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Manager Recommended Fee Schedule - FY 2022-23 52 <br /> Last <br /> Department/Program Description Current Fee Revision <br /> 99501 Home Visit Postpartum $200.00 2015 <br /> 99502 Home Visit Newborn $200.00 2015 <br /> D0145 Oral Evaluation<3 yrs with counseling $55.00 2012 <br /> D 1206 Topical Fluoride Appl $47.00 2012 <br /> G0008 Admin.Influenza Vaccine-Medicare $18.00 2009 <br /> G0009 Admin.Pneumococcal Vaccine-Medicare $18.00 2009 <br /> G0010 Hep B.-Admin.-Medicare $18.00 2015 <br /> 2015 DSME Minimum Fee $20.00 2015 <br /> G0108 DSME/DSMT Individual Assessment-Medicare $52.00 2015 <br /> G0109 DSME/DSMT Group Class-Medicare $17.00 2015 <br /> G0270 Additional MD requested MNT indiv-Medicare $25.00 2010 <br /> G0271 <br /> 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-physician $22.00 2015 <br /> J0696 Ceftriaxone Sodium/Rocephin per 250mg $22.00 2008 <br /> J1050 Medroxyprogesterone acetate, 1 mg(150 units) $0.87 2022 <br /> Medicaid only J1050ud Medroxyprogesterone acetate, 1 mg(150 units) $0.87 2022 <br /> J1200 Diphenhydramine HCLBenadryl up to 50mg $6.00 2009 <br /> Injection hydroxyprogesterone caproate, 1 mg(250 <br /> J1725 units) $3.00 2015 <br /> J1885 Ketorolac IM Injection,per 15m (Toradol) $20.00 2022 <br /> J2550 Promethazine m $8.00 2009 <br /> J2790 Rho am Injection $88.00 2012 <br /> J3420 B-12In'ection $6.00 2009 <br /> J7300 Para ardIUD $253.58 2022 <br /> Medicaid only J7300ud Para and IUD $253.58 2022 <br /> J7296 K leena IUD $249.00 2021 <br /> Medicaid only J7296ud K leena IUD $249.00 2021 <br /> J7301 Skyla IUD $142.49 2022 <br /> Medicaid only J7301ud Skyla IUD $142.49 2022 <br /> J7297 Liletta IUD $100.00 2021 <br /> Medicaid only J7297ud Liletta IUD $100.00 2021 <br /> J7298 Mirena IUD $249.00 2019 <br /> Medicaid only J7298ud Mirena IUD $249.00 2019 <br /> J7303 Nuvarin (3pack) $10.45 2020 <br /> J7303ud Nuvarin (3pack) $10.45 2020 <br /> J7307 Nex lanon $399.00 2019 <br /> Medicaid only J7307ud Nex lanon $399.00 2019 <br /> Q2037 Fluvirin Vacc,3 yrs&>,IM $31.00 2015 <br /> Q2038 Fluzone Vacc,3 yrs&>,IM $40.00 2015 <br /> Medicaid only S0280 PMH Risk Screening $50.00 2015 <br /> Medicaid only S0281 Postpartum Risk Screening $150.00 2015 <br /> Self-Pay only S4993 Oral Contraceptive Pills $5.00 2012 <br /> S5000 Prescription Drug Dispensing $4.00 2021 <br /> S9465 Diabetic management program,dietitian visit $35.00 2011 <br /> S9470 lNutritional counseling,dietitian visit $35.00 2011 <br /> S9442 Birthing classes 8.69/1 hr block 2013 <br /> S5001 Plan B/Ella Emergency Contraception $19.71 2022 <br /> T1002 RN Services up to 15 min. $21.00 2005 <br /> U0005 HC COVID-19 High Throughput(UNC Lab Add on <br /> Payment) 1$0.00 12022 <br /> **UNC and State Lab Fees are established by reference lab and not by OCHD <br />