Mental Hygiene Services Fees
Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees
Fees Effective 4/1/2022
- Fee Comparisons is also available in Portable Document Format (PDF)
| Independent Practioner Services for Individuals with Developmental Disabilities (IPSIDD) Fees | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Fees Effective 4/1/2022 | |||||||||
| 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 | $169.74 | $171.88 | $160.93 | $172.25 | $153.45 | |
| 90832 | Psytx, 30 min | LP (0580)/ LCSW (0560) | 1 | $101.79 | $103.02 | $96.58 | $103.26 | $92.28 | |
| 90834 | Psytx, 45 min | LP (0580)/ LCSW (0560) | 1 | $135.70 | $137.17 | $128.84 | $137.52 | $123.38 | |
| 90837 | Psytx, 60 min | LP (0580)/ LCSW (0560) | 1 | $188.00 | $190.23 | $178.42 | $190.72 | $170.56 | |
| 90846 | Family psytx w/o patient | LP (0580) / LCSW (0560) | 1 | $101.78 | $102.89 | $96.62 | $103.14 | $92.49 | |
| 90847 | Family psytx w/patient | LP (0580) / LCSW (0560) | 1 | $203.60 | $206.23 | $193.12 | $206.72 | $184.24 | |
| 90853 | Group psychotherapy | LP (0580) / LCSW (0560) | 1 | $52.63 | $53.30 | $49.88 | $53.41 | $47.56 | |
| 92507 | Speech/hearing therapy | SLP (0623) | 1 | $109.23 | $111.29 | $102.64 | $111.18 | $95.73 | |
| 92508 | Speech/hearing therapy | SLP (0623) | 1 | $31.93 | $32.60 | $29.90 | $32.53 | $27.67 | |
| 92521 | Eval of Speech Fluency | SLP (0623) | 1 | $148.47 | $151.59 | $139.37 | $151.41 | $129.49 | |
| 92522 | Eval of Speech Sound Production | SLP (0623) | 1 | $148.47 | $151.58 | $139.38 | $151.39 | $129.50 | |
| 92523 | Eval of Speech Sound Production with eval of language comprehension and expression | SLP (0623) | 1 | $148.51 | $151.96 | $139.25 | $151.75 | $128.83 | |
| 92524 | Behavioral and qualitative analysis of voice and resonance | SLP (0623) | 1 | $148.47 | $152.56 | $139.06 | $152.34 | $127.89 | |
| 92526 | Oral function therapy | SLP (0623) | 1 | $109.31 | $111.44 | $102.60 | $111.29 | $95.45 | |
| 92606 | Use of non-speech device | SLP (0623) | 1 | $109.49 | $111.80 | $102.50 | $111.54 | $94.73 | |
| 92609 | Use of speech device service | SLP (0623) | 1 | $109.49 | $111.80 | $102.50 | $111.54 | $94.73 | |
| 92610 | Evaluate swallowing function | SLP (0623) | 1 | $109.34 | $111.68 | $102.53 | $111.51 | $95.01 | |
| 96112 | (C) | Devel tst phys/qhp 1st hr | LP (0580) / LCSW (0560) | 1 | $136.12 | $138.69 | $128.39 | $138.77 | $120.62 |
| 96113 | (C) | Devel tst phys/qhp ea addl | LP (0580) / LCSW (0560) | 1 | $68.07 | $69.35 | $64.20 | $69.40 | $60.32 |
| 96130 | (C) | Psycl tst eval phys/qhp 1st | LP (0580) / LCSW (0560) | 1 | $67.89 | $68.68 | $64.39 | $68.85 | $61.52 |
| 96136 | (C) | Psycl/nrpsyc tst phy/qhp 1st | LP (0580) / LCSW (0560) | 1 | $135.75 | $137.36 | $128.77 | $137.69 | $123.02 |
| 96137 | (C) | Psycl/nrpsyc tst phy/qhp ea | LP (0580) / LCSW (0560) | 1 | $67.89 | $68.68 | $64.39 | $68.85 | $61.52 |
| 96138 | (C) | Psycl/nrpsyc tech 1st | LP (0580) / LCSW (0560) | 1 | $137.51 | $141.67 | $127.57 | $140.96 | $114.89 |
| 96139 | (C) | Psycl/nrpsyc tst tech ea | LP (0580) / LCSW (0560) | 1 | $68.76 | $70.85 | $63.80 | $70.48 | $57.45 |
| 97110 | Therapeutic exercises, 15 min | OT (0621) / PT (0622) | 3 | $39.68 | $40.61 | $37.12 | $40.53 | $35.35 | |
| 97112 | Neuromuscular reeducation, 15 min | OT (0621) / PT (0622) | 3 | $39.89 | $40.70 | $37.35 | $40.61 | $34.73 | |
| 97113 | Aquatic therapy/exercises, 15 min | OT (0621) / PT (0622) | 3 | $40.03 | $41.00 | $37.31 | $40.85 | $34.11 | |
| 97116 | Gait training therapy, 15 min | OT (0621) / PT (0622) | 3 | $39.90 | $40.71 | $37.40 | $40.63 | $34.65 | |
| 97124 | Massage therapy, 15 min | OT (0621) / PT (0622) | 3 | $39.94 | $41.01 | $37.30 | $40.89 | $34.15 | |
| 97129 | (B) | Ther ivntj 1st 15 min | OT (0621) / PT (0622) / SLP (0623) | 1 | $39.82 | $40.51 | $37.45 | $40.46 | $35.03 |
| 97130 | (B) | Ther ivntj ea addl 15 min | OT (0621) / PT (0622) / SLP (0623) | 2 | $39.82 | $40.51 | $37.45 | $40.46 | $35.03 |
| 97140 | Manual therapy, 15 min | OT (0621) / PT (0622) | 3 | $39.90 | $40.68 | $37.41 | $40.59 | $34.71 | |
| 97150 | Group therapeutic procedures | OT (0621) / PT (0622) | 1 | $39.82 | $40.59 | $37.42 | $40.56 | $34.90 | |
| 97161 | (A) | Pt evaluation, low complexity | PT (0622) | 1 | $89.57 | $91.35 | $84.11 | $91.24 | $78.28 |
| 97162 | (A) | Pt evaluation, med complexity | PT (0622) | 1 | $119.43 | $121.79 | $112.15 | $121.66 | $104.37 |
| 97163 | (A) | Pt evaluation, high complexity | PT (0622) | 1 | $149.29 | $152.24 | $140.18 | $152.07 | $130.46 |
| 97164 | (A) | PT re-evaluation, re-defined | PT (0622) | 1 | $89.70 | $91.62 | $84.02 | $91.45 | $77.73 |
| 97165 | (A) | Ot evaluation, low complexity | OT (0621) | 1 | $80.76 | $82.63 | $75.59 | $82.45 | $69.72 |
| 97166 | (A) | Ot evaluation, med complexity | OT (0621) | 1 | $107.68 | $110.17 | $100.78 | $109.94 | $92.94 |
| 97167 | (A) | Ot evaluation, high complexity | OT (0621) | 1 | $134.59 | $137.70 | $125.98 | $137.41 | $116.18 |
| 97168 | (A) | OT re-evaluation, re-defined | OT (0621) | 1 | $80.93 | $82.91 | $75.52 | $82.63 | $69.16 |
| 97530 | Therapeutic activities, 15 min | OT (0621) / PT (0622) | 3 | $39.95 | $40.81 | $37.38 | $40.70 | $34.46 | |
| 97533 | Sensory integration, 15 min | OT (0621) / PT (0622) / SLP (0623) | 3 | $39.88 | $40.61 | $37.42 | $40.56 | $34.83 | |
| 97535 | Self care mngment training, 15 min | OT (0621) / PT (0622) | 3 | $39.94 | $40.78 | $37.38 | $40.69 | $34.51 | |
| 97537 | Community/work reintegration, 15 min | OT (0621) / PT (0622) | 3 | $40.61 | $41.38 | $38.12 | $41.31 | $31.87 | |
| 97542 | Wheelchair mngment training, 15 min | OT (0621) / PT (0622) | 8 | $43.00 | $43.83 | $40.35 | $43.75 | $37.50 | |
| 97755 | Assistive technology assess, 15 min | OT (0621) / PT (0622) | 6 | $39.80 | $40.53 | $37.44 | $40.51 | $35.01 | |
*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.
