Mental Hygiene Services Fees

Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees

Fees Effective 4/1/2024 (updated in eMedNY in cycle 2462)

Rates currently pending State Plan Amendment 24-0052 approval by the Centers for Medicare and Medicaid Services.

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 $181.54 $183.83 $172.12 $184.23 $164.12
90832   Psytx, 30 min LP (0580)/ LCSW (0560) 1 $108.87 $110.18 $103.29 $110.44 $98.70
90834   Psytx, 45 min LP (0580)/ LCSW (0560) 1 $145.13 $146.70 $137.80 $147.08 $131.96
90837   Psytx, 60 min LP (0580)/ LCSW (0560) 1 $201.07 $203.46 $190.82 $203.99 $182.42
90846   Family psytx w/o patient LP (0580) / LCSW (0560) 1 $108.86 $110.04 $103.34 $110.32 $98.92
90847   Family psytx w/patient LP (0580) / LCSW (0560) 1 $217.76 $220.57 $206.55 $221.10 $197.05
90853   Group psychotherapy LP (0580) / LCSW (0560) 1 $56.29 $57.01 $53.35 $57.12 $50.87
92507   Speech/hearing therapy SLP (0623) 1 $116.83 $119.03 $109.78 $118.91 $102.39
92508   Speech/hearing therapy SLP (0623) 1 $34.15 $34.86 $31.98 $34.79 $29.59
92521   Eval of Speech Fluency SLP (0623) 1 $158.80 $162.13 $149.06 $161.94 $138.49
92522   Eval of Speech Sound Production SLP (0623) 1 $158.80 $162.12 $149.07 $161.92 $138.51
92523   Eval of Speech Sound Production with eval of language comprehension and expression SLP (0623) 1 $158.84 $162.53 $148.94 $162.30 $137.79
92524   Behavioral and qualitative analysis of voice and resonance SLP (0623) 1 $158.80 $163.17 $148.73 $162.93 $136.79
92526   Oral function therapy SLP (0623) 1 $116.91 $119.18 $109.73 $119.03 $102.08
92606   Use of non-speech device SLP (0623) 1 $117.10 $119.57 $109.63 $119.30 $101.32
92609   Use of speech device service SLP (0623) 1 $117.10 $119.57 $109.63 $119.30 $101.32
92610   Evaluate swallowing function SLP (0623) 1 $116.94 $119.45 $109.66 $119.26 $101.62
96112 (C) Devel tst phys/qhp 1st hr LP (0580) / LCSW (0560) 1 $145.59 $148.33 $137.32 $148.42 $129.01
96113 (C) Devel tst phys/qhp ea addl LP (0580) / LCSW (0560) 1 $72.80 $74.18 $68.67 $74.22 $64.51
96130 (C) Psycl tst eval phys/qhp 1st LP (0580) / LCSW (0560) 1 $72.61 $73.46 $68.87 $73.64 $65.80
96136 (C) Psycl/nrpsyc tst phy/qhp 1st LP (0580) / LCSW (0560) 1 $145.19 $146.91 $137.72 $147.26 $131.57
96137 (C) Psycl/nrpsyc tst phy/qhp ea LP (0580) / LCSW (0560) 1 $72.61 $73.46 $68.87 $73.64 $65.80
96138 (C) Psycl/nrpsyc tech 1st LP (0580) / LCSW (0560) 1 $147.07 $151.52 $136.45 $150.76 $122.87
96139 (C) Psycl/nrpsyc tst tech ea LP (0580) / LCSW (0560) 1 $73.54 $75.77 $68.23 $75.38 $61.45
97110   Therapeutic exercises, 15 min OT (0621) / PT (0622) 3 $42.43 $43.44 $39.70 $43.35 $37.81
97112   Neuromuscular reeducation, 15 min OT (0621) / PT (0622) 3 $42.66 $43.53 $39.95 $43.44 $37.14
97113   Aquatic therapy/exercises, 15 min OT (0621) / PT (0622) 3 $42.81 $43.85 $39.91 $43.69 $36.48
97116   Gait training therapy, 15 min OT (0621) / PT (0622) 3 $42.67 $43.54 $40.00 $43.46 $37.06
97124   Massage therapy, 15 min OT (0621) / PT (0622) 3 $42.72 $43.86 $39.90 $43.73 $36.53
97129 (B) Ther ivntj 1st 15 min OT (0621) / PT (0622) / SLP (0623) 1 $42.59 $43.32 $40.05 $43.28 $37.47
97130 (B) Ther ivntj ea addl 15 min OT (0621) / PT (0622) / SLP (0623) 2 $42.59 $43.32 $40.05 $43.28 $37.47
97140   Manual therapy, 15 min OT (0621) / PT (0622) 3 $42.67 $43.50 $40.01 $43.41 $37.13
97150   Group therapeutic procedures OT (0621) / PT (0622) 1 $42.59 $43.41 $40.02 $43.38 $37.32
97161 (A) Pt evaluation, low complexity PT (0622) 1 $95.80 $97.70 $89.96 $97.59 $83.72
97162 (A) Pt evaluation, med complexity PT (0622) 1 $127.74 $130.26 $119.95 $130.12 $111.62
97163 (A) Pt evaluation, high complexity PT (0622) 1 $159.67 $162.83 $149.93 $162.64 $139.53
97164 (A) PT re-evaluation, re-defined PT (0622) 1 $95.94 $98.00 $89.87 $97.81 $83.14
97165 (A) Ot evaluation, low complexity OT (0621) 1 $86.37 $88.38 $80.85 $88.18 $74.56
97166 (A) Ot evaluation, med complexity OT (0621) 1 $115.17 $117.83 $107.79 $117.58 $99.41
97167 (A) Ot evaluation, high complexity OT (0621) 1 $143.95 $147.27 $134.74 $146.97 $124.26
97168 (A) OT re-evaluation, re-defined OT (0621) 1 $86.55 $88.67 $80.77 $88.38 $73.97
97530   Therapeutic activities, 15 min OT (0621) / PT (0622) 3 $42.73 $43.65 $39.97 $43.53 $36.86
97533   Sensory integration, 15 min OT (0621) / PT (0622) / SLP (0623) 3 $42.65 $43.44 $40.02 $43.38 $37.25
97535   Self care mngment training, 15 min OT (0621) / PT (0622) 3 $42.72 $43.62 $39.97 $43.52 $36.91
97537   Community/work reintegration, 15 min OT (0621) / PT (0622) 3 $43.44 $44.26 $40.77 $44.19 $34.09
97542   Wheelchair mngment training, 15 min OT (0621) / PT (0622) 8 $45.99 $46.87 $43.15 $46.79 $40.11
97755   Assistive technology assess, 15 min OT (0621) / PT (0622) 6 $42.57 $43.35 $40.04 $43.32 $37.45
* 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.