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Home My WebLink About20111798.tiff RESOLUTION RE: APPROVE REVISIONS TO FEE SCHEDULE FOR FEES COLLECTED BY THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PUBLIC HEALTH SERVICES 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 the fees collected by the Weld County Department of Public Health and Environment Public Health Services, and WHEREAS, after study and review, the Board deems it advisable to approve the proposed revisions, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the matter concerning the revised fee schedule for the fees collected by the Weld County Department of Public Health and Environment Public Health Services, be,and hereby is, approved. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 25th day of July, A.D., 2011. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: EXCUSED Barbara Kirkmeyer, Chair Weld County Clerk to the Board ? p ..� ` ) � � Sean P. Ca, ay, Pro-Tem Deputy CI a k to the Boar. • n FQ I n,i 14 a``• t ._.S i' k - . G. is Vitt APP DA RM:V •a_A • • / ,` \ � /Dad E. Long •aufi y Attorney ?44Sy (W. Douglas a emach r Date of signature: Ti a `1 -// 2011-1798 . HL HL0003 - (-1 • II Elizabeth Strong From: Talya DeAngelis Sent: Thursday, July 21, 2011 10:39 AM To: Elizabeth Strong Subject: Fee Schedule for the Agenda Attachments: 2011 Nursing Fee Schedule passaround.PDF Hi, I just go off the phone with Esther and she said it would be okay if I email you this fee schedule for the agenda. I would greatly appreciate it if this Fee Schedule can go on the Agenda for Monday, July 25, 2011. If you have any questions, please do not hesitate to ask. Thanks Again, 7afya DeAngelis Office Technician lll-Administrative Assistant Weld County Department of Public Health and Environment 1555 N. 17th Avenue Greeley_CO 80631 970-304-6410 ext 2102 101 w E CO_%ECG V N�v u Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 1 2011-1798 r r DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT F 1 8 6 1 - 2 0 1 1 1555 N. 17th Avenue ` Greeley, CO 80631 Public Health Web: http://www.weldhealth.org i . Health Administration Public Health&Clinical Environmental Health Communication, Emergency Preparedness W E L .,C O U N T Y Vital Records Services Services Education I Planning &Response Tele:970.3046410 Tale':970.301.6420 Tele:970.304.6415 Tele:970.304,6470 Tele:970.304.6420 Fax: 970,304 6412 Fax: 970 304 6416 Fax: 970 J046411 Fax: 9]0.304.6452 Fu: 970 304 6469 Our vision Together with the communities we serve,we are working to make Weld County the healthiest place to 4w,learn,work and play. Memorandum Date: June 25, 2011 To: Commissioners Cc: Don Warden, Monica Mika, Tanya Geiser From: Mark E. Wallace, MD, MPH — Director Re: Resolution to increase Public Health Services clinical fees Interferon Gamma Release Assays (IGRA) QuantiFERON®-TB Gold test and PPD test. The Weld County Department of Public Health & Environment operates a comprehensive Tuberculosis prevention and treatment program through an agreement with the Colorado Department of Public Health & Environment (CDPHE) approved annually by the Board of County Commissioners. Under this program the Department tests at-risk individuals for the presence of latent and active tuberculosis through a variety of methods. The traditional screening modality is a skin test known as a PPD (or TST). This method requires the client to make two visits to the Department—once for the skin test to be placed and a second time after a prescribed period of time to have the results interpreted by a qualified staff member. The PPD has significant limitations that include the required two visits spaced at a prescribed interval precluding testing on some days of the week, specialized staff training to place and interpret the skin test, client failure to return for the test to be interpreted, and a false positive rate that requires the Department to treat individuals who might not actually have TB. All of these limitations significantly increase Department costs. The Department has worked with CDPHE and other health departments to deploy an enhanced testing methodology referred to as QuantiFERON. This test requires a single blood sample to be drawn, less technical expertise to draw the test, and the client to make only one visit to the Department. In addition, the test has a low false positive rate requiring fewer individuals to be treated. Medicaid and insurance companies reimburse for this test. Under the FY2011-12 TB contract with CDPHE approved by the Board, the Department is also receiving additional funding to deploy this new testing methodology in targeted uninsured populations. Anticipating the Department would deploy the QuantiFERON test in 2011, we received approval in 2010 to establish a fee. This fee was initially set at$62.00 when it should have been set at $82.00. The Department seeks permission to correct this error by increasing the fee to $82.00. Through supplemental funding from CDPHE this fee will slide to $25.00 for qualifying individuals without insurance. Page 1 of 2 Even though the new test has a higher fee, overall costs are reduced to due decreased staff time and a lower false positive rate requiring fewer people to receive 4-9 months of monitored drug therapy. While the Department will primarily utilize the new testing methodology, we will continue to offer the older PPD in selected situations. Due to higher PPD administration costs, and to achieve parity in reduced testing fees between the two methodologies, the Department seeks approval to raise the fee for PPDs from $20.00 to $25.00. This fee has not been increased for 10 years. The Department requests a resolution to immediately increase these two clinical fees. The fee schedule is attached with the two proposed fee changes identified. No other fees on the schedule are proposed to be changed at this time. Approve.o cinq resolution on the agenda Sean Conway P' Yes O No Bill Garcia B Yes O No Barbara Kirkmeyer 0. Yes O No Dave Long tr Yes O No Doug Rademacher O Yes O No Page 2 of 2 PHS 2011 Fees Page 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMEN1 PUBLIC HEALTH SERVICES and 2011 SLIDING FEE SCHEDULE _ _HOUSEHOLD CODE SIZE -- Procedure Code Code Code _Code Code Code Procedure 1 2 3 4 5 VISITS New Client _- - --- - - - .- 99201 Focused-nurse visit* _ 0.00 10.00 _ 20.00 30.00 40.00 99202 Expanded* _ 0.00 23.25 46.50 69.75 93.00 99203 Detailed* 0.00 31.00 62.00 93.00 124.00 99204 Comprehensive* 0.00 - 46.25 92.50 138.75 185.00 Established Client 99211 Nurse Visit* _ 0.00 9.25 18.50 27.75 37.00 99212 Focused* _ _ 0.00 15.50 31.00 46.50 62.00 99213 Expanded* 0.00 20.25 40.50 60.75 81.00 99214 Detailed" 0.00 31.50 63.00 94.50 126.00 Home Visits 999341 New Client-Focused _ 75.00 75.00 75.00 _ 75.00 75.00 99342 New Client-Expanded _ 75.00 75.00 75.00 75.00 75.00 99347 Est.Client-Focused _ 75.00 75.00 75.00 75.00 75.00 99348 Est.Client-Expanded 75.00 75.00 75.00 75.00 75.00 Preventive Medicine Counseling _ 99401 _ Individual-15 min* 0.00 10.00 20.00 30.00 40.00 99402 Individual-30 min* 0.00 12.25 24.50 36.75 49.00 Travel Visits 99404 _ Individual Initial Visit-60 _ 62.00 62.00 62.00 62.00 62.00 99401W Return Visit 39.00 39.00 39.00 39.00 39.00 99412 Group Initial Visit-60 - 39.00 39.00 39.00 39.00 39.00 Preventive Medicine 99384 New Client 12-17 years old* - 0.00 31.00 62.00 93.00 124.00 99385 New Client 18-39 years old* 0.00 31.00 62.00 93.00 124.00 99386 New Client 40-64 years old* 0.00 33.50 67.00 100.50 134.00 99394 Est.Client 12-17 years old" _ _ 0.00 20.25 40.50 60.75 81.00 99495 Est.Client 18-39 years old" _ _0.00 20.25 40.50 60.75 81.00 99396 Est.Client 40-64 years old* 0.00 22.00 44.00 66.00 88.00 Miscellaneous INC _ _ Scv. Includes Follow-up Care 0.00 _ 0.00 0.00 0.00 0.00 99212 Antepartum Care 1 visit 62.00 62.00 62.00 62.00 62.00 59425 _Antepartum care 4-6 visits _ 569.00 569.00 569.00 569.00 569.00 59426 Antepartum care 7 or more visits 1170.00 1170.00 1170.00 1170.00 1170.00 Miscellaneous(continued) 99402W PE Establishing Medical Record 54.00 54.00 54.00 54.00 54.00 0255W Phone visit 0.00 0.00 0.00 0.00 0.00 59430 Post Partum Only _ 103.00 103.00 103.00 103.00 103.00 H1005 Prenatal Plus(1-4 visits) 165.00 165.00 165.00 165.00 165.00 H1005 Prenatal Plus(5-9)visits) 441.00 441.00 441.00 _ 441.00 441.00 H1005 Prenatal Plus(10 visits) 827.00 827.00 827.00 827.00 827.00 H1005 Prenatal Plus(11 or more visits) 937.00 937.00 937.00 937.00 937.00 09006 NHV Mother-Task Care Mgmt. 12.00 12.00 12.00 12.00 12.00 T1017 NHV Child-Task Care Mgmt. 12.00 12.00 12.00 12.00 12.00 0072W Swift Global Package _ 302.00 302.00 302.00 302.00 302.00 STI Exam pre-pay 55.00 55.00 55.00 55.00 55.00 PHS 2011 Fees Page 2 Procedure Code Code_ Code _Code Code Code Procedure 1 2 3 4 5 99499 TB Consultation 35.00 35.00 35.00 35.00 35.00 Lab 86850 _ Antibody Screen 30.00 30.00 30.00 30.00 30.00 82947 Blood Sugar(FBS)* 0.00 3.75 7.50 11.25 15.00 85025 CBC w/dill 16.00 16.00 16.00 16.00 16.00 85027 CBC w/o Diff 14.00 14.00 14.00 14.00 14.00 87491 Chlamydia PCR* 0.00 6.00 12.00 _ 18.00 24.00 0090W Court Ordered Lab Draw _ 15.00 15.00 15.00 15.00 15.00 82270 Fecal/Occult Blood Test _ 0.00 6.25 _ 12.50 18.75 25.00 Fecal/Occult Blood Test(New Test) 0.00 9.50 19.00 28.50 38.00 83001 FSH 31.00 31.0O 31.00 31.00 31.00 87591 Gonorrhea PCR" 0.00 6.00 12.00 18.00 24.00 82948 Glucose Random 5.00 5.00 _ 5.00 5.00 5.00 82950 Glucose Tolerance Test 1 hr _ 15.00 15.00 15.00 15.00 15.00 82951 Glucose Tolerance Test 2 hr 20.00 20.00 20.00 20.00 20.00 82951/82952 Glucose Tolerance Test 3 hr(89999A08) 43.00 43.00 _ 43.00 43.00 43.00 87205 Gram Stain 22.00 22.00 22.00 22.00 22.00 86706 Hep B Surface Antibody 19.00 _ 19.00 19.00 19.00 19.00 87250 Herpes Culture _ _ 62.00 62.00 62.00 _62.00 62.00 86695 Herpes Select-Type I(89999A33) _ 25.00 25.00 25.00 25.00 25.00 86696 Herpes Select Type II(89999A33) 25.00 25.00 25.00 25.00 25.00 85018 HGB-Finger Stick* _ _ 0.00 2.75 5.50 8.25 _ 11.00 86703 HIV Test _ 19.00 19.00 _ 19.00 19.00 19.00 87621 HPV/DNA Testing 62.00 62.00 62.00 62.00 62.00 484006W Immunohistochemical Stain 88.00 88.00 88.00 88.00 88.00 86480 Tuberculosis Test-Quantiferon(proposed) 82.00 82.00 82.00 82.00 82.00 88480 i 62-00 62-00 _ 62,00 62,00 62,00 83002 LH _ _ 31.00 31.00 31.00 31.00 31.00 800s1 W Lipid Panel-SFS* - 0.00 8.00 16.00 24.00 32.00 800s1N Lipid Panel 32.00 _ 32.00 32.00 _ 32.00 32.00 80076 Liver Panel 25.00 25.00 25.00 25.00 25.00 80048 Metabolic Panel 26.00 26.00 26.00 26.00 26.00 88142 Pap Smear-Thin Prep* 0.00 _ 9.00 18.00 27.00_ 36.00 81025 Pregnancy Test-Urine* 0.00 2.50 5.00 7.50 10.00 84702 Pregnancy Test-Serum-Quantitative 36.00 36.00 36.00 36.00 36.00 84703 Pregnancy Test-Serum-Qualitative 36.00 36.00 36.00 36.00 36.00 PHS 2011 Fees Page 3 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 Lab(continued) 84146 Prolactin 32.00 32.00 32.00 32.00 32.00 0080W Repeat Pap 36.00 36.00 36.00 36.00 36.00 86592 RPR 18.00 18.00 18.00 18.00 18.00 84480 T3 40.00 40.00 40.00 40.00 40.00 84436 T4 5.00 5.00 5.00 5.00 5.00 82465 Total Cholesterol 20.00 20.00 20.00 20.00 20.00 84443 TSH 30.00 30.00 30.00 30.00 30.00 81002 UA-Dip 7.00 7.00 7.00 7.00 7.00 36415 Venipuncture 5.00 5.00 5.00 5.00 5.00 36415W Venipuncture with sliding lab 0.00 1.25 2.50 3.75 5.00 87210 Wet Prep 20.00 20.00 20.00 20.00 20.00 Medicines and Treatments oozow Amoxicillin 875 mg#20 12.00 12.00 12.00 12.00 12.00 0062W Azythromycin 250 mg-#6 12.00 12.00 12.00 12.00 12.00 101456W Azithromycin 1g suspension 10.00 10.00 10.00 10.00 10.00 0456W Azithromycin State supplied 0.00 0.00 0.00 0.00 0.00 0058W Ciprofloxacin 500 mg-#6 12.00 12.00 12.00 12.00 12.00 0035W Condylox 5.00 5.00 5.00 5.00 5.00 0006W Cytotec 200 mcg#2 5.00 5.00 5.00 5.00 5.00 0011W Fluconazole 15.00 15.00 15.00 15.00 15.00 0005W Doxycycline 14 Capsules 8.00 8.00 8.00 8.00 8.00 0059W Estradiol 1 mg-#100 12.00 12.00 12.00 12.00 12.00 0009W Metronidazole 4 Tablets _. . 7.00 7.00 7.00 7.00 7.00 0010W Metronidazole 14 Tablets 8.00 8.00 8.00 8.00 8.00 0013W Metronidazole 28 Tablets 13.00 13.00 13.00 13.00 13.00 0012W Iron 9.00 9.00 9.00 9.00 9.00 J0580 LA Bicillin 2.4 Units 0.00 0.00 0.00 0.00 0.00 0014W Lice Shampoo _12.00 12.00 12.00 12.00 12.00 0060W Medroxyprogesterone 10 mg-#5 12.00 12.00 12.00 12.00 12.00 0008W Metrogel _ 8.00 8.00 8.00 8.00 8.00 0061W Nitrofurantoin Macrocrystals-#14 17.00 17.00 17.00 17.00 17.00 0034W Ofloxacin _ 90.00 90.00 90.00 90.00 90.00 0016W Podophyllin/TCA 12.00 12.00 12.00 12.00 12.00 00006W Premarin Vaginal Cream 11.00 11.00 11.00 11.00 11.00 0192W Prenatal Vitamins 10.00 10.00 10.00 10.00 10.00 J0696 Ceftriaxone 25.00 25.00 25.00 25.00 25.00 0004W Sulfatrim SMX/TMP 7.00 7.00 7.00 7.00 7.00 00180W Suprax 400 mg#1 17.00 17.00 17.00 17.00 17.00 00180NC Suprax 400 mg#1 -State Supplied 0.00 0.00 0.00 0.00 0.00 Procedures 56420 Bartholin Cyst 28.00 28.00 28.00 28.00 28.00 11100 Biopsy of skin,single 26.00 26.00 26.00 26.00 26.00 57500 Cervical Lesion Biopsy 31.00 31.00 31.00 31.00 31.00 0116W Chest X-Ray(Prepay) 45.00 45.00 45.00 45.00 45.00 57452 Colposcopy w/o Biopsy" 88.00 88.00 88.00 88.00 88.00 57454 Colposcopy with Biopsy" 88.00 88.00 88.00 88.00 88.00 Procedures(continued) _ 56501 Destruction Lesion Vulva 85.00 85.00 85.00 85.00 85.00 57511 Cryocautery cervix-initial or repeat 96.00 96.00 96.00 96.00 96.00 57170 Diaphragm/Cervical Cap Fitting' _ _ 0.00 19.25 38.50 57.75 77.00 58100 Endometrial biopsy w/wo Biopsy 43.00 43.00 43.00 43.00 43.00 58110 Endometrial biopsy with Colposcopy 54.00 54.00 54.00 54.00 54.00 Essure by referral*** - _ 0.00 0.00 0.00 0.00 0.00 11400 Excisions,benign lesion _ 75.00 75.00 75.00 75.00 75.00 11975 Implanon Insertion _ 0.00 40.00 80.00 120.00 160.00 11976 Implanon Removal 0.00 47.50 9.5.00 142.50 190.00 J7307NC Implanon**" _ 0.00 0.00 0.00 0.00 0.00 11977 Implant Removal with Reinsertion 0.00 75.00 150.00 225.00 300.00 PHS 2011 Fees Page 4 Procedure _ _ Code Code _ Code Code Code Code Procedure 7 2 3 4 5 Incision&drainage of abcess,single or - .. 10060 simple _ 30.00 30.00 30.00 30.00 30.00 J7302NC IUD Mirena'** _ 0.00 0.00 0.00 0.00 0.00 58300 _ IUD Insertion* _ 0.00 40.00 _ 80.00 1.20.00 160.00 J7300NC IUD Paragard*** - 0.00 0.00 0.00 0.00 0.00 58301 IUD Removal* - 0.00 32.25 _64.50 96.75 129.00 59025 Non Stress Test Intern 0.00 0.00 0.00 0.00 0.00 A4550 Surgical Tray 57.0.0 57.00 57.00 57.00 57.0.0 Shaving of epidermal lesion,single on 11300 trunk,arms or legs, .5cm 36.00 36.00 36.00 _36.00 36.00 17000 Skin Cryo 1st lesion** 25.00 25.00 25.00 25.00 25.00 17003 _ Skin Cryo 2nd-14th lesions** 25.00 25.00 25.00 25.00 25.00 17004 Skin Cryo 15+lesions** 25.00 25.00 25.00 25.00 25.00 88305 _ Level 4 Pathology 1st spec 88.00 88.00 88.00 88.00 88.00 88305w Level 4 Pathology 2nd&each added 88.00 88.00 88.00 88.00 88.00 Vasectomy by referral**** 75.00 75.00 75.00 75.00 75.00 55250 Vasectomy on site** 75.00 75.00 75.00 75.00 75.00 Additional Codes 0071W _ Community Education 1 hr. 62.00 62.00 6.2.00 62.00 62.00 0069W Travax Printout 7.00 7.00 7.00 7,00 7.00 Immunizations -- - - -- 90748 Comvax-Hep B&Hib 0.00 0.00 0.00 0.00 0.00 90700 DTAP 0.00 0.00 0.00 0.00 0.00 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 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 90746 Hepatitis B-Adult 45.00 45.00 45.00 45.00 45.00 90647 HIB _ _ 0.00 0.00 0.00 0.00 0.00 90649 HPV-VFC 0.00 0.00 0.00 _ 0.00 0.00 90649A HPV-Adult- 160.00 1.60.00 160.00 160.00 160.00 90649AT HPV-Adult Temporary 0.00 0.00 0.00 0.00 0.00 90281 --- IG Hepatitis A _ - 0.00 0.00 0.00 0.00 0.00 902811 IG Hepatitis A-TVL 41.00 41.00 41.00 41.00 41.00 PHS 2011 Fees Page 5 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 Immunizations(continued) 90471 Imm.Admin-one vaccine 14/0 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-Child(6 mo thru 35 mo) 0.00 0.00 0.00 0.00 _ 0.00 90658 Influenza-Child(3 years thru 18 years) 0.00 0.00 0.00 _ 0.00 0.00 90658A Influenza-Adult(Ages 19&over) 0.00 0.00 0.00 0.00 0.00 00656W 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 25.00 25.00 25.00 25.00 25.00 G0008 Influenza-Admin. 14.70 14.70 14.70 14.70 14.70 90713 IPV-VFC 0.00 0.00 0.00 0.00 0.00 90713A IPV-Adult _ 45.00 45.00 45.00 45.00 45.00 90735w Japanese Encephalitis 124.00 124.00 124.00 124.00 124.00 90735 Japanese Encephalitis(new formulation) 230.00 230.00 230.00 230.00 230.00 90696 Kinrix 0.00 0.00 0.00 _ 0.00 0.00 90733 Meningitis(Menomune) 113.00 113.00 113.00 113.00 113.00 90734 Menectra-Child 0.00 _ 0.00 0.00 0.00 _ 0.00 90734A Meneclra-Adult 113.00 1.13.00 113.00 113.00 _ 113.00 90734AT Menectra Adult Temporary-317 Vaccine 0.00 0.00 0.00 0.00 0.00 90707 MMR-VFC 0.00 0.00 0.00 0.00 0.00 90707A MMR-Adult 58.00 58.00 58.00 58.00 58.00 9o7o7AT MMR-Adult Temporary-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-DTAP,Hep B&IPV _ _ 0.00 0.00 _ 0.00 0.00 0.00 90698 Pentacel 0.00 0.00 0.00 0.00 0.00 90670 Pneumococal conjutgate 0.00 0.00 _ _ 0.00 0.00 0.00 90732 Pneumovax-VFC 0.00 0.00 0.00 0.00 0.00 90732A Pneumovax -Adult 52.00 52.00 52.00 52.00 52.00 90732AT Pneumovax-Adult Temporary-317 Vacc. 0.00 0.00 0.00 0.00 0.00 c0009 Pneumovax Admin. 5.00 5.00 5.00 5.00 5.00 86580 Tuberculosis Interdermal Skin Test 25.00 25.00 25.00 25.00 25.00 86589 29:90 20-:00 2090 29-09 20:00 6580W PPD N/C 0.00 _ 0.00 0.00 0.00 0.00 6658W PPD reading only 0.00 0.00 0.00 0.00 0.00 90669 Prevnar 0.00 0.00 0.00 0.00 0.00 90675 Rabies IM 227.00 227.00 227.00 227.00 227.00 90675AT Rabies IM-Adult Temporary 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus _ 0.00 0.00 _ 0.00 0.00 0.00 90681 Rotarix 0.00 0.00 0.00 0.00 0.00 90718 TD 0.00 0.00 0.00 0.00 0.00 90715 Tdap 0.00 0.00 0.00 0.00 0.00 so715Ar Tdap Adult 0.00 0.00 0.00 0.00 0.00 90636 Twinrix-Hep A&Hep B 67.00 67.00 67.00 67.00 67.00 90636AT Twinrix Adult Temporary-Hep A&Hep B 0.00 0.00 0.00 0.00 0.00 90691 Typhoid-1 Shot 67.00 67.00 67.00 67.00 67.00 90690 Typhoid-Oral 57.00 57.00 57.00 57.00 57.00 90716 Varivax-VFC 0.00 0.00 0.00 0.00 0.00 90716A Varivax-Adult 98.00 98.00 98.00 9&00 9.8.00 90716AT Varivax-Adult Temporary-317 Vaccine 0.00 0.00 0.00 0.00 0.00 Immunizations(continued) 90717 Yellow Fever 103.00 103.00 103.00 103.00 103.00 VFC Vaccines 0.00 0.00 0.00 0.00 0.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg. 12* 0.00 1.50 3.00 4.50 6.00 0052W Cycle Beads* 0.00 2.50 5.00 7.50 10.00 J1055 Depo Provera* 0.00 8.00 16.00 24.00 32.00 A4266 Diaphragm* 0.00 6.25 12.50 18.75 25.00 PHS 2011 Fees Page 6 Procedure Code Code Code Code Code Code Procedure _ 1 2 _ 3 4 5 A4269 Foam Contraception* 0.00 2.50 5.00 7.50 10.00 J7307NC Implanon*** _ _ 0.00 0.00 0.00 0.00 0.00 J7303NC Nuva Ring`** _ 0.00 0.00 0.00 0.00 0.00 S4993 Oral Contraceptives* 0.00 5.75 11.50 17.25 23.00 0065W Today's Sponge 0.00 1.00 2.00 3.00 4.00 J7302 NC IUD Mirena*** _ 0.00 0.00 0.00 0.00 0.00 J7300NC IUD Paragard*** 0.00 0.00 0.00 0.00 0.00 FAMILY PLANNING SUPPLIES-Third Party Payei J7307 Implanon _ 371.00 371.00 371.00 371.00 371.00 J7302 IUD Mirena _ 412.00 412.00 412.00 412.00 412.00 J7300 IUD Paragard _ _ 258.00 258.00 258.00 258.00 258.00 J7303 Nuva Ring 36.00 36.00 36.00 36.00 36.00 * 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 free of charge to the client through the Colorado Family Planning Initiative **** Pending MOU and approval by State _- Rev.06/29/2011 Hello