Mental Hygiene Services Fees
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
Fees Effective 1/1/2020
- Fee Comparisons is also available in Portable Document Format (PDF)
| Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees Fees Effective 1/1/2020 |
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|---|---|---|---|---|---|---|---|---|---|
| Procedure Codes | Authorized Provider Types | IPSIDD Max Units | Regional Fees* | ||||||
| Procedure Code | Note Below | CPT Descprition | 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 | 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 with eval of language comprehension and expression | 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 | |
| 96112 | (C) | Devel tst phys/qhp 1st hr | LP (0580) / LCSW (0560) | 1 | $127.87 | $130.28 | $120.61 | $130.36 | $113.31 |
| 96113 | (C) | Devel tst phys/qhp ea addl | LP (0580) / LCSW (0560) | 1 | $63.94 | $65.15 | $60.31 | $65.19 | $56.66 |
| 96130 | (C) | Psycl tst eval phys/qhp 1st | LP (0580) / LCSW (0560) | 1 | $63.77 | $64.52 | $60.49 | $64.68 | $57.79 |
| 96136 | (C) | Psycl/nrpsyc tst phy/qhp 1st | LP (0580) / LCSW (0560) | 1 | $127.52 | $129.03 | $120.96 | $129.34 | $115.56 |
| 96137 | (C) | Psycl/nrpsyc tst phy/qhp ea | LP (0580) / LCSW (0560) | 1 | $63.77 | $64.52 | $60.49 | $64.68 | $57.79 |
| 96138 | (C) | Psycl/nrpsyc tech 1st | LP (0580) / LCSW (0560) | 1 | $129.17 | $133.08 | $119.84 | $132.41 | $107.92 |
| 96139 | (C) | Psycl/nrpsyc tst tech ea | LP (0580) / LCSW (0560) | 1 | $64.59 | $66.55 | $59.93 | $66.21 | $53.97 |
| 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 | |
| 97129 | (B) | Ther ivntj 1st 15 min | OT (0621) / PT (0622) / SLP (0623) | 1 | $37.41 | $38.05 | $35.18 | $38.01 | $32.91 |
| 97130 | (B) | Ther ivntj ea addl 15 min | OT (0621) / PT (0622) / SLP (0623) | 2 | $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 | (A) | Pt evaluation, low complexity | PT (0622) | 1 | $84.14 | $85.81 | $79.01 | $85.71 | $73.53 |
| 97162 | (A) | Pt evaluation, med complexity | PT (0622) | 1 | $112.19 | $114.41 | $105.35 | $114.28 | $98.04 |
| 97163 | (A) | Pt evaluation, high complexity | PT (0622) | 1 | $140.24 | $143.01 | $131.68 | $142.85 | $122.55 |
| 97164 | (A) | PT re–evaluation, re–defined | PT (0622) | 1 | $84.26 | $86.07 | $78.93 | $85.91 | $73.02 |
| 97165 | (A) | Ot evaluation, low complexity | OT (0621) | 1 | $75.86 | $77.62 | $71.01 | $77.45 | $65.49 |
| 97166 | (A) | Ot evaluation, med complexity | OT (0621) | 1 | $101.15 | $103.49 | $94.67 | $103.27 | $87.31 |
| 97167 | (A) | Ot evaluation, high complexity | OT (0621) | 1 | $126.43 | $129.35 | $118.34 | $129.08 | $109.14 |
| 97168 | (A) | OT re–evaluation, re–defined | 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 | |
| 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 | |
| 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 | |
| 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)
(A) Effective 1/1/2017, the American Medical Association (AMA) replaced procedure codes 97001, 97002, 97003, 97004 with eight new procedure codes.
- New codes: 97161 through 97168
(B) Effective 1/1/2018, the American Medical Association (AMA) replaced procedure code 97532 with 97127.
Effective 1/1/2020, the American Medical Association (AMA) replaced procedure code 97127 with 97129 and 97130.
(C) Effective 1/1/2019, the American Medical Association (AMA) replaced procedure codes as follows:
- 96101 replaced with 96130, 96131, 96136 and 96137, however, 96131 is not reimbursable by Medicaid.
- 96102 replaced with 96138 & 96139.
- 96111 replaced with 96112 & 96113.
