Rate Codes Carved Out of APGs
- Also available in Excel Format (XLS) and Portable Document Format (PDF)
| Rate Code |
Rate Code Description | Notes |
|---|---|---|
| 1226 | FITTING OF SPECTACLES, MONOFOCAL, BIFOCAL, MULTIFOCAL | No longer carved out -Subsumed into APGs as of 1/1/2011 |
| 1227 | FITTING OF SPECTACLES & EYEGLASS MATERIALS | No longer carved out -Subsumed into APGs as of 1/1/2011 |
| 1228 | Comprehensive Wheelchair Evaluation and Management | Rate Code effective 10/1/2009 |
| 1381 | SBHC Flu Seasonal Vaccines - Administration Only | Rate Code effective 9/1/2009 |
| 1382 | SBHC Flu H1N1 Vaccine - Administration Only | Rate Code effective 9/1/2009 |
| 1383 | SBHC Pneumo, Vaccines - Administration Only | Rate Code effective 9/1/2009 |
| 1604 | MOMS HEALTH SUPPORTIVE SERVICES | |
| 1813 | TB/HIV COUNSELING W/O TESTING - MC CLIENT | |
| 1814 | STD/HIV COUNSELING W/O TESTING - MC CLIENT | |
| 1815 | TB/HIV COUNSELING & TESTING - MC CLIENT | |
| 1816 | STD/HIV COUNSELING & TESTING - MC CLIENT | |
| 1817 | TB/HIV POST TEST NEGATIVE - MC CLIENT | |
| 1818 | STD/HIV POST TEST NEGATIVE - MC CLIENT | |
| 1819 | TB/HIV POST TEST POSITIVE - MC CLIENT | |
| 1820 | STD/HIV POST TEST POSITIVE - MC CLIENT | |
| 1850 | DAY HEALTH CARE SERVICE (HIV) | |
| 2887 | CHILD REHABILITATION | |
| 2961 | AIDS CLINIC, THERAPEUTIC VISIT | |
| 3107 | MONTHLY DIALYSIS SVCS - MEDICARE CROSSOVER | No longer carved out -Subsumed into APGs as of 1/1/2012 |
| 3138 | NEWBORN HEARING SCRNG SVC - 1ST/INITIAL STAGE | Rate Code set to $0 effective 12/1/2009 |
| 3141 | SCREENING FOR ORTHODONTIC TREATMENT | Rate Code set to $0 effective 9/5/2012 |
| 3142 | D & T CS/MMIS TC INTAKE EXAM MANAGED CARE | |
| 3257 | SBHC - Individual Brief Psychotherapy 20-30 min w/ Patient | Rate Code effective 9/1/2009 |
| 3258 | SBHC - Individual Comprehensive Psychotherapy 45-50 min w/ Patient | Rate Code effective 9/1/2009 |
| 3259 | SBHC - Family Psychotherapy with or w/o Patient present | Rate Code effective 9/1/2009 |
| 3260 | SBHC-Individ LMHC/LMFT Service 20-30 min w/patient | Rate Code effective 3/1/2023 |
| 3261 | SBHC-Individ LMHC/LMFT Service 45-50 min w/patient | Rate Code effective 3/1/2023 |
| 3262 | SBHC-Fam Srvcs LMHC/LMFT with or w/o p/t present | Rate Code effective 3/1/2023 |
| 4011 | FQHC GROUP PSYCHOTHERAPY | Carved out for all FQHCs |
| 4012 | FQHC OFF-SITE SERVICES | Carved out for all FQHCs |
| 4013 | FQHC INDIVIDUAL THRESHOLD VISIT[1] | Carved out only for FQHCs that opted out of APGs |
| 4222 | Individ LMHC/LMFT Services 20-30 min w/patient | Rate Code effective 3/1/2023 |
| 4223 | Individ LMHC/LMFT Services 45-50 min w/patient | Rate Code effective 3/1/2023 |
| 4224 | Family Srvcs LMHC/LMFT with or w/o p/t present | Rate Code effective 3/1/2023 |
| 4257 | Clinics - Individual Brief Psychotherapy 20-30 min w/ Patient | Rate Code effective 9/1/2009 |
| 4258 | Clinics - Individual Comprehensive Psychotherapy 45-50 min w/ Patient | Rate Code effective 9/1/2009 |
| 4259 | Clinics - Family Psychotherapy with or w/o Patient present | Rate Code effective 9/1/2009 |
| 5246 | Collaborative Care Monthly Case Payment - Year 1 | Rate Code effective 1/1/2015 |
| 5247 | Collaborative Care Monthly Case Payment - Year 2 | Rate Code effective 1/1/2015 |
| 5248 | Collaborative Care retainage - Year 1 | Rate Code effective 1/1/2015 |
| 5249 | Collaborative Care retainage - Year 2 | Rate Code effective 1/1/2015 |
| 5301 | MEDICAL EVALUATION SSHSP | |
| 5312 | TB/DIRECTLY OBSERVED THERAPY - DNST LVL 1 | |
| 5313 | TB/DIRECTLY OBSERVED THERAPY - DNST LVL 2 | |
| 5317 | TB/DIRECTLY OBSERVED THERAPY - UPST LVL 1 | |
| 5318 | TB/DIRECTLY OBSERVED THERAPY - UPST LVL 2 | |
| 5388 | PRESCHOOL SUPPORTIVE HEALTH PROGRAM - IEP | |
| 5389 | SCHOOL-AGE SUPPORTIVE HEALTH PROGRAM - IEP |
