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Commissioner Approved Fee Schedule- FY 2017-18 ATTACHMENT 4 42 <br /> Commissioner Approved <br /> Fee Change for Last <br /> De artment/Pro ram Description Current Fee FY 2017-18* Revision <br /> Recode Em to Measles ubeola Titer $48.00 2009 <br /> Recode Em to Mmn s Titer $50.00 2009 <br /> Recode Em to Rubella Titer $75.00 2009 <br /> G0008 Adm ofhdluenaa Vaceine $18.00 2009 <br /> G0008 Admire Influetva Vaceine-Medicare $18.00 2009 <br /> G0009 AdmofPnecanoceccal Vacs- $18.00 2009 <br /> G0009 Admire Pnemnococcal Vaceme-Medicare $18.00 2009 <br /> G0108 DSMEJDSMT hxh dual 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 nested MNT u -Medicate $13.00 2010 <br /> H0001 Alcohol and/or dm assessment $20.00 2015 <br /> H0031 Mental Health assessment,b rnn-h icaian $22.00 2015 <br /> J1055 D Proveraldection $25.30 2016 <br /> J1050 Injection medro ro estetow acetate 1 m $0.67(12) $0.16 2015 <br /> Medicaid only J1050ud Infection,medroacyprogesterone acetate,1 mg $0.18(12) $0.16 NEW <br /> J1725 Injection,coedroxyprogesterone roate,1 rag $3.00 2015 <br /> J 1200 Di henh draroine HCL/Ben I to 50m $6.00 2009 <br /> J2550 Promethaane m $8.00 2009 <br /> J2790 Rho Injection $88.00 2012 <br /> J3420 B-12 Injection $6.00 2009 <br /> J3490 17 Alpha-hydroxprogesterone $21.00 2012 <br /> J7300 Par and IUD $233.34(12) $264.43 2016 <br /> Medicaid only J7300ud Para and IUD $233.34 12 $264.43 NEW <br /> J730 1 Skyla IUD $488.00 12 $235.00 2016 <br /> Medicaid only J7301ud Sk Ia IUD $207.72 12 $235.00 NEW <br /> J7298 Mirena RlD $297.46 12 $235.00 2016 <br /> Medicaid only J7298ud Mire-IUD $207.72 1 $235.00 NEW <br /> J7303 Nwarin (3 pack) $57.00 12 2 $27.92 2008 <br /> J7307 Nexplanon $364.00 12 $399.00 2016 <br /> Medicaid only J7307ud Ng lanon $364.00 12 $399.00 NEW <br /> JO696 CeBriaxone Sdium/Rcephin pec 250.g $22.00 2008 <br /> Recoiled Sports Physical $44.00 2008 <br /> Recoded C-P Physical $44.00 2009 <br /> Recoiled Colle ePh ical $44.00 2009 <br /> Recoiled 1-693 Form $0.00 2015 <br /> Recaded Pricnary Care Minimum Fee $20.00 2012 <br /> Recaded I MNT Mini-Fee $20.00 2012 <br /> Recoiled Adult Medicaid Co-a $3.00 2010 <br /> 54993 Oral Co. five Pills $2.00 2012 <br /> 59465 Diabetic ement ro am diettan visit $35.00 2011 <br /> 59470 Nutrifionalceunselin dietitian visit $35.00 2011 <br /> T1002 RN Services a to 15 min $21.00 2005 <br /> 59442 "itthing classes 8.69/1 hr block 2013 <br /> 90714 TD Vaccine $35.00 2013 <br /> 2037 Fluvirin V-.2 $31.00 2015 <br /> 2038 Flumne 3 &1 IM $40.00 2015 <br /> 50280 !PMHRUS-ig $50.00 2015 <br /> '*UNC and State Lab Fees in BOLD are established by reference lab and not b OCHD <br /> ""No Code and Recode" resent local use codes that can be billed however are rot recd ized b ICD-10. <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 2017-18 Commissioner Approved Fee Schedule <br />