RESOLUTION 11-172 AND FEE SCH��
�Before the Board of Supervisors in and for the
County of Monterey, State of California
Resolution 11-172
Amending Article I.d. of the Monterey County Master
Fee Resolution effective July 1, 2011, to adjust certain
fees related to the Health Department's Clinic Services
Bureau pursuant to the attached Fee Schedule
THE MONTEREY COUNTY BOARD OF SUPERVISORS FINDS:
43 Resolution
A. Section 1.40.010 of Chapter 1.40 of Monterey County Code provides that all fees, penalties,
refunds, reimbursements and charges of any kind by the County may be specified in the Monterey
County Fee Resolution.
B. The Health Department has Clinic Services Bureau fees and charges which are appropriate to
specify in the Monterey County Master Fee Resolution, Article I.d. for fiscal year 2011-12.
C. This action to modify charges to meet operational expenses is statutorily exempt from
environmental review Pub Res. Code sec. 21080 subd. b)(8)].
D. Any and all adjustments to charges for these Clinical Services reflect no more than the actual
reasonable cost of the service or benefit received by the payor.
By Constitutional definition, these Clinic Service charges are not a tax' and are exempt from
voter approval pursuant to Article XIII C section 1(e)(1)-(2) of the California Constitution
Charges imposed for specific benefit, service, product, or privilege granted or provided directly to
payor).
THE MONTEREY COUNTY BOARD OF SUPERVISORS RESOLVES:
1. Article I.d. of the Monterey County Fee Resolution is amended effective July 1, 2011 for Fiscal
Year 2011-12 with all schedules, tables, fees, taxes, penalties, and charges contained therein are
hereby adopted as described in the attachment to this Resolution.
II. All prior Resolutions regarding such fees are hereby repealed.
PASSED AND ADOPTED on this 14th day of June, 2011, upon motion of Supervisor Salinas, seconded
by Supervisor Armenta by the following vote, to wit:
AYES: Supervisors Armenta, Calcagno, Salinas, Parker, and Potter
NOES: None
ABSENT: None
1, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby certify that
the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in the minutes thereof
of Minute Book 75 for the meeting on June 14, 2011.
Dated: June 17, 2011 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By
Deputy
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
PSYCHIATRIC EVALUATION AND MANAGEMENT
90801 Psychiatric Diagnostic Interview/Examination 0.00 238.00
90802 Psychiatric Diagnostic Interview/Examination, Play Therapy 0.00 258.00
90804 Individual Psychotherapy, OP, 20-30 Min 102.00 103.00
90805 Individual Psychotherapy, OP, 20-30 Min with evaluation 114.00 117.00
90806 Individual Psychotherapy, OP, 45-50 Min 142.00 137.00
90807 Individual Psychotherapy, OP, 45-50 Min with evaluation 160.00 161.00
90808 Individual Psychotherapy, OP, 75-80 Min 209.00 201.00
90809 Individual Psychotherapy, OP, 75-80 Min with evaluation 226.00 226.00
90810 Individual Interactive Psychotherapy, 20-30 Min 109.00 105.00
90811 Individual Interactive Psychotherapy, 20-30 Min with evaluation 127.00 131.00
90812 Individual Interactive Psychotherapy, 45-50 Min 155.00 150.00
90813 Individual Interactive Psychotherapy, 45-50 Min with evaluation 173.00 175.00
90814 Individual Interactive Psychotherapy, 75-80 Min 225.00 216.00
90815 Individual Interactive Psychotherapy, 75-80 Min with evaluation 238.00 245.00
90846 Family Psychotherapy Without Patient Present 133.00 129.00
90847 Family Psychotherapy With Patient Present 165.00 144.00
90853 Group Psychotherapy 48.00 49.00
90862 Medication Management 0.00 90.00
90882 Environmental Intervention for Medical Management with Agencies, Employer,
Institutions
0.00
110.00
90885 Psychiatric Evaluation of Hospital, OP Records to Establish Diagnosis 0.00 120.00
90887 Interpretation/Explanation of Tests to Family, Advise How to Assist Patient 0.00 110.00
90889 Preparation of Reports on Psychiatric Status for Doctors, Agencies, Insurances 0.00 75.00
PATIENT EDUCATION AND SELF MANAGEMENT
96150 Bio s chosocial Factors Assessment, 15 Min 35.00 33.00
96151 Biopsychosocial Factors Reassessment 34.00 32.00
96152 Bio s chosocial Factors Intervention, 15 Min 32.00 30.00
96153 Bio s chosocial Factors Intervention, Group, Each Participant 8.00 8.00
96154 Bio s chosocial Factors Intervention, Family with Patient 32.00 30.00
96155 Bio s chosocial Factors Intervention, Family without Patient 32.00 30.00
97802 Medical Nutrition Therapy, Individual, Each 15 Min 0.00 40.00
97803 Medical Nutrition Therapy, Individual, Reassess and Intervention, Each 15 Min 0.00 40.00
97804 Medical Nutrition Therapy, Group, Each 15 Min 0.00 15.00
98960 Patient Self Management, Qualified Non-Physician, Face to Face, 20 Min 32.00 32.00
98961 Patient Self Management, Qualified Non-Physician, Face to Face, 20 Min, 2-4 Patients 32.00 32.00
98962 Patient Self Management, Qualified Non-Physician, Face to Face, 20 Min, 5-8 Patients 32.00 32.00
99401 Medical Counseling/Risk Factor Assess, 15 Min 20.00 20.00
99402 Medical Counseling/Risk Factor Assess, 30 Min 40.00 40.00
99403 Medical Counseling/Risk Factor Assess, 45 Min 60.00 90.00
99404 Medical Counseling/Risk Factor Assess, 60 Min 80.00 155.00
99406 Tobacco Use Cessation Counseling, 4-10 Min 20.00 21.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
99407 Tobacco Use Cessation Counseling, 10 Min 38.00 41.00
99408 Alcohol/Substance Abuse Screening SBIRT), 15-30 Min 47.16 48.00
99409 Alcohol/Substance Abuse Screening SBIRT), 30 Min 0.00 70.00
99411 Preventative Medicine/High Risk Reduction Counsel, Group, Separate Procedure, 30
Min
0.00
40.00
99412 Preventative Medicine/High Risk Reduction Counsel, Group, Separate Procedure, 60
Min
0.00
50.00
99420 Administration of a Health Risk Assessment Other) 50.00 50.00
G0108 Medicare Diabetes Self Management, Individual, 30 Min 44.00 85.00
G0109 Medicare Diabetes, Group Education Class, 30 Min 25.00 30.00
G0270 Medical Nutrition Therapy, Face To Face, 15 Min Medicare) 37.00 43.00
G0271 Medical Nutrition Therapy, Reassessment, 30 Min Medicare) 21.00 22.00
G0372 Physician Evaluation for Power Mobility Device Medicare) 17.00 16.00
G0396 Substance Abuse/Testing/Intervention SBIRT), 30 Min 48.00 48.00
G0397 Substance Abuse/Testino/I ntervention SBIRT), 15-30 Min 93.00 104.00
S9470 Nutritional Counseling Dietician 0 67.00
PUBLIC HEALTH VISIT FEES
LCODE HIV Confidential Visit 30.00 32.00
LCODE HIV Anonymous Visit 30.00 32.00
LCODE HIV Counseling/Education with STD Visit 57.00 57.00
LCODE HIV Counseling and Education, Court Ordered 142.00 142.00
LCODE Wound Management Visit 30.00 32.00
LCODE Hepatitis A Contact Visit 57.00 57.00
LCODE Latent Tuberculosis TB) Clearance Visit 30.00 32.00
LCODE Hepatitis B Vaccine, Public Safe /Public Health Worker 68.00 68.00
LCODE Rabies Vaccine Pre-exposure Staff only) 160.00 160.00
LCODE Latent TB Prevention Visit 30.00 32.00
LCODE PPD/TB Screening Test/Read 30.00 32.00
LCODE Positive PPD Test Counseling Visit 30.00 32.00
LCODE International Immunization Card and Stamp 15.00 20.00
LCODE Transcribe New Immunization Record 15.00 15.00
LCODE Print D6 plicate Registry Form 10.00 15.00
LCODE soniazid 50 MG 30 Day Supply 25.00 25.00
LCODE Isoniazid 100 MG 30 Day Supply 25.00 25.00
LCODE soniazid 150 MG 30 Day Supply 25.00 25.00
LCODE soniazid 200 MG 30 Day Supply 25.00 25.00
LCODE soniazid 250 MG 30 Day Supply 25.00 25.00
LCODE soniazid 300 MG 30 Day Supply 25.00 25.00
LCODE Rifampin 150 MG 30 Day Supply 25.00 25.00
LCODE Rifampin 300 MG 30 Day Supply 25.00 25.00
M PROCEDURE CODES
10060 I&D Abscess, Simple/Single 150.00 169.00
10061 I&D Abscess, Complex/Multi le 254.00 278.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
10120 Removal of Foreign Body/Simple 184.00 209.00
10121 Removal of Foreign Body/Complex 356.00 402.00
10140 Incise/Drain Hematoma 211.00 239.00
10160 Aspiration C st/Hematoma 172.00 194.00
10180 I&D Post Operative Wound Infection 316.00 359.00
11040 Debridement Skin, Partial Thickness 65.00 62.00
11100 Biopsy Skin, Single Lesion 143.00 160.00
11101 Biopsy Skin, Additional Lesion 46.00 51.00
11200 Skin Tags, Removal First 15 Skin Tags 112.00 130.00
11201 Skin Tags, Additional 10 Skin Tags 26.00 29.00
11300 have Skin Lesion, Extremity, 0.50 CM 94.00 99.00
11301 have Skin Lesion, Extremity, 0.6-1.0 CM 128.00 121.00
11305 have Skin Lesion, Scalp, Neck, 0.50 CM 96.00 106.00
11306 have Skin Lesion, Scalp, Neck, 0.6-1.0 CM 132.00 129.00
11310 Shave Skin Lesion, Face, Head, 0.50 CM 116.00 121.00
11311 Shave Skin Lesion, Face, Head, 0.60 1.0 CM 147.00 143.00
11400 Excise Neoplasm Upper Body, 0.50 CM 159.00 183.00
11401 Excise Neoplasm, Upper Body, 0.60-1.0 CM 195.00 222.00
11402 Excise Neoplasm, Upper Body, 1.1-2.0 CM 217.00 247.00
11420 Excise Neoplasm, Neck Scalp, 0.50 CM 160.00 182.00
11421 Excise Neoplasm, Neck Scalp, 0.60-1.0 CM 207.00 235.00
11440 Excise Neoplasm, Face, 0.50 CM 175.00 201.00
11441 Excise Neoplasm, Face, 0.60-1.0 CM 222.00 251.00
11730 Avulsion of Nail Plate, Single 135.00 146.00
11732 Avulsion of Nail Plate, Each Additional 63.00 67.00
11750 Excision of Nail Matrix 292.00 329.00
11765 Nail Wedge Excision 178.00 213.00
11975 Contraceptive Implant Insertion 0.00 184.00
11976 Contraceptive Implant Removal 206.00 184.00
12011 Laceration, Simple, 2.5 CM 213.00 177.00
12013 Laceration, Simple, 2.6-5.0 CM 234.00 190.00
12051 Laceration, Layered, 2.5 CM 364.00 411.00
12052 Laceration, Layered, 2.6-5.0 CM 413.00 469.00
16000 Burn, 1st Degree 94.00 103.00
16020 Debride Small Burn Area 112.00 126.00
17000 Destruct Benign Lesion, 1st Lesion 109.00 125.00
17003 Destruct Benign Lesion, 2nd-14th Lesion 11.00 12.00
17004 Destruct Benign Lesion, 15 or more Lesion 241.00 265.00
17110 Destruct Wart, Laser, Cryo, etc. 152.00 170.00
17111 Destruct 15 or more Warts, Laser, Cryo, etc. 180.00 203.00
19000 Drain Breast Lesion 159.00 171.00
19001 As iration of Breast Cyst, Simple 39.00 41.00
19100 Breast Biopsy 193.00 219.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
20526 Injection, Carpal Tunnel Syndrome 105.00 113.00
20550 Trigger Point Inject, Tendon, Ligament, Cyst 81.00 87.00
20551 Trigger Point Inject, Origin/Insert 80.00 88.00
20552 Trigger Point Inject, Muscle 73.00 81.00
20553 Trigger Point Inject, 3 or more Sites 82.00 92.00
20600 Arthrocentesis, Small Joint 77.00 82.00
20605 Arthrocentesis, Intermediate Joint/Bursa 82.00 90.00
20610 Arthrocentesis, Major Joint Injection 106.00 119.00
29125 Short Arm Temporary Splint 90.00 103.00
29130 Splint Finger 55.00 60.00
29260 Strap Wrist/Elbow 0.00 78.00
29280 Strap Hand/Finger 68.00 76.00
29550 Strap Toes 0.00 43.00
30901 Epistaxis Control, Simple 144.00 148.00
30903 Epistaxis Control, Complex 265.00 306.00
36000 IV Start 38.00 40.00
36405 Venipuncture, 3 Years Physician Scalp Vein 0.00 37.00
36406 Venipuncture, 3 Years Physician Other Vein 0.00 27.00
36416 Blood Draw, Capillary 0.00 25.00
36420 Venipuncture Cutdown, 1 Year 0.00 71.00
36425 Venipuncture Cutdown, 1 Year 0.00 60.00
36510 Umbilical Catheter 162.00 163.00
45005 I&D, Anal Abscess 386.00 394.00
45330 Flex Si moidosco 194.00 216.00
46320 Enucleate/Excise External Hemorrhoid 227.00 264.00
46600 Anoscopy 113.00 128.00
46900 Destruct Anal Condlyoma 304.00 278.00
51700 Bladder, Irrigation 137.00 134.00
51701 Bladder, Catheter Insert 96.00 94.00
51702 Bladder, Foley Insert 124.00 122.00
51725 C stometro ram, Simple 347.00 310.00
52320 C stourethroscop 391.00 387.00
53660 Urethral Dilation, 1st 116.00 117.00
53661 Urethral Dilation, Return Visit 116.00 116.00
54050 Destruct Penile Lesion 187.00 205.00
54056 Cryosurgery Penile Lesion 195.00 220.00
54100 Biopsy of Penis 291.00 313.00
54152 Circumcision 185.00 200.00
55250 Vasectomy 687.00 675.00
56405 I&D of Vulva/Perineum 155.00 167.00
56420 I&D Bartholin's Abscess 180.00 191.00
56501 Destruct Lesions Vulva, Simple, Laser, Cryo, etc. 0.00 201.00
56515 Destruct Lesions Vulva, Extensive, Laser, Cryo, etc. 0.00 341.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
57061 Destruct Vaginal Lesion, Simple 0.00 176.00
57065 Destruct Vaginal Lesion, Extensive 0.00 292.00
57100 Biopsy, Vagina 127.00 134.00
57150 Treat Vaginal Infection 74.00 74.00
57160 Pessary Insertion 111.00 119.00
57170 Fit Diaphragm/Cap 100.00 99.00
57180 Treat Vaginal Bleeding 0.00 218.00
57410 CHDP Pelvic Exam, 20 Years Old 152.00 162.00
57415 Remove Vaginal Foreign Object 0.00 243.00
57420 Exam of Vagina with Scope 0.00 176.00
57452 Col osco without Biopsy 157.00 166.00
57454 Colposcopy with Biopsy 220.00 233.00
57455 Col osco with Biopsy Cervix 0.00 204.00
57456 Col osco with Endocervical Curettage 0.00 206.00
57460 Col osco with Biopsy LEEP) 432.00 452.00
57461 Conization of Cervix with Scope LEEP) 483.00 506.00
57500 Biopsy of Cervix 192.00 203.00
57505 Endocervical Curettage 146.00 157.00
57510 Cautery of Cervix 190.00 200.00
57511 C others of Cervix 208.00 222.00
58100 Endometrial Biopsy 158.00 167.00
58300 IUD Insertion 115.00 112.00
58301 IUD Removal 138.00 147.00
59410 Obstetric Care Private Pa /Low Risk 1,252.00 1,361.00
59425 Ante artum Care Only, 0-6 Visits 619.00 512.00
59426 Antepartum Care Only, 7 or more Visits 1,108.00 1,120.00
59430 Postpartum Care Only 197.00 201.00
59425TG Ante artum Care Only, High Risk, 0-6 Visits 819.00 512.00
59426 TG Ante artum Care Only, High Risk, 7 or more Visits 1,308.00 1,525.00
59430 TG Postpartum Care Only, High Risk 397.00 201.00
99420 Perinatal Education Package Private Insurance/Pay, 8 hours 200.00 200.00
60100 Thyroid Needle Biopsy 167.00 173.00
62270 Lumbar Puncture 222.00 241.00
64435 Paracervical Nerve Block 0.00 217.00
64450 Nerve Block, Other 145.00 159.00
65205 Foreign Body 74.00 82.00
65220 Foreign Body, Corneal 76.00 85.00
69210 Ear Lava a 69.00 77.00
G0102 MEDICARE Digital Rectal Exam 31.00 31.00
G0104 MEDICARE Flex Si moidosco Fee 197.00 216.00
G0130 MEDICARE Bone Density Heel Scan 16.00 36.00
2 ULTRASONOGRAPHY, OTHER TESTING CODES
74742 Ultrasound Follicle Stud 195.00 265.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
76801 Ultrasound OB First Trimester 125.00 133.00
76805 Ultrasound Preg Uterus 149.00 163.00
76810 Ultrasound Multi gestational 79.00 81.00
76811 Ultrasound Complete 169.00 162.00
76815 Ultrasound Preg Uterus, Limited 90.00 97.00
76816 Ultrasound Preg Uterus, Follow-up 98.00 122.00
76818 Ultrasound Fetal Biophysical Profile 107.00 115.00
76825 Echocardiography, Fetal 195.00 221.00
76830 Ultrasound Transvaginal 132.00 148.00
76856 Ultrasound Pelvic 133.00 147.00
76946 Ultrasound Amniocentisis Guide 40.00 32.00
76977 Ultrasound Bone Density Test 17.00 13.00
92551 Audio ram, Screening, Pure Tone Air 26.00 21.00
92567 T anomet 26.00 24.00
93000 Routine ECG 12 Leads) 32.00 31.00
94010 S iromet 51.00 44.00
94375 Peak Flow Meter 57.00 39.00
94640 Airway Inhalation Treatment 21.00 26.00
94760 Pulse Oximetry 5.00 5.00
95115 mmunotherap 17.00 17.00
96372 Injection of Medicine, Subcutaneous or Intramuscular 0.00 37.00
96373 njection of Medicine, Intra arterial 0.00 30.00
96374 njection of Medicine, IV Push 0.00 89.00
99000 CHDP Lead Charge 8.00 8.00
99000 Handling of Specimen 8.00 8.00
99024 Post Operative Visit that is Part of Fee for Original Procedure 0.00 0.00
99075 Medical Testimony, Per Hour 225.00 245.00
99080 Special Reports, Forms 30.00 40.00
99173 Snellen Eye Test 20.00 5.00
LCODE Returned Check Fee 25.00 25.00
IIN HOUSE LABORATORY, SPECIMEN COLLECTION
81000 Urinalysis, Complete 7.00 7.00
81002 Urine Chem Strip 6.00 6.00
81025 Urine Pregnancy Test 9.00 5.00
82106 Amniotic Fluid Index 25.00 36.00
82270 Occult Blood 7.00 7.00
82803 Blood Gasses Arterial Blood Gasses) 43.00 43.00
82948 Glucose, Blood Reagent Strip 7.00 7.00
83036 Hemoglobin Al C CLIA waived) 22.00 22.00
85018 Hemoglobin 6.00 5.00
85610 Coag U Chek Protime Test 9.00 9.00
86580 PPD, Tuberculin Skin Test 17.00 17.00
86710 One Step Influenza Test 0.00 30.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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FO99828-U03
MG99866-U03
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DO103195-U03
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RESOLUTION-U07
AMENDING-U07
ARTICLE-U07
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COUNTY-U07
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FEE-U07
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EFFECTIVE-U07
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2011,-U07
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SUSIE-U09
MCKEES-U10
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
87210 Wet Mount, PAP Smear, Vaginal Infection Q0111 10.00 10.00
87220 KOH Solution Prep 10.00 10.00
87265 Pertussis Culture 22.00 21.00
87880 One Step Streptococcus Test 22.00 21.00
88720 Bilicheck Biliruben Meter 6.00 12.00
89220 Sputum Collection 21.00 26.00
Q0091 MEDICARE Pap Smear Collection 63.00 30.00
MMUNIZATIONS, INJECTABLES, MEDICAL SUPPLIES
90281 Immune Globulin, Human, IM 45.00 45.00
90396 Varicella Zoster Immune Globulin 950.00 950.00
90465 Immunization, 8 Years age, with Counseling, Single Vaccine 39.00 39.00
90466 Immunization, 8 Years age, with Counseling, Single Vaccines, 2 or more 20.00 20.00
90467 Immunization, 8 Years of age, Combination Vaccine, 1 Injection 26.00 26.00
90468 Immunization, 8 Years of age, Combination Vaccine, 2 or more 19.00 19.00
90471 Administration of One Vaccine, 8 years 33.00 37.00
90472 Administration of Two or more Vaccines, 8 years 16.00 18.00
90473 Administration of Vaccine Orally or Intranasal, Any Age, 1 Vaccine 26.00 26.00
90474 Administration of Vaccine Orally or Intranasal, Any Age, 2 or more 17.00 18.00
G0008 MEDICARE Influenza Vaccine Admin Fee 32.00 32.00
G0009 MEDICARE Pneumonia Vaccine Admin Fee 32.00 32.00
G0010 MEDICARE HEP B Vaccine Admin Fee 32.00 32.00
90632 Hepatitis A, Adult Dose 106.00 77.00
90633 Hepatitis A, Child/Teen 43.00 43.00
90645 HIB Vaccine 36.00 36.00
90646 HIB Titer 38.00 38.00
90649 Human Papilloma Virus Vaccine HPV) Quadravalent 221.00 221.00
90655 Influenza Preservative Free 28.00 29.00
90656 nfluenza Preservative Free, 3 Years of age and older 20.00 32.00
90657 nfluenza Split Virus, 6-35 months 0.00 14.00
90658 nfluenza Split Virus, 3 Years of age and older 20.00 14.00
90660 nfluenza Intranasal FLU MIST) 34.00 32.00
90669 Prevnar Varicella + MMRB) 117.00 117.00
90675 Rabies Vaccine 298.00 298.00
90680 Rotavirus 67.00 67.00
90691 Typhoid Vaccine 17.00 90.00
90700 DTaP Diphtheria, Tetanus, Pertussis), Patients 7 ears 39.00 39.00
90702 DT, Pediatric Diphtheria, Tetanus) 17.00 17.00
90703 Tetanus Toxiods 17.00 42.00
90707 MMR Measles, Mumps, Rubella) 89.00 89.00
90710 MMRV Measles, Mumps, Rubella, Varicella) 84.00 84.00
90713 IPV Inactivated Polio Virus) 30.00 90.00
90714 Td, booster Tetanus Diphtheria) 14.00 29.00
90715 Tda Tetanus, Diphtheria, Pertussis), 11 Years of age and older 69.00 61.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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FO99828-U03
MG99866-U03
AS99892-U03
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DO103195-U03
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ARTICLE-U07
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
90716 Varicella Chickenpox) 149.00 149.00
90716 Varicella, Adult Dose 149.00 149.00
90717 Yellow Fever Vaccine 17.00 98.00
90718 TD Tetanus, Diphtheria), Adult 21.00 36.00
90720 DTAP/HIB Hemophilus Influenza b Hib) Vaccine 53.00 53.00
90723 Pediarix Tetanus, Diphtheria, Pertussis, Hep B, Polio) 227.00 126.00
90725 Cholera Vaccine 18.00 18.00
90727 Plague Vaccine 16.00 16.00
90732 Pneumonia Vaccine 86.00 86.00
90733 Meningococcal Vaccine, Adult 121.00 156.00
90734 Meningococcal Vaccine, 11 Years of age and older 153.00 183.00
90744 Hepatitis B, Child/Teen 42.00 42.00
90746 Hepatitis B, Adult Dose 102.00 102.00
90748 Comvax Hep B, HIB) 79.00 79.00
A4267 Condoms, Male, Each X1500 0.30 0.30
A4268 Condoms, Female, Each X1500) 6.00 3.00
J0170 E hine hrine To 1MG 11.00 11.00
J0290 Ampicillan Per 500 MG 18.00 25.00
J0520 Bicillin To 5 MG 21.00 20.00
J0530 Bicillin 600,000 Units 21.00 10.00
J0540 Bicillin 1.2 Million Units 21.00 20.00
J0690 Ancef To 500 MG 14.00 13.00
J0696 Roce hin 250 MG 41.00 24.00
J0696,2 Rocephin 500 MG 41.00 36.00
J0696,4 Rocephin 1 GM 41.00 48.00
J0702 Bethamethasone 12.5 MG 18.00 25.00
J0725 Human Chorionic Gonadotropin 5,000 Units 14.00 12.00
J0735 Clonidine Hydrochloride 0.1 MG 163.00 113.00
J1000 Depo Estradiol To 5 MG 12.00 11.00
J1055 Depo Provera 150 MG 153.00 122.00
J1060 Depo Testosterone To 1 ML 14.00 11.00
J1090 Depo Testosterone 50 ML 11.00 11.00
J1100 Decadron 4 MG 14.00 10.00
J1200 Benad l 50 MG 12.00 12.00
J1380 Depo Estradiol 5 MG 12.00 16.00
J1390 Delestrogen 20 MG 16.00 16.00
J1720 Solu-Cortef To 100 MG 16.00 16.00
J1815 Insulin Injection Each 5 Units 15.00 12.00
J1820 Insulin Injection To 100 Units 15.00 12.00
J1885 Toradol 15 MG 12.00 12.00
J1950 Lupron Depot 3.75 MG 1,308.00 1,308.00
J1960 Lu ron Depot 7.50 MG 1,557.00 1,557.00
J2001 Lidocaine 50 CC 12.00 10.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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MG99866-U03
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
J2175 Demerol Mipiderine) 100 MG 11.00 14.00
J2270 Morphine To 10 MG 11.00 14.00
J2550 Phenergan Per 50 MG 11.00 11.00
J2675 Projesterone 150 MG 11.00 11.00
J2790 Rho am 233.00 233.00
J2920 Solu-Medrol 40 MG 19.00 16.00
J2950 Phener an 25 MG 11.00 11.00
J3105 Terbutaline 0.25 MG 11.00 11.00
J3301 Kenalo To 10 MG 12.00 14.00
J3420 Vitamin B12 11.00 11.00
J3430 Vitamin K Per 1 MG 11.00 11.00
J3490 Zithromax 250 MG 9.00 11.00
J7300 Intrauterine Device Para and X1522) 853.00 640.00
J7302 Intrauterine System Mirena X1532) 936.00 1,051.00
J7307 Implanon 0.00 1,243.00
J7510 Prednisolone To 20mg 14.00 12.00
J7610 Albuterol 1 MG Compounded Solution 9.00 10.00
J7613 Albuterol 1 MG Inhalation Solution 10.00 10.00
J7619 Albuterol 1 MG 9.00 10.00
J7644 patro ium Bromide Inhalation Solution 1 MG 10.00 12.00
J8499 Plan B Emergency Contraception 42.00 40.00
X1500 Spermicidal Gel 15.00 15.00
X1500 Spermicidal Foam 15.00 15.00
COMPREHENSIVE PERINATAL SERVICES PROGRAM
Z1032 Initial Ante artum Visit 127.00 127.00
Z1034 Antepartum Visit 61.00 61.00
Z1036 Tenth Ante artum Visit 114.00 114.00
Z1038 Postpartum Visit 61.00 61.00
Z5220 Collection/Handling of Blood Specimen 12.00 12.00
Z6200 nitial Nutrition Assessment/Additional CPSP) 18.00 18.00
Z6202 nitial Assessment, Each 15 Additional Minutes CPSP) 9.00 9.00
Z6204 Follow-up Nutrition Individual Assessment) CPSP) 9.00 9.00
Z6206 Group Nutrition Assessment, Each 15 Min CPSP) 9.00 9.00
Z6208 Post Partum Nutritional Assessment, Individual CPSP) 9.00 9.00
Z6210 Prenatal Vitamins #300 40.00 30.00
Z6300 nitial Psychological Assessment CPSP) 18.00 18.00
Z6302 nitial Psychological Assessment, Each Additional 15 Min CPSP) 9.00 9.00
Z6304 Follow up Psychological Assessment, Each 15 Min CPSP) 9.00 9.00
Z6306 Group Psychological Assessment, Each 15 Min CPSP) 9.00 9.00
Z6308 Postpartum Psychological, Each 15 Min CPSP) 9.00 9.00
Z6400 Client Orientation CPSP) 9.00 9.00
Z6402 Initial Health Education Assessment CPSP) 18.00 18.00
Z6404 Initial Health Education Assessment, Each Additional 15 Min CPSP) 9.00 9.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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FO99828-U03
MG99866-U03
AS99892-U03
AS99894-U03
AI102719-U03
DO103195-U03
C13-U03
RESOLUTIONS-U03
6/17/2011-U04
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
Z6406 Follow-up Health Education, Individual CPSP) 9.00 9.00
Z6408 Group Health Education, Each 15 Min CPSP) 9.00 9.00
Z6410 Perinatal Education, Individual, Each 15 Min CPSP) 9.00 9.00
Z6412 Perinatal Education, Group, Each Additional 15 Min CPSP) 9.00 9.00
Z6414 Postpartum Health Education, Individual, Each 15 Min CPSP) 9.00 9.00
Z6500 Initial Comprehensive Assessment CPSP) 136.00 136.00
H1001 Prenatal Care, At Risk Assessment 0.00 69.00
H1002 Prenatal Care, At Risk, Enhanced Services, Care Coordination 0.00 69.00
H1003 Prenatal Care, At Risk, Enhanced Services, Education 0.00 69.00
H2000 Comprehensive Multi Disciplinary Evaluation 0.00 69.00
Z7610 Ferrous Sulfate Supplement 6.00 6.00
Famil Planning/Education Family Planning Access Care Treatment- PACT)
29750 Individual Family Planning/Counseling, 5 Min PACT) 3.00 6.00
Z9751 Individual Family Planning/Counseling, 10 Min PACT) 13.00 13.00
Z9752 Individual Family Plan nin /Counselin 15 Min PACT) 52.00 26.00
Z9753 Individual Family Planning/Counseling, 30 Min PACT) 32.00 42.00
Z9754 Individual Family Planning/Counseling, 45 Min PACT) 45.00 68.00
Z7610 Acyclovir 200/400/800 MG Tabs PACT) 0.00 17.00
Z7610 Azithromycin 500 MG Tabs/1 GM Packet PACT) 0.00 46.00
Z7610 Butoconazole 2% Cream PACT) 0.00 32.00
Z7610 Cefixime 400 MG Tabs PACT) 0.00 12.00
Z7610 Cephalexin 250/500 MG Tabs PACT) 0.00 11.00
Z7610 Ciprofloxacin 250 MG Tabs PACT) 0.00 6.00
Z7610 Clindamycin 2% Cream PACT) 0.00 38.00
Z7610 Clotrimazole 1%/2% Cream or Tabs PACT) 0.00 10.00
Z7610 Dox c line 100 MG Tabs PACT) 0.00 11.00
Z7611 Estradiol PACT) 0.00 14.00
Z7610 Fluconazole 150 MG Tabs PACT) 0.00 12.00
Z7610 Imi uimod 5% Cream PACT) 0.00 127.00
Z7611 Metroniadazole 250/500 MG Tabs, 0.75% Gel PACT) 0.00 38.00
Z7610 Miconazole 2%/4% Cream or Tabs PACT) 0.00 16.00
Z7610 Ofloxacin 200/400 MG Tabs PACT) 0.00 125.00
Z7610 Podofilox 0.5% Solution/Gel PACT) 0.00 79.00
Z7610 Probenecid 500 MG Tabs PACT) 0.00 5.00
Z7610 Terconazole 0.4%/0.8% Cream or Tabs PACT) 0.00 46.00
Z7610 Tinidazole 250/500 MG Tabs PACT) 0.00 15.00
X5854 Cefoxitin 1 GM/2 GM/IM PACT) 0.00 22.00
X7716 Azithromycin 250 MG tabs PACT) 0.00 6.00
X7722 Emergency Contraception PACT) 0.00 21.00
J0570 Benzathine PCN 1.2 Units/cc PACT) 0.00 60.00
J0580 Benzathine PCN 2.4 Units/cc PACT) 0.00 117.00
Article I.d. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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FO99828-U03
MG99866-U03
AS99892-U03
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AI102719-U03
DO103195-U03
C13-U03
RESOLUTIONS-U03
6/17/2011-U04
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16627-U05
9-U06
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RESOLUTION-U07
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2011,-U07
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RESOLUTION 11-172 AND FEE SCH��
�ARTICLE I.d.
HEALTH DEPARTMENT
CLINIC SERVICES BUREAU
SCHEDULE OF FEES AND CHARGES
CPT
CODE
SERVICE DESCRIPTION Existing
fees Proposed
new fees
EVALUATION AND MANAGEMENT CODES
99201 New Patient, Minimal, 25 Minute *Min=Minute) 57.00 64.00
99202 New Patient, Low Severity, 20 Min 97.00 110.00
99203 New Patient, Moderate, 30 Min 140.00 159.00
99204 New Patient, Moderate-High Complexity, 45 Min 215.00 243.00
99205 New Patient, Moderate-High Complexity, 60 Min 272.00 302.00
99211 Established Patient, Nurse/Medical Assistant, 5 Min 30.00 32.00
99212 Established Patient, Minimal, 10 Min 57.00 65.00
99213 Established Patient, Moderate, 15 Min 94.00 107.00
99214 Established Patient, Moderate-High, 25 Min 141.00 157.00
99215 Established Patient, Moderate-High, 40 Min 190.00 213.00
99241 Outpatient Consultation, Problem Focused/Straightforward, 15 Min *OP=Out atient 74.00 72.00
99242 OP Consultation Expand ed/Straihtforward, 30 Min 138.00 134.00
99243 OP Consultation Detail/Low Complexity, 40 Min 190.00 183.00
99244 OP Consultation Complicated/Moderate Complexity, 60 Min 280.00 271.00
99245 OP Consultation Complicated/High Complexity, 80 Min 343.00 330.00
99378 Hospice Care Supervision, 30 or more Min 135.00 167.00
99379 Nursing Facility Supervision, 15-29 Min 104.00 90.00
99380 Nursing Facility Supervision, 30 or more Min 135.00 142.00
99381 New Patient Exam Under 1 Year old 91.00 105.00
99382 New Patient Exam, 1-4 Years old 95.00 111.00
99383 New Patient Exam, 5-11 Years old 110.00 121.00
99384 New Patient Exam, 12-17 Years old 132.00 131.00
99385 New Patient Exam, 18-39 Years old 162.00 207.00
99386 New Patient Exam, 40-64 Years old non Medicare) 192.00 234.00
99387 New Patient Exam, 65 Years of age and over non Medicare) 212.00 274.00
99391 Established Patient Exam, Under 1 Year old 70.00 100.00
99392 Established Patient Exam, 1-4 Years old 75.00 106.00
99393 Established Patient Exam, 5-11 Years old 88.00 115.00
99394 Established Patient Exam, 12-17 Years old 110.00 125.00
99395 Established Patient Exam, 18-39 Years old 140.00 168.00
99396 Established Patient Exam, 40-64 Years old 170.00 184.00
99397 Established Patient Exam, 65 Years of age and over non Medicare) 200.00 209.00
G0101 Medicare Annual Well Woman Exam 54.00 42.00
G0179 Physician Recertification of Home Health Care 69.00 64.00
G0180 Physician Certification of Home Health Care 90.00 83.00
G0181 Physician Supervision of Patient Receiving Home Health Care 159.00 161.00
G0182 Ph sician Supervision of Patient Receiving Hospice Care 165.00 163.00
G0402 Medicare Preventative Exam, New Medicare Patient 141.00 229.00
G0403 Routine EKG, When Performed with Above Exam 32.00 31.00
Article W. Monterey County Master Fee Resolution
Health Department: Clinc Services Bureau
Effective July 1, 2011
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FO99828-U03
MG99866-U03
AS99892-U03
AS99894-U03
AI102719-U03
DO103195-U03
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RESOLUTIONS-U03
6/17/2011-U04
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2011,-U07
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SIGNED BOARD REPORT"�|E���MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: June 14, 2011 Consent AGENDA NO.:
SUBJECT: Adopt a Resolution amending Article I.d. of the Monterey County Master Fee
Resolution effective July 1, 2011, to adjust certain fees related to the Health
Department's Clinic Services Bureau pursuant to the attached Fee Schedule.
DEPARTMENT: Health Clinic Services Bureau
RECOMMENDATION
It is recommended that the Board of Supervisors:
Adopt a Resolution amending Article I.d. of the Monterey County Master Fee Resolution effective
July 1, 2011, to adjust certain fees related to the Health Department's Clinic Services Bureau.
SUMMARY/DISCUSSION
Periodically, the Health Department Clinic Services Bureau reviews its fee schedule to ensure its
appropriateness, and to ensure that it accurately reflects the costs of services provided. On April 14,
2009, your Board approved the Health Department's recommendation to amend specific fees and
charges applicable to the Federally Qualified Health Center FQHC) clinics. The Clinic Services
Bureau has updated its schedule to be in synchronization with either the Medicare or Medi-Cal fee
schedules applicable to Federally Qualified Health Care Center FQHC) clinics as appropriate.
OTHER AGENCY INVOLVEMENT
County Counsel has reviewed the proposed schedule of fees and charges. A copy of the fee schedule is
on file with Clerk of the Board showing current and proposed fees, along with additional calculations
documenting the recommended fees.
FINANCING
The recommended fee adjustments are intended to capture no more than the reasonable costs
associated with the provision of services, and do not exceed the actual costs of providing these
services. All patients under the 200% Federal Poverty Level can apply for reduced service costs as
approved by FQHC regulations. The reduction in income to fully cover medical service costs are paid
via FQHC prospective payment rates and general fund contributions, and do not result in increased
costs to other payors. Currently, all patients visiting the Clinic Services Bureau's clinics are pre-
screened for eligibility into State and Federal programs to ensure that all patients eligible for a third
party payor source are enrolled in appropriate programs in an effort to reduce General Fund
Contribution.
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SIGNED BOARD REPORT"�|E���The fee schedule adjustment is needed to ensure that fees accurately represent, but not exceed, the cost
to the County for the services and benefits provided to Clinic Services Bureau patrons. The proposed
fees help assure that the Health Department remains within budgeted General Fund Contribution,
while still not exceeding the actual cost of services. It is estimated that the fee schedule adjustments
will realize increased revenues for FY 2011-12 of approximately $12,000.
Prepared by: Approved by:
Robin Kimball, 796-1386
Senior Secretary
Date
Date
Attachments:
A copy of the proposed Article I.d. fee schedule is on file with the Clerk of the Board.
A copy of the Clinic Services fee schedule calculations is on file with the Clerk of the Board.
cc: County Counsel
Auditor-Controller
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