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Commissioner Approved Fee Schedule - FY 2024-25 50 <br /> Last <br /> Department/Program Description Current Fee Revision <br /> 96110 Developmental Test $23.00 2012 <br /> 96125 ASQ-Developmental $80.00 2024 <br /> 96127 Social-emotional Screens $6.00 2017 <br /> 96152 Health&Behavior Intervention $55.00 2015 <br /> 96158 Health Behavior Ivntj Indiv 1st 30 minutes $56.94 2023 <br /> 96159 Health Behavior Ivntj Indiv Each Additional 15 <br /> minutes $19.86 2023 <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) $16.00 2024 <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 />