County Health Department Billing Codes, Effective January 1, *Requires prior authorization. CODE DESCRIPTION OF SERVICES Maximum Fee
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1 County Health Department Billing Codes, Effective January 1, 2018 *Requires prior authorization Adult Health Screening Codes CODE DESCRIPTION OF SERVICES Maximum Fee Adult Health Screening, new patient, age yrs Adult Health Screening, new patient, age yrs Adult Health Screening, new patient, age 65 yrs. and over Adult Health Screening, established patient, age yrs Adult Health Screening, established patient, age yrs Adult Health Screening, established patient, 65 yrs. and over Dental Services Codes CODE DESCRIPTION OF SERVICES Maximum Fee D0150 Comprehensive Oral Evaluation D0120 Periodic Oral Evaluation D5211 Upper Partial-Resin Base * D5212 Lower Partial-Resin Base * D5213 Maxillary Partial Denture * D5214 Mandibular Partial Denture * D5820 Interim Partial Denture (Maxillary) * D5821 Interim Partial Denture (Mandibular) *
2 Well Child Visit (Child Health Check-Up) Codes CODE MODIFIER DESCRIPTION OF SERVICES Maximum Fee Well Child Visit new patient <1year Well Child Visit new patient 1 through 4 years Well Child Visit new patient 5 through 11 years Well Child Visit new patient 12 through 17 years EP Well Child Visit new patient 18 through 20 years Well Child Visit established patient <1 year Well Child Visit established patient 1 through 4 years Well Child Visit established patient 5 through 11 years Well Child Visit established patient 12 through 17 years EP Well Child Visit established patient 18 through 20 years
3 Family Planning Codes CODE MODIFIER DESCRIPTION OF SERVICES FP Family Planning Initial Family Planning Examination age 5-11 years FP Family Planning Initial Family Planning FP Family Planning Initial Family Planning FP Family Planning Initial Family Planning Examination age years FP Family Planning Annual Family Planning Examination age 5-11 years FP Family Planning Annual Family Planning FP Family Planning Annual Family Planning FP Family Planning Annual Family Planning Examination age years Maximum Fee FP Family Planning Counseling Visit FP Family Planning Supply Visit FP HIV Counseling
4 Family Planning Waiver Codes For more information about the family planning waiver program, visit: CODE MODIFIER DESCRIPTION OF SERVICES FP Family Planning Initial Family Planning FP Family Planning Initial Family Planning FP Family Planning Initial Family Planning Examination age years FP Family Planning Annual Family Planning FP Family Planning Annual Family Planning FP Family Planning Annual Family Planning Examination age years Maximum Fee FP Family Planning--Counseling Visit FP Family Planning--Supply Visit 99401, FP HIV Counseling 57452, 57454, FP Colposcopy Surgeries (Billed with the Fee-For- Service Group Practitioner Provider Number) See Practitioner Fee Schedule
5 Primary Medical Care Codes CODE DESCRIPTION OF SERVICES Maximum Fee Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit H1000 Antepartum Care only Postpartum Care only Registered Nurse Services Code CODE MODIFIER DESCRIPTION OF SERVICES Maximum Fee TD Services provided by registered nurses Exception: Bill adult health screenings, Well Child Visit screenings (Child Health Check-Up screenings), family planning services, and antepartum services rendered by RNs with the applicable service procedure code rather than TD.
6 Immunization Codes CODE MODIFIER DESCRIPTION OF SERVICES Maximum Fee Administration of Vaccines to Medicaid recipients from birth through 18 years $5.50 per vaccine dose
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