TMPPM 2007 >44.5.1.3 Initial Examination and Procedure Codes

An initial examination should be performed by providers when any class of client is evaluated for the first time. A client can receive another initial examination six months (180 rolling days) from the previous one if there has been an interruption in therapy (such as reinitiation of treatment for clients lost to follow-up). Services may include, but are not limited to:

The following table describes the procedure codes and modifiers to be billed for initial examinations:


Service	Client Class	Procedure Code/Modifier	Maximum Fee
Initial Exam Level 01: Nonphysician services only	1 or 2	D-99204 with modifier TF	$26.53
Initial Exam Level 01: Nonphysician services only	3 or 5	D-99204 with modifier TG	$43.27
Initial Exam Level 06: Nonphysician and Physician services	1 or 2	D-99204 with modifiers TF and AM	$52.90
	3 or 5	D-99204 with modifiers TG and AM	$73.51
Initial Exam Level 07: Nonphysician and Physician services Prescribed Medications (Initial Treatment)	3 or 5	D-99205 with modifier TG	$253.99
Initial Exam Level 08: Nonphysician and Physician services Prescribed Medications (Preventive Treatment)	1 or 2	D-99205 with modifier TF	$54.10

Physician examination procedure codes may be used only when any class of client was initially evaluated without the consultation and evaluation of a physician. This examination cannot be billed if the provider billed for Level 06, 07, or 08 for the initial examination. Services may include, but are not limited to, the following:


Service	Client Class	Procedure Code/Modifier	Maximum Fee
Physician Exam Level 06: Nonphysician and Physician services	1 or 2	D-99201 with modifier TF	$37.48
	3 or 5	D-99201 with modifier TG	$38.51
Physician Exam Level 07: Nonphysician and Physician services Prescribed Medications (Initial Treatment)	3 or 5	D-99202 with modifier TG	$218.99
Physician Exam Level 08: Nonphysician and Physician services Prescribed Medications (Preventive Treatment)	1 or 2	D-99202 with modifier TF	$38.68