Mental Hygiene Services Fees

Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees

Fees Effective 1/1/2019

Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
Fees Effective 1/1/2019
Procedure Codes Authorized Provider Types IPSIDD Max Units Regional Fees*
Procedure Code Note Below CPT Descprition Locality 1 Locality 2 Locality 3 Locality 4 Locality 99
90791 Psy dx evaluation LP (0580)/ LCSW (0560) 1 $159.45 $161.46 $151.17 $161.81 $144.15
90832 Psytx, 30 min LP (0580)/ LCSW (0560) 1 $95.62 $96.77 $90.72 $97.00 $86.69
90834 Psytx, 45 min LP (0580)/ LCSW (0560) 1 $127.47 $128.85 $121.03 $129.18 $115.90
90837 Psytx, 60 min LP (0580)/ LCSW (0560) 1 $176.60 $178.70 $167.60 $179.16 $160.22
90846 Family psytx w/o patient LP (0580) / LCSW (0560) 1 $95.61 $96.65 $90.76 $96.89 $86.88
90847 Family psytx w/patient LP (0580) / LCSW (0560) 1 $191.26 $193.73 $181.41 $194.19 $173.07
90853 Group psychotherapy LP (0580) / LCSW (0560) 1 $49.44 $50.07 $46.86 $50.17 $44.68
92507 Speech/hearing therapy SLP (0623) 1 $102.61 $104.54 $96.42 $104.44 $89.93
92508 Speech/hearing therapy SLP (0623) 1 $29.99 $30.62 $28.09 $30.56 $25.99
92521 Eval of Speech Fluency SLP (0623) 1 $139.47 $142.40 $130.92 $142.23 $121.64
92522 Eval of Speech Sound Production SLP (0623) 1 $139.47 $142.39 $130.93 $142.21 $121.65
92523 Eval of Speech Sound Production with eval of language comprehension and expression SLP (0623) 1 $139.51 $142.75 $130.81 $142.55 $121.02
92524 Behavioral and qualitative analysis of voice and resonance SLP (0623) 1 $139.47 $143.31 $130.63 $143.10 $120.14
92526 Oral function therapy SLP (0623) 1 $102.68 $104.68 $96.38 $104.54 $89.66
92606 Use of non-speech device SLP (0623) 1 $102.85 $105.02 $96.29 $104.78 $88.99
92609 Use of speech device service SLP (0623) 1 $102.85 $105.02 $96.29 $104.78 $88.99
92610 Evaluate swallowing function SLP (0623) 1 $102.71 $104.91 $96.31 $104.75 $89.25
96112 (C) Devel tst phys/qhp 1st hr LP (0580) / LCSW (0560) 1 $127.87 $130.28 $120.61 $130.36 $113.31
96113 (C) Devel tst phys/qhp ea addl LP (0580) / LCSW (0560) 1 $63.94 $65.15 $60.31 $65.19 $56.66
96130 (C) Psycl tst eval phys/qhp 1st LP (0580) / LCSW (0560) 1 $63.77 $64.52 $60.49 $64.68 $57.79
96136 (C) Psycl/nrpsyc tst phy/qhp 1st LP (0580) / LCSW (0560) 1 $127.52 $129.03 $120.96 $129.34 $115.56
96137 (C) Psycl/nrpsyc tst phy/qhp ea LP (0580) / LCSW (0560) 1 $63.77 $64.52 $60.49 $64.68 $57.79
96138 (C) Psycl/nrpsyc tech 1st LP (0580) / LCSW (0560) 1 $129.17 $133.08 $119.84 $132.41 $107.92
96139 (C) Psycl/nrpsyc tst tech ea LP (0580) / LCSW (0560) 1 $64.59 $66.55 $59.93 $66.21 $53.97
97110 Therapeutic exercises, 15 min OT (0621) / PT (0622) 3 $37.27 $38.15 $34.87 $38.07 $33.21
97112 Neuromuscular reeducation, 15 min OT (0621) / PT (0622) 3 $37.47 $38.23 $35.09 $38.15 $32.62
97113 Aquatic therapy/exercises, 15 min OT (0621) / PT (0622) 3 $37.60 $38.51 $35.05 $38.37 $32.04
97116 Gait training therapy, 15 min OT (0621) / PT (0622) 3 $37.48 $38.24 $35.13 $38.17 $32.55
97124 Massage therapy, 15 min OT (0621) / PT (0622) 3 $37.52 $38.52 $35.04 $38.41 $32.08
97127 (B) Cognitive skills development, 15 min OT (0621) / PT (0622) / SLP (0623) 3 $37.41 $38.05 $35.18 $38.01 $32.91
97140 Manual therapy, 15 min OT (0621) / PT (0622) 3 $37.48 $38.21 $35.14 $38.13 $32.61
97150 Group therapeutic procedures OT (0621) / PT (0622) 1 $37.41 $38.13 $35.15 $38.10 $32.78
97161 (A) Pt evaluation, low complexity PT (0622) 1 $84.14 $85.81 $79.01 $85.71 $73.53
97162 (A) Pt evaluation, med complexity PT (0622) 1 $112.19 $114.41 $105.35 $114.28 $98.04
97163 (A) Pt evaluation, high complexity PT (0622) 1 $140.24 $143.01 $131.68 $142.85 $122.55
97164 (A) PT re-evaluation, re-defined PT (0622) 1 $84.26 $86.07 $78.93 $85.91 $73.02
97165 (A) Ot evaluation, low complexity OT (0621) 1 $75.86 $77.62 $71.01 $77.45 $65.49
97166 (A) Ot evaluation, med complexity OT (0621) 1 $101.15 $103.49 $94.67 $103.27 $87.31
97167 (A) Ot evaluation, high complexity OT (0621) 1 $126.43 $129.35 $118.34 $129.08 $109.14
97168 (A) OT re-evaluation, re-defined OT (0621) 1 $76.02 $77.88 $70.94 $77.62 $64.97
97530 Therapeutic activities, 15 min OT (0621) / PT (0622) 3 $37.53 $38.34 $35.11 $38.23 $32.37
97533 Sensory integration, 15 min OT (0621) / PT (0622) / SLP (0623) 3 $37.46 $38.15 $35.15 $38.10 $32.72
97535 Self care mngment training, 15 min OT (0621) / PT (0622) 3 $37.52 $38.31 $35.11 $38.22 $32.42
97537 Community/work reintegration, 15 min OT (0621) / PT (0622) 3 $38.15 $38.87 $35.81 $38.81 $29.94
97537 Community/work reintegration, 15 min OT (0621) / PT (0622) 3 $38.15 $38.87 $35.81 $38.81 $29.94
97542 Wheelchair mngment training, 15 min OT (0621) / PT (0622) 8 $40.39 $41.17 $37.90 $41.10 $35.23
97542 Wheelchair mngment training, 15 min OT (0621) / PT (0622) 8 $40.39 $41.17 $37.90 $41.10 $35.23
97755 Assistive technology assess, 15 min OT (0621) / PT (0622) 6 $37.39 $38.07 $35.17 $38.05 $32.89
97755 Assistive technology assess, 15 min OT (0621) / PT (0622) 6 $37.39 $38.07 $35.17 $38.05 $32.89

*Locality Breakdown
Locality 1 – Manhattan
Locality 2 – Bronx, Brooklyn, Nassau, Rockland, Staten Island, Suffolk, Westchester
Locality 3 – Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, Ulster
Locality 4 – Queens
Locality 99 – Remainder of State

Authorized Provider Types
OT Occupational Therapist (PCOS: 0621)
PT Physical Therapist (PCOS: 0622)
SLP Speech and Lang Pathologist (PCOS: 0623)
LP Licensed Psychologist (PCOS: 0580)
LCSW Licensed Clinical Social Worker (PCOS: 0560)

(A) Effective 1/1/2017, the American Medical Association (AMA) replaced procedure codes 97001, 97002, 97003, 97004 with eight new procedure codes.

  • New codes: 97161 through 97168

(B) Effective 1/1/2018, the American Medical Association (AMA) replaced procedure code 97532 with 97127.

(C) Effective 1/1/2019, the American Medical Association (AMA) replaced procedure codes as follows:

  • 96101 replaced with 96130, 96131, 96136 and 96137, however, 96131 is not reimbursable by Medicaid.
  • 96102 replaced with 96138 & 96139.
  • 96111 replaced with 96112 & 96113.