Mental Hygiene Services Fees
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
Fees Effective 7/1/2021
- Fee Comparisons is also available in Portable Document Format (PDF)
| Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Fees Effective 7/1/2021 | |||||||||
| 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 | $161.58 | $163.61 | $153.19 | $163.97 | $146.07 | |
| 90832 | Psytx, 30 min | LP (0580)/ LCSW (0560) | 1 | $96.89 | $98.06 | $91.93 | $98.29 | $87.85 | |
| 90834 | Psytx, 45 min | LP (0580)/ LCSW (0560) | 1 | $129.17 | $130.57 | $122.64 | $130.90 | $117.45 | |
| 90837 | Psytx, 60 min | LP (0580)/ LCSW (0560) | 1 | $178.95 | $181.08 | $169.83 | $181.55 | $162.36 | |
| 90846 | Family psytx w/o patient | LP (0580) / LCSW (0560) | 1 | $96.88 | $97.94 | $91.97 | $98.18 | $88.04 | |
| 90847 | Family psytx w/patient | LP (0580) / LCSW (0560) | 1 | $193.81 | $196.31 | $183.83 | $196.78 | $175.38 | |
| 90853 | Group psychotherapy | LP (0580) / LCSW (0560) | 1 | $50.10 | $50.74 | $47.48 | $50.84 | $45.28 | |
| 92507 | Speech/hearing therapy | SLP (0623) | 1 | $103.98 | $105.93 | $97.71 | $105.83 | $91.13 | |
| 92508 | Speech/hearing therapy | SLP (0623) | 1 | $30.39 | $31.03 | $28.46 | $30.97 | $26.34 | |
| 92521 | Eval of Speech Fluency | SLP (0623) | 1 | $141.33 | $144.30 | $132.67 | $144.13 | $123.26 | |
| 92522 | Eval of Speech Sound Production | SLP (0623) | 1 | $141.33 | $144.29 | $132.68 | $144.11 | $123.27 | |
| 92523 | Eval of Speech Sound Production with eval of language comprehension and expression | SLP (0623) | 1 | $141.37 | $144.65 | $132.55 | $144.45 | $122.63 | |
| 92524 | Behavioral and qualitative analysis of voice and resonance | SLP (0623) | 1 | $141.33 | $145.22 | $132.37 | $145.01 | $121.74 | |
| 92526 | Oral function therapy | SLP (0623) | 1 | $104.05 | $106.08 | $97.67 | $105.93 | $90.86 | |
| 92606 | Use of non–speech device | SLP (0623) | 1 | $104.22 | $106.42 | $97.57 | $106.18 | $90.18 | |
| 92609 | Use of speech device service | SLP (0623) | 1 | $104.22 | $106.42 | $97.57 | $106.18 | $90.18 | |
| 92610 | Evaluate swallowing function | SLP (0623) | 1 | $104.08 | $106.31 | $97.59 | $106.15 | $90.44 | |
| 96112 | (C) | Devel tst phys/qhp 1st hr | LP (0580) / LCSW (0560) | 1 | $129.57 | $132.02 | $122.22 | $132.10 | $114.82 |
| 96113 | (C) | Devel tst phys/qhp ea addl | LP (0580) / LCSW (0560) | 1 | $64.79 | $66.02 | $61.11 | $66.06 | $57.42 |
| 96130 | (C) | Psycl tst eval phys/qhp 1st | LP (0580) / LCSW (0560) | 1 | $64.62 | $65.38 | $61.30 | $65.54 | $58.56 |
| 96136 | (C) | Psycl/nrpsyc tst phy/qhp 1st | LP (0580) / LCSW (0560) | 1 | $129.22 | $130.75 | $122.57 | $131.06 | $117.10 |
| 96137 | (C) | Psycl/nrpsyc tst phy/qhp ea | LP (0580) / LCSW (0560) | 1 | $64.62 | $65.38 | $61.30 | $65.54 | $58.56 |
| 96138 | (C) | Psycl/nrpsyc tech 1st | LP (0580) / LCSW (0560) | 1 | $130.89 | $134.85 | $121.44 | $134.18 | $109.36 |
| 96139 | (C) | Psycl/nrpsyc tst tech ea | LP (0580) / LCSW (0560) | 1 | $65.45 | $67.44 | $60.73 | $67.09 | $54.69 |
| 97110 | Therapeutic exercises, 15 min | OT (0621) / PT (0622) | 3 | $37.77 | $38.66 | $35.33 | $38.58 | $33.65 | |
| 97112 | Neuromuscular reeducation, 15 min | OT (0621) / PT (0622) | 3 | $37.97 | $38.74 | $35.56 | $38.66 | $33.05 | |
| 97113 | Aquatic therapy/exercises, 15 min | OT (0621) / PT (0622) | 3 | $38.10 | $39.02 | $35.52 | $38.88 | $32.47 | |
| 97116 | Gait training therapy, 15 min | OT (0621) / PT (0622) | 3 | $37.98 | $38.75 | $35.60 | $38.68 | $32.98 | |
| 97124 | Massage therapy, 15 min | OT (0621) / PT (0622) | 3 | $38.02 | $39.03 | $35.51 | $38.92 | $32.51 | |
| 97129 | (B) | Ther ivntj 1st 15 min | OT (0621) / PT (0622) / SLP (0623) | 1 | $37.91 | $38.56 | $35.65 | $38.52 | $33.35 |
| 97130 | (B) | Ther ivntj ea addl 15 min | OT (0621) / PT (0622) / SLP (0623) | 2 | $37.91 | $38.56 | $35.65 | $38.52 | $33.35 |
| 97140 | Manual therapy, 15 min | OT (0621) / PT (0622) | 3 | $37.98 | $38.72 | $35.61 | $38.64 | $33.04 | |
| 97150 | Group therapeutic procedures | OT (0621) / PT (0622) | 1 | $37.91 | $38.64 | $35.62 | $38.61 | $33.22 | |
| 97161 | (A) | Pt evaluation, low complexity | PT (0622) | 1 | $85.26 | $86.95 | $80.06 | $86.85 | $74.51 |
| 97162 | (A) | Pt evaluation, med complexity | PT (0622) | 1 | $113.69 | $115.94 | $106.75 | $115.80 | $99.35 |
| 97163 | (A) | Pt evaluation, high complexity | PT (0622) | 1 | $142.11 | $144.92 | $133.44 | $144.75 | $124.18 |
| 97164 | (A) | PT re–evaluation, re–defined | PT (0622) | 1 | $85.38 | $87.22 | $79.98 | $87.06 | $73.99 |
| 97165 | (A) | Ot evaluation, low complexity | OT (0621) | 1 | $76.87 | $78.65 | $71.96 | $78.48 | $66.36 |
| 97166 | (A) | Ot evaluation, med complexity | OT (0621) | 1 | $102.50 | $104.87 | $95.93 | $104.65 | $88.47 |
| 97167 | (A) | Ot evaluation, high complexity | OT (0621) | 1 | $128.12 | $131.07 | $119.92 | $130.80 | $110.60 |
| 97168 | (A) | OT re–evaluation, re–defined | OT (0621) | 1 | $77.03 | $78.92 | $71.89 | $78.65 | $65.84 |
| 97530 | Therapeutic activities, 15 min | OT (0621) / PT (0622) | 3 | $38.03 | $38.85 | $35.58 | $38.74 | $32.80 | |
| 97533 | Sensory integration, 15 min | OT (0621) / PT (0622) / SLP (0623) | 3 | $37.96 | $38.66 | $35.62 | $38.61 | $33.16 | |
| 97535 | Self care mngment training, 15 min | OT (0621) / PT (0622) | 3 | $38.02 | $38.82 | $35.58 | $38.73 | $32.85 | |
| 97537 | Community/work reintegration, 15 min | OT (0621) / PT (0622) | 3 | $38.66 | $39.39 | $36.29 | $39.33 | $30.34 | |
| 97542 | Wheelchair mngment training, 15 min | OT (0621) / PT (0622) | 8 | $40.93 | $41.72 | $38.41 | $41.65 | $35.70 | |
| 97755 | Assistive technology assess, 15 min | OT (0621) / PT (0622) | 6 | $37.89 | $38.58 | $35.64 | $38.56 | $33.33 | |
*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. Effective 1/1/2020, the American Medical Association (AMA) replaced procedure code 97127 with 97129 and 97130
(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.
