Mental Hygiene Services Fees

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

Fees Effective 4/1/2025

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 $186.26 $188.61 $176.59 $189.02 $168.39
90832   Psytx, 30 min LP (0580)/ LCSW (0560) 1 $111.70 $113.04 $105.98 $113.31 $101.27
90834   Psytx, 45 min LP (0580)/ LCSW (0560) 1 $148.91 $150.52 $141.38 $150.90 $135.39
90837   Psytx, 60 min LP (0580)/ LCSW (0560) 1 $206.30 $208.75 $195.78 $209.29 $187.16
90846   Family psytx w/o patient LP (0580) / LCSW (0560) 1 $111.69 $112.90 $106.02 $113.18 $101.49
90847   Family psytx w/patient LP (0580) / LCSW (0560) 1 $223.42 $226.31 $211.92 $226.85 $202.17
90853   Group psychotherapy LP (0580) / LCSW (0560) 1 $57.75 $58.49 $54.74 $58.61 $52.19
92507   Speech/hearing therapy SLP (0623) 1 $119.87 $122.12 $112.63 $122.00 $105.05
92508   Speech/hearing therapy SLP (0623) 1 $35.03 $35.77 $32.81 $35.70 $30.36
92521   Eval of Speech Fluency SLP (0623) 1 $162.92 $166.35 $152.94 $166.15 $142.10
92522   Eval of Speech Sound Production SLP (0623) 1 $162.92 $166.34 $152.95 $166.12 $142.11
92523   Eval of Speech Sound Production with eval of language comprehension and expression SLP (0623) 1 $162.97 $166.76 $152.81 $166.52 $141.37
92524   Behavioral and qualitative analysis of voice and resonance SLP (0623) 1 $162.92 $167.41 $152.60 $167.16 $140.34
92526   Oral function therapy SLP (0623) 1 $119.95 $122.28 $112.59 $122.12 $104.74
92606   Use of non-speech device SLP (0623) 1 $120.15 $122.68 $112.48 $122.40 $103.96
92609   Use of speech device service SLP (0623) 1 $120.15 $122.68 $112.48 $122.40 $103.96
92610   Evaluate swallowing function SLP (0623) 1 $119.98 $122.55 $112.51 $122.37 $104.26
96112 (C) Devel tst phys/qhp 1st hr LP (0580) / LCSW (0560) 1 $149.37 $152.19 $140.89 $152.28 $132.36
96113 (C) Devel tst phys/qhp ea addl LP (0580) / LCSW (0560) 1 $74.69 $76.11 $70.45 $76.15 $66.19
96130 (C) Psycl tst eval phys/qhp 1st LP (0580) / LCSW (0560) 1 $74.49 $75.37 $70.66 $75.56 $67.51
96136 (C) Psycl/nrpsyc tst phy/qhp 1st LP (0580) / LCSW (0560) 1 $148.96 $150.73 $141.30 $151.09 $134.99
96137 (C) Psycl/nrpsyc tst phy/qhp ea LP (0580) / LCSW (0560) 1 $74.49 $75.37 $70.66 $75.56 $67.51
96138 (C) Psycl/nrpsyc tech 1st LP (0580) / LCSW (0560) 1 $150.89 $155.46 $139.99 $154.68 $126.07
96139 (C) Psycl/nrpsyc tst tech ea LP (0580) / LCSW (0560) 1 $75.45 $77.74 $70.01 $77.34 $63.05
97110   Therapeutic exercises, 15 min OT (0621) / PT (0622) 3 $43.54 $44.57 $40.73 $44.47 $38.79
97112   Neuromuscular reeducation, 15 min OT (0621) / PT (0622) 3 $43.77 $44.66 $40.99 $44.57 $38.11
97113   Aquatic therapy/exercises, 15 min OT (0621) / PT (0622) 3 $43.92 $44.99 $40.94 $44.82 $37.43
97116   Gait training therapy, 15 min OT (0621) / PT (0622) 3 $43.78 $44.67 $41.04 $44.59 $38.02
97124   Massage therapy, 15 min OT (0621) / PT (0622) 3 $43.83 $45.00 $40.93 $44.87 $37.47
97129 (B) Ther ivntj 1st 15 min OT (0621) / PT (0622) / SLP (0623) 1 $43.70 $44.45 $41.10 $44.40 $38.44
97130 (B) Ther ivntj ea addl 15 min OT (0621) / PT (0622) / SLP (0623) 2 $43.70 $44.45 $41.10 $44.40 $38.44
97140   Manual therapy, 15 min OT (0621) / PT (0622) 3 $43.78 $44.64 $41.05 $44.54 $38.09
97150   Group therapeutic procedures OT (0621) / PT (0622) 1 $43.70 $44.54 $41.06 $44.51 $38.29
97161 (A) Pt evaluation, low complexity PT (0622) 1 $98.29 $100.24 $92.30 $100.12 $85.90
97162 (A) Pt evaluation, med complexity PT (0622) 1 $131.06 $133.65 $123.07 $133.50 $114.53
97163 (A) Pt evaluation, high complexity PT (0622) 1 $163.82 $167.06 $153.82 $166.87 $143.16
97164 (A) PT re-evaluation, re-defined PT (0622) 1 $98.43 $100.54 $92.20 $100.36 $85.30
97165 (A) Ot evaluation, low complexity OT (0621) 1 $88.62 $90.67 $82.95 $90.47 $76.50
97166 (A) Ot evaluation, med complexity OT (0621) 1 $118.16 $120.89 $110.59 $120.64 $101.99
97167 (A) Ot evaluation, high complexity OT (0621) 1 $147.69 $151.10 $138.24 $150.79 $127.49
97168 (A) OT re-evaluation, re-defined OT (0621) 1 $88.80 $90.98 $82.87 $90.67 $75.90
97530   Therapeutic activities, 15 min OT (0621) / PT (0622) 3 $43.84 $44.79 $41.01 $44.66 $37.81
97533   Sensory integration, 15 min OT (0621) / PT (0622) / SLP (0623) 3 $43.76 $44.57 $41.06 $44.51 $38.22
97535   Self care mngment training, 15 min OT (0621) / PT (0622) 3 $43.83 $44.75 $41.01 $44.65 $37.87
97537   Community/work reintegration, 15 min OT (0621) / PT (0622) 3 $44.57 $45.41 $41.83 $45.34 $34.97
97542   Wheelchair mngment training, 15 min OT (0621) / PT (0622) 8 $47.18 $48.09 $44.27 $48.01 $41.15
97755   Assistive technology assess, 15 min OT (0621) / PT (0622) 6 $43.68 $44.47 $41.08 $44.45 $38.42
* 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.