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Last modified
7/19/2018 2:54:55 PM
Creation date
7/19/2018 2:53:27 PM
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Resolutions
Resolution Number
2018-066
Approved Date
07/17/2018
Agenda Item Number
9.A.
Resolution Type
Fees
Entity Name
Florida Department of Health (DOH) in Indian River
Subject
2018/2019 Fee Schedule
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INDIAN RNER COUNTY HEALTH DEPARTMENT <br />FEE SCHEDULE - <br />Fen shall be no lees then the Medklad Fee4w -8ervice reimbursement and no BrNbrtim the Medkan reimbursement rate plus fill <br />In effect at the time of service, comparable reimbursement rates If no such rates are available. <br />n..* .,f r -...h, Patient Fees- Patients will he assessed at inn-/. of Siidinn Fee Scala <br />VISIT DESCRIPTION E/M CODES <br />0% -A <br />17% - B <br />33% - C 50% - D <br />67% - E <br />83%- F <br />100%- G <br />Cy 18-19 Fee <br />$0.00 <br />$20.86 <br />Medical Visit <br />- New Patient <br />$82.22 <br />$101.85 <br />$122.71 .NO <br />CHANGE <br />99201 Level One <br />$0.00 <br />$8.37 <br />$16.26 <br />$24.63 <br />$33.00 <br />$40.89 <br />$49.26 <br />NO CHANGE <br />99202 Level Two <br />$0.00 <br />$14.191 <br />$27.54 i <br />$41.731 <br />$55.91 ' <br />$69.26 <br />$83.45 <br />JiO CHANGE <br />99203 Level Three <br />$0.00 <br />$20.73 <br />$40.24 <br />$60.971 <br />$81.70 <br />$101.21 <br />$121.94 <br />00CHANGE <br />99204 Level Four <br />$0.00 <br />$31.65 <br />$61.44 <br />$93.10 <br />$124.75 <br />$154.54 <br />$186.19 <br />O CHANGE <br />99201 TD Nurse Protocol <br />$0.00 <br />$3.86 <br />$7.49 <br />$11.361 <br />$15,22 <br />$18.85 <br />$22.71 <br />O CHANGE <br />$0.001 <br />$28.59 <br />Medical Visit - Established Patient <br />$84.09 <br />$112.67 <br />$139.58 <br />$168.17 <br />V O CHANGE <br />99211 Level One <br />$0.00 <br />$3.86 <br />$7.49 <br />$11.36 <br />$15.22 <br />$18.85 <br />$22.71 <br />NO CHANGE <br />_ _ <br />99212 Level Two <br />$0.001 <br />$8.37 <br />$16.26 <br />$24.63 <br />$33.00 <br />$40.89 <br />$49.26 <br />NO CHANGE <br />99213 Level Three <br />$0.001 <br />$13.79 <br />$26.76 <br />$40.55 <br />$54.34 <br />$67.31 <br />$81.10 <br />O CHANGE <br />99214 Level Four <br />$0.00 <br />$20.22 <br />$39.24 <br />$59.46 <br />$79.68 <br />$98.70 <br />$118.92 <br />O CHANGE <br />99211 TD Nurse Protocol <br />$0.00 <br />_ <br />$3.86 <br />$7.49 <br />$11.36 <br />$15.22 I <br />$18.8sl <br />$22.71 IND <br />CHANGE <br />Lab fees will be charged in addition to office visits on a sliding fee scale. <br />Well Child Visit 0-1 <br />- Well Chid Visit 1-4 <br />- Well Child Visits 5-11 <br />- <br />Well Child Visit 12-17 <br />EP - Well Child Visit 1840 <br />- Adult Scr 21-39 yrs <br />Adult Scr 40-64 yrs <br />- Adult Scr 65> yrs <br />Well Child Vbk 0-1 <br />- Well Chid Visit 1-4 <br />1- Well Child Visits 5-11 <br />I - Well Child Visit 12-17 <br />i EP - Well Child Visit 18-20 <br />i - Adult Scr 21-39 yrs <br />i - Adult Scr 40-64 yrs <br />F - Adult Scr 65> yrs <br />icaid "Child Health Check -Up" and routine physical Includes applicable In-house laboratory services. <br />be established Primary arc Patient to receive Physical on sliding fee sale. <br />Palle 1 of 7 7/11/2018 <br />Physicals - New Patient <br />$0.00 <br />$20.86 <br />$40.49 <br />$61.36 <br />$82.22 <br />$101.85 <br />$122.71 .NO <br />CHANGE <br />$0.00 <br />$21.61 <br />$41.94 <br />$63.55 <br />$85.16 <br />$105.49 <br />$127.10 <br />O CHANGE <br />$0.00 <br />$22.53 <br />$43.73 <br />$66.27 <br />$88.80 <br />$110.00 <br />$132.53 <br />NO CHANGE <br />$0.00 <br />$25.50 <br />$49.49 <br />$74.99 <br />$100.49 <br />$124.48 <br />$149.98 <br />NO CHANGE <br />$0.00 <br />$24.82 <br />$48.17 <br />$72.99 <br />$97.81 <br />$121.16 <br />$145.98 <br />NO CHANGE <br />$0.00 <br />$24.82 <br />$48.17 <br />$72.99 <br />$97.81 <br />$121.16 <br />$145.98 <br />O CHANGE <br />$0.001 <br />$28.59 <br />$55.50 <br />$84.09 <br />$112.67 <br />$139.58 <br />$168.17 <br />V O CHANGE <br />$0.00 <br />$31.161 <br />$60.48 <br />$91.64 <br />$122.80 <br />$1S2.121 <br />$183.28 <br />%0 CHANGE <br />Physicals - Established Patient <br />$0.00 <br />$_18.72 <br />$36.34 <br />$55.07_ <br />$73.79 <br />$91.41 <br />$110.13 <br />NO CHANGE <br />$0.00 <br />$19.96 <br />$38.74 <br />$58.70 <br />$78.66 <br />$97.44 <br />$117.40 <br />NO CHANGE <br />$0.00 <br />$19.89 <br />$38.62 <br />$58.51 <br />$78.40 <br />$97.13 <br />$117.02 <br />NO CHANGE <br />$0.00 <br />$21.69 <br />$42.11 <br />$63.81 <br />$85.50 <br />$105.92 <br />$127.61 <br />NO CHANGE <br />$0.00 <br />$22.13 <br />$42.95 <br />$65.08 <br />$87.21 <br />$108.03 <br />$130.16 <br />O CHANGE <br />$0.00 <br />$22.13 <br />$42.95 <br />$65.08 <br />$87.21 <br />$108.03 <br />$130.16 <br />NO CHANGE <br />$0.00 <br />$23.67 <br />$45.95 <br />$69.62 <br />$93.29 <br />$115.57 <br />$139.24 <br />NO CHANGE <br />$0.00 <br />$2S.S6 <br />$49.62 <br />$75.18 <br />$100.74 <br />$124.80 <br />$150.36 <br />O CHANGE <br />icaid "Child Health Check -Up" and routine physical Includes applicable In-house laboratory services. <br />be established Primary arc Patient to receive Physical on sliding fee sale. <br />Palle 1 of 7 7/11/2018 <br />
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