Mental Hygiene Services Fees
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
Fees Effective 4/1/2023 (updated in eMedNY in cycle 2462)
Rates currently pending State Plan Amendment 23-0054 approval by the Centers for Medicare and Medicaid Services.
- Fee Comparisons is also available in Portable Document Format (PDF)
| Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Fees Effective 4/1/2023 (updated in eMedNY in cycle 2462) | |||||||||
| 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 | $176.53 | $178.76 | $167.36 | $179.14 | $159.59 | |
| 90832 | Psytx, 30 min | LP (0580)/ LCSW (0560) | 1 | $105.86 | $107.14 | $100.44 | $107.39 | $95.98 | |
| 90834 | Psytx, 45 min | LP (0580)/ LCSW (0560) | 1 | $141.12 | $142.65 | $133.99 | $143.02 | $128.32 | |
| 90837 | Psytx, 60 min | LP (0580)/ LCSW (0560) | 1 | $195.52 | $197.84 | $185.55 | $198.35 | $177.38 | |
| 90846 | Family psytx w/o patient | LP (0580) / LCSW (0560) | 1 | $105.85 | $107.00 | $100.48 | $107.27 | $96.19 | |
| 90847 | Family psytx w/patient | LP (0580) / LCSW (0560) | 1 | $211.75 | $214.48 | $200.84 | $214.99 | $191.61 | |
| 90853 | Group psychotherapy | LP (0580) / LCSW (0560) | 1 | $54.74 | $55.43 | $51.88 | $55.54 | $49.47 | |
| 92507 | Speech/hearing therapy | SLP (0623) | 1 | $113.60 | $115.74 | $106.75 | $115.63 | $99.56 | |
| 92508 | Speech/hearing therapy | SLP (0623) | 1 | $33.20 | $33.90 | $31.10 | $33.83 | $28.77 | |
| 92521 | Eval of Speech Fluency | SLP (0623) | 1 | $154.41 | $157.65 | $144.94 | $157.47 | $134.67 | |
| 92522 | Eval of Speech Sound Production | SLP (0623) | 1 | $154.41 | $157.64 | $144.96 | $157.44 | $134.68 | |
| 92523 | Eval of Speech Sound Production with eval of language comprehension and expression | SLP (0623) | 1 | $154.45 | $158.04 | $144.82 | $157.82 | $133.98 | |
| 92524 | Behavioral and qualitative analysis of voice and resonance | SLP (0623) | 1 | $154.41 | $158.66 | $144.62 | $158.43 | $133.01 | |
| 92526 | Oral function therapy | SLP (0623) | 1 | $113.68 | $115.89 | $106.70 | $115.74 | $99.26 | |
| 92606 | Use of non-speech device | SLP (0623) | 1 | $113.87 | $116.27 | $106.60 | $116.00 | $98.52 | |
| 92609 | Use of speech device service | SLP (0623) | 1 | $113.87 | $116.27 | $106.60 | $116.00 | $98.52 | |
| 92610 | Evaluate swallowing function | SLP (0623) | 1 | $113.71 | $116.15 | $106.63 | $115.97 | $98.81 | |
| 96112 | (C) | Devel tst phys/qhp 1st hr | LP (0580) / LCSW (0560) | 1 | $141.57 | $144.24 | $133.53 | $144.32 | $125.45 |
| 96113 | (C) | Devel tst phys/qhp ea addl | LP (0580) / LCSW (0560) | 1 | $70.79 | $72.13 | $66.77 | $72.17 | $62.73 |
| 96130 | (C) | Psycl tst eval phys/qhp 1st | LP (0580) / LCSW (0560) | 1 | $70.60 | $71.43 | $66.97 | $71.61 | $63.98 |
| 96136 | (C) | Psycl/nrpsyc tst phy/qhp 1st | LP (0580) / LCSW (0560) | 1 | $141.18 | $142.85 | $133.92 | $143.20 | $127.94 |
| 96137 | (C) | Psycl/nrpsyc tst phy/qhp ea | LP (0580) / LCSW (0560) | 1 | $70.60 | $71.43 | $66.97 | $71.61 | $63.98 |
| 96138 | (C) | Psycl/nrpsyc tech 1st | LP (0580) / LCSW (0560) | 1 | $143.01 | $147.34 | $132.68 | $146.59 | $119.48 |
| 96139 | (C) | Psycl/nrpsyc tst tech ea | LP (0580) / LCSW (0560) | 1 | $71.51 | $73.68 | $66.35 | $73.30 | $59.75 |
| 97110 | Therapeutic exercises, 15 min | OT (0621) / PT (0622) | 3 | $41.26 | $42.24 | $38.61 | $42.15 | $36.77 | |
| 97112 | Neuromuscular reeducation, 15 min | OT (0621) / PT (0622) | 3 | $41.48 | $42.33 | $38.85 | $42.24 | $36.11 | |
| 97113 | Aquatic therapy/exercises, 15 min | OT (0621) / PT (0622) | 3 | $41.63 | $42.64 | $38.80 | $42.48 | $35.47 | |
| 97116 | Gait training therapy, 15 min | OT (0621) / PT (0622) | 3 | $41.49 | $42.34 | $38.89 | $42.26 | $36.04 | |
| 97124 | Massage therapy, 15 min | OT (0621) / PT (0622) | 3 | $41.54 | $42.65 | $38.79 | $42.52 | $35.52 | |
| 97129 | (B) | Ther ivntj 1st 15 min | OT (0621) / PT (0622) / SLP (0623) | 1 | $41.42 | $42.13 | $38.95 | $42.08 | $36.44 |
| 97130 | (B) | Ther ivntj ea addl 15 min | OT (0621) / PT (0622) / SLP (0623) | 2 | $41.42 | $42.13 | $38.95 | $42.08 | $36.44 |
| 97140 | Manual therapy, 15 min | OT (0621) / PT (0622) | 3 | $41.49 | $42.30 | $38.90 | $42.21 | $36.10 | |
| 97150 | Group therapeutic procedures | OT (0621) / PT (0622) | 1 | $41.42 | $42.21 | $38.92 | $42.18 | $36.29 | |
| 97161 | (A) | Pt evaluation, low complexity | PT (0622) | 1 | $93.15 | $95.00 | $87.47 | $94.89 | $81.41 |
| 97162 | (A) | Pt evaluation, med complexity | PT (0622) | 1 | $124.21 | $126.67 | $116.64 | $126.52 | $108.54 |
| 97163 | (A) | Pt evaluation, high complexity | PT (0622) | 1 | $155.26 | $158.33 | $145.79 | $158.15 | $135.68 |
| 97164 | (A) | PT re-evaluation, re-defined | PT (0622) | 1 | $93.29 | $95.29 | $87.39 | $95.11 | $80.84 |
| 97165 | (A) | Ot evaluation, low complexity | OT (0621) | 1 | $83.99 | $85.93 | $78.62 | $85.75 | $72.51 |
| 97166 | (A) | Ot evaluation, med complexity | OT (0621) | 1 | $111.99 | $114.58 | $104.81 | $114.33 | $96.66 |
| 97167 | (A) | Ot evaluation, high complexity | OT (0621) | 1 | $139.97 | $143.21 | $131.02 | $142.91 | $120.83 |
| 97168 | (A) | OT re-evaluation, re-defined | OT (0621) | 1 | $84.16 | $86.22 | $78.54 | $85.93 | $71.93 |
| 97530 | Therapeutic activities, 15 min | OT (0621) / PT (0622) | 3 | $41.55 | $42.45 | $38.87 | $42.33 | $35.84 | |
| 97533 | Sensory integration, 15 min | OT (0621) / PT (0622) / SLP (0623) | 3 | $41.47 | $42.24 | $38.92 | $42.18 | $36.23 | |
| 97535 | Self care mngment training, 15 min | OT (0621) / PT (0622) | 3 | $41.54 | $42.41 | $38.87 | $42.31 | $35.89 | |
| 97537 | Community/work reintegration, 15 min | OT (0621) / PT (0622) | 3 | $42.24 | $43.03 | $39.65 | $42.97 | $33.15 | |
| 97542 | Wheelchair mngment training, 15 min | OT (0621) / PT (0622) | 8 | $44.72 | $45.58 | $41.96 | $45.50 | $39.00 | |
| 97755 | Assistive technology assess, 15 min | OT (0621) / PT (0622) | 6 | $41.40 | $42.15 | $38.94 | $42.13 | $36.41 | |
| * 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 |
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| 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) |
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(A) Effective 1/1/2017, the American Medical Association (AMA) replaced procedure codes 97001, 97002, 97003, 97004 with eight new procedure codes.
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