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Manager Recommended Fee Schedule - FY 2022-23 51 <br /> Last <br /> Department/Program Description Current Fee Revision <br /> 94150 Peak Flow $3.25 2018 <br /> 94640 Airway Inhalation Treatment $22.00 2009 <br /> 94664 Aerosol Inhalation Treatment-Teaching $22.00 2009 <br /> 94760 Pulse Oxygen $8.00 2009 <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 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 /> 99212 Estab Office/Outpt Tx Prob Focused E&M $100.00 2012 <br /> 99213 Estab Office/Outpt Tx Expanded Focused E&M $150.00 2012 <br /> 99214 Estab Office/Outpt Tx Detailed E&M $225.00 2012 <br /> 99215 Estab Office/Outpt Tx Comprehensive E&M $305.00 2012 <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 /> 99385 Preventive/New Pt 18-39 yrs. $235.00 2012 <br /> 99386 Preventive/New Pt 40-64 yrs. $267.00 2009 <br /> 99387 Preventive/New Pt 65+yrs. $242.00 2008 <br /> 99391 Preventive/Estab Pt<1 yr. $225.00 2012 <br /> 99392 Preventive/Estab Pt 1-4 yrs. $225.00 2012 <br /> 99393 Preventive/Estab Pt 5-11 yrs. $200.00 2012 <br /> 99394 Preventive/Estab Pt 12-17 yrs. $205.00 2012 <br /> 99395 Preventive/Estab Pt 18-39 yrs. $225.00 2012 <br /> 99396 Preventive/Estab Pt 40-64 yrs. $220.00 2012 <br /> 99397 Preventive/Estab Pt 65+yrs. $212.00 2004 <br /> 99401 Covid Counseling-Preventive Medicine Counseling, <br /> 15 min. $45.00 2022 <br /> 99406/G0436 Tobacco Use Cessation Counseling-(3-10 min) $13.00 2015 <br /> 99407/G0437 Tobacco Use Cessation Counseling-(10+min) $32.00 2015 <br /> 99408/G0396 ETOH&Substance Abuse Screening(15-30 min) $35.00 2018 <br /> 99409/G0397 ETOH&Substance Abuse Screening(30+min) $67.00 2018 <br /> 99441 Telephone Evaluation 5-10 min $15.00 2021 <br /> 99442 Telephone Evaluation 11-20 min $25.00 2021 <br /> 99443 Telephone Evaluation 21-30 min $30.00 2021 <br /> 99499 IDOT Physical $100.00 2019 <br />