Medicaid Reimbursement Survey, Nevada

Medicaid Reimbursement Survey, 2015 Nevada

Nevada - 2015 AAP Medicaid Reimbursement Survey Survey Summary As part of its effort to monitor the impact of the Medicaid program on pediatrics, the American Academy of Pediatrics (AAP) conducts its Medicaid Reimbursement Survey periodically. The Survey, which collects state-administered fee-for-service program payment rates for commonly reported pediatric Current Procedural Terminology/CPT codes and dental codes, was most recently mailed to State Medicaid Directors in the 50 states and the District of Columbia between January 2015 and September 2015 to request payment rates effective July 1, 2015, the beginning of the 2010-11 fiscal year for most states. In addition, the survey requested ACA rates, in effect as of October 1, 2014. As of publication of this report, 39 states have responded to the survey. This and earlier AAP Medicaid Reimbursement Survey reports can be found at URL: http://www.aap.org/research/medreimintro.htm In this Report... This report provides state-reported fees paid for pediatric services represented by over 150 CPT and dental codes used by state-administered fee-for-service Medicaid programs to reimburse providers. Medicaid fees are compared to Medicare where available, or to other benchmark fees (such as prices listed in the Clinical Diagnostic Lab Fee Schedule, or prices based on the Ingenix Essential RBRVS) where Medicare comparisons are unavailable. Codes are selected for inclusion in the survey based on (i) utilization, and (ii) importance to Academy priorities, such as Bright Futures and the pediatric medical home. Also included in this report are summary updates on Medicaid managed care (MMC) enrollment, state-monitoring of MMC physician reimbursement, coverage of Bright Futures benefits, and reimbursement of pediatricians for providing certain mental and preventive oral health services to children.

Nevada - 2015 AAP Medicaid Reimbursement Survey Caveats and Notes Medicaid fees shown in this report represent fee-for-service payments reported by states for stateadministered Medicaid programs at the time of the study (January, 2015 - September, 2015). The rates are subject to change. Nationally, the majority of children enrolled in Medicaid programs are enrolled in managed care plans, which may or may not benchmark provider payment rates to fees shown in this report. Depending on managed care penetration levels, the impact of state-administered fee-for-service Medicaid payment rates varies by state. Unless noted otherwise, non-facility rates and enhanced payment rates for pediatric services, where available and reported by the state, are included in this report. Nevada reported that reimbursement for preventive medicine services does not include immunization and/or laboratory tests, that the state provides vaccines for children through a universal immunization program, that it pays the administration fee on the product code for vaccines administered through the Vaccines for Children (VFC) program, and that it paid a vaccine adminstration fee of (a) $26.23 to self-attested physican providers eligible for the ACA Medicaid, and (b) $7.80 to non-self-attested qualifying physician providers ineligible for the ACA Medicaid payment increase. The state reported also that it paid on the actual vaccine administration code. For more information on the state's fee schedule please see the following state-provided link: https: //dhcfp.nv.gov/ratesunit.htm Medicare rates in this report are (a) based on non-facility Medicare payment published by the Centers for Medicare and Medicaid Services for 2011, and (b) adjusted with Geographic Practice Cost Index (GPCIs) published by CMS. Certain codes, including not not limited to 99381-5 and 99391-5, are assigned RVUs but not covered by Medicare. CPT is a trademark of the American Medical Association. Dental codes (CDT Codes) are copyright 2016 American Dental Association. Reprinted with permission. Contact Information Contact Kelly Loes, Division of Quality, for comments on this report. Contact Dan Walter or Wendy Chill, Division of State Government Affairs, for Medicaid questions and advocacy advice. Contact Elizabeth Sobczyk, Division of Pediatric Practice, for pediatric immunization questions and advocacy advice. For coding or RBRVS questions, please contact the AAP Coding Hotline at aapcodinghotline@aap.org. Suggested Citation 2015 AAP Medicaid Reimbursement Survey. American Academy of Pediatrics. Elk Grove Village, Illinois. Available for download at the AAP Website, at URL: https://www.aap.org/en-us/professionalresources/research/research-resources/pages/medicaid-reimbursement-reports.aspx

AAP BC BI/BR/IC /MP/PR BO CMS C-NP DMS FFS Nevada - 2015 AAP Medicaid Reimbursement Survey American Academy of Pediatrics Abbreviations Billed amount / billed charges By invoice/ by report/ individual consideration/manually priced/per review, i.e., Carrier will establish payment amounts for these services on a case-by-case basis following review of documentation, such as an operative report Bundled with other services, i.e., Payment for covered services is always bundled into payment for other services not specified. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident Centers for Medicare and Medicaid Services Covered, rate not provided Department of Medicaid Services/DMS system amount paid to Public Health Departments in the state of Kentucky only. Discounted fee-for-service RVUs not published for this code in the Medicare RBRVS; values are based on the IER Ingenix Essential RBRVS. Ratio (percentage listed under %Medicare column) represents Medicaid payment as a percentage of the rate calculated using the RVUs published in the Ingenix Essential RBRVS. Amount per Clinical Diagnostic Lab Fee Schedule. Ratio (percentage listed under LFS %Medicare column) represents Medicaid payment as a percentage of the mount listed for the state in the Clinical Diagnostic Lab Fee Schedule. NA Not applicable NC Not covered Code non-eligible for Medicaid fee increase for Affordable Care Act NIS Not priced by the current Physician Fee Schedule, or RVUs not included in RBRVS Payment information specific to procedure code not listed on state Medicaid website NL or physician fee schedule. Note: absence of such information from fee schedule often indicates that the service is either not covered, or covered under alternate code(s). NP Information not provided by state in returned AAP survey OM Other method used QMB Qualified Medicare Beneficiary RBRVS Resource-Based Relative Value Scale, the physician payment schedule for Medicare RNE Rate not established RVU(s) Relative Value Unit(s), the numeric value of the resources needed to provide services according to the Resource-Based Relative Value Scale SE Data not available due to survey error.

List of CPT and Dental Codes Included in Report Service Type Code Description Page # Preventive Medicine Services Office and Other Outpatient Services 99381 New patient, under 1 year 1 99382 New patient, 1 through 4 years 1 99383 New patient, 5 through 11 years 1 99384 New patient, 12 through 17 years 1 99391 Established patient, under 1 year 1 99392 Established patient, 1 through 4 years 1 99393 Established patient, 5 through 11 years 1 99394 Established patient, 12 through 17 years 1 99406 Smoking and tobacco use cessation counseling; >3-10 mins 2 99407 Smoking and tobacco use cessation counseling: >10 mins 2 99408 Alcohol/substance abuse structured screening/sbi srvc; 15-30 mins 2 99409 Alcohol/substance abuse structured screening/sbi srvc; >10 mins 2 99420 Administration+interpretation of health risk assessment instrument 2 99201 New patient, problem-focused 2 99202 New patient, expanded 2 99203 New patient, low complexity 2 99204 New patient, moderate complexity 2 99205 New patient, high complexity 3 99211 Established patient, nurse only 3 99212 Established patient, problem-focused 3 99213 Established patient, low complexity 3 99214 Established patient, moderate complexity 3 99215 Established patient, high complexity 3 92551 Screening test, hearing evaluation 3 92567 Tympanometry, hearing evaluation 3 99173 Screening test, visual acuity 4 99174 Ocular photoscreening 4 99188 Application of topical fluoride varnish by a physician or other qualified health care professional 4 96110 Developmental testing; limited 4 Newborn Care 99460 Initial newborn care 4 99462 Subsequent newborn care 4 99463 Admit and discharge on same day 4 99464 Physician attendance at delivery 4 99465 Newborn resuscitation 4 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block 5 Immunizations 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component 5 Service Type Code Description Page # Immunizations Continued Evaluation and Management Non-physician Provider (NPP) Services Hospital Care 90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component 5 90471 One immunization administration 5 90472 Each additional immunization administration 5 90473 One immunization administration, oral or intranasal 5 90474 Each additional administration, oral or intranasal 5 99354 Prolonged service outpatient, 1st hour, face-to-face 5 99355 Same as 99354, each additional 30 minutes 5 99356 Prolonged service, inpatient, 1 st hour, face-to-face 5 99357 Same as 99356, each additional 30 minutes 5 99358 Prolonged service, inpatient, 1 st hour, nonface-to-face 5 99359 Same as 99356, each additional 30 minutes 5 99367 Medical team conference, patient/family not present, 30 min 5 99339 Care plan oversight, supervision of patient in home, 15-29 minutes per month 5 99442 Telephone evaluation and management 11-20 minutes 5 99447 Physician to physician tele/internet consultation 11-20 minutes 5 99448 Physician to physician tele/internet consultation 21-30 minutes 5 99490 Chronic care management services 20 mins clinical staff time directed by a physician or other qualified health care professional, per calendar month 6 96150 Health and Behavior assessment; by NPP 6 96151 Health and Behavior re-assessment; by NPP 6 96152 Health and Behavior intervention; by NPP 6 97802 Medical Nutrition Therapy, individual, initial 6 97803 Medical Nutrition Therapy, individual, follow-up 6 99222 Initial hospitalization, per day, moderate complexity 6 99223 Initial hospitalization, per day, high complexity 6 99232 Subsequent hospitalization, per day, mod complexity 6 99233 Subsequent hospitalization, per day, high complexity 6

List of CPT and Dental Codes Included in Report (Continued) Service Type Code Description Page # Hospital Care 99238 Hospital discharge, day management, 30 min Continued 6 Pathology and Laboratory 81000 Urinalysis, non-automated with microscopy 7 81002 Urinalysis, non-automated without microscopy 7 86500 Tuberculosis, intradermal 7 87081 Throat culture 7 87880 Rapid Streptococcus screen 7 Mental Health 90791 Psychiatric diagnostic eval 7 90792 Psychiatric diagnostic eval w/ medical services 7 90832 Psychotherapy, 30 mins w/ patient/family 7 90837 Consultation w/ family 7 90889 Preparation of report 7 96111 Developmental testing, extended 7 90887 Interpretation of explanation of psychiatric or other medical exams 7 90889 Preparation of reports on patient s psychiatric status, history, treatment or progress. 7 96127 Brief emotional/behavioral assessment 7 Allergy and Immunology 95004 Percutaneous tests with allergenic extracts 8 95017 Allergy testing, with venoms 8 95018 Allergy testing, with drugs or biologics 8 95024 Intracutaneous tests, with allergenic extracts 8 95115 Allergen immunotherapy, single injection 8 95117 Allergen immunotherapy, two or more injections 8 Cardiology 32551 Tube thoracostomy, includes water seal 8 92950 Cardiopulmonary resuscitation 8 93303 Transthoracic echocardiography 8 93307 Echocardiography, real-time w/ image documentation 8 93320 Doppler echocardiograph 8 93451 Right heart catheterization 8 93452 Left heart catheterization 8 Critical Care 31500 Intubation, endotracheal 8 36555 Insertion of non-tunneled center venous cathether; < 5 yrs 8 36568 Insertion of peripherally inserted CVC; under 5 years 8 36660 Arterial puncture, diagnostic 8 36620 Arterial line placement 8 99291 Critical care, first hour 8 Emergency 10120 Simple surgical removal of foreign body Care 8 36400 Venipuncture necessitating physician skill; < 3 8 yrs 36410 Venipuncture necessitating physician skill; >= 3 8 yrs 36415 Routine venipuncture 8 62270 Lumbar puncture, diagnostic 8 99282 ED visit, problem focused 8 99283 ED visit, expanded 8 99284 ED visit, detailed 8 Service Type Code Description Page # Gastrointestinal 43239 Upper gastrointestinal endoscopy 8 44389 Colonoscopy with biopsy 8 45331 Sigmoidoscopy with biopsy 8 Ophthalmology 67311 Strabismus surgery, horizontal 8 67314 Strabismus surgery, vertical 8 68810 Nasolacrimal probing 8 Otolaryngology 42820 Tonsillectomy/adenoidectomy, < 12 years 8 42821 Tonsillectomy/adenoidectomy, > 12 years 8 69436 Tympanostomy and tubes 8 Neonatal and Pediatric Critical Care Initial and Continuing Intensive Care Services 36510 Umbilical vein catheterization 9 36660 Umbilical artery catheterization 9 99471 Initial pediatric critical care (29d-24m) 9 99472 Subsequent pediatric critical care (29d- 24m) 9 99475 Initial pediatric critical care (2-5 yrs) 9 99476 Subsequent pediatric critical care (2-5 yrs) 9 99468 Initial neonatal critical care 9 99469 Subsequent neonatal critical care 9 99477 Initial neonatal intensive care 9 99478 Subsq intensive care, < 1500 gm 9 99479 Subsq intensive care, 1500-2500 gm 9 99480 Subsq intensive care, 2501-5000 gm 9 Plastic Surgery 40700 Cleft lip repair 9 42200 Cleft palate repair 9 Pulmonology 31622 Bronchoscopy 9 32421 Thoracentesis for aspiration 9 94010 Spirometry, including graphic record 9 94640 Inhalation treatment 9 94644 Continuous inhalation treatment, first hour 9 94664 Demonstration/evaluation 9 Radiology 71010 Frontal chest x-ray 9 Surgery 28262 Extensive clubfoot release 9 44950 Appendectomy 9 49500 Bilateral inguinal hernia, 6 mos to < 5 years 9 49505 Bilateral inguinal hernia, 5 years or over 9 Urology and Dialysis 50200 Renal biopsy; percutaneous, by trocar or needle 9 90957 ESRD services; 12-19 yrs, 4+ physician visits/mo 9 90959 Same as above, 1 physician visits/mo 9 90965 Same, home dialysis for full month 9 90945 Peritoneal dialysis 9 Dental Services D0120 Periodic exam 10 D0145 Caries Risk Assessment 10 D1206 Topical fluoride varnish 10 D1120 Prophylaxis, child 10 D2150 Amalgam 2 surfaces, primary or perm 10 D2330 Resin-based composite 1 surface anterior 10 D1351 Sealant, per tooth 10 D2930 Stainless steel crown on a primary tooth 10 D3220 Pulpotomy 10 D7140 Extraction 10

AAP Medicaid Reimbursement Survey: Nevada Coverage of Bright Futures Preventive Services Nevada covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks. 2015 Medicaid Payments for Commonly Reported Pediatric CPT TM Codes Medicaid Medicare %Medicare Current/ACA Ratio* Preventive Medicine Services 99381 - New Patient, under 1 yr 99382 - New Patient, 1-4 yrs 99383 - New Patient, 5-11 yrs 99384 - New Patient, 12-17 yrs 99391 - Established patient, under 1 yr 99392 - Established patient, 1-4 yrs 99393 - Established Patient, 5-11 yrs 99394 - Established Patient, 12-17 yrs 99406 - Smoking and tobacco use cessation counseling; >3-10 mins $115.22 $114.44 $59.07 $113.80 51.9% $119.95 $119.14 $59.07 $119.25 49.5% $125.11 $124.26 $59.07 $124.32 47.5% $141.30 $140.35 $59.07 $140.31 42.1% $103.66 $102.96 $59.07 $102.74 57.5% $110.66 $109.91 $59.07 99407 - Smoking and tobacco use cessation counseling; >10 mins $109.29 54.0% $110.03 $109.53 100.5% $59.07 $108.92 54.2% $120.54 $119.73 $59.07 $119.81 49.3% $14.32 $14.29 100.2% $12.46 $14.59 85.4% $28.38 $28.19 $24.32 $28.04 86.7% 51.27% 49.25% 47.21% 41.80% 56.98% 53.38% 53.69% 49.00% 87.01% 85.69% * Current/ACA Ratio = 2015 state-reported Medicaid rates divided by 2015 state-reported Medicaid rates.

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 2 of 10 ) Medicaid Medicare %Medicare Current/ACA Ratio* Preventive Medicine Services (Continued) 99408 - Alcohol/Substance abuse structured screening/sbi srvc; 15-30 min NP $36.23 $36.03 99409 - Alcohol/Substance abuse structured screening/sbi srvc; >10 min NP $70.57 NP $69.78 99420 - Administration+interpretation of health risk assessment instrument Office and Other Outpatient Services 99201 - New patient, problem focused $45.18 $44.88 $25.68 $45.33 56.7% 99202 - New patient, expanded $77.46 $76.94 $46.56 $77.21 60.3% 99203- New patient, low complexity $112.39 $111.63 $69.84 $111.91 62.4% 99204 - New patient, moderate complexity $172.23 $171.07 $99.01 $169.82 58.3% 99205 - New patient, high complexity $214.24 $212.80 $125.77 $213.15 59.0% 99211 - Established patient, nurse only $20.98 $20.83 $15.52 $20.72 74.9% 99212 - Established patient, problem focused $45.56 $45.25 $27.56 $45.33 60.8% 99213 - Established Patient, low complexity $75.86 $75.35 $38.26 $74.92 51.1% 56.84% 60.11% 62.14% 57.49% 58.71% 73.98% 60.49% 50.44% * Current/ACA Ratio = 2015 state-reported Medicaid rates divided by 2015 state-reported Medicaid rates.

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 3 of 10) Medicaid Medicare %Medicare Current/ACA Ratio* Office and Other Outpatient Services (Continued) 99214 - Established patient, moderate complexity $111.80 $111.04 100.70% $59.67 $111.15 53.70% 99215 - Established patient, high complexity $149.48 $148.47 100.70% $87.77 $149.83 58.60% 92551- Screening test, hearing evaluation $8.62 $12.75 67.60% 92567 - Tympanometry, hearing evaluation 99173 - Screening test, visual acuity $17.85 $15.05 118.6% NP $3.36 99174 - Instrument-based ocular screening,bilatera Current Rate... NP NIS 99188 - Application of topical fluoride varnish by a physician or other qualified health care professional 96110 - Developmental screening $12.30 NIS $11.68 $10.12 115.4% 53.37% 58.72% Nevada reports it pays for multiple units of 96110 on the same day, and that 92551, 92567, 99188, and 96110 are bundled with the preventive service. * Current/ACA Ratio = 2015 state-reported Medicaid rates divided by 2015 state-reported Medicaid rates.

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 4 of 10) Medicaid Medicare %Medicare TM Current/ACA Ratio* Newborn Care 99460 - Initial newborn care $97.24 $96.59 $42.20 $101.79 41.5% 99462 - Subsequent newborn care $43.36 $43.06 $22.44 $42.49 52.8% 99463 - Admin and discharge on same day $118.20 $117.40 Current Rate... $56.57 $123.14 45.9% 99464 - Physician attendance at delivery $72.93 $72.44 $53.00 $76.23 69.5% 99465 - Newborn resuscitation $152.22 $151.19 $108.78 $154.47 70.4% 54150 - Circumcision, using clamp or other device with regional dorsal penile or ring block NP $161.51 $186.82 $161.28 115.8% 43.40% 51.75% 47.86% 72.67% 71.46% Immunizations* 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component $26.32 $26.14 $7.80 $26.38 29.6% 29.64% 90461 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each addtional vaccine/toxoid component NP $12.96 NP $13.26 0.0% 90471 - Immunization administration; one vaccine $26.32 $26.14 $7.80 $26.38 29.6% 29.64% 90472- Each additional vaccine $13.04 $12.96 100.6% $7.80 $13.26 58.8% 59.82% 90473 - Immunization administration by intranasal or oral route; one vaccine $26.32 $26.14 $7.80 $26.38 29.6% 29.64% 90474 - Each additional vaccine $13.04 $12.96 100.6% $7.80 $13.26 58.8% 59.82% * For state-specific information on vaccine administration, please refer to the 'Caveat' section on page three of this report. ** Current/ACA Ratio = 2015 state-reported Medicaid rates divided by 2015 state-reported Medicaid rates.

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 5 of 10) Evaluation and Management * 99354 - Prolonged service outpatient, 1st hour, face-to-face $103.30 $102.60 $90.18 $102.39 88.1% 99355 - Same as 99354, each additional 30 minute $101.02 $100.33 $84.02 $99.38 84.5% 99356 - Prolonged service, inpatient, 1st hour, face-to-face $95.05 $94.40 $64.75 $94.24 68.7% 99357 - Same as 99356, each additional 30 minute $94.28 $93.65 $65.56 $93.14 70.4% 99358 - Prolonged service, 1st hour, non-face-to-fac 99359 - Same as 99358, each additional 30 minute NP NIS 99367 - Medical team conference, patient/family not present 30 minutes $47.77 NIS 99339- Care plan oversight, supervision of patient in home, 15-29 minutes per month. NP $80.50 99442 - Telephone evaluation and management - 11-20 minutes NP $27.81 NP $27.66 99447 - Physician to physician tele/internet consultation 11-20 min 99448 - Physician to physician tele/internet consultation 21-30 min 99490 - Chronic care management services, >= 20 mins clinical staff time directed by a physician or other qualified health care professional, per calendar mont $37.53 $43.62 86.0% *State reports payments for 99367 and 99490 are bundled with the E/M code. Medicaid Medicare %Medicare Current/ACA Ratio* 87.30% 83.17% 68.12% 69.54% ** Current/ACA Ratio = 2015 state-reported Medicaid rates divided by 2015 state-reported Medicaid rates.

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 6 of 10) Medicaid Medicare %Medicare Current/ACA Ratio* Non-physician Provider (NPP) Services 96150 - Health and behavior assessment; by NPP $22.77 $22.05 103.3% 96151 - Health and behavior re-assessment; by NPP $22.15 $20.96 105.7% 96152 - Health and Behavior intervention; by NPP $21.23 $19.89 105.7% 97802 - Medical Nutrition Therapy, individual, initial; by NPP NP $35.91 97803 - Medical Nutrition Therapy, individual, follow-up; by NPP NP $30.80 Hospital Care 99222 - Initial hospitalization, per day, moderate complexity $142.57 $141.60 $81.61 $140.62 58.0% 99223 - Initial hospitalization, per day, high complexity $209.89 $208.48 $113.73 $208.23 54.6% 99232 - Subsequent hospitalization, per day, moderate complexity $74.30 $73.80 $40.40 $74.15 54.5% 99233 - Subsequent hospitalization, per day, high complexity $107.04 $106.31 $57.53 $106.85 53.8% 99238 - Hospital discharge, day management, 30 min or less $74.88 $74.37 $49.77 $75.08 66.3% 57.24% 54.19% 54.37% 53.75% 66.47% * Current/ACA Ratio = 2015 state-reported Medicaid rates divided by 2015 state-reported Medicaid rates.

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 7 of 10) Medicaid Medicare %Medicare Pathology and Laboratory* 81000 - Urinalysis, non-automated with microscopy $2.22 NIS 81002 - Urinalysis, non-automated without microscopy $1.79 NIS 86580 - Tuberculosis, intradermal $13.33 $8.24 161.8% 87081- Throat culture $4.64 NIS 87880 - Rapid Streptococcus screen $8.39 NIS *State reports payments for Pathology and Laboratory codes 81000, 81002, 86580, 87081, and 87880 are paid separately when reported with an E/M code. In addition, Nevada requires the five tests listed in the Pathology and Laboratory section to be performed at approved facilities in order to qualify for payment. Mental Health ** 90791 - Psychiatric diagnostic eval $139.46 $132.73 105.1% 90792 - Psychiatric diagnostic eval w/ medical services $113.76 $149.13 76.3% 90832 - Psychotherapy, 30 mins w/ patient/family $57.78 $64.67 89.3% 90837 - Psychotherapy, 60 mins w/ patient/family $108.15 $128.60 84.1% 96111 - Developmental testing, extended $112.36 $131.08 85.7% 90887 - Interpretation of explanation of psychiatric or other medi NA NIS 90889 - - Preparation of reports on patient s psychiatric status 96127- Brief emotional/behavioral assessment $4.82 $5.61 85.9% **State reports it reimburses general pediatricians for mental health code(s): 90791, 90792, 90832, 90837, 96111, and 96127. In addition, Nevada currently reimburses developmental/behavioral pediatric subspecialists the same rates as general pediatricians for providing the services listed above.

AAP Medicaid Reimbursement Survey Report, 2014/15 - Nevada, Continued (page 8 of 10) Specialty Care Codes Allergy/Immunology 95004 - Percutaneous tests with allergenic extracts 95017 - Allergy testing, with venoms 95018 - Allergy testing, with drugs or biologics 95024 - Intracutaneous tests, with allergenic extracts 95115 - Allergen immunotherapy, single injection 95117 - Allergen immunotherapy, two or more injections Medicaid Medicare %Medicare $3.39 $6.72 50.4% $81.95 $8.13 1008.0% $27.78 $19.66 141.3% $4.92 $8.23 59.8% $12.62 $9.37 134.7% $16.00 $10.87 147.2% Cardiology 32551 - Tube thoracostomy, includes water seal $214.89 $178.49 120.4% 92950 - Cardiopulmonary resuscitation $176.00 $316.78 55.6% 93303 - Transthoracic echocardiography $181.85 $498.22 73.0% 93307 - Echocardiography, real-time with image documentatio $165.85 $136.30 121.7% 93320 - Doppler echocardiograph $72.92 $57.20 127.5% 93451 - Right heart catheterization $708.35 $828.76 85.5% 93452 - Left heart catheterization $786.80 $933.36 84.3% Critical Care 31500 - Intubation, endotracheal 36555 - Insertion of non-tunneled center venous catheter; < 5 yrs 36568 - Insertion of peripherally inserted CVC; under 5 year 36600 - Arterial puncture, diagnostic 36620 - Arterial line placement 99291 - Critical care, first hour Emergency Care 10120 - Simple surgical removal of foreign body 36400 - Venipuncture necessitating physician skill; < 3 years 36410 - Venipuncture necessitating physician skill; 3 yrs 36415 - Routine venipuncture 62270 - Lumbar puncture, diagnostic 99282 - ED visit, problem focused 99283 - ED visit, expanded 99284 - ED visit, detailed $152.46 $114.58 133.1% $141.30 $266.74 53.0% $103.86 $321.05 32.4% $15.92 $33.24 47.9% $53.93 $53.10 101.6% $180.93 $283.59 63.8% $80.93 $159.96 50.6% $18.10 $29.39 61.6% $8.68 $17.69 49.1% $3.98 NIS $61.90 $168.59 36.7% $22.77 $41.97 54.3% $51.69 $63.26 81.7% $80.31 $120.33 66.7% Gastrointestinal 43239 - Upper gastrointestinal endoscopy with biopsy $158.19 $426.41 37.1% 44389 - Colonoscopy with biopsy $179.91 $417.17 43.1% 45331 - Sigmoidoscopy with biopsy $65.16 $172.05 37.9% Opthalmology 67311 - Strabismus surgery, horizontal $493.04 $621.69 79.3% 67314 - Strabismus surgery, vertical $547.70 $699.45 78.3% 68810 - Nasolacrimal probing $106.79 $252.00 42.4% Otolaryngology 42820 - Tonsillectomy/adenoidectomy, under 12 years $305.52 $307.19 99.5% 42821 - Tonsillectomy/adenoidectomy, over 12 years $330.86 $318.93 103.7% 69436 - Tympanostomy and tubes $154.57 $169.94 91.0%

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 9 of 10) Specialty Care Codes Neonatal and Pediatric Critical Care 36510 - Umbilical vein catheterization 36660 - Umbilical artery catheterization 99471 - Initial pediatric critical care (29d-24m) 99472 - Subsequent pediatric critical care (29d-24m) 99475 - Initial pediatric critical care (2-5 yrs) 99476 - Subsequent pediatric critical care (2-5 yrs) 99468 - Initial neonatal critical care 99469 - Subsequent neonatal critical care Initial and Continuing Intensive Care Services 99477 - Initial neonatal intensive care 99478 - Subsq intensive care, < 1500 gm present body weight 99479 - Subsq intensive care, 1500-2500 gm present body weigh 99480 - Subsq intensive care, 2501-5000 gm present body weigh Plastic Surgery 40700 - Cleft lip repair 42200 - Cleft palate repair (Continued) Pulmonology 31622 - Bronchoscopy 32421- Thoracentesis, puncture of pleural cavity for aspiration initial or subsq 94010 - Spirometry, including graphic record 94640 - Inhalation treatment 94644 - Continuous inhalation treatment, first hour 94664 - Demonstration/evaluation Medicaid Medicare %Medicare $69.86 $97.04 72.0% $68.78 $63.19 108.8% $671.11 $894.46 75.0% $331.10 $417.95 79.2% $462.51 $590.12 78.4% $274.44 $355.58 77.2% $750.49 $939.05 79.9% $326.77 $406.93 80.3% $263.54 $369.45 71.3% $119.18 $144.95 82.2% $104.82 $127.42 82.3% $100.78 $122.32 82.4% $915.13 NIS $846.71 $900.78 94.0% $198.12 $329.86 60.1% $32.62 $38.00 85.84% $24.31 $19.52 124.5% $30.23 $46.20 65.4% $18.15 $18.39 98.7% Radiology 71010 - Frontal chest x-ray $27.15 $46.66 58.2% Surgery 28262 - Extensive clubfoot release 44950 - Appendectomy 49500 - Bilateral inguinal hernia, 6 months to under 5 years 49505 - Bilateral inguinal hernia, 5 years or over $1,612.74 $1,561.36 103.3% $602.00 $673.97 89.3% $350.41 $432.27 81.1% $460.10 $546.39 84.2% Urology and Dialysis 50200 - Renal biopsy; percutaneous, by trocar or needle $137.19 $652.18 21.0% 90957 - ESRD services; 12-19 yrs, 4+ face-to-face physician $545.52 $661.46 82.5% visits/mo 90959 - ESRD services; 12-19 yrs, 1 face-to-face physician $241.53 $303.94 79.5% visits/mo 90965 - ESRD services; 12-19 yrs, home dialysis for full month $370.71 $465.07 79.7% 90945 - Peritoneal dialysis $69.54 $88.15 78.9%

AAP Medicaid Reimbursement Survey Report, 2015 - Nevada, Continued (page 10 of 10) Dental and Oral Health Services Dental codes (CDT Codes) are copyright 2006 American Dental Association. Medicaid Non-Dental Medical Provider Rate D0120 - Periodic exam $33.24 $33.24 D0145 - Caries Risk Assessment D1206 - Topical flouride varnish D1120 - Prophylaxis, child D2150 - Amalgam - two survaces, primary or permanent D2330 - Resin-based composite - one surface anterior D1351 - Sealant, per tooth D3220 - Pulpotomy D7140 - Extraction $20.50 $53.30 $57.28 $86.04 $56.38 $23.57 $61.50 $45.09 $20.50 $53.30 Medicaid Reimbursement for Preventive Oral Health Services Performed by Non-dental Medical Providers

Nevada - 2015 AAP Medicaid Reimbursement Survey Additional Affordabale Care Act (ACA) and Managed Care Implementation Below is additional ACA and Managed Care Implementation-related information as provided by the state: Rates shown in this report apply to payment of services for children enrolled in stateadministered medical fee-for-service (FFS) plans only. Nevada reported that 50 percent of its Medicaid children are enrolled in its state-administered FFS plan. It should be noted, therefore, that fees in other prepaid Medicaid plans, where a substantial proportion of Nevada Medicaid children are enrolled, may vary from ones included in this report.on methodology used to determine the Medicaid payment increase in the managed care context, Nevada explained as follows: Nevada pays capitation rates without the enhanced primary care payments; Capitations rates are not inclusive of the enhanced rate. On a monthly basis, MCOs summarize actual encounter and reporting data to calculate the total payment that eligible providers need to be paid for eligible services in order to reach the mandated Medicare payment rates. Nevada reviews this report and, after it is determined to be reasonable, pays the MCO the calculated additional payment amount. The MCOs then distribute those payments to the primary care providers using a method approved by DHCFP. Each MCO submitted a delivery method that demonstrated an accurate service payment model to eligible providers, not based on medical capitation or sub-capitation payments, and based on claims or shadow claims. The state noted that it monitored MCO implementation of the payment increase by requiring MCO plans to submit claim-level detail in order to receive PCP enhanced payments, and reported federal cost to implement the ACA Medicaid payment increase at $77.7M. Nevada used retroactive and other lump sum payments to pay providers the fee increase, and all of total outstanding lump sum payments (100%) were paid as of January 1, 2015, according to the state. Nevada reported that all (100%) of claims submitted under the 8 preventive services codes (99381-4 and 99391-4) during the 4th quarter of 2014 were paid the bumped-up rate as required by the ACA.State reports that generally children receive medical, dental, and mental health services from the same health plan. However, some services are carved out and delivered fee-for-service. The state does not monitor plan-toprovider rates in its Medicaid managed care plans. State cannot share provider fee data due to its confiential/proprietary nature.