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Home My WebLink About20153899.tiff RESOLUTION 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 January 1 , 2016 , 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 January 1 , 2016 . The above and foregoing Resolution was , on motion duly made and seconded , adopted by the following vote on the 14th day of December, A . D . , 2015 . BOARD OF COUNTY COMMISSIONERS WE/ D COUNTY , COL RADO ATTEST : da.44, ,,i , a � Q � . iitt-t__ `` j • IC r_ANI �( r W , Ti rbara Kirkmeyer, hair Weld Co Clerk to the 1: Jan tts ,,a;1 „ 1 et'ilatr , XCUSED it - o%iit► V ike Freeman , Pro-Tem BY : - 4, 4,- , , '1/4 dip let AV, c...----------- \ ----Th - - — Deputy Clerk lb the Boar . S: �-� i L , / J> - ---- Sean Conway APP D AS �. aim is;i / Julie A . Cozad ounty Attorney EXCUSED c, Steve Moreno Date of signature : 6ev: alr' /Atli & 2015-3899 HL0003 BOARD OF COUNTY COMMISSIONERS PASS-AROUND REVIEW/WORK SESSION REQUEST RE: Proposed 2016 Fee Schedule Increases 1 DEPARTMENT: PUBLIC HEALTH& ENVIRONMENT DATE: November 13, 2015 PERSON REQUESTING: Mark E. Wallace, MD,MPH, Executive Director Brief description of the problem/issue: For the Board's review and approval are the Health Department's proposed Environmental Health Services ("EHS")and Public Health Services("PHS") fees schedules for 2016. Both a strike-through version and the final versions of each are attached to aid in the Board's review. ENVIRONMENTAL HEALTH SERVICES: A detailed review of the EHS fee schedule was made to ensure that costs are adequately recovered across all sections of the EHS division. In addition, the EHS lab completed an informal cost comparison with State and private labs to make sure that our fees are reasonable and in-line with providers of similar services. Several line items under Septic Inspection Services were increased to ensure fuller cost recovery for 2016 services per the Board's directive and approval via a work session dated October 5, 2015. The 2016 Household Hazardous Waste Facility - CESQG fee schedule reflects an across-the-board increase of 3%to account for the vendor's price increase for 2016. PUBLIC HEALTH SERVICES: A detailed review of the PHS fee schedule was made to ensure that costs are adequately recovered across all clinic programs of the PHS division. All fees were reviewed to establish that the Health Department is charging at least the Medicare reimbursement rate for all services provided at the Health Department. For services that are not covered by Medicare, the Medicaid reimbursement rate was used as a reimbursement floor. Consistent with prior year fee schedule adjustments, following that comparison and after making increases where appropriate, we increased our fees for all services and supplies by 3%across-the-board. Again,this fee increase request is a modest increase compared to the medical rate of inflation which is anticipated to be approximately 6.5% in 2016. What options exist for the Board? Approval of all of the recommended fee schedule increases will allow the Health Department to achieve greater cost recovery for the services we provide and reduce costs to taxpayers by shifting the financial responsibility to the clients who utilize these services. If the Board declines one or all of the proposed fee schedule increases the costs for services provided to clients of the Health Department will not be fully recouped from the clients using the services which will result in an increased County subsidy to provide these services. Recommendation: I recommend approval of the 2016 PHS and EHS fee schedule increases. Approve Schedule Recommendation Work Session Other/Comments Barbara Kirkmeyer, Chair Mike Freeman, Pro-Tern Sean P. Conway Julie A. Cozad �'� ' Steve Moreno 2015-3899 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES-2016 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Procedure 1 2 3 4 5 99201 Minimal* 0.00 11.50 23.00 34.50 46.00 99202 Expanded* 0.00 27.75 55.50 83.25 111.00 99203 Detailed* 0.00 36.00 72.00 108.00 144.00 99204 Comprehensive* 0.00 53.75 107.50 161.25 215.00 Established Client 99211 Minimal* 0.00 10.75 21.50 32.25 43.00 99212 Focused* 0.00 18.00 36.00 54.00 72.00 99213 Expanded* 0.00 23.50 47.00 70.50 94.00 99214 Detailed* 0.00 36.75 73.50 110.25 147.00 Home Visits 99341 New Client-Focused 87.00 87.00 87.00 87.00 87.00 99342 New Client-Expanded 87.00 87.00 87.00 87.00 87.00 99347 Est. Client-Focused 87.00 87.00 87.00 87.00 87.00 99348 Est. Client-Expanded 87.00 87.00 87.00 87.00 87.00 Preventive Medicine Counseling(Family Planning O 99401 Individual- 15 min* 0.00 11.50 23.00 34.50 46.00 99402 Individual-30 min* 0.00 16.25 32.50 48.75 65.00 99403 Individual-45 min* 0.00 22.75 45.50, 68.25, 91.00 Travel Visits 99404 Individual Initial Visit-60 117.0O 117.00 117.00 117.00 117.00 99401W Return Visit 54.00 54.00 54.00 54.00 54.00 99412 Group Initial Visit(per person)-60 54.00 54.00 54.00 54.00 54.00 Preventive Medicine 99384 New Client 12-17 years old* 0.00 36.00 72.00 108.00 144.00 99385 New Client 18-39 years old* 0.00 36.00 72.00 108.00 144.00 99386 New Client 40-64 years old* 0.00 39.00 78.0O 117.00 156.00 99394 Est. Client 12-17 years old* 0.00 30.25 60.50 90.75 121.00 99395 Est. Client 18-39 years old* 0.00 31.00 62.00 93.00 124.00 99396 Est. Client 40-64 years old* 0.00 33.00 66.00 99.00 132.00 Additional Codes 0071W Community Education 1 hr. 70.00 70.00 70.00 70.00 70.00 0069W Travax Printout 15.00 15.00 15.00 15.00 15.00 G9006 NHV Mother-Task Care Management 15.00 15.00 15.00 15.00 15.00 T1017 NHV Child-Task Care Management 15.00 15.00 15.00 15.00' 15.00 STI Exam pre-pay-NP 182.00 182.00 182.00 182.00 182.00 Wellness Package 47.00 47.00 47.00 47.00 47.00 99499 TB Consultation 43.00 43.00 43.00 43.00 43.00 PROCEDURES 56420 Bartholin Cyst 129.00 129.00 129.00 129.00 129.00 11100 Biopsy of skin, single 109.00 109.00 109.00 109.00 109.00 57500 Cervical Lesion Biopsy 136.00 136.00 136.00 136.00 136.00 0116W Chest X-Ray(Prepay) 63.00 63.00 63.00 63.00 63.00 57452 Colposcopy without Biopsy** 116.00 116.00 116.00 116.00 116.00 57454 Colposcopy with Biopsy** 163.00 163.00 163.00 163.00 163.00 57511 Cryocautery cervix-initial or repeat 155.00 155.00 155.00 155.00 155.00 Revised 11/02/2015 Page 1 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH& ENVIRONMENT PUBLIC HEALTH SERVICES-2016 SLIDING FEE SCHEDULE Code Code Code Code Code Code Procedure 1 2 3 4 5 17000 Cryotherapy first lesion** 70.00 70.00 70 00 70.00 70.00 17003 Cryotherapy 2-14 lesions** 6.00 6.00 6.00 6.00 6.00 17004 Cryotherapy 15 +lesions** 158.00 158.00 158.00 158.00 158.00 56501 Destruction Lesion Vulva 139.00 139.00 139.00 139.00 139.00 57170 Diaphragm/Cervical Cap Fitting* 0.00 22.50 45.00 67.50 90.00 58100 Endometrial biopsy w/wo Biopsy 116.00 116.00 116.00 116.00 116.00 58110 Endometrial biopsy with Colposcopy 64.00 64.00 64.00 64.00 64.00 Essure by referral`" 0.00 0.00 0.00 0.00 0.00 11400 Excisions, benign lesion 131.00 131.00 131.00 131.00 131.00 11981 Implanon Insertion* 0.00 46.25 92.50 138.75 185.00 .. y 10060 simple 124.00 124.00 124.00 124.00 124.00 58300 Insertion IUD* 0.00 46.50 93.00 139.50 186.00 57460 LEEP with biopsy 299.00 299,00 299.00.7 299.00 299.00 57461 LEEP with conization 339.00 339.00 339.00 339.00 339.00 88305 Level 4-Surgical pathology 1st site 102.00 102.00 102.00 102.00 102.00 88305W Level 4-Surgical Pathology 2nd site&eacl 102.00 102.00 102.00 102.00 102.00 59025 Non Stress Test Interp 0.00 0 00 0.00 0.00 0.00 11976 Removal, implant contraceptive(Implanon)' 0.00 55.00 110.00 165.00 220.00 11983 Removal implant, with reinsertion* 0.00 84.75 169.50 254.25 339.00 58301 Removal IUD* 0.00 37.25 74.50 111.75 149.00 A4550 Surgical Tray 67.00 67.00 67.00 67.00 67.00 Shaving of epidermal lesion, single on ' 11300 trunk. arms or legs, .5cm 102.00 102.00 102.00 102.00 102.00 76857 Ultrasound-pelvic non-obstetric 72.00 72.00 72.00 72.00 72.00 FAMILY PLANNING SUPPUES 1 A4267 Condoms pkg 10* 0.00 1.75 3.50 5.25 7.00 0052W Cycle Beads* 0.00 3.75 7.50 11.25 15.00 A4266 Diaphragm* 0.00 7.75 15.50 23.25 31.00 A4269 Foam Contraception* 0.00 3.00 6.00 9.00 12.00 J7307 Nexplanon(Etonogestrel)' 0.00 199,25 398 50 597.75 797.00 J7306 Levonorgestrel 0.00 199.25 398.50 597.75 797.00 J7302 IUD Mirena* 0.00 228.75 457.50 686.25 915.00 J7300 IUD Paragard* 0.00 190.25 380.50 570.75 761.00 J3490 IUD Skyla* 0.00 212.25 424.50 636.75 849.00 J3490W IUD Liletta 0.00 _64.50 129.00 193.50' 258.00 J1050 Medroxyprogesterone 150mg IM (Depo)* 0.001 17.25 34.50 51.75 69.00 96732 Admin fee depo- if visit for injection only 3.75 7.50 11.25 15.00 J7303 Nuva Ring* 0.00 10.25 20.50 30.75 41.00 S4993 Oral Contraceptives* 0.00 7.25 14.50 21.75 29.00 0068W Seasonale* 0.00 17.25 34.50 51.75 69.00 0065W Today's Sponge* 0.00 1.25 2.50 3.00 5.00 LAB 82947 Assay. body fluid, glucose, (FBS)* 0.00 5.00 10.00 15.00 20.00 85025 CBC w/Diff 21.00 21.00 21.00 21.00 21.00 85027 CBC w/o Diff 19.00 19.00 19.00 87491 Chlamydia PCR* 24.00 36.00 48.00 87491 NS Chlamydia PCR* -full fee 48.00 48.00 48.00 48.00 48.00 80053 Comprehensive Metabolic Panel 14.00 14.00 14.00 14.00 14.00 0090W Court Ordered Lab Draw 16.00 16.00 16.00 16.00 16.00 82627 DHEAS 29.00 29.00 29.00 29.00 29.00 Revised 11/02/2015 Page 2 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES -2016 SLIDING FEE SCHEDULE Code Code Code Code Code Code Procedure 1 2 3 4 5 83001 FSH 36.00 36.00 36.00 36.00 36.00 87591 Gonorrhea PCP* 48.00 48.00 48.00 48.00 48.00 87591 NS Gonorrhea PCR*-full fee 48.00 48.00 48.00 48.00 48.00 82948 Glucose Random 8.00 8.00 8.00 8.00 00 82951 Glucose Tolerance Test 2 hr (GTT) 25.00 25.00 25.00 25.00 25.00 87205 Gram Stain 27.00 27.00 27.00 27.00 27.00 84702 HCG Quantitative-Serum Pregnancy Test 42.00 42.00 42.00 42.00 42.00 84703 HCG Qualitative- Serum Pregnancy Test 42.00 42.00 42.00 42.00 42.00 83718 HDL Cholesterol 31.00 31.00 31.00 31.00 31.00 86706 Hep B Surface Antibody 24.00 24.00 24.00 24.00 24.00 87255 Herpes Culture 72.00 72.00 72.00 72.00 72.00 86695 Herpes Select- Type I (89999A33) 72.00 72.00 72.00 72.00 72.00 86696 Herpes Select-Type II (89999A33) 72.00 72.00 72.00 72.00 72.00 85018 HGB-(Finger Stick)* 0.00 3.50 7.00 10.50 14.00 83036 HGB A1c 34.00 34.00 34.00 34.00 34.00 86703 HIV Screen, ELISA 24.00 24.00 24.00 24.00 24.00 G0435 HIV Screen, Rapid Test 24.00 24.00 24.00 24.00 24.00 87624 HPV, High Risk 72.00 72.00 72.00 72.00 72.00 0081W HPV, High Risk w/repeat pap(LabCorp USE 114.00 114.00 114.00 114.00 114.00 484006W Immunohistochemical Stain 103,00 103.00 103.00 103.00 103.00 87254 Influenza -Viral Culture 44.00 44.00 44.00 44.00._ 44.00 83525 Insulin, Fasting 15.00 15.00 15.00 15.0O 15.00 83002 LH 36.00 36.00 36.00 36.00 36.00 80061W Lipid Panel-SFS* 0.00 9.50 19.00, 28.50 38.00 80061N Lipid Panel 38.00 38 00 38.00 38.00 38.00 80076 Liver Panel 30.00 30.00 30.00 30.00 30.00 80048 Metabolic Panel 31.00 31.00 31.00 31.00 31.00 82274 Occult Blood Test, Fecal, IA* 29.00 29.00 29.00 29.00 29.00 88142 Pap -Thin Prep' 0.00 11.00 22.00 33.00 44.00 0080W Pap, repeat thin prep 44.00 44.00 44.00 44.00_ 44.00 88175 Pap, Thin prep, w HR HPV, Reflex 16,18.4E 116.00 116.00 116.00 116.00 116.00 88141 Physician Read Pap 34.00 34.00 34.00 _ 34.00 34.00 84146 Prolactin 38.00 38. 38 00 38.00 38.00 86592 RPR/Syphillis test 23.00 23.00 23.00 23.00 23.00 87081 Streptococcus-Hemolytic 6.00 6.00 6.00 6.00 6.00 84480 T3 Triiodothyronine _ 47.00 47.00 47.00 47.00 47.00 84481 TT-3(Free-Unbound) 47.00 47.00 47.00 47.00 47.00 84436 T4 Thyroxine 8.00 8.00. 8.00 8.00 8.00 84439 T4 (Total Free-Unbound) 9.00 9.00 9.00 9.00 9.00 84403 Testosterone. Total 34.00 34.00 34.00 34.00 34.00 82465 Total Cholesterol 22.00 22.00 22.00 22.00 22.00 87798 Trichomonas vaginalis-amplified 11.00 11.00 11.00 11.0O 11.00 84443 TSH 34.00 34.00 34.00 34.00 34.00 86480 Tuberculosis Test-Quantiferon (IGRA) 91.00 91.00 91.00 91.00 91.00 81001 Urinalysis, complete with micro ex 7.00 7.00 7.00 7.00 7.00 81002 Urinalysis, w/o scope(UA) 10.00 10.00 10.00 10.00 10.00 87086 Urine Culture, Comprehensive 11.00 11.00 11.00 11.00 11.00 81025 Urine Preganancy Test* 0.00 3.75 7.50 11.25 15.00 36415 Venipuncture 6.00 6.00 6.00 6.00 6.00 36415W Venipuncture with sliding fee lab 0.00 1.50 3.00 4.50 6.00 87210 Wet Prep 24.00 24.00 24.00 24.00 24.00 Revised 11/02/2015 Page 3 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH&ENVIRONMENT PUBLIC HEALTH SERVICES-2016 SLIDING FEE SCHEDULE Code Code Code Code Code Code Procedure 1 2 3 4 5 MEDICINES and TREATMENTS 0036W Aldarra Cream 266 00 266.00 266.00 266.00 266.00 0020W Amoxicillin 875 mg#20 16 00 16.00 16.00 16.00 16.00 0062W Azythromycin, Z pack 16.00 16.00 16.00 16.00 16.00 101456W Azithromycin 1g-partner pack 11.00 11.00 11.00 11.00 11.00 0456W Azithromycin State supplied 0.00 0.00 0.00 '.00 0.00 J0696 Ceftriaxone 250 mg 32.00 32.00 32.00 32.00 32.00 0696W Ceftriaxone 250 mg State Supplied 0.00 0.00 0.00 0.00 0.00 0007W Cephalexin 500 mg#14 10.00 10.00 10.00 10.00 10.00 0058W Ciprofloxcin 500 mg #6 16.00 16.00 16.00 16.00 16.00 0035W Condylox 10.00 10.00 10.00 10.00 10.00 0005W Doxycycline 100 mg#14 11.00 11.00 11.00 11.00 11.00 0059W Estradiol 1 mg-#100 16.00 16.00 16 00 16.00 16.00 0011W Fluconazole 150 mg#1 21.00 21.00 21.00 21.00 21.00 0012W Iron 12.00 12.00 12.00 12.00 12.00 J0561 LA Bicillin 2.4 Units 0.00 0.00 0.00 0.00 0.00 0060W Medroxyprogesterone 10 mg-#5 16.00 16.00 16.00 16.00 16.00 0008W Metrogel 10.00 10.00 10.00 10.00 10.00 0009W Metronidazole 500 mg#4 10.00 10.00 10.00 10.00 10.00 0010W Metronidazole 500 mg#14 15.00 15.00 15.00 15.00 15.00 0013W Metronidazole 250 mg#28 15.00 15.00 15.00 15.00 15.00 0006W Misoprostel (Cytotec)200 mcg#2 10.00 10.00 10.00 10.00 10.00 0061W Nitrofurantoin Macrocrystals-#14 47.00 47.00 47.00 47.00 47.00 0034W Ofloxacin 110 00 110.00 110.00 110.00 110.00 0016W Podophyllin/TCA 16.00 16.00 16.00 16.00 16.00 00006W Premarin Vaginal Cream 15.00 15.00 15.00 15.00 15.00 0192W Prenatal Vitamins 12.00 12.00 12.00 12.00 12.00 0004W Sulfatrim SMX/TMP 10 00 10.00 10.00 10.00 10.00 00180W Suprax 400 mg#1 -partner pak 27.00 27.00 27.00 _ 27.00 . 00180NC Suprax 400 mg#1 -State Supplied 0.00 0 00 0.00 0.00 0.00 IMMUNIZATIONS 90471 Imm. Admin -one vaccine 27 00 27 00 27.00 27.00 27.00 90472 Imm Admin-each addl. Vaccine 27.00 27.00 27.00 27.00 27.00 90473 Imm Admin- intranasal or oral 27.00 27.00 27.00 27.00 27.00 90700N DTaP-State supplied 0.00 _0.00 0.00 0.00 0.00 0.00 90700 DTaP 30.00 30.00 30.00 30.00 30.00 90702N DT -State supplied 0.00 0.00 0.00 0.00 0.00 90633N Hepatitis A-Child-State supplied 0.00 0.00 0.00 0.00 0.00 90633 Hepatitis A-Child 32.00 32.00 32.00 32.00 32.00 90632N Hepatitis A-Adult-State supplied 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A-Adult 85.00 85.00 85.00 85.00 85.00 90744N Hepatitis B-Child-State supplied 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B-Child _ 27.00 27.00 27.00 27.00 27.00 90746N Hepatitis B-Adult-State supplied 0.00 0.00 0.00 0.00 0.00 90746 Hepatitis B-Adult 79.00 79.00 79.00 79.00 79.00 90647N HIS-State supplied 0.00 0 00 0.00 0.00 0.00 90647 HIB 36.00 36.00 36.00 36.00 36.00 90649N HPV 4-State supplied 0.00 0.00 0.00 0.00 0.00 90649 HPV -4 175.00 175.00 175.00 175.00 175.00 90651N HPV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 90651 HPV 9 175.00 175.00 175.00 175.00 175.00 Revised 11/02/2015 Page 4 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES-2016 SLIDING FEE SCHEDULE Code Code Code Code Code Code Procedure 1 2 3 4 5 90281 IG Hepatitis A-State supplied 0.00 0.00 0.00 0.00 0 00 90657N Influenza infant-State supplied 0.00 0.00 0.00 0.00 0 00 90657 Influenza infant 34.00 34.00 34.00 34.00 34.00 90658N Influenza (3 yrs to 18 yrs) -State supplied 0.00 0.00 0.00 0.00 0.00 90658 Influenza (3 yrs to 18 yrs) 34.00 34.00 34.00 34.00 34.00 90660N Influenza- intranasal use-State supplied 0.00 0.00 0.00 0.00 0.00 90660 Influenza-Intranasal Adult 34.00 34.00 34.00 34.00 34.00 90687 Influenza-infant quadrivalent 34.00 34.00 34.00 34.00 34.00 90687N Influenza- infant quadrivalent-State suppli 0.00 0.00 0.00 0 CC 0.00 90688 Influenza- 3 yrs and up-quadrivalent 34.00 34.00 34.00 34.00 34.00 90688N Influenza -3 yrs and up -State supplied qui 0.00 0.00 0.00 0.00 0.00 90713N IPV-VFC -State supplied 0.00 0.00 0.00 0.00 0.00 90713 IPV 66.00 66.00 66.00 66 00 66.00 90735 Japanese Encephalitis(new formulation) 269.00 269 00 269.00 269.00 269.00 90696N Kinrix -(DTaP/IPV) -State supplied 0.00 0.00 0.00 0.00 0.00 90696 Kinrix-(DTaP/IPV) 59.00 59.00 59.00 59.00, 59.00 90734N MCV4-State supplied 0.00 0.00 0.00 0.00 0.00 90734 MCV4 160.00 160.00 160.00 160.00 160.00 90733 MPSV4 (Menomune)(polysaccharide) 160.00 160.00 160.00 160.00 160.00 90707N MMR-State supplied 0.00 0.00 0.00 0.00 0.00 90707 MMR 67.00 67.00 ' 67.00 67.00 90723N Pediarix (DTAP, IPV, Hep B)-State suppli, 0.00 0.00 0.00 0.00 90723 Pediarix-(DTaP/IPV/Hep B) 82.00 82.00 82.00 82.00 82.00 90698N Pentacel -(DTaP/IPV/HepB) -State supplie 0.00 0.00 0.00 0.00 0.00 90698 Pentacel-(DTaP/IPV/HepB) 121.00 121.00 121.00 121.00 121.00 90732N Pneumovax-State supplied 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 82.00 82.00, 82.00 82.00 82.00 90669N Prevnar-(PCV13)-State supplied 0.00 0.00 0.00 0.00 0.00 90669 Prevnar-(PCV13) 179.00 179.00 179.00 179.00 179.00 90675 Rabies IM 256.00 256.00 256.00 256.00 256.00 90675N Rabies IM-State supplied 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) -per cc 228.00 228.00 228.00 228.00 228.00 90680N Rotavirus-State supplied 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus- (RV5) 92.00 92.00 92.00 92.00 92.00 90714N Td-State supplied 0.00 0.00 0.00 0.00 0.00 90714 Td - 54.00 54.00 54.00 54.00 54.00 90715N Tdap-State supplied 0.00 0.00 0.00 0.00 0.00 90715 Tdap- 105.00 105.00 105.00 105.00 105.00 86580 Tuberculosis Interdermal Skin Test(PPD) 47.00 47.00 47.00 47.00 47.00 90636 Twinrix- Hep A& HepB 115.00 115.00 115.00 115.00 115.00 90691 Typhoid- 1 Shot 75.00 75.00 75.00 75.00 75.00 90690 Typhoid -Oral 65.00 65.00 65.00 65.00 65.00 90716N Varivax-State supplied 0.00 0.00 0.00 0.00 0.00 90716 Varivax 115.00 115.00 115.00 115.00 115.00 90717 Yellow Fever 123.00 123.00 123.00 123.00 123.00 Miscellaneous INC Service Includes Follow-up Care _ 0.00 0.00 0.00 0.00 0.00 99212 Antepartum Care 1 visit 70.00 70.00 70.00 70.00 70.00 59425 Antepartum care 4-6 visits 641.00 641.00 641.00 641.00 641.00 59426 Antepartum care 7 or more visits 1317.00 1317.00 1317.00 1317.00 1317.00 99402W PE Establishing Medical Record 62.00 62.00 62.00 62.00 62.00 0255W Phone visit 0.00 0.00 0.00 0.00 0.00 Revised 11/02/2015 Page 5 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES -2016 SLIDING FEE SCHEDULE Code Code Code Code Code Code Procedure 1 2 3 4 5 59430 Post Partum Only 201.00 201.00 201.00 201.00 201.00 H1005 Prenatal Plus (1-4 visits) 186.00 186.00 186.00 186.00 186.00 H1005 Prenatal Plus(5-9 visits) 496.00 496.00 496.00 496.00 496.00 H1005 Prenatal Plus (10 visits) 931.00 931.00 931.00 931.00 931.00 H1005 Prenatal Plus(11 or more visits) 1055.00 1055.00 1055.00 1055.00 1055.00 * 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 Revised 11/02/2015 Page 6 of 6 14 ehlecip raila,;073 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2016 SLIDING FEE SCHEDULE Yellow - New Procedures/Codes PROPOSED 3% Increase from Mediciad/Medicare/Actual Floor HOUSEHOLD CODE SIZE - 20151 2016 Procedure Code Code Code Code Code CURRENT PROPOSED i 3% increase Code Procedure 1 2 3 4 5 Rounded 99201 Minimal* 0. 00 11 .50 23.00 34.50 46.00 45.00 46.00 99202 Expanded* ` P 0.00 27.75 55.50 83.25 111 00 108 00 111 . 00 99203 Detailed* 0 00 36.00 72.00 108.00 144.00 140.00 144 .00 99204 Comprehensive* 0. 00 53. 75 107.50 161 .25 215 00 209.00 . 215 .00 Established Client - ' . 99211 Minimal* -__ _ . -_ ___ .. 0.00 10. 75 21 .50 32.25 , 43 00 42 00 43 00 99212 Focused* 0 .00 18.00 36.00 54.00 72.00 70.00 72.00 99213 _Expanded' 0.00 23.50 47.00 70. 50 94 00 91 .00 . _ 94.00 99214 Detailed* 0.00 36 . 75 73 . 50 110.25 147.00 143-.00i 147.00 _ 4 Home Visits 99341 New Client - Focused } 87.00 87.00 87.00 87.00 87 00 84. 00 87 00 99342 New Client - Expanded 87 00 87.00 87.00 87 . 00 87 . 00 84.00 87.00 99347 Est. Client - Focused 87.00 87 .00 87 00 87.00 87 00 84.00 87.00 99348 Est. Client - Expanded 87 00 87.00 87.00 87.00 87 00 84.00 . 87.00 Preventive Medicine Counseling (Family Planning C 99401 _ individual - 15 min' 0.00 11 50 23.00 34 50 46.00 45 .00 46.00 99402 Individual - 30 min* _0.00 16.25 32.50 48. 75 65 00 56 00 65.00 99403 Individual - 45 min* 0 . 00 2215 45.50 68.25 91 . 00 77. 00 91 .00 Travel Visits 99404 Individual Initial Visit - 60 117.00 117.00 117.00 117.00 117.00 98.00 117 .00 99401W Return Visit 54 00 54 00 54.00 54 .00 54 00 52.00 54.00 99412 Group Initial Visit (per person) - 60 _ 54.00 __ _ 54.00 54 00 54 .00 54 00 52 . 00 54 00 Preventive Medicine 99384 New Client 12-17 years old'` 0.00 36 00 72.00 108.00 144.00 140.00 144.00 a _ 99385 New Client 18-39 years old* _ 0 00 36.00 72.00 _ _ 108.00 144.00 _ __ 140.00 144 00 99386 New Client 40-64 years old* 0.00 39.00 78. 00 117.00 156 00 151 .00 156.00 99394 Est. Client 12-17 years old* 0 .00 30.25 60. 50 90.75 121 00 91 .00 121 .00 99395 Est. Client 18-39 years old* 0 00 31 .00 62.00 93.00 124 00 91 .00 124.00 99396 Est. Client 40-64 years old* 0.00 33.00 66.00 99.00 132.00 100.00 132.00 Additional Codes - 0071W Community Education 1_ hr 70 00 70 00 70 .00 70 00 70 00 68 .00 70.00 0069W Travax Printout 15. 00 15 00 15 00 15 00 15.00 15.00_ 15 .00 G9-606 NHV Mother - Task Care Management 15 00 15 00 15.00 15.00 15. 00 _ 15.00 15 .00 T1017 NHV Child - Task Care Management 15 00 15.00 15.00 15.00 15 .00 15 .00 15 .00 STI Exampre-pay-NP _ 182.00. 182.00 182.00 182.00 . 182 .00 177 ,00 182 .00 Wellness Package 47 00 47.00 47 00 47.00 47.00 46.00 47 .00 99499 TB Consultation 43. 00 43 00 43 00 43.00- 43 00 42 .00 43 00 PROCEDURES 56420 Bartholin Cyst 129. 00 129 .00 129. 00 129.00 129.00 1 32.00 129.00 11100 Biopsy of skin, single 109 00 109 00 109.00 109.00 109.00 30 00 109.00 57500 Cervical Lesion Biopsy 136 00 136.00 136 . 00 136 00 136.00 35.00 136.00 0116W Chest X-Ray (Prepay) 63.00 63 00 63 00 63. 00 63 00 __ 61 .00 63.00 57452 Colposcopy without Biopsy ** 116.00 _ 116.00 116.00 116 00 116. 00 98.00 116.00 57454 Colposcopy with Biopsy ** 163.00 163.00 163.00 163.00 163.00 109 00 163.00 57511 Cryocautery cervix- initial or repeat 155 00 155. 00 155.00 155 00 155.00 109 .00 155.00 17000 _ _ Cryotherapy first lesion" 70.00 70 00 70.00 70.00 70 . 00 46 00 70.00 17003 Cryotherapy 2- 14 lesions** 6 00 6.00 6.00 6.00 6.00 6 .00 6. 00 17004 Cryotherapy 15 + lesions** 158. 00 158 00 158.00 158.00 158 .00 134. 00 158.00 56501 Destruction Lesion Vulva 139 00 139 00 139.00 139.00 139.00 _ 97.00 139.00 57170 Diaphray.m/Cervical Cap Fitting* 0.00 22.50 45.00 67.50 90 .00 87 00 90 .00 58100 Endometrial biopsy w/wo Biopsy 116 . 00 116. 00 116 00 116.00 116 00 48 00 116.00 58110 Endometrial biopsy with Colposcopy 64 00 64 . 00 64 00 64.00 64 .00 62 .00 ' 64 00 Essure by referral"* 0. 00 0. 00 0.00 0 00 0 00 0 00 0 00 11400 Excisions, benign lesion 131 00 131 .00 131 .00 131 00 131 00 84 .00 131 .00 11981 Im !anon Insertion* ".____ -9-2 - � - -- ---- P 0 .00 46.25 50 138. 75 185.00 180"00 185 00 V 10060 simple 124 00 124 00 124. 00 124 00 124 00 34.00 124.00 58300 Insertion IUD* 0.00 46 .50 93.00 139.50 186.00 181 .00 186.00 r ' 57460 LEEP with biopsy 299 .00 ° 299 00 299.00 299.00 299.00 148.00 299.00 Revised 11/02/2015 Page 1 of 5 Jo/S - 3 399 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2016 SLIDING FEE SCHEDULE Procedure Code Code Code Code Code CURRENT PROPOSED 3% increase Code Procedure 1 2 3 4 5 Rounded 57461 LEEP with conization 339.00 339. 00 339 00 339 00 339 00 246.00 339.00 88305 Level 4 - Surgical pathology 1st site 102 . 00 102 .00 102 .00 102.00 102 00 99.00 102.00 88305W Level 4 - Surgical Pathology 2nd site & eac 102 . 00 102 00 102 00 102.00 102 . 00 99 00 102 00 59025 Non Stress Test Interp 0.00 0.00 0. 00 0.00 0 00 0. 00 0.00 11976 Removal, implant contraceptive (Implanon) 0.00 55.00 110.00 165.00 220. 00 214 .00 220 00 11983 Removal implant. with reinsertion' _ 0. 00 84.75 169.50 254.25 339 00 329 .00 339.00 58301 Removal IUD* 0.00_ 37.25 74.50 111 , 75 149 00 145 00 149.00 A4550 Surgical Tray � r � - _ r9 67.00 67.00 67. 00 67.00 67 .00 65.00 67. 00 Shaving of epidermal lesion , single on 11300 trunk, arms or legs , .5cm 102.00 102 . 00 102. 00 102.00 102 00 41 . 00 102.00 76857 Ultrasound - pelvic non-obstetric 72.00 72.00 72.00 72.00 72.00 70 00 72 .00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10* 0 .00 1 .75 3 .50 5.25 7.00 7. 00 7.00 0052W Cycle Beads* 0.00 3.75 7.50 11 .25 15 00 15 00 15.00 A4266 Diaphragm* 0.00 7.75 15 50 23.25 31 .00 __ _ 30 00 32.00 A4269 Foam Contraception' 0.00 3.00 6 .00 9. 00 12 00 12. 00 12 00 J7307 _ _ Nexplanon (Etonogestrel)* - 0.00 199.25 398.50 597 75 797 00 734 00 797.00 J7306 Levonorgestrel 0.00 199.25 398. 50 597. 75 797.00 734 .00 797.00 J7302 IUD Mirena* 0.00 228.75 _ 457.50 686.25 915 00 _ 784 .00 915.00 J7300 IUD Paragard* 0.00 190.25 380.50 570.75 761 .00 674 00 761 .00 J3490 IUD Skyla* 0 .00 212 25 424 .50 636. 75 849 00 824. 00 874.00 J3490W IUD Liletta 0.00 64.50 129.00 193 . 50 258.00 250 00 258.00 J1050 Medroxyprogesterone 150mg IM (Depo)* 0 .00 17.25 34. 50 51 .75 69.00 67 .00 69 00 96732 Admin fee depo- if visit for injection only 3.75 7. 50 11 25 15.00 15 00 15.00 J7303 Nuva Ring* 0.00 10 25 20.50 30.75 41 .00 36.00 41 . 00 S4993 Oral Contraceptives' _ 0.00 7.25_ 14.50 21 75 29 00 _ 28 .00 29.00 0068W Seasonale' 0.00 17.25 34.50 51 .75 ; 69.00_ _ _ 67 . 00 _ 69 00 0065W _ Today's Sponge' _ 0.40 1 .25 2.50 3.00 5.00 5.00 5.00 LAB - _ 82947 Assay, body fluid, glucose, (FE 3S)*_ S)' _0.00 5.00 10.00 15.00 20.00 19.00 20.00 85025 CBC w/Diff - - 21 .00 21 00 21 .00 21 .00 21 .00 - . - 20.00 21 .00 85027 __ . C--BC w/o Diff 19.00 19.00 19 00 19 00 19 00 18 00 19.00 . 87491 Chiamydia PCR* 0.00 12. 00 24.00 36.00 48.00 47 .00 _ 48.00 87491 NS Chiamydia PCR* - full fee 48.00 48.00 48 00 48 00 48 .00 47 .00 48.00 80053 Comprehensive Metabolic Panel 14. 00 14.00 14 .00 14.00 14.00 14 00 _ 14.00 0090W Court Ordered Lab Draw 16.00 16.00 _ _16.00 16 00 16 00 16_00 16 00_ 82627 RHEAS 29.00 29.00 29 00 29.00 29.00 28 00 29 00 83001 FSH 36.00 _ 36.00 36.00 36 00 36 00 35. 00 36 .00 87591 Gonorrhea PCR* 48 00 48 .00 48 00 48 .00 _ 48.00 47.00 48.00 87591 NS Gonorrhea PCR* - full fee 48.00 48.00 48 .00 48.00 48.00 4.7.00 48. 00 82948 Glucose Random 8 00 8.00 8 00 _8 ___ 8 00 8.00 8. 00 82951 Glucose Tolerance Test 2 hr (GTT) 25.00 25.00 25. 00 25 00 25 .00 24.00 25.00 87205 Gram Stain 27,00 27.00 27.00 27 00 27 00 26 00 27 .00 84702 HCG Quantitative - Serum Pregnancy Test ' 42.00 42 00 42.00 42 .00 42.00 41 00 42 00 84703 HCG Qualitative - Serum Pregnancy Test 42. 00 42.00 42.00 42 00 42 00 41 00 42.00 83718 HDL Cholesterol 31 . 00 31 .00 31 .00 31 .00 31 .00 30 00 31 .00 86706 : Hop B Surface Antibody _ 24.00 24. 00 24.00 24 00 24 00 _ 23.00 24.00 87255 Herpes Culture 72 00 72 00 72.00 72 00 72.00 70 .00 72.00 86695 Herpes Select - Type I (89999A33) 72 00 72 00 72 00 72 .00 72 00 70.00 72 00 86696 Herpes Select - Type II (89999A33) 72 00 72 00 72 00 72 00 72 00 70 00 72.00 85018 HGB - (Finger Stick)* 0 .00 3. 50 7.00 10.50 14.00 14 00 14 00 83036 HGB Al c 34.00 34.00 34.00 34.00 34 00 33 00 34.00 gi 86703 : HIV Screen, ELISA 24.00 24. 00 24.00 24.00 24.00 23 00 24 00 G0435 HIV Screen, Rapid Test 24.00 24.00 24.00 24 00 24.00 23 00 24.00 87624 HPV, High Risk 72.00 72.00 72.00 72.00 72.00 70 00 72.00 0081W HPV, High Risk wI repeat pap (LabCorp us 114 00 114.00 114 00 114.00 114.00 111 00 114 00 484006W Immunohistochemical Stain 103.00 103. 00 103 .00 103 00 103.00 100 00 103 00 0 87254 Influenza - Viral Culture 44.00 44. 00 44 00 44.00 44.00 43 .00 44 00 83525 Insulin. Fasting 15__00 15 00 15 00 15.00 15.00 15.00 15 00 83002 LH 36.00 36 00 36 00 36 00 36 00 35 00 36 .00 80061W Lipid Panel - SFS* 0.00 9.50 19 00 28.50 38 00 37.00 38.00 80061N Lipid Panel 38 00 38 00 38. 00 38.00 38 00 37 .00 38.00 I 80076 Liver Panel s 30.00_ _30.00 30. 00 30.00 30. 00 29 00 30 00 80048 Metabolic Panel 31 DO 31 00 31 00 31 .00 31 .00 30 00 31 .00 I 82274 Occult Blood Test. Fecal, IA' 29.00 29 00 29.00 29.00 29.00 28 00 29.00 Revised 11/02/2015 Page 2 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2016 SLIDING FEE SCHEDULE Procedure Code Code Code Code Code CURRENT PROPOSED 3% increase Code Procedure 1 2 3 4 5 Rounded 88142 Pap - Thin Prep" 0.00 11 . 00 22 .00 33. 00 44 00 43 00 44 00 0080W Pap, repeat thin prep 44 . 00 44 .00 44 .00 44 00 44 .00 43.00 44.00 88175 Pap, Thin prep, w HR HPV, Reflex 16, 18 4 116.00 116.00 116.00 116.00 116.00 113 00 116.00 88141 Physician Read Pap 34 . 00 34 00 34.00 34 00 34 00 16.00 34.00 84146 Prolactin 38. 00 38.00 38.00 38.00 38.00 37.00 38.00 86592 RPR/Syphillis test 23 00 23.00 23.00 23.00 23 00 22 00 23.00 87081 Streptococcus - Hemolytic 6 .00 6 00 6.00 6.00 6.00 6.00 6.00 84480 T3 Triiodothyronine 47.00 47 .00 47 00 47 .00 47-00 46 00 47 00 84481 TT-3 (Free-Unbound) 47.00 47.00 47.00 47 00 47.00 46 00 47 00 84436 I T4 Thyroxine 8.00 8.00 ; 8 . 00 8 00 8.001 8 .00 8. 00 84439 T4 (Total Free-Unbound) 9.00 9 00 9.00 9. 00 9.00 9 .00 9.00 84403 Testosterone, Total 34 . 00 34.00 34 .00 34.00 34 .00j 33 .00 34.00 82465 Total Cholesterol 22.00 22.00 22.00 22.00 22.00 21 00 22. 00 87798 Trichomonas vaginalis - amplified 11 00 11 00 11 . 00 11 .00 11 00 ; 11 00 11 .00 84443 TSH 34 .00 34 00 34. 00 34 .00 34.00 33 00 34.00 86480 Tuberculosis Test-Quantiferon (IGRA) 91 .00 91 .00 91 .00 91 .00 91 .00 88 00 91 00 81001 Urinalysis, complete with micro ex 7 .00 7.00 7.00 [ 7 00 7 00 _ 7 .00 7 .00 10. 81002 Urinalysis, w/o scope (UA) 10 .00 00 1000 10 . 00 10.00 . _ 10 00 10 .00 87086 Urine Culture, Comprehensive 11 .00 11 .00 11 .00 11 .00 11 .00 11 .00 11 .00 81025 _ Urine Preganancy Test* 0.00 3.75 7.50 11 .25 15 00 15 00 15 .00 36415 Venipuncture 6.00 6.00 6.00 6.00 6.00 6 00 6 .00 36415W Venipuncture with sliding fee lab 0.00 1 . 50 3.00 4.50 6 00 6 00 6 .00 87210 Wet Prep i 24.00_ 24.00 24.00. 24 00 24 .00 23 00 24 00 MEDICINES and TREATIWtTS 0036W Aldarra Cream 266.00 266.00 266.00 266.00 266.00 258.00 266.00 0020W Amoxicillin 875 mg #20 16.00 16 00 16.00 16.00 16.00 16.00 16.00 0062W Azythromycin, Z pack 16.00 16.00 16.00 16.00 . 16.00 16 00 16.00 101456W Azithromycin 1g - partner pack moo , 00 11 .00 _ 1. 1 .00 11 .00' 11 .00 11 00 0456W Azithromycin State supplied 0.00 0.00 0 00 0.00 0 00 0 .00 0.00 4 J0696 _Ceftriaxone 250 mg 32.00 32.00 3.2 .00 32.00 32 00 31 .00 32 . 00 0696W Ceftriaxone 250 mg State Supplied 0. 00 0.00 000 0.00 0.00 0 00 _ 0 00 0007W Cephalexin 500 mg #14 10.00_ 10.00_ 10.00 10.00 10 00 10.00 10-00 0058W Ciprofloxcin500 -my #6 16.00 16.00 16.00 16 00 16 00 16 00 16 00 0035W Condyiox 1-0.00 10 00 10.00 10.00_ 10 00 10 .00 10 00 0005W Doxycycline 100 mg #14 11 .00 11 .00 11 .00 11 00 11 00 11 .00 11 00 0059W Estradioi 1 mg- #100 16.00 16.00_ 16.00 16.00 16.00 16.00 16 00 0011W Fluconazole 150 mg #1 21 .00 2I-00 21 00 21 00 21 . 00 20 . 00 21 .00 0012W _ Iron 12 .00 12 00 12.00 12 .00 12. 00 12 00 12 00 J0561 __ __ _LA Bicillin 2.4 Units 0 00 0 00 0 00 0 . 00 0 00 0.00 0 00 0060W Medroxyprogesterone 10 mg - #5 1 16.00 16.00 16 00 16.00 16.00 16 .00 16. 00 0008W Metrogel 10 00 10.00 10 00 10 00 _ 10.00 _ 10.00 10 00 0009W Metronidazole 500 mg #4 10.00 10 .00 10 . 00 10.00 10.00 10 00 10 .00 0010W Metronidazole 500 mg #14 15 00 15 00 15 00 15 00 15 . 00 15.00 15 .00 0013W Metronidazole 250 mg #28 15.00 15 00 15 00 15 00 15 00 15 00 15.00 0006W Misoprostel (Cytotec) 200 mcg #2 10. 00 10. 00 10.00 10. 00 10.00 10.00 10 00 0061W Nitrofurantoin Macrocrystals - #14 47 00 47 00 47 00 47 00 47 .00 46 00 47 00 0034W Ofloxacin 110 .00 110 . 00 110.00 110.00_ 110.00 107 00 110. 00 0016W Podophyllin/TCA 16 00 16 00 16.00 16.00 16.00 16 00 16. 00 00006W Premarin Vaginal Cream 15 . 00 15.00 _ __ 15.00 15.00 _ 15.00_ 15 00 15 00 0192W Prenatal Vitamins 12 00 12 00` 12.00 . 12 00 12 00 12 00 12 00 0004W Sulfatrim SMX/TMP 10. 00 10. 00 10.00 10. 00 10 00 10 00 10 00 00180W Suprax 400 mg #1 - partner pak 27 .00 27 00 27 00 27 .00 27 00 26 00 27 00 00180NC Suprax 400 mg #1 - State Supplied 0 00 0 00 0.00 0.00 0 .00 0 00 0. 00 IMMUNIZATIONS 90471 Imm. Admin - one vaccine 27 00 27 00 27 00 27.00 27 00 23 00 27 00 90472 Imm Admin - each addl. Vaccine 27 00 27 00 27 00 27 00 27 00 23 00 27 . 00 90473 Imm Admin - intranasal or oral _ 27 .00 27.00 27 00 27. 00 27.00 23. 00 27.00 _ 90700N DTaP -State supplied 0.00 0.00 0 00 0 00 0.00 0 00 0 00 90700 DTaP 30. 00 30 .00 30.00 30 00 30 00 29. 00 30 00 90702N DT - State supplied 0.00 0.00 0.00 0 . 00 0.00 0.00 0 .00 90633N Hepatitis A - Child - State supplied 0.00 0 00 0.00 0 00 _ 0.00 0.00 0 .00 90633 Hepatitis A - Child 32.00 32 00 32.00 32, 00 32. 00 311 00 32 00 90632N Hepatitis A - Adult - State supplied i 0.00 _ 0.00 0.00 0.00 0 00 0 00 0 00 90632 Hepatitis A - Adult 85.00 85.00 85.00 85. 00 85 .00 63 00 85 00 0 Revised 11 /02/2015 Page 3 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2016 SLIDING FEE SCHEDULE Procedure Code Code Code Code Code CURRENT PROPOSED 3% increase Code Procedure 1 2 3 4 5 Rounded 90744N Hepatitis B - Child - State supplied 0 00 0 .00 0.00 0 00 0 00 _ 0 00 0 00 90744 Hepatitis B - Child 27.00 27.00 27.00 27.00 27 00 2. 6.00 27.00 90746N Hepatitis B - Adult - State supplied 0-00 0.00 0 . 00 0.00 0 00 0 00 0.00 90746 Hepatitis B - Adult 79 00 79 00 79.00 79. 00 79.00 77 .00 79.00 90647N HIB - State supplied 0.00 0 .00 0 00 0 00 0 00 0 00 0 00 I 90647 HIB - 36 .00 36 00 36.00 36.00 36.00 35.00 36.00 90649N HPV 4 State supplied 0.00 0.00 0.00 0 00 0 . 00 0.00 0.00 90649 HPV - 4 175.00 175 .00 175. 00 175 00 175. 00 170.00 175.00 90651N HPV 9 - State supplied 0.00 0.00 0.00 0. 00 0 00 0 00 0.00 90651 HPV 9 175.00 175.00 175.00 175 00 175.00 170 00 175.00 90281 IG Hepatitis A - State supplied 0.00 0 00 0.00 0.00 0. 00 0 .00 0.00 90657N Influenza infant - State supplied 0.00 0.00 0. 00 0 00 0 00 34 00 34.00 34 00 34 00 34 .00 0.00 0.00 90657 Influenza infant 33 00 34.00 90658N Influenza (3 yrs to 18 yrs) - State supplied 0.00 0 00 0.00 0.00 0.00 0 00 0.00 90658 Influenza (3 yrs to 18 yrs) 34.00 34.00 34 . 00 34.00 34 00 3.3 00 34.00 90660N Influenza - intranasal use - State supplied 0.00 0 00 0.00 0. 00 0.00 0. 00 _ 0.00 90660 Influenza - Intranasal Adult 34.00 34 00 34 . 00 34.00 34 .00 33. 00 34.00 90687 Influenza - infant quadrivalent 34.00 34.00 34 00 34.00 34.00 33 00 34.00 90687N Influenza - infant quadrivalent - State suppl 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalent 34.00 34.00 34.00 34 00 34 00 33 00 34.00 90688N Influenza - 3 yrs and up - State supplied qu 0.00 0 00 0.00 0.00 0.00 0 00 0.00 90713N IPV-VFC - State supplied 0.00 0.00_ 0.00_ 0.00_ 0.00 0 00 0.00 90713 IPV 66 00 66 .00 66.00 66 00 66.00 i 64 .00 66.00 -p Encephalitis ( ette�+1►- n� 90735 Ja anese Erne hatitis formulation 269.00 269.00 269.00 269.00 269.00 261 . 00 269 00 90696N ,' Kinrbc - (DTaP/IPV) - State supplied 0 00 0.00 0.00 0 00 0.00 0 00 0.00 90696 Kinrix - (DTaP/IPV) 59 -00 59 00 59.00 59.00 59.00 57 .00 59 00 90734N MCV4 - State supplied 0.00 0.00 0.00 0 00 0.00 0 .00 0.00 90734 MCV4 160.00 160 00 160.00 160.00 160.00 155 00 160.00 90733 MPSV4 (Menomune)(polysaccharide) 160.00 160.00 16O00 160.00 160 00 _ 155.00 160 .00 90707N _MMR - State supplied 0 00 0.00 0. 00 0 .00 0.00 1 0 .00 0 00 90707 MMR _ 67.00 67 00 67 00 67 00 67. 00 65 00 67 -00 90723N Pediarix (DTAP. IPV, Hep B) - State suppli 0.00 0 00 0.00 0.00 0 .00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 82.00 82.00 82 .00 82.00 _ __ 82 . 00. 80 .00 �� 82 .00 90698N Pentacel - (DTaP/IPV/HepB) - State supplif 0 00 0.00_ 0.00 0.00 0.00 0 00 0 .00 90698 Pentacel - (DTaP/IPV/HepB) _121 00 121 00 121 .00 121 00 121 .00 117 00 121 00 90732N Pneumovax - State supplied - 0. 00 0.00 0.00 0.00 0.00 0 00 0.00 90732 Pneumovax 82 00 82.00 82 00 82 00 82 00 80 00 82 .00 90669N Prevnar - (PCV13) - State supplied 0 . 00 0 00 0 00 0.00 0.00 0 00 0.00 90669 Prevnar - PCV13 ( ) 179.00 179.00 179.00 179. 00 179.00 164 00 179.00 90675 Rabies IM 256.00 256 00 256 00 256 00 256 00 249.00 256 00 90675N Rabies IM - State supplied 0.00 0.00 0.00_ 0.00_ 0.00 0.00 0 00 90375 RIG (rabies) - per cc 228.00 228.00— 228 00 228 00 228 00 221 00 228.00 90680N Rotavirus - State supplied 0 . 00 0 00 0.00 0.00 0.00 0 .00 0.00 90680 Rotavirus - (RV5) 92.00 92.00, 92 . 00 92.00 92-00 89 00 . 92 .00 90714N Td - State supplied 0 .00 0.00 0.00 0.00 0 .00 000___ 0 00 90714 Td - 54 00 54,00 54 00 54 00 54.00 52 00 __54.00 90715N Tdap - State supplied j 0.00 0.00 0 00 0 00 0.00 0.00 0.00 90715 Tdap - 105.00 105.00 105.00 105.00 105.00 102 .00 105.00 86580 Tuberculosis Interdermal Skin Test (PPD) 47 00 47 00 47 00 47 00 47 00 46 00 47.00 90636 Twinrix - Hep A & Hep B 115 00 115 00 115.00 115.00 115.00 112 . 00 115 00 90691 Typhoid - 1 Shot 75. 00 75.00 75 .00 75.00 75 00 73 00 75 .00 90690 _ Typhoid - Oral 65. 00 65 .00 65 00 65.00 65.00 63 00 65 . 00 90716N Varivax - State supplied 0 .00 0.00 0.00 O 00 0.00 0 00 0.00 90716 ____, Varivax 115 00 115.00 115 00 115.00 115.00 112 00 115 00 90717 Yellow Fever 123 .00 123. 00 123 00 123 00 123 00 119 00 123 00 Miscellaneous INC Service Includes Follow-up Care 0.00 0.00 0.00 0.00 0.00 0.00 0.00 99212 Antepartum Care 1 visit 70 00 70 00 70 00 70.00 70 00 68 00 70 00 y 59425 Antepartum care 4-6 visits 641 00 641 . 00 641 . 00 641 .00 641 00 622 00 641 .00 59426 Antepartum care 7 or more visits 1317 00 1317 .00 1317 00 1317.00 1317.00 1279.00 1317 00 99402W PE Establishing Medical Record 62 - 00 62.00 62 .00 62 .00 62 00 60.00 62 00 0255W _Phone _visit 0. 00 0.00 0 00 0.00 0 00 0 00 0.00 59430 PostPartum Only 201 .00 201 00 201 00 201 .00 201 00 113 . 00 201 .00 H1005 Prenatal Plus (1-4 visits) 186 00 186 00 186.00 186.00 186. 00 181 .00 186.00 H1005 Prenatal Plus (5-9 visits) 496 00 496 00 496.00 496 00 496 00 482 00 496.00 H1005 Prenatal Plus (10 visits) 931 .00 931 00 931 00 931 00 931 .00 904.00 931 .00 H1005 Prenatal Plus 01 or more visits) 1055 00 1055 .00 1055. 00 1055 . 00 1055 00 1024 .00 1055.00 Revised 11 /02/2015 Page 4 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2016 SLIDING FEE SCHEDULE Procedure Code Code Code Code Code ' CURRENT PROPOSED 3% increase Code Procedure 1 2 3 4 5 Rounded * 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 In process 11 /02/2015 • • Revised 11/02/2015 Page 5 of 5 Hello