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Commissioner Approved Fee Schedule - FY 2016-17 ATTACHMENT 4 <br /> 49 <br /> Approved Fee Change for Last <br /> Department/Program Description Current Fee FY 2016-17 Revision <br /> Recoding Consultant Services Health Educators $20.00/hr 2010 <br /> Recoding Patient Education in.Physician) $35.00/wit 2012 <br /> Recoding Health Risk Appraisal $12.00 2004 <br /> 82465 W Cholesterol $11.00 2011 <br /> 82947 W Glucose Random $18.00 2006 <br /> 82950 W O'Sullivan $28.00 2007 <br /> 82951 W OGTT 3 HR $50.00 2006 <br /> 83036 W Hemo lobin AlC $21.00 2006 <br /> 85018 W Hemoglobin $11.00 2009 <br /> 88175-90 Pap,Thin Pre State Lab $18.38 2012 <br /> D0145 Oral Evaluation<3 yrs with counseling $55.00 2012 <br /> D 1206 Topical Fluoride A l $47.00 2012 <br /> Recede Em to ee Varicella Titer(UNC Lab $78.00 2009 <br /> Recede Employee Measles Rubeola Titer $48.00 2009 <br /> Recede Employee Mumps Titer $50.00 2009 <br /> Recede Employee Rubella Titer $75.00 2009 <br /> G0008 Adm of Influenza Vaccine $18.00 2009 <br /> G0008 Admin.Influenza Vaccine-Medicare $18.00 2009 <br /> G0009 Adm ofPneumococcal Vaccine $18.00 2009 <br /> G0009 Admin.Pneumococcal Vaccine-Medicare $18.00 2009 <br /> G0108 DSME/DSMT Individual Assessment $22.00 2010 <br /> G0109 DSME/DSMT Group Class $12.00 2010 <br /> G0270 Additional MD requested MNT indiv-Medicare $25.00 2010 <br /> G0271 Additional MD requested MNT group-Medicare $13.00 2010 <br /> H0001 Alcohol and/or drug assessment $20.00 2015 <br /> H0031 Mental Health assessment by non-h sicaian $22.00 2015 <br /> J1055 De o Provers Injection $40.00 $25.30 2012 <br /> J1050 Injection medroxyprogesterone acetate lm $0.67 2015 <br /> J1725 Injection medroxyprogeatuone ca roate 1 m $3.00 2015 <br /> J1200 1 Di henh dramine HCL/Bwadryl up to 50mg $6.00 2009 <br /> J2550 Promethazlne m $8.00 2009 <br /> J2790 Rho am Injection $88.00 2012 <br /> J3420 B-12 Injection $6.00 2009 <br /> J3490 17 AI ha-h drox ro esterone $21.00 2012 <br /> J7300 Para and IUD $390.00(5) $233.34 2012 <br /> J7301 S la IUD $726.00(5) $488.00 2015 <br /> J7302 Mirena IUD $745.23 5 $297.46 2014 <br /> J7303 Nuvaring $57.00 2008 <br /> J7307 Im lanon $698.99(5) $364.00 2014 <br /> JO696 Ceftriaxone Sodium/Roce hin per 250m $22.00 2008 <br /> Recoded Sports Physical $44.00 2008 <br /> Receded Camp Physical $44.00 2009 <br /> Reeoded College Ph sical $44.00 2009 <br /> Reeoded I-693 Form $0.00 2015 <br /> Reeoded Prim Cue Minimum Fee $20.00 2012 <br /> Reeoded MNT Minimum Fee $20.00 2012 <br /> Reeoded Adult Medicaid Co-pay $3.00 2010 <br /> 54993 Oral Contraceptive Pills $5.00 2012 <br /> 59465 Diabetic enumt ro am dietitian visit $35.00 2011 <br /> 59470 Nutritional counsel' dietitian visit $35.00 2011 <br /> T1002 RN Services u to 15 min $21.00 2005 <br /> 59442 Birthin classes 8.69/1 hr block 2013 <br /> 90714 TD Vaccin 1$35.00 1 2013 <br /> * Any fee changes wi I I be included in this column; <br /> a blank beside each fee means there is no fee change in FY 2016-17 Manager Recommended Fee Schedule <br />