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Reimbursement Rates for Some Family Planning Procedure Codes Will Change for Texas Medicaid

Information posted August 26, 2010

Effective for dates of service on or after October 1, 2010, reimbursement rates for the following family planning services procedure codes will change: The Family Planning Reimbursement Rate Table begins on the following page. Providers can also refer to the static fee schedule and Online Fee Lookup (OFL) for the latest reimbursement rates. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. For more information, call the TMHP Contact Center at 1-800-925-9126.

Family Planning Medicaid Relative Value Unit Conversion Reimbursement Rate (RVU) Factor Eff 10-1-10 6.00 $23.220 $139.32 6.00 $19.580 $117.48 4.00 $19.830 $79.32 4.00 $18.420 $73.68 2.09 $27.276 $57.01 2.68 $27.276 $73.10 4.67 $27.276 $127.38 0.27 $27.276 $7.36 9.64 $28.640 $276.09 9.64 $27.276 $262.94 9.31 $28.640 $266.64 9.31 $27.276 $253.94 1.37 $28.640 $39.24 1.37 $27.276 $37.37 1.43 $28.640 $40.96 1.43 $27.276 $39.00 1.43 $27.276 $39.00 1.91 $27.276 $52.10 1.91 $28.640 $54.70 1.91 $27.276 $52.10 1.58 $28.640 $45.25 1.58 $27.276 $43.10 45.22 $28.640 $1,295.10 45.22 $27.276 $1,233.42 NA NA $335.95 NA NA $319.95 10.02 $28.640 $286.97 10.02 $27.276 $273.31 10.02 $28.640 $286.97 10.02 $27.276 $273.31 1.61 $28.640 $46.11 1.61 $27.276 $43.91 9.05 $28.640 $259.19 9.05 $27.276 $246.85 1.45 $28.640 $41.53 1.45 $27.276 $39.55 2.18 $28.640 $62.44 2.18 $27.276 $59.46 0.35 $28.640 $10.02 0.35 $27.276 $9.55 6.70 $28.640 $191.89 6.70 $27.276 $182.75 1.08 $28.640 $30.93 1.08 $27.276 $29.46 17.90 $28.640 $512.66 17.90 $27.276 $488.24

Type of Service (TOS)* 7 7 7 7 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 2 2 8 8 2 2 8 8 2 2 8 8 2 2 8 8 2 2

Procedure Provider Age Code Type Range 00851 0-20 00851 21-999 00952 0-20 00952 21-999 11975 0-999 11976 0-999 11977 0-999 36410 0-999 55250 0-20 55250 21-999 55450 0-20 55450 21-999 57170 0-20 57170 21-999 58300 0-20 58300 21-999 58300 71 0-999 58301 71 0-999 58301 0-20 58301 21-999 58340 0-20 58340 21-999 58565 0-20 58565 21-999 58565 0-20 58565 21-999 58600 0-20 58600 21-999 58600 0-20 58600 21-999 58600 0-20 58600 21-999 58605 0-20 58605 21-999 58605 0-20 58605 21-999 58611 0-20 58611 21-999 58611 0-20 58611 21-999 58615 0-20 58615 21-999 58615 0-20 58615 21-999 58661 0-20 58661 21-999

Family Planning Medicaid Relative Value Unit Conversion Reimbursement Rate (RVU) Factor Eff 10-1-10 17.90 $27.276 $488.24 2.87 $28.640 $82.20 2.87 $27.276 $78.28 2.86 $27.276 $78.01 10.05 $28.640 $287.83 10.05 $27.276 $274.12 10.04 $28.640 $287.55 10.04 $27.276 $273.85 21.51 $28.640 $616.05 21.51 $27.276 $586.71 3.45 $28.640 $98.81 3.45 $27.276 $94.10 19.98 $28.640 $572.23 19.98 $27.276 $544.97 3.20 $28.640 $91.65 3.20 $27.276 $87.28 3.54 $28.640 $101.39 3.54 $27.276 $96.56 0.61 $28.640 $17.47 0.61 $27.276 $16.64 0.25 $28.640 $7.16 0.25 $27.276 $6.82 0.36 $28.640 $10.31 0.36 $27.276 $9.82 0.95 $28.640 $27.21 0.95 $27.276 $25.91 0.31 $28.640 $8.88 0.31 $27.276 $8.46 0.64 $28.640 $18.33 0.64 $27.276 $17.46 1.96 $28.640 $56.13 1.96 $27.276 $53.46 0.51 $28.640 $14.61 0.51 $27.276 $13.91 1.45 $28.640 $41.53 1.45 $27.276 $39.55 3.16 $28.640 $90.50 3.16 $27.276 $86.19 0.94 $28.640 $26.92 0.94 $27.276 $25.64 2.22 $28.640 $63.58 2.22 $27.276 $60.55 3.14 $28.640 $89.93 3.14 $27.276 $85.65 0.94 $28.640 $26.92 0.94 $27.276 $25.64

Type of Service (TOS)* 2 8 8 8 2 2 2 2 2 2 8 8 2 2 8 8 2 2 4 4 I I T T 4 4 I I T T 4 4 I I T T 4 4 I I T T 4 4 I I

Procedure Provider Age Code Type Range 58661 71 0-999 58661 0-20 58661 21-999 58661 71 0-999 58670 0-20 58670 21-999 58671 0-20 58671 21-999 58700 0-20 58700 21-999 58700 0-20 58700 21-999 58720 0-20 58720 21-999 58720 0-20 58720 21-999 64435 0-20 64435 21-999 74000 0-20 74000 21-999 74000 0-20 74000 21-999 74000 0-20 74000 21-999 74010 0-20 74010 21-999 74010 0-20 74010 21-999 74010 0-20 74010 21-999 74740 0-20 74740 21-999 74740 0-20 74740 21-999 74740 0-20 74740 21-999 76830 0-20 76830 21-999 76830 0-20 76830 21-999 76830 0-20 76830 21-999 76856 0-20 76856 21-999 76856 0-20 76856 21-999

Family Planning Medicaid Relative Value Unit Conversion Reimbursement Rate (RVU) Factor Eff 10-1-10 2.20 $28.640 $63.01 2.20 $27.276 $60.01 2.40 $28.640 $68.74 2.40 $27.276 $65.46 0.52 $28.640 $14.89 0.52 $27.276 $14.18 1.88 $28.640 $53.84 1.88 $27.276 $51.28 3.60 $28.640 $103.10 3.60 $27.276 $98.19 0.79 $28.640 $22.63 0.79 $27.276 $21.55 2.81 $28.640 $80.48 2.81 $27.276 $76.65 NA NA $10.00 NA NA $10.00 NA NA $10.00 NA NA $50.84 NA NA $1,230.00 NA NA $34.11 NA NA $0.54 NA NA $2.83 NA NA $12.26 NA NA $11.46 NA NA $11.46 NA NA $10.91 NA NA $10.91 NA NA $6.83 NA NA $419.90 NA NA $705.00 NA NA $56.85 NA NA $21.26 NA NA $607.19

Type of Service (TOS)* T T 4 4 I I T T 4 4 I I T T 1 1 1 9 9 9 1 1 1 1 1 1 1 1 1 1 1 1 1

Procedure Provider Age Code Type Range 76856 0-20 76856 21-999 76857 0-20 76857 21-999 76857 0-20 76857 21-999 76857 0-20 76857 21-999 76880 0-20 76880 21-999 76880 0-20 76880 21-999 76880 0-20 76880 21-999 99000 0-20 99000 21-999 99001 0-999 A4261 0-999 A4264 0-999 A4266 0-999 A4267 0-999 A4268 0-999 A4269 0-999 H1010 0-20 H1010 71 0-20 H1010 21-999 H1010 71 21-999 J1000 0-999 J7300 0-999 J7302 0-999 J7303 0-999 J7304 0-999 J7307 0-999

*Type of Service (TOS): 1 = Medical, 2 = Surgery, 4 = Radiology, 7 = Anesthesia, 8 = Assistant Surgery, 9 = durable medical equipment, I = Interpretation (Professional Component), T = Technical Component *Provider Type: 71 = Family Planning Clinic **Relative Value Unit (RVU)

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Reimbursement Rates for Some Family Planning Procedure Codes Will Change for Texas Medicaid

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