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Correction to CSHCN Services Program Reimbursement Rate Changes for Clinical Laboratory, Anesthesia
Information posted November 28, 2008: This is a correction to a website article posted on November 7, 2008, titled “CSHCN Reimbursement Rates to Change for Clinical Laboratory, Anesthesia Services and Dental Services.“ The effective date was incorrectly stated as January 1, 2009. The correct effective date is January 1, 2007. Click on the title to view the complete, corrected article.
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Effective for dates of service on or after January 1, 2007, the CSHCN Services Program has adopted new reimbursement rates for clinical laboratory, anesthesia services, and dental services procedure codes. Affected claims with dates of service on or after January 1, 2007, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
The following table shows the revised rates and their effective dates:
|
Procedure Code |
New Reimbursement Rate |
Effective Date |
|
Clinical Laboratory Services |
|
5-83913 |
$18.66 |
January 1, 2007 |
|
5-86788 |
$11.43 |
January 1, 2007 |
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5-86789 |
$20.11 |
January 1, 2007 |
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5-87305 |
$16.76 |
January 1, 2007 |
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5-87498 |
$49.04 |
January 1, 2007 |
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5-87640 |
$49.04 |
January 1, 2007 |
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5-87641 |
$49.04 |
January 1, 2007 |
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5-87653 |
$49.04 |
January 1, 2007 |
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5-87808 |
$16.76 |
January 1, 2007 |
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Anesthesia Services |
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7-00625 |
13 base units, $15.55 conversion factor |
January 1, 2007 |
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7-00625 |
13 base units, $19.83 conversion factor (clients birth through 20 years) |
January 1, 2007 |
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7-00625 |
13 base units $16.72 conversion factor (clients 21 years and older) |
January 1, 2007 |
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7-00626 |
13 base units $15.55 conversion factor |
January 1, 2007 |
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7-00626 |
13 base units $19.83 conversion factor (clients birth through 20 years) |
January 1, 2007 |
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7-00626 |
13 base units $16.72 conversion factor (clients 21 years and older) |
January 1, 2007 |
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Dental Services |
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D0145 |
$15.25 |
January 1, 2007–
February 29, 2008.
Procedure code D0145
(in association with First Dental
Home) is reimbursed at $144.97
effective March 1, 2008 |
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D0273 |
$29.60 |
January 1, 2007 |
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D1555 |
$50.00 |
January 1, 2007 |
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D4230 |
$162.50 |
January 1, 2007 |
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D4231 |
$97.50 |
January 1, 2007 |
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D8693 |
$50.00 |
January 1, 2007 |
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D9120 |
$20.00 |
January 1, 2007 |
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D9612 |
$37.50 |
January 1, 2007 |
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For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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