Mental Hygiene Services Fees
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
January 1, 2018
- Fee Comparisons is also available in Portable Document Format (PDF)
| Procedure Codes | Prov Types | Max Units | Regional Fees* | |||||
|---|---|---|---|---|---|---|---|---|
| Procedure Code | CPT Description | Auth Prov Types | IPSIDD Max Units |
Locality 1 | Locality 2 | Locality 3 | Locality 4 | Locality 99 |
| 90791 | Psy dx evaluation | LP (0580)/ LCSW (0560) | 1 | $159.45 | $161.46 | $151.17 | $161.81 | $144.15 |
| 90832 | Psytx, 30 min | LP (0580)/ LCSW (0560) | 1 | $95.62 | $96.77 | $90.72 | $97.00 | $86.69 |
| 90834 | Psytx, 45 min | LP (0580)/ LCSW (0560) | 1 | $127.47 | $128.85 | $121.03 | $129.18 | $115.90 |
| 90837 | Psytx, 60 min | LP (0580)/ LCSW (0560) | 1 | $176.60 | $178.70 | $167.60 | $179.16 | $160.22 |
| 90846 | Family psytx w/o patient | LP (0580) / LCSW (0560) | 1 | $95.61 | $96.65 | $90.76 | $96.89 | $86.88 |
| 90847 | Family psytx w/patient | LP (0580) / LCSW (0560) | 1 | $191.26 | $193.73 | $181.41 | $194.19 | $173.07 |
| 90853 | Group psychotherapy | LP (0580) / LCSW (0560) | 1 | $49.44 | $50.07 | $46.86 | $50.17 | $44.68 |
| 92507 | Speech/hearing therapy | SLP (0623) | 1 | $102.61 | $104.54 | $96.42 | $104.44 | $89.93 |
| 92508 | Speech/hearing therapy, group | SLP (0623) | 1 | $29.99 | $30.62 | $28.09 | $30.56 | $25.99 |
| 92521 | Eval of Speech Fluency | SLP (0623) | 1 | $139.47 | $142.40 | $130.92 | $142.23 | $121.64 |
| 92522 | Eval of Speech Sound Production | SLP (0623) | 1 | $139.47 | $142.39 | $130.93 | $142.21 | $121.65 |
| 92523 | Eval of Speech Sound Production w eval of lang comp and express | SLP (0623) | 1 | $139.51 | $142.75 | $130.81 | $142.55 | $121.02 |
| 92524 | Behavioral and qualitative analysis of voice and resonance | SLP (0623) | 1 | $139.47 | $143.31 | $130.63 | $143.10 | $120.14 |
| 92526 | Oral function therapy | SLP (0623) | 1 | $102.68 | $104.68 | $96.38 | $104.54 | $89.66 |
| 92606 | Use of non–speech device | SLP (0623) | 1 | $102.85 | $105.02 | $96.29 | $104.78 | $88.99 |
| 92609 | Use of speech device service | SLP (0623) | 1 | $102.85 | $105.02 | $96.29 | $104.78 | $88.99 |
| 92610 | Evaluate swallowing function | SLP (0623) | 1 | $102.71 | $104.91 | $96.31 | $104.75 | $89.25 |
| 96101 | Psycho testing by psych/phys | LP (0580) / LCSW (0560) | 1 | $255.05 | $258.08 | $241.94 | $258.69 | $231.14 |
| 96102 | Psycho testing by technician | LP (0580) / LCSW (0560) | 1 | $193.76 | $199.62 | $179.77 | $198.62 | $161.89 |
| 96111 | Developmental test, extend | LP (0580) / LCSW (0560) | 1 | $191.82 | $195.42 | $180.92 | $195.54 | $169.97 |
| 97110 | Therapeutic exercises, 15 min | OT (0621) / PT (0622) | 3 | $37.27 | $38.15 | $34.87 | $38.07 | $33.21 |
| 97112 | Neuromuscular reeducation, 15 min | OT (0621) / PT (0622) | 3 | $37.47 | $38.23 | $35.09 | $38.15 | $32.62 |
| 97113 | Aquatic therapy/exercises, 15 min | OT (0621) / PT (0622) | 3 | $37.60 | $38.51 | $35.05 | $38.37 | $32.04 |
| 97116 | Gait training therapy, 15 min | OT (0621) / PT (0622) | 3 | $37.48 | $38.24 | $35.13 | $38.17 | $32.55 |
| 97124 | Massage therapy, 15 min | OT (0621) / PT (0622) | 3 | $37.52 | $38.52 | $35.04 | $38.41 | $32.08 |
| 97127*** | Cognitive skills development, 15 min | OT (0621) / PT (0622) / SLP (0623) | 3 | $37.41 | $38.05 | $35.18 | $38.01 | $32.91 |
| 97140 | Manual therapy, 15 min | OT (0621) / PT (0622) | 3 | $37.48 | $38.21 | $35.14 | $38.13 | $32.61 |
| 97150 | Group therapeutic procedures | OT (0621) / PT (0622) | 1 | $37.41 | $38.13 | $35.15 | $38.10 | $32.78 |
| 97161** | PT evaluation low complex 20 min | PT (0622) | 1 | $84.14 | $85.81 | $79.01 | $85.71 | $75.53 |
| 97162** | PT evaluation, med complex 30 min | PT (0622) | 1 | $112.19 | $114.41 | $105.35 | $114.28 | $98.04 |
| 97163** | PT evaluation, high complex 45 min | PT (0622) | 1 | $140.24 | $143.01 | $131.68 | $142.85 | $122.55 |
| 97164** | PT re–eval est plan care | PT (0622) | 1 | $84.26 | $86.07 | $78.93 | $85.91 | $73.02 |
| 97165** | OT evaluation low complex 30 min | OT (0621) | 1 | $75.86 | $77.62 | $71.01 | $77.45 | $65.49 |
| 97166** | OT evaluation med complex 45 min | OT (0621) | 1 | $101.15 | $103.49 | $94.67 | $103.27 | $87.31 |
| 97167** | OT evaluation high complex 60 min | OT (0621) | 1 | $126.43 | $129.35 | $118.34 | $129.08 | $109.14 |
| 97168** | OT re–eval est plan care | OT (0621) | 1 | $76.02 | $77.88 | $70.94 | $77.62 | $64.97 |
| 97530 | Therapeutic activities, 15 min | OT (0621) / PT (0622) | 3 | $37.53 | $38.34 | $35.11 | $38.23 | $32.37 |
| 97533 | Sensory integration, 15 min | OT (0621) / PT (0622) / SLP (0623) | 3 | $37.46 | $38.15 | $35.15 | $38.10 | $32.72 |
| 97535 | Self care mngment training, 15 min | OT (0621) / PT (0622) | 3 | $37.52 | $38.31 | $35.11 | $38.22 | $32.42 |
| 97537 | Community/work reintegration, 15 min | OT (0621) / PT (0622) | 3 | $38.15 | $38.87 | $35.81 | $38.81 | $29.94 |
| 97542 | Wheelchair mngment training, 15 min | OT (0621) / PT (0622) | 8 | $40.39 | $41.17 | $37.90 | $41.10 | $35.23 |
| 97755 | Assistive technology assess, 15 min | OT (0621) / PT (0622) | 6 | $37.39 | $38.07 | $35.17 | $38.05 | $32.89 |
*Locality Breakdown
Locality 1 – Manhattan
Locality 2 – Bronx, Brooklyn, Nassau, Rockland, Staten Island, Suffolk, Westchester
Locality 3 – Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, Ulster
Locality 4 – Queens
Locality 99 – Remainder of State
Authorized Provider Types
OT Occupational Therapist (PCOS: 0621)
PT Physical Therapist (PCOS: 0622)
SLP Speech and Lang Pathologist (PCOS: 0623)
LP Licensed Psychologist (PCOS: 0580)
LCSW Licensed Clinical Social Worker (PCOS: 0560)
**Effective 1/1/2017, the American Medical Association (AMA) replaced procedure codes 97001, 97002, 97003, 97004 with eight new procedure codes.
***Effective 1/1/2018, the American Medical Association (AMA) replaced procedure code 97532 with 97127.
