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Commissioner Approved Fee Schedule - FY 2019-20 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2019-20 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2019-20* <br />Last <br />Revision <br />96110 Developmental Test $23.00 2012 <br />96125 ASQ - Developmental $78.38 2018 <br />96127 Social-emotional Screens $6.00 2017 <br />96152 Health & Behavior Intervention $55.00 2015 <br />96160 Adolescent Risk & Strength Screening $9.20 2017 <br />96161 Maternal Depression Screening $9.20 2017 <br />96372 Ther/Proph/Diag inj/SC/IM $60.00 2012 <br />97802 Medical Nutrition Therapy/Initial 15 min. Unit $34.00 2015 <br />97803 Medical Nutrition Therapy/Re-Assess 15 min. Unit $34.00 2016 <br />97804 Medical Nutrition Therapy-Group (2 or more)$15.00 2011 <br />97804ud MDPP Fee $25.00 2017 <br />99000 Lab: Handling Fee $11.00 2009 <br />99070 Special Supplies $18.00 2009 <br />99080 Screening Form Completion $0.00 2018 <br />99173 Vision $7.00 2009 <br />99175 Induction of Vomiting $67.00 2009 <br />99201 New Office/Outpt Tx Brief E&M $110.00 2009 <br />99202 New Office/Outpt Tx Expanded Prob Focused <br />E&M $165.00 2009 <br />99203 New Office/Outpt Tx Detailed E&M $200.00 2009 <br />99204 New Office/Outpt Tx Moderate Complex E&M $335.00 2009 <br />99205 New Office/Outpt Tx High Complex E&M $405.00 2009 <br />99211 Estab Offic/Outpt Tx Brief E&M $60.00 2012 <br />Medicaid only 99211OB Estab Offic/Outpt Tx Brief E&M $0.00 2017 <br />99212 Estab Office/Outpt Tx Prob Focused E&M $100.00 2012 <br />Medicaid only 99212OB Estab Office/Outpt Tx Prob Focused E&M $0.00 2017 <br />99213 Estab Office/Outpt Tx Expanded Focused E&M $150.00 2012 <br />Medicaid only 99213OB Estab Office/Outpt Tx Expanded Focused E&M $0.00 2017 <br />99214 Estab Office/Outpt Tx Detailed E&M $225.00 2012 <br />Medicaid only 99214OB Estab Office/Outpt Tx Detailed E&M $0.00 2017 <br />99215 Estab Office/Outpt Tx Comprehensive E&M $305.00 2012 <br />Medicaid only 99215OB Estab Office/Outpt Tx Comprehensive E&M $0.00 2017 <br />99381 Preventive/New Pt < 1 yr.$255.00 2012 <br />99382 Preventive/New Pt 1-4 yrs.$270.00 2012 <br />99383 Preventive/New Pt 5-11 yrs.$275.00 2012 <br />99384 Preventive/New Pt 12-17 yrs.$235.00 2012 <br />70