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Fee Schedules and Rates

Below are the fee schedules and rates listed by codes for particular provider or facility types.

Envision

Fee Schedules File Type File Type Effective Date
Ambulance PDF Excel July 1, 2016
Anesthesia Base Unit PDF Excel July 1, 2016
Ambulatory Surgical Center Fee Schedule for DOS PDF Excel October 1, 2016
Billing Guidelines for Autism Spectrum Disorder (ASD) Services PDF Jan. 1, 2017
Billing Guidelines for Psychiatry and Psychiatric Nurse Practitioners for Mental Health/Psychiatry Services PDF July 1, 2016
Billing Guidelines for Therapeutic and Evaluative Mental Health Services for Expanded EPSDT (T&E) PDF July 1, 2016
Billing Guidelines for Community/Private Mental Health Centers (CMHC/PMHC) PDF July 1, 2016
Dental Fees – Outpatient Hospital PDF Excel July 1, 2016
Dental Fees – Professional Services PDF Excel Jan. 1, 2016
Durable Medical Equipment (DME), Orthotic, Prosthetic PDF Excel July 1, 2016
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) PDF July, 1, 2009
Hearing PDF Excel July 1, 2015
Intellectual and Developmental Disabilities (ID/DD) waiver PDF July 1, 2016
Increased Primary Care Provider PDF Excel July 1, 2016
Medical Supply PDF Excel July 1, 2016
Medical Supply Codes – Manually Priced PDF Excel July 1, 2015
Outpatient Prospective Payment System (OPPS) Medicaid PDF Excel July 1, 2016
Pathology Laboratory PDF Excel July 1, 2016
Physician Administered Drug PDF Excel October 1, 2016
Radiology PDF Excel July 1, 2016
Vision PDF Excel July 1, 2015

 

Prescribed Pediatric Extended Care

Code/Modifier Description of Service Maximum Fee
T1025 (code) Full day PPEC services
(over four hours, up to 12 hours per day)
$240 per day
T1026 (code) Partial day PPEC services
(four hours or less per day, billed in units of one hour)
$30 per hour
UC (modifier) Transportation provided by PPEC center $35 per day

 

Rates Effective Date
End-Stage Renal Disease Jan. 1, 2015
Jan. 1, 2016
End-Stage Renal Disease bundled list Jan. 1, 2015
Jan. 1, 2016
Federally Qualified Health Center (FQHC) Calendar Year 2015
Calendar Year 2016
Home Health Effective: Oct. 1, 2015 – Sept. 30, 2016
Hospice FY 2017 Rates by County Effective: Oct. 1, 2016 (PDF)
Effective: Oct. 1, 2016 (Excel)
Hospice FY 2016 Rates by County Effective: Jan. 1, 2016 (PDF)
Hospice FY 2016 Rates by County Effective: Oct. 1, 2015
Psychiatric Residential Treatment Facilities (PRTF) Calendar Year 2015
Calendar Year 2016
Rural Health Clinics (RHC) Calendar Year 2015
Calendar Year 2016
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) Calendar Year 2015
Calendar Year 2016
MS Dept. of Health Clinic July 1, 2011
Nursing Facilities 2015 First Quarter
2015 Second Quarter
2015 Third Quarter
2015 Fourth Quarter
2016 First Quarter
2016 Second Quarter
2016 Third Quarter

 

 Code descriptions on the various fee schedules available below are incomplete. Providers must use current CPT, HCPCS, CDT and ICD9 books for correct coding.

 

Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS Apply.

CPT only copyright 2014 American Medical Association. All rights reserved.