Foster Care Article 29-I Other Limited Health Services Schedule Summary
Schedule Summary is also available in the following formats:
Apr 2022
| Service Description | Rate Code | Unit | Upstate | Downstate | Statewide (where applicable) |
|---|---|---|---|---|---|
| Alcohol and /or Drug Screening, Testing, Treatment | 4588 | 15 min | $40.10 | $47.85 | N/A |
| Developmental Test Administration | 4589 | 15 min | $29.59 | $35.32 | N/A |
| Psychotherapy (Individual and Family) | 4590 | 15 min | $33.91 | $40.46 | N/A |
| Psychotherapy Group | 4591 | 15 min | $11.75 | $13.05 | N/A |
| Neuropsychological Testing/Evaluation Services | 4592 | 15 min | $32.89 | $39.25 | N/A |
| Psychiatric Diagnostic Examination | 4593 | 15 min | $49.33 | $58.86 | N/A |
| Office Visit | 4594 | 15 min | $48.74 | $63.67 | N/A |
| Smoking Cessation treatment | 4595 | 15 min | $18.13 | $21.62 | N/A |
| ECG | 4596 | Per occurrence | N/A | N/A | $15.15 |
| Screening - Developmental/Emotional/Behavioral | 4597 | Per occurrence | $59.67 | $71.21 | N/A |
| Hearing and Evaluation of Speech | 4598 | 15 min | N/A | N/A | $8.37 |
| Immunization (Administration) | 4599 | Per occurrence | N/A | N/A | $18.03 |
| Lab: Lithium | 4600 | Per Laboratory Procedure | N/A | N/A | $8.08 |
| Lab: Urinalysis, by dip stick or tablet reagent Lab: Urinalysis, by dip stick or tablet reagent Lab: Urinalysis; Bacterium scree, except B | 4671 | Per Laboratory Procedure | N/A | N/A | $2.02 |
| Infectious agent antigen detection by immunoassay technique (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID19]) | 4672 | Per Laboratory Procedure | N/A | N/A | $45.68 |
| Interpreter Services | 4673 | Per occurrence | N/A | N/A | $11.11 |
| Lab: Urine pregnancy test, by visual color comparison methods | 4674 | Per Laboratory Procedure | N/A | N/A | $2.02 |
| Lab: Hemoglobin; glycosylated (A1C) | 4675 | Per Laboratory Procedure | N/A | N/A | $11.11 |
| Blood count; Hemoglobin (HGB) | 4676 | Per Laboratory Procedure | N/A | N/A | $2.02 |
| Lab: Antibody; HIV-1 | 4677 | Per Laboratory Procedure | N/A | N/A | $11.11 |
| Lab: Smear, primary source with Interpretation | 4678 | Per Laboratory Procedure | N/A | N/A | $4.04 |
| Lab: Infectious agent detection by nucleic ac | 4679 | Per Laboratory Procedure | N/A | N/A | $97.97 |
| Lab: Infectious agent detection by immunoassay | 4680 | Per Laboratory Procedure | N/A | N/A | $4.04 |
| Lab: Infectious agent antigen detection by IM (Influenza rapid test) | 4681 | Per Laboratory Procedure | N/A | N/A | $15.15 |
| Lab: Molecular PCR Test | 4682 | Per Laboratory Procedure | N/A | N/A | $51.82 |
| COVID-19 Specimen Collection (can be reimbursed if specimen collection is a standalone service not associated with an office visit or a COVID-19 Molecular PCR test). | 4683 | Per Laboratory Procedure | N/A | N/A | $23.69 |
| Tuberculosis (TB) tests | 4684 | Per Laboratory Procedure | N/A | N/A | $5.05 |
| Child and Family Treatment and Support Services | Refer here. | ||||
| Home and Community Based Services | Refer here. | ||||
