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Attachment 2. Health Department Fee Schedule Revisions 5 <br /> CPT Code Description Current Fee Proposed Change Last Revision Notes <br /> 96158 Health Behavior Ivntj Indiv 1st 30 minutes $0.00 $56.94 N/A NEW <br /> 96159 Health Behavior Ivntj Indiv Each Additional 15 minutes $0.00 $19.86 N/A NEW <br /> Diphtheria,tetanus toxoids,acellular pertussis vaccine,haemophilus influenza Type B, <br /> 90697 inactivated poliovirus vaccine and Hep B DTaP-IPV/Hib 6 weeks through 4 years-Vaxelis $0.00 $134.53 N/A NEW <br /> 90380 1 RSV,monoclonal antibody,seasonal dose,0.5 mL dosage for intramuscular-BeyFortus $0.00 $99.75 N/A NEW <br /> 90381 RSV,monoclonal antibody,seasonal dose,1.0 mL dosage for intramuscular-BeyFortus $0.00 $99.75 N/A NEW <br /> 87324 Clostridium Difficile Toxin(UNC Lab $0.00 $14.57 N/A NEW <br /> 87449 Infectious Agent Detection by Enzyme Immunoassay Tech,Qualitative(UNC Lab) $0.00 $14.57 N/A NEW <br /> 87426 Detection Test by Immunoassay Tech for SARS Coronovirus(UNC Lab) $0.00 $38.13 N/A NEW <br /> Infectious Agent Dection by DNA or RNA for SARS-COV-2 and Influenza Virus Types A&B <br /> 87637 and RSV(UNC Lab $0.00 $142.63 N/A NEW <br /> Immunization Administration by Intramuscular Injection of SARS-Coronovirus-Booster <br /> 0134A Dose $0.00 $65.00 N/A NEW <br /> 87484 Ehrlichia PCR(UNC Lab $0.00 $35.09 N/A NEW <br /> 86666 Ehrlichia IGG Titers(UNC Lab $0.00 $10.18 N/A NEW <br /> 87563 M coplasma Genitalium(UNC Lab $0.00 $35.09 N/A NEW <br /> Revise:New Medicaid <br /> 59430 Postpartum Care Only $175.00 $181.66 2012 reimbursement rate as of 7/23 <br /> 0020A Novavax COVID-19 Vaccine 12 years and older,5 dose vial $0.00 $113.00 N/A NEW <br /> 0001A 1Pfizer COVID-19 Vaccin Adult 12 years and older,single dose vial $65.00 $115.00 2022 Revise to reflect administration cost <br /> 0002A Pfizer COVID-19 Vaccin Adult 12 years and older,prefilled syringe) $65.00 $115.00 2022 Revise to reflect administration cost <br /> 0003A Pfizer COVID-19 Vaccin Pediatric 5 to 12 years,single dose vial $65.00 $77.00 2022 Revise to reflect administration cost <br /> 0004A Pfizer COVID-19 Vaccin Pediatric 6 months to 5 years,3-dose vial) $65.00 $58.00 2022 Revise to reflect administration cost <br /> 0051A $65901 $0.00 2022 Remove <br /> 0062 $6590 $0.00 2022 Remove <br /> 0063 $65 00 $0.00 2022 Remove <br /> 0054A $65 00 $0.00 2022 Remove <br /> 0074A OVID 19Va.e'n Add(1st) o that.,,. $66-.00 $0.00 2022 Remove <br /> 0072A Pfizer GOVID19v..,.oin Add(2nd��a $66-.00 $0.00 2022 Remove <br /> 0011A Moderna COVID-19 Vaccine Aft)Adult(12 years and older,single dose vial) $65.00 $115.00 2022 Revise to reflect administration cost <br /> 0012A Moderna COVID-19 Vaccine Ada)Adult(12 years and older,prefilled syringe) $65.00 $115.00 2022 Revise to reflect administration cost <br /> 0013A Moderna COVID-19 Vaccine Adman(3rd)Pediatric(6 months to 11 years,single dose vial) <br /> $65.00 $115.00 2022 Revise to reflect administration cost <br /> 0044A $609 $0.00 2022 Remove <br />