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Home My WebLink AboutAgenda - 12-06-2004-5gORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 6, 2004 Action Agenda Item No. q SUBJECT: Dental and Primary Care Fees for the Health Department DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Dental Fee Adjustment Schedule Primary Care Fee Schedule INFORMATION CONTACT: Rosemary Summers, ext 2411 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To approve dental fee adjustments based on Medicaid adjustments and to approve fees for primary care services that will begin January 1, 2005, BACKGROUND: The State revises Medicaid reimbursement levels twice a year, Based on the most recent adjustment on October 1, 2004, the Board of Health is recommending that four dental fees be adjusted and two new fees created by Medicaid be established with the charges as indicated in the attached spreadsheet. In addition, the Health Department is beginning limited primary care services on January 1, 2005 as approved by the Board of Commissioners as part of the regular budget approval process. There are a number of procedures that the Health Department previously did not provide and therefore there were no established fees for these procedures. The attached fee schedule includes additional procedures that may be needed in the delivery of primary care, It should be noted that some laboratory charges are lower than the actual Medicaid rate. For those tests, the Health Department uses the UNG Hospitals' McLendon Labs and may only charge the actual charge to the County from the lab, All fees have been reviewed and approved by the Board of Health, All new fees are established by examining current reimbursement rates by Medicaid, by private pay fees and by estimating cost to provide the service by the Health Department. All adjustments to fees once established are based on either a cost study (performed once every 5 years) or adjusted in accordance with Board of Health adapted Fee and Eligibility Policies. All fees for Personal Health and Dental Health services are subject to a sliding fee scale, FINANCIAL IMPACT: Income from these fees were part of the budget projection for the start- up of primary care. The fees are established to provide for full cost recovery of the services provided. However, since the Health Department operates on a sliding fee scale, 100% cost recovery of service provision is not likely since 75-80% of the Health Departments' patients are below 200% of the federal poverty level, RECOMMENDATION(S): The Manager recommends that the Board approve the proposed dental fees effective October 1, 2004 and the proposed primary care fees effective January 1, 2005. Fee Adjustments for Denta( Health Services Orange County Health Department October 2004 ADA DESCRIPTION OF SERVICE OCIID MEDICAID NEW OCHD CODES PRESENT FEE RECOmmENDED FEE FEE 100% DO150 COMPREI1BNStvE ORAL. $41.00 $45A0 $45.00 EVALUATION D2335 RESIN FOUR SURFACE $115,00 $116.07 $118,00 ANTERIOR D2930 STAINL.ESSSTEEL.CROWN $125.00 $144,25 $145.00 PRIMARY D2933 PREFABRICATED SSC W RESIN $150.00 $181.77 $182..00 WINDOW DO170 RE-EVALUATION-LIMITED, NEW $20,.00 $25.00 PROBLEM FOCUSED D1204 TOPICAL.APPL[CATIONOF NEW $15.44 $27.00** FLUORIDE-ADULT LIMITED TO RECIPIENTS 1.3-20 YEARS OF AGE **CHAROE IS THE SAME AS THIS SERVICE PROVIDED FOR CHILDREN UNDER THE AGE OF 13 4 Proposed New Fees Primary Care Effective January 1, 2005 Determinatic of OCHD fees: If Medicaid rate < or = to $20, add $5 to MC, rate If Medicaid rate $21-$100, then multiply MC rate X 1,25% If Medicaid rate $101 or >, then multiply MC rate X 1,2% UNC labs: Round to lowest dollar of Medicare rate NEW CPT Medicaid Code Service Type Rate eff.1/1/2004 PROPOSED' NEW OCHD FEE (adjusted to nearest $5) 10120 Remove Foreign Body $94.12 $120.00 10140 Drainage of Hematoma/Fluid $108.08 $130.00 10160 Puncture Drainage of Lesion $69.52 $85.00 11000 Debride Infected Skin $41.42 $50.00 11200 Removal of Skin Tags $63.41 $80.00 11300 Shave Skin Lesion $51.99 $65.00 11400 Removal of Skin Lesion $97.73 $120.00 11401 Removal of Skin Lesion $114.40 $140.00 11402 Removal of Skin Lesion $130.93 $155.00 11403 Removal of Skin Lesion $147.57 $175.00 11420 Removal of Skin Lesion $95.40 $120.00 11421 Removal of Skin Lesion $121.91 $145.00 11422 Removal of Skin Lesion $136.51 $165.00 11423 Removal of Skin Lesion $162.09 $195.00 11719 Trim Nail(s) $14.50 $20.00 11720 Debride Nail, 1-5 $23.02 $30.00 11740 Drain Blood From Under Nail $42.07 $50.00 12001 Repair Superficial Wound(s) $129.85 $155.00 12002 Repair Superficial Wound(s) $137.95 $165.00 16000 Initial Treatment of Burn(s) $61.50 $75.00 17000 Destroy BenignlPremal Lesion $54.52 $65.00 17003 Destroy Lesions, 2-14 $9.17 $15.00 17110 Destruct Lesion, 1-14 $77.98 $98.00 20550 Inject Single TendonlLigament/Cyst $51.58 $65.00 20551 Inject Single tendon origin? Insertion $50.59 $60.00 20552 Inject, Single/Mull Trigger Pts, 1-2 Musc $49.05 $60.00 20553 Inject, single/Mutt Trigger Pts, 3/More Musc $55.88 $70.00 20600 Drain/Inject, Joint/Bursa $46.08 $60.00 20605 Drainllnject, Joint/Bursa $50.42 $65.00 20610 Drain/Inject, JoinUBursa $61.26 $75.00 26010 Drainage of Finger Abscess $245.59 $295.00 29130 Application of Finger Splint $33.91 $40.00 30901 Control of Nosebleed $90.24 $110.00 46600 Diagnostic Anoscopy $71.01 $90.00 46611 Anoscopy $178.77 $215.00 56405 I & D of Vulva/Perineum $98.72 $125.00 CPT Service Type Medicaid FEE 56420 Drainage of Gland Abscess $128.43 $155.00 65205 Remove Foreign Body From Eye $45.87 $60.00 69200 Clear Outer Ear Canal $105.57 $125.00 82040 Alb (UNC lab test) *change in rate $6.92 $6.00 82248 Neonatal Bilirubin *change in rate $7.02 $7.00 82310 Ca (UNC lab test) $7.39 $7.00 82374 CO2 (UNC lab test) $6.83 $6.00 82435 CI (UNC lab test) $6.42 $6.00 82465 Total Chol (UNC lab test) $6.08 $6.00 82565 Creat (UNC lab test) $7.16 $7.00 82607 612 (UNC lab test) $21.01 $21.00 82728 Ferritin (UNC lab test) $19.03 $19.00 82746 Folate (UNC lab test) $20.54 $20.00 82947 Glu (UNC lab test) $5.48 $5.00 83001 FSH (UNC lab test $25.97 $25.00 83001 LH (UNC lab test) $25.88 $25.00 83D36 Hemoglobin A1C (UNC lab test) $13.56 $13.00 83540 Fe (UNC lab test) $9.05 $9.00 83550 IBC (UNC lab test) $12.21 $12.00 83718 HDL(UNC lab test) $11.44 $11.00 83721 LDL (UNC lab test) $13.33 $13.00 84075 Alk Phos (UNC lab test) *change in rate $7.23 $7.00 84132 K (UNC lab test) $6.42 $6.00 84155 TP (serum) (UNC lab test) $5.12 $5.00 84156 Total Protein: 24 hrs (urine) (UNC lab test) $5.12 $5.00 84295 Na (UNC lab test) $6.72 $6.00 84439 Free T4 (UNC lab test) $12.60 $12.00 84443 TSH (UNC lab test) $22.77 $22.00 84446 T4 (UNC lab test) $19.81 $19.00 84478 Trig (UNC lab test) $8.04 $8.00 84479 T3U (UNC lab test) $8.33 $8.00 84520 BUN (UNC lab test $5.51 $5.00 84702 Quan[. HCG/Serum (UNC lab test) $12.54 $12.00 85021 CBC without dill (UNC lab test) $9.04 $9.00 85025 CBC with dill (UNC lab test) $10.86 $10.00 85651 Sed Rate (UNC lab test) $4.96 $4.00 86308 Mono Spot (UNC lab test) $7.23 $7.00 86430 RA factors - Qual. (UNC lab test) $7.93 $7.00 86431 RA factors - Quan. (UNC lab test) $7.93 $7.00 86677 H.pylori (UNC lab test) $20.28 $20.00 86762 Rubella (UNC lab test) $20.80 $20.00 87081 Throat Culture (UNC lab test) $8.06 $8.00 87086 Urine Culture (UNC lab test) $11.28 $11.00 87184 ID and Sensitivity (UNC lab test) $9.63 $9.00 87210 Skin Scraping (KOH) (UNC lab test) $5.33 $5.00 87340 HBsAG (UNC lab test) $13.00 $13.00 87880 Strep A Assay w/optic (in-house) $16.01 $20.00 93000 Electrocardiogram, Complete $23.53 $30.00 93005 Electrocardiogram, Tracing $15.30 $20.00 94664 Aerosol or Vapor Inhalations $11.44 $20.00 99175 Induction of Vomiting $48.42 $60.00 J0696 Ceftriaxone Sodium, per 250 mg (Rocephin) $13.47 $20.00 J1200 Diphenhydramine HCL, up to 50 mg (Benadryl) $1.11 $5.00