxicillin 875 mg #20 0062W Azythromycin, Z pack 101456W Azithromycin 1g - partner pack 0456W Azithromycin State supplied J0696 Ceftriaxone 250 mg 0695W Ceftriaxone 250 mg State Supplied 0007W Cephalexin 500mg #14 0058w Ciprofloxcin 500 mg #6 0035W Condylox 0005W Doxycycline 100 mg #14 oo59W Estradiol 1 mg- #100 0011W Fluconazole 150 mg #1 0012W Iron J0580 LA Bicillin 2.4 Units 0060W Medroxyprogesterone 10 mg - #5 0008W Metrogel mom Metronidazole 500 mg #4 0010W Metronidazole 500 mg #14 0013W Metronidazole 250 mg #28 0006w Misoprostel (Cytotec) 200 mcg #2 0061W Nitrofurantoin Macrocrystals -#14 0034w Ofloxacin 0016W Podophyllin/TCA 00006W 'Premarin Vaginal Cream 0192W Prenatal Vitamins 0004W Sulfatrim SMX/TMP 0o18ow Suprax 400 mg #1 - partner pak 00180NC Suprax 400 mg #1 - State Supplied IMMUNIZATIONS 90748 ' Comvax - Hep B & Hib 90700 DTaP - VFC 90700C DTaP - Child 90702 DT 90633 Hepatitis A VFC 90633C Hepatitis A - Child 90632 Hepatitis A - Adult 90744 Hepatitis B - VFC 907440 Hepatitis B - Child 90746 Hepatitis B - Adult 90647 HIB -VFC 25.00 --- 25.00 25.00 25.00 _- 25.001 -- - 14.00 14.00 14.00 14.00 14.00: 14.00 14.00 14.00 14.00 14.00 10.00 10.00 10.00 10.00 10.00 0.00 0.00 0.00 0.00 0.00 27.00, 27.00 27.00, 27.00 27.00 0.001 0.00 0.00 __-- 0.00j 000' 9.00 9.00 9.00 9.001 9.00' 14.00 14.00 14.00 14.00 14.00 7.00 7.00 7.00 7.00 7.00 10.00 10.00. 10.00 10.00 10.00 14.00, 14.00 ---14.00 14.00 14.00!-_-- 17.0011 17.00', 17.00, 17.00 17.001 11.00'. 11.00' 11.00 11.00 11.00' 0.00 0.00 0.00 0.00 0.00 14.00 14.00 14.00 14.00 14.00 9.00 9.00 9.00 9.00 9.00. 1000, 10001 10.00- 10.001' 10.00,r 15.00'. 15.00'. 15.00 15.00 15.00 7.00 7.00 7.00 7.00 7.00 41.00 41.00 41.00 41.00 41.00 96.00 96.00 96.00 96.00 96.00': 14.00 1400 14 00, 14.00 14.00!, 13.00 13.00 13.00, 13.00 13.00'! 11.00 11.00 11.00 11.001 11.00 9.00 9.00 9.00 - 9.00 9.00 23.00 23.00 23.00 23.00 23.00 0.00: 0.00 0.00 000 - 0.00_ 0.00 0.00 0.00 - 0.00 0.00'. 0.00 0.00 0.00 0.00 0.00 27.001 27.00 27.00. 27.00 27.00 0001 0.00 000 000 000 00011 0.00 000! 0001 0001 29.00,- 29.00 29.00 29.00.- 29.00' 45.00 45.00 45.00 45.00 45.00' 0.00 0.00 0.00 0.00 0.00 24.00 24.00 24.00 24.00 24.00 72.00 72.00' 72.00 72.00 72.00 ! 1 0.00 0.00' 0.001 0.00', 0.00, WELD COUNTY DEPARTMENT OF PUBLIC HEALTH ENVIRONMENT PUBLIC HEALTH SERVICES - 2013 SLIDING FEE SCHEDULE Page 4 Revised 7/11/2013 Procedure. Code Procedure 906470 HIB - Child 90649 HPV - VFC 906490 HPV - Child 90649A HPV - Adult - 90649AT HPV - Adult - 317 vaccine 90281 IG Hepatitis A 90471 Imm Admin - one vaccine 90472 Imm Admin - each addl. Vaccine 90473 Imm • Admin - intranasal or oral 90657 Influenza infant- VFC (6 no thru 35 mo) 90657C Influenza infant - Child (6 mo thru 35 mo) 90658 Influenza - VFC (3 years thru 18 years) 906580 Influenza Child (3 years thru 18 years). 90658A Influenza -Adult (Ages 19 & over) oos58W !Influenza - Adult (State Vaccine) 90660 Influenza - intranasal use 90660A Influenza - Intranasal Adult 90660O Influenza - Intranasal Child G0008 Influenza - Admin. - MEDICARE 90713 IPV-VFC 907130 IPV - Child - - 90713A IPV-Adult 90735 '.Japanese Encephalitis (new formulation) 90696 Kinrix - VFC (DTaP/IPV) 906960 Kinrix - Child ( DTaP/IPV) 90734 j Menectra - VFC 90734C Menectra - Child (MCV4) I 145.00 90734A Menectra - Adult (Menveo) (conjugate) P 125.00 90734AT Menectra Adult - 317 Vaccine 0.00' 90733 Meningitis-(Menomune)(polysaccharide) _ 145.00 90707 MMR - VFC 907070 MMR - Child 90707A MMR - Adult 90707AT JMMR -Adult-317 Vaccine _ 90710 MMRV (MMR & Varivax) Proquad 90723 Pediarix - VFC (DTAP, IPV, Hep B) 907230 Pediarix - Child (DTaP/IPV/Hep B) 90698 Pentacel - VFC 906980 Pentacel - Child (DTaP/IPV/HepB) 90670 Pneumococal conjugate 90732 ' Pneumovax - VFC 90732C Pneumovax Child (PPSV23) 90732A 'Pneumovax - Adult 90732A7 I Pneumovax Adult - 317 Vacc. 60009 Pneumovax Admin - MEDICARE 90669 Prevnar sosssc Prevnar - Child (PCV13)Flwoer 90675 Rabies IM 90675AT Rabies IM - Adult Temporary 90680 Rotavirus - VFC 906800 Rotovirus - Child (RV5) 90681 Rotarix - VFC 90681c Rotarix - Child (RV10 90718 Td - VFC 907180 ITd -Child 90718A '.Td - Adult 90715 Tdap - VFC 907150 Tdap - Child 90715A .Tdap - Adult 90715AT ,Tdap Adult - 317 vaccine 86580 Tuberculosis Interdermal Skin Test (PPD) Code Code Code Code Code' 1 2 3. 4 5, 33.00i! 33.00 33.00' 33.001 33.001 _,- 0.00 0.001r 0.00' 0.00! 0.00 160.0O 160.00 160.00 160.00' 160.00 160.00 160.00 160.00 160.00 160.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.70 14.70 14.70 14.70 !. 14.70 14.70 14.70'. 14.70 14.70! 14.70''' _--- 1 0.00 4.7O, 14 70 14.70 1 14.70T 14.70] 0 00] 0 00' 0.00. 0.001, 25.00'! 25.00I 25.00 25.0O 25.00,_ 0.00 0 00' 0.00 0.00 0.00'. _ 25.00 25.00 25.00 25.00 25.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00.. 0.00 0.00 0.00 '1 31.00 31.00, 31.00 31.001 31.00, 14.70, 14.001 31.00 31. 31.00 ! 00 '1 3100 31.00 14.70 14.701 14.70, 0.00 0.00!. 0.00 0.00. 0.00!. 45.00 45.00 45.00 45.00 45.00 63.00 63.00 63.00 63.00 63.00 245.00 245.00 245.00 245.00 245.00 0.00 0.00. 0.00 0.00 0.00 53.00 53.00, 53.00 53.00 53.00 0.00 0.00'_ 0.00 0.00 0.00 145.00 145.00', 145.00!, 145.00'.. 125.00, 125.00 125.001 125.001 0.00'. 0.00 0.00! 0.00!. 145.00. 145.00 145.00 145.00 0.00 0.00 0.00 0.00 0.00 61.00 61.00 61.00 61.00 61.00 61.00 61.00 61.00 61.00 61.00 r 0.00 0 00 0.00 0 00�.- 0.00', .00 70.` 5011 75.00 75.00 ' 76 00 7.0 00' ' - 0.00 0.00'! 0.00 0.00 0.00' 110.00 110.00 110.00 110.00 110.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 80.00 80.00 80.00. 80.00 80.00 ! 73.00 73 00 73.00 73.00', 73.0O, 0.00 0.001] 0.00, 0.00 0.001 I 14.70 14.701 14.70 14.70' 14.70 ! 0.00 0.001 0.00 0.00'. 0.001 145.00 145.00 145.00 145.0O. 145.00. 235.00 235.00 235.00 235.00 235.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 , 3.00 _ 0.00 0.00 80.00 iI 115.00 115.00 r 115.00' 115.00 115.001 I_ 000: 000],._ 000 0.00i 0.00I 44.00 44.00'. 44.00 44.00' 44.00 44.00 44.00 44.00 44.00 44.00 0.00 0.00 0.00 0.00 0.00 44.00 44.00. 44.00 44.00 44.00. j 96.00 96.00' 96.00 96.00 96.00' ' 0.00 0.00' 0.00 0.00 0.00'; 25.00 25.00'1 25.00. 25.00 25.00! WELD COUNTY DEPARTMENT OF PUBLIC HEALTH ENVIRONMENT PUBLIC HEALTH SERVICES - 2013 SLIDING FEE SCHEDULE Page 5 Revised 7/11/2013 Procedure' Code Procedure Tuberculosis Interdermal Skin Test(PPD) 8658w I reading only 90636 ITwinrix- HepA&HepB 90636AT Twinrix Adult -317 vaccine - Hep A & Hep B 90691 _ Typhoid - 1 Shot 90690 Typhoid - Oral 90716 Varivax - VFC so7lsc Varivax - Child 105.00 105.00. 105.001. 105.0O, 105.00 90716A 'Varivax - Adult 90716AT Varivax - Adult - 317 Vaccine 90717 Yellow Fever Code I Code'. Code', Code', Codel 1 2 3' 4 5. 0.00 0.00 0.00, 0.00 0.00 '.. 67.00!, 67.00 67.00i 67.00 67.00] 0.001 0.00 0.00, 0.00 0.00', 68.0O 68.00. 68.00' 68.00 68.00'' 57.00 57.00 57.00 57.00 57.00 0.00 0.00 0.00 0.00 0.00 100.00 100.00' 100.00 100.001 100.00',. 0.00 0.00 0.00 0.00' 0.00 109.00 109.00 109.00 109.00 109.00 *.Fees only slide for the Family Planning Program. Charges for all other programs are the Code 5 fee. ** Services include surgical procedure only. ***,These items are for referral Miscellaneous INC Scv. Includes Follow-up Care 99212 Antepartum Care 1 visit 59425 Antepartum care 4-6 visits 59426 Antepartum care 7 or more visits 99402W PE Establishing Medical Record. 0255W ' Phone visit 59430 Post Partum Only H1oos Prenatal Plus (1-4 visits) H1oo5 Prenatal Plus (5-9) visits) H1005 Prenatal Plus (10 visits) H1o05 Prenatal Plus (11 or more visits) 0.00 0.00 000: 64.00 64.00 64.00 586.00 586.00 586.00 12.05.00 1205.00 1205.00 56.00', 56.00 56 00,. 0.00 000, 0.00 106.00 106.00 106.00 170.00 170.00 170.00 454.00 454.00 454.00 852.00! 85200, 852.00, 965.00', 965.00 965.001, I 0.001• 0.00 II 64.00 64.00 586.00 586.00 1205.00 1205.00 56.00, 0.00' 106.0O 170.00 454.00 852.001 965.00 56.00 0.00 106.00 170.00 454.00 852.00 965.00 PHS 2013 Fees Page 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PUBLIC HEALTH SERVICES 2013 SLIDING FEE SCHEDULE Revised 11/7/12 7/11/2013 Procedure Code Procedure HOUSEHOLD CODE SIZE Code Code Code Code Code 1 2 3 4 5 VISITS New Client 99201 Focused - nurse visit* 99202 Expanded* 99203 Detailed* 99204 Comprehensive* 0.00 10.50 21.00 31.50 42.00 0.00 25.25 50.50 75.75 101.00 0.00 33.00 66.00 99.00 132.00 0.00 49 25 98 50 147.75 197.00 Established Client 99211 Nurse Visit* 99212 Focused* 99213 Expanded* 99214 Detailed* 0.00 0.00 0.00 0.00 9.75 16 50 2125 33.50 19.50 33.00 4250 67 00 29.25 49.50 63.75 100.50 39.00 66.00 8500 134.00 Home Visits 99341 New Client - Focused 99342 New Client - Expanded 99347 Est. Client - Focused 99348 Est. Client - Expanded 79,00 79.00 79.00 79 00 79.00 79.00 7900 7900 79.00 79.00 79 00 79.00 Preventive Medicine Counseling 99401 Individual - 15 min* 99402 Individual - 30 min* 99403 Individual - 45 min* 0.00 0.00 0.00 10.50 13.00 14.75 21.00 26, 00 29 50 Travel Visits 99404 Individual Initial Visit - 60 99401W Return Visit 99412 Group Initial Visit - 60 66.00 42,00 42 00 66.00 42.00 42.00 66.00 42 00 4200 Preventive Medicine 99384 New Client 12-17 years old* 99385 New Client 18-39 years old* 99386 New Client 40-64 years old* 99394 Est. Client 12-17 years old* 99395 Est. Client 18-39 years old* 99396 Est Client 40-64 years old* Additional Codes 0071W Community Education 1 hr. 0069W Travax Printout G9006 NHV Mother - Task Care Mgmt T1017 NHV Child - Task Care Mgmt. 0072W Swift Annual FP STI Exam pre -pay 99499 TB Consultation 79.00 79.00 79.00 79.00 79.00 79.00 79.00 79.00 31.50 39.00 44.25 42.00 52.00 59 00 66.00 42.00 42.00 66.00 42.00 42.00 0.00 33.00 66.00 99.00 132.00 0.00 33.00 66.00 99.00 132.00 0.00 35.50 71.00 106.50 142.00 0.00 21.25 42.50 63.75 85.00 0 00 21 25 42 50 63.75 85.00 0.00 23 50 47 00 70.50 94.00 64.00 64.00 64.00 64.00 64.00 8.00 8 00 8.00 8.00 8.00 12.00 12 00 12 00 12.00 12.00 12.00 12.00 12 00 12.00 12.00 311.00 31100 31100 311.00 311.00 60.00 60 00 60 00 60.00 60.00 37.00 37 00 37.00 37.00 37.00 PROCEDURES 56420 Bartholin Cyst 11100 Biopsy of skin, single 57500 Cervical Lesion Biopsy 0116W Chest X -Ray (Prepay) 57452 Colposcopy w/o Biopsy ** 57454 Colposcopy with Biopsy ** 57511 Cryocautery cervix- initial or repeat 30.00 28 00 33.00 57.00 92.00 30.00 28.00 33.00 57 00 92 00 30.00 28.00 33.00 57 00 9200 30.00 28.00 33.00 5700 92.00 30.00 28.00 33.00 57.00 92.00 92.00 92.00 92.00 92 00 92.00 102.00 102 00 102.00 102.00 102.00 102.00 PHS 2013 Fees Page 2 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 17000 Cryotherapy first lesion ** 27.00 27.00 27.00 27.00 27.00 17003 Cryotherapy 2-14 lesions ** 27.00 27.00 27.00 27.00 27.00 17004 Cryotherapy 15 + lesions ** 27.00 27.00 27.00 27.00 27.00 56501 Destruction Lesion Vulva 91.00 91.00 91.00 91.00 91.00 57170 Diaphragm/Cervical Cap Fitting ' 0.00 20.25 40.50 60.75 81.00 58100 Endometrial biopsy w/wo Biopsy 45.00 45.00 45.00 45.00 45.00 58110_ Endometrial biopsy with Colposcopy _ 58.00 58.00 58.00 58.00 58.00 Essure by referral*** 0.00 0.00 0.00 0.00 0.00 11400 Excisions, benign lesion 79.00 79.00 79.00 79.00 79.00 11981 Implanon Insertion 0.00 42.25 84.50 126.75 169.00 10060 Incision & drainage of abcess, single or simple 32.00 32.00 32.00 32.00 32.00 58300 Insertion IUD* 0.00 42.50 85.00 127.50 170.00 57460 LEEP with biopsy 139.00 139.00 139.00 139.00 139.00 57461 LEEP with conization 232.00 232.00 232.00 232.00 232.00 88305 Level 4 - Surgical pathology 1st site 93.00 93.00 93.00 93.00 93.00 88305W Level 4 -Surgical Pathology 2nd site & each add] 93.00 93.00 93.00 93.00 93.00 59025 Non Stress Test Interp 0.00 0 00 0.00 0.00 0.00 11976 Removal. implant contraceptive (lmplanon) 0.00 50.25 100.50 150.75 201.00 11983 Removal implant, with reinsertion 0.00 77.25 154.50 231.75 309.00 58301 Removal IUD* 0.00 34.00 68.00 102.00 136.00 A4550 Surgical Tray 61.00 61.00 61.00 61.00 61.00 Shaving of epidermal lesion, single on trunk. 11300 arms or legs. 5cm 38.00 38.00 38.00 38.00 38.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg. 10k 0.00 1.50 3.00 4.50 6.00 0052W Cycle Beads* 0.00 2.75 5.50 8.25 11.00 A4266 Diaphragm* 0.00 6.50 13.00 19.50 26.00 A4269 Foam Contraception* 0.00 2 75 5.50 8.25 11.00 J7307 Implanon/Nexplanon 0.00 0.00 J7302 IUD Mirena 0.00 0.00 J7300 IUD Paragard 0.00 0.00 95.50 191.00 286.50 382.00 165.00 330.00 495.00 660.00 106.00 212.00 318.00 424.00 176 00 352.00 528.00 704.00 66.50 133.00 199.50 266.00 151.25 302.50 453.75 605.00 J1055 Medroxyprogesterone 150mg IM (Depo)* 0.00 4.50 0.00 7.75 9.00 15.50 13.50 18.00 J7303 Nuva Ring 23.25 31.00 S4993 Oral Contraceptives* 0.00 5.75 11.50 17.25 23.00 0068W Seasonale 0.00 15.00 30 00 45.00 60.00 o065W Today's Sponge 0.00 1.00 2.00 3.00 4 00 LAB 82947 Assay, body fluid. glucose, (FBS)* 0.00 4.25 8.50 12.75 17.00 85025 CBC w/diff 18.00 18.00 18.00 18.00 18.00 85027 CBC w/o Diff 16.00 16.00 16.00 16.00 16 00 87491 Chlamydia PCR* 0.00 6.25 12.50 18.75 25.00 87491NS Chlamydia PCR' - full fee 25.00 25.00 25.00 25.00 25.00 44.00 44.00 0090W Court Ordered Lab Draw 15.00 15.00 15.00 15.00 15.00 83001 FSH 33.00 33.00 33.00 33.00 33.00 87591 Gonorrhea PCR* 0.00 6.25 12.50 18.75 25.00 87591NS Gonorrhea PCR" - full fee 25.00 25.00 25.00 25.00 25.00 44.00 44.00 82948 Glucose Random 7 00 7.00 7.00 7.00 7 00 82951 22.00 22.00 22.00 22.00 22.00 Glucose Tolerance Test 2 hr (GTT) 87205 Gram Stain 24.00 24.00 24.00 24.00 24.00 84702 HCG Quantitative - Serum Pregnancy Test 38.00 38.00 38.00 38.00 38.00 84703 HCG Qualitative - Serum Pregnancy Test 38.00 38.00 38.00 38.00 38.00 86706 Hep B Surface Antibody 21.00 21.00 21.00 21 00 21.00 87250 Herpes Culture 66.00 66.00 66.00 66.00 66.00 86695 Herpes Select - Type I (89999A33) 64.00 64.00 64.00 64.00 64.00 86696 Herpes Select - Type II (89999A33) 64.00 64.00 64.00 64.00 64 00 85018 HGB - (Finger Stick)* 0.00 3.25 6.50 9.75 13 00 PHS 2013 Fees Page 3 Procedure Code Procedure 86703 87621 0081W 484006W 83002 80061W 80061N 80076 80048 82274 88142 0080W 84146 86592 84480 84436 87798 84443 86480 81001 81002 87086 81025 36415 36415W 87210 HIV Screen, ELISA HPV. High Risk HPV, High Risk wl repeat pap (labcorp use) Immunohistochemical Stain LH Lipid Panel - SFS* Lipid Panel Liver Panel Metabolic Panel Occult Blood Test, Fecal. IA Pap - Thin Prep' Pap, repeat thin prep Prolactin RPR/Syphillis test T3 T4 Trichomonas vaginalis - amplified TSH Tuberculosis Test-Quantiferon (IGRA) Urinalysis, complete with micro ex Urinalysis, w/o scope (UA) Urine Culture Comprehensive Urine Preganancy Test* Venipuncture Venipuncture with sliding fee lab Wet Prep Code _ Code Code 1 2 3 Code 4 Code 5 21.00 21.00 21 00 66.00 66.00 66.00 104.00 104.00 104.00 94.00 94.00 94.00 33.00 33_00 33 00 0.00 8.50 17.00 34.00 34.00 34.00 27.00 27.00 27.00 28.00 28.00 28.00 0.00 6.50 13.00 0.00 10.00 20.00 40.00 40.00 40 00 34.00 34 00 34 00 20.00 20.00 20 00 43.00 43.00 43.00 7.00 7.00 7.00 10.00 10 00 10 00 31.00 31.00 31.00 82.00 82.00 82 00 6.00 6.00 6.00 9.00 9.00 9 00 10.00 10.00 10.00 0.00 3.00 6.00 5.00 5.00 5 00 0.00 1 25 2 50 21.00 21.00 21.00 0036W 0020W 0062W 101456W 0456W J0696 0696W 0007W 0058W 0035W 0005W 0059W 0011W 0012W J0580 0060W 0008W 0009W 0010W 0013W 0006W 0061W 0034W 0016W 00006W 0192W 0004W 00180W 00180NC MEDICINES and TREATMENTS Aldarra cream Amoxicillin 875 mg #20 Azythromycin, Z pack Azithromycin 1g - partner pack Azithromycin State supplied Ceftriaxone 250 mg Ceftriaxone 250 mg State Supplied Cephalexin 500mg #14 Ciprofloxcin 500 mg #6 Condylox Doxycycline 100 mg #14 Estradiol 1 mg- #100 Fluconazole 150 mg #1 Iron LA Bicillin 2.4 Units Medroxyprogesterone 10 mg - #5 Metrogel Metronidazole 500 mg #4 Metronidazole 500 mg #14 Metronidazole 250 mg #28 Misoprostel (Cytotec) 200 mcg #2 Nitrofurantoin Macrocrystals - #14 Ofloxacin Podophyllin/TCA Premarin Vaginal Cream Prenatal Vitamins Sulfatrim SMX/TMP Suprax 400 mg #1 - partner pak Suprax 400 mg #1 - State Supplied 21 00 66.00 104.00 94.00 33.00 25.50 34.00 27.00 28, 00 19.50 30.00 40.00 34.00 20.00 43.00 7.00 10.00 31.00 8.2.00 6.00 9.00 10.00 9.00 5.00 3.75 21.00 21.00 6600 104.00 94.00 33.00 34.00 3400 27.00 28.00 2600 40 00 40.00 _ 34.00 20.00 43.00 7.00 10.00 31.00 82.00 6.00 900 10.00 12.00 5.00 5.00 21.00 25.00 25.00 25 00 25.00 25.00 14.00 1400 1400 14.00 1400 14 00 14.00 14.00 14.00 14.00 10.00 10.00 10.00 10.00 10.00 0.00 0.00 0.00 0.00 0.00 27.00 27 00 27 00 27.00 27.00 0 00 0 00 0.00 0.00 0.00 9 00 9.00 9.00 9.00 9.00 14.00 14.00 14 00 14.00 14.00 7.00 7 00 7.00 7.00 7.00 10.00 10.00 10.00 10.00 10.00 14.00 14.00 14.00 14.00 14.00 17.00 17.00 17 00 17.00 17.00 11 00 11 00 11 00 11 00 11.00 0 00 0 00 0 00 0.00 0.00 14.00 14.00 14.00 14.00 14.00 9.00 9.00 9 00 9 00 9.00 9.00 9.00 9 00 9.00 9.00 10.00 10.00 10.00 10.00 10.00 15.00 15.00 15 00 15.00 15 00 7.00 7 00 7 00 7.00 7.00 41.00 4100 4100 41.00 41.00 96.00 96.00 96 00 96.00 96.00 14.00 14 00 14 00 14.00 14.00 13.00 13 00 13.00 13.00 13 00 11.00 11.00 11 00 11.00 11 00 9.00 9.00 9.00 9.00 9.00 23.00 23.00 23.00 23.00 23.00 0.00 0.00 0.00 0.00 0.00 PHS 2013 Fees Page 4 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 IMMUNIZATIONS 90748 Comvax - Hep B & Hib 0 00 0.00 0.00 0.00 0.00 90700 DTaP - VFC 0.00 0.00 0.00 0.00 0.00 90700C DTaP - Child 27.00 27.00 27.00 27.00 27.00 90702 DT 0.00 0.00 0 00 0.00 0 00 90633 Hepatitis A - VFC 0.00 0 00 0.00 0.00 0.00 90633C Hepatitis A - Child 29.00 29.00 29.00 29.00 29.00 90632 Hepatitis A - Adult 45.00 45.00 45.00 45.00 45 00 90744 Hepatitis B - VFC 0.00 0.00 0.00 0.00 0.00 90744C 90746 90647 Hepatitis B - Child 24.00 Hepatitis B - Adult 45.00 FHB - VFC 0.00 24.00 45.00 0.00 24.00 45.00 0.00 24.00 45.00 0.00 24 00 45.00 0.00 90647C HIS - Child 33.00 33.00 33.00 33.00 33 00 90649 HPV - VFC 0.00 0 00 0.00 0.00 0.00 90649C HPV - Child 160.00 160.00 160.00 160.00 160.00 90649A HPV - Adult 160.00 160.00 160.00 160.00 160.00 90649AT _ _HPV - Adult - 317 vaccine 0.00 0.00 0.00 0.00 0.00 90281 IG Hepatitis A 0.00 0.00 0 00 0.00 0.00 90471 Imm. Admin - one vaccine 14.70 14.70 14.70 14.70 14 70 90472 Imm Admin - each addl. Vaccine 14.70 14.70 14.70 14.70 14.70 90473 Imm. Admin - intranasal or oral 14.70 14.70 14.70 14.70 14.70 90657 Influenza infant- VFC (6 mo thru 35 mo) 0.00 0.00 0.00 0.00 0.00 90657C Influenza infant - Child (6 mo thru 35 mo) 25.00 25.00 25.00 25.00 25 00 90658 Influenza - VFC (3 years thru 18 years) 0.00 0.00 0.00 0.00 0 00 90658C Influenza - Child (3 years thru 18 years) 25.00 25.00 25.00 25.00 25.00 90658A Influenza - Adult (Ages 19 & over) 0.00 0.00 0.00 0.00 0.00 00658W Influenza - Adult (State Vaccine) 0.00 0.00 0.00 0.00 0.00 90660 Influenza - intranasal use 0.00 0.00 0.00 0.00 0.00 90660A Influenza - Intranasal Adult 31.00 31.00 31.00 31.00 31.00 90660C Influenza - Intranasal Child 31.00 31.00 31 00 31.00 31.00 G0008 Influenza - Admin. - MEDICARE 14.70 14.70 14.70 14.70 14.70 90713 IPV-VFC 0.00 0.00 0.00 0.00 0.00 90713C IPV - Child 45.00 45.00 45.00 90713A IPV - Adult 45.00 45.00 45.00 90735 Japanese Encephalitis (new formulation) 245.00 245 00 245 00 45 00 45.00 245.00 45.00 45.00 245 00 63.00 90696 Kinrix - VFC (DTaP/IPV) 0.00 0.00 0.00 0.00 0.00 90696C Kinrix - Child ( DTaP/IPV) 53.00 0.00 53.00 53.00 53.00 53.00 90734 Menectra - VFC 0.00 0.00 0.00 0.00 90734C Menectra - Child (MCV4) 145.00 145.00 145.00 145.00 145.00 90734A Menectra - Adult (Menveo) (conjugate) 125.00 125.00 125 00 125.00 125.00 90734AT Menectra Adult - 317 Vaccine 90733 Meningitis-(Menomune)(polysaccharide) 90707 MMR - VFC 0.00 0.00 0 00 125.00 125.00 125.00 0.00 0 00 0.00 0.00 0.00 125.00 125.00 0.00 0.00 90707C MMR - Child 61.00 61.00 61.00 61.00 61.00 90707A MMR - Adult 61.00 61.00 61.00 61.00 61.00 90707AT MMR - Adult - 317 Vaccine 0.00 0.00 0 00 0.00 0.00 90710 MMRV (MMR & Varivax) Proquad 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - VFC (DTAP, IPV, Hep B) 0.00 0.00 0.00 0.00 0.00 90723C Pediarix- Child (DTaP/IPV/Hep B) 75.00 75.00 75.00 75.00 75.00 90698 Pentacel - VFC 0.00 0.00 0.00 0.00 0 00 906980 Pentacel - Child (DTaP/IPV/HepB) 110.00 110.00 110.00 110.00 110.00 90670 Pneumococal conjugate 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax - VFC 0.00 0.00 0 00 0.00 0 00 90732C Pneumovax - Child (PPSV23) 80.00 80.00 80.00 80.00 80.00 90732A Pneumovax - Adult 73.00 73.00 73.00 73 00 73.00 90732AT Pneumovax - Adult - 317 Vacc 0.00 0.00 0.00 0.00 0.00 G0009 Pneumovax Admin_ - MEDICARE 14.70 14 70 14.70 14.70 14.70_ 90669 Prevnar 0.00 145.00 0 00 0.00 0.00 0 00 906690 Prevnar - Child (PCV13)Flwoer 145.00 145.00 145.00 145.00 90675 Rabies IM 235.00 235 00 235.00 235.00 235.00 90675AT Rabies IM - Adult Temporary 0.00 0.00 0.00 0 00 0.00 PHS 2013 Fees Page 5 Procedure Code Procedure Code Code Code Code Code 1 2 3 4 5 90680 90680C 90681 90681C 90718 90718C 90718A 90715 90715C 90715A 90715AT 86580 Rotavirus - VFC Rotovirus - Child (RV5) Rotarix - VFC Rotarix - Child (RV10 Td - VFC Td - Child Td - Adult Tdap - VFC Tdap - Child Tdap - Adult Tdap Adult - 317 vaccine Tuberculosis Interdermal Tuberculosis Interdermal reading only Twinrix - Hep A & Hep B Twinrix Adult -317 vaccine - Hep Typhoid - 1 Shot Typhoid - Oral Varivax - VFC Varivax - Child Varivax - Adult Varivax - Adult - 317 Vaccine Yellow Fever 8658W 90636 90636AT 90691 90690 90716 90716C 90716A 90716AT 90717 Skin Test (PPD) Skin Test(PPD) 0.00 0.00 0 00 0.00 0.00 83.00 83.00 83.00 83.00 83.00 0.00 0.00 0.00 0.00 0.00 115.00 115.00 115.00 115.00 _ 115.00 0.00 0.00 0.00 0.00 0.00 44.00 44 00 44.00 44.00 _ 44.00 44 00 44 00 44 00 44.00 44.00 0.00 0.00 0.00 0.00 0.00 44.00 44.00 44.00 44.00 44.00 44 00 44.00 44 00 44.00 44.00 000 000 0.00 000 0.00 25.00 25.00 25.00 25 00 25.00 A&HepB 0.00 0.00 0.00 0.00 0.00 67.00 67.00 67.00 67 00 67.00 0.00 0.00 0.00 0.00 0.00 68.00 68.00 68.00 68.00 68.00 57.00 57.00 57 00 57 00 57.00 0.00 0 00 0.00 0.00 0.00 105.00 105 00 105.00 105.00 105.00 100.00 100.00 100.00 100.00 100.00 000 000 000 0.00 109 00 109.00 109 00 109.00 0.00 109.00 ** Fees only slide for the Family Planning Program. Charges for all other programs are the Code 5 fee. Services include surgical procedure only_ *** These items are for referral INC 99212 59425 59426 99402W 0255W 59430 H1005 H1005 H1005 H1005 Miscellaneous Scv Includes Follow-up Care Antepartum Care 1 visit Antepartum care 4-6 visits Antepartum care 7 or more visits PE Establishing Medical Record Phone visit Post Partum Only Prenatal Plus (1-4 visits) Prenatal Plus (5-9) visits) Prenatal Plus (10 visits) Prenatal Plus (11 or more visits) Revised 11/7/12 7/11/2013 0.00 0.00 0.00 64.00 64.00 64.00 586.00 586.00 586.00 1205.00 1205.00 1205.00 56.00 56 00 56 00 0 00 0.00 0.00 106 00 106.00 106 00 170 00 170.00 170 00 454.00 454 00 454 00 852 00 852 00 852 00 965.00 965.00 965.00 0.00 64.00 586.00 1205.00 56.00 0.00 106.00 170.00 454 00 852.00 965.00 0.00 64.00 586.00 1205.00 56.00 0.00 106.00 170.00 454.00 852.00 965.00 Hello