Reimbursement Rates for Some Medical and Laboratory Procedure Codes to Change

Reimbursement Rates for Some Medical and Laboratory Procedure Codes to Change

Effective for dates of service on or after November 1, 2009, reimbursement rates for some medical and laboratory procedure codes will change for the Children with Special Health Care Needs (CSHCN) Services Program.

The following procedure code reimbursement rates are effective for dates of service on or after November 1, 2009.

Type of Service / Procedure Code / Reimbursement Rate /
Clinical Pathology
2 / 36600 / $23.48 (0.82 Relative Value Unit [RVU], $28.640 conversion factor)
3 / 80500 / $17.19
3 / 80502 / $50.98 (1.78 RVUs, $28.640 conversion factor)
5 / 81099 / Manually priced
5 / 84999 / Manually priced
5/I / 85060 / $16.91 (1.24 RVUs, $27.276 conversion factor)
5/I / 85097 / $68.16 (2.38 RVUs, $28.640 conversion factor)
5 / 85396 / $14.46 (0.53 RVU, $27.276 conversion factor)
5/I / 85999 / Manually priced
5/I / 86077 / $38.66 (1.35 RVUs, $28.640 conversion factor)
5/I / 86078 / $39.24 (1.37 RVUs, $28.640 conversion factor)
5/I / 86079 / $39.52 (1.38 RVUs, $28.640 conversion factor)
5/I / 86490 / $5.18 (0.19 RVU, $27.276 conversion factor)
5/I / 86510 / $5.18 (0.19 RVU, $27.276 conversion factor)
5 / 86580 / $7.21
I / 86580 / $5.46 (0.20 RVU, $27.276 conversion factor)
5 / 86849 / Manually priced
5/I / 86850 / $16.99
5/I / 86860 / $29.71
5/I / 86870 / $16.98
5/I / 86890 / Manually priced
5/I / 86891 / Manually priced
5/I / 86920 / $14.06
5/I / 86921 / $16.00
5/I / 86922 / $34.02
5 / 86923 / $15.62
5/I / 86950 / $61.70
5 / 86960 / $25.52
5/I / 86999 / Manually priced
5 / 87999 / Manually priced
5 / 88182 / $100.99
I / 88182 / $35.35
T / 88182 / $65.64
T / 88184 / $6.82 (0.25 RVU , $27.276 conversion factor)
T / 88185 / $6.82 (0.25 RVU , $27.276 conversion factor)
I / 88187 / $50.98 (10.47 RVUs, $28.640 conversion factor)
I / 88188 / $62.72 (2.19 RVUs, $28.640 conversion factor)
I / 88189 / $79.91 (2.79 RVUs, $28.640 conversion factor)
5 / 88291 / $21.55 (0.79 RVU, $27.276 conversion factor)
5 / 89230 / $3.97
5/I / 89240 / Manually priced
5/I / P9012 / $30.00
5/I / Q0091 / $30.28 (1.11 RVUs, $27.276 conversion factor)
5 / S3845 / $355.25
Anatomic Pathology
3 / 88323 / $106.92 (3.92 RVUs, $27.276 conversion factor)
I / 88323 / $64.37 (2.36 RVUs, $27.276 conversion factor)
T / 88323 / $42.55 (1.56 RVU, $27.276 conversion factor)
3 / 88329 / $25.09 (0.92 RVU, $27.276 conversion factor)
5 / 88104 / $50.07
I / 88104 / $22.63
T / 88104 / $27.44
5 / 88106 / $59.86 (2.09 RVUs, $28.640 conversion factor)
I / 88106 / $21.77 (0.76 RVU, $28.640 conversion factor)
T / 88106 / $38.09 (1.33 RVUs, $28.640 conversion factor)
5 / 88107 / $76.63
I / 88107 / $30.65
T / 88107 / $45.98
5 / 88108 / $59.66
I / 88108 / $22.91
T / 88108 / $36.75
5 / 88112 / $88.37
I / 88112 / $47.73
T / 88112 / $40.64
I / 88141 / $21.28 (Clients 21 years of age or older)
I / 88141 / $22.34 (Clients from birth through 20 years of age)
5 / 88160 / $42.46
I / 88160 / $20.34
T / 88160 / $22.12
5 / 88161 / $47.42
I / 88161 / $21.48
T / 88161 / $25.94
5 / 88162 / $74.26
I / 88162 / $36.09
T / 88162 / $38.17
5 / 88172 / $51.94
I / 88172 / $29.57
T / 88172 / $22.37
5 / 88173 / $104.54 (3.65 RVUs, $28.640 conversion factor)
I / 88173 / $54.13 (1.89 RVUs, $28.640 conversion factor)
T / 88173 / $50.41 (1.76 RVUs, $28.640 conversion factor)
5/I / 88199 / Manually priced
5 / 88300 / $23.08
I / 88300 / $4.33
T / 88300 / $18.75
5 / 88302 / $48.33
I / 88302 / $6.49
T / 88302 / $41.84
5 / 88304 / $61.31
I / 88304 / $10.82
T / 88304 / $50.49
5 / 88305 / $103.87
I / 88305 / $37.15
T / 88305 / $66.72
5 / 88307 / $192.95
I / 88307 / $73.32
T / 88307 / $119.63
5 / 88309 / $248.02 (8.66 RVUs, $28.640 conversion factor)
I / 88309 / $107.97 (3.77 RVUs, $28.640 conversion factor)
T / 88309 / $140.05 (4.89 RVUs, $28.640 conversion factor)
5 / 88311 / $16.05
I / 88311 / $10.59
T / 88311 / $5.46
5 / 88312 / $77.61 (2.71 RVUs, $28.640 conversion factor)
I / 88312 / $20.91 (0.73 RVU, $28.640 conversion factor)
T / 88312 / $56.71 (1.98 RVUs, $28.640 conversion factor)
5 / 88313 / $65.37
I / 88313 / $10.59
T / 88313 / $54.78
5 / 88314 / $87.28
I / 88314 / $22.36
T / 88314 / $64.92
5 / 88318 / $77.90 (2.72 RVUs, $28.640 conversion factor)
I / 88318 / $16.32 (0.57 RVU, $28.640 conversion factor)
T / 88318 / $61.58 (2.15 RVUs, $28.640 conversion factor)
5 / 88319 / $123.47
I / 88319 / $23.46
T / 88319 / $100.01
5 / 88331 / $70.45 (2.46 RVUs, $28.640 conversion factor)
I / 88331 / $47.26 (1.65 RVUs, $28.640 conversion factor)
T / 88331 / $23.20 (0.81 RVU, $28.640 conversion factor)
5 / 88332 / $31.50 (1.10 RVUs, $28.640 conversion factor)
I / 88332 / $23.20 (0.81 RVU, $28.640 conversion factor)
T / 88332 / $8.31 (0.29 RVU, $28.640 conversion factor)
5 / 88333 / $68.74 (2.52 RVUs, $27.276 conversion factor)
I / 88333 / $45.01 (1.65 RVUs, $27.276 conversion factor)
T / 88333 / $23.73 (0.87 RVU, $27.276 conversion factor)
5 / 88334 / $41.46 (1.52 RVUs, $27.276 conversion factor)
I / 88334 / $27.00 (0.99 RVU, $27.276 conversion factor)
T / 88334 / $14.46 (0.53 RVU, $27.276 conversion factor)
5 / 88342 / $77.90 (2.72 RVUs, $28.640 conversion factor)
I / 88342 / $32.65 (1.14 RVUs, $28.640 conversion factor)
T / 88342 / $45.25 (1.58 RVUs, $28.640 conversion factor)
5 / 88346 / $78.19 (2.73 RVUs, $28.640 conversion factor)
I / 88346 / $33.22 (1.16 RVUs, $28.640 conversion factor)
T / 88346 / $44.96 (1.57 RVUs, $28.640 conversion factor)
5 / 88347 / $61.86 (2.16 RVUs, $28.640 conversion factor)
I / 88347 / $31.79 (1.11 RVUs, $28.640 conversion factor)
T / 88347 / $30.07 (1.05 RVUs, $28.640 conversion factor)
5 / 88348 / $617.45
I / 88348 / $73.94
T / 88348 / $543.51
5 / 88349 / $293.94
I / 88349 / $37.87
T / 88349 / $256.07
5 / 88355 / $233.17
I / 88355 / $85.34
T / 88355 / $147.83
5 / 88356 / $282.24
I / 88356 / $136.04
T / 88356 / $146.20
5 / 88358 / $77.54
I / 88358 / $45.80
T / 88358 / $31.74
5 / 88360 / $103.05
I / 88360 / $46.68
5 / 88361 / $113.74 (4.17 RVUs, $27.276 conversion factor)
I / 88361 / $42.25
T / 88361 / $71.49
5 / 88362 / $231.76
T / 88362 / $136.97
T / 88365 / $73.37 (2.69 RVUs, $27.276 conversion factor)
5 / 88367 / $237.32
I / 88367 / $85.34
5 / 88368 / $208.83
I / 88368 / $64.92
5 / 88384 / $105.12
5 / 88385 / $391.68 (14.36 RVUs, $27.276 conversion factor)
5 / 88386 / $501.61 (18.39 RVUs, $27.276 conversion factor)
5/I / 88399 / Manually priced
Electroencephalogram
5 / 89049 / $178.11 (6.53 RVUs, $27.276 conversion factor)
5 / 95812 / $177.84 (6.52 RVUs, $27.276 conversion factor)
I / 95812 / $40.64 (1.49 RVUs, $27.276 conversion factor)
T / 95812 / $137.20 (5.03 RVUs, $27.276 conversion factor)
5 / 95813 / $217.94 (7.99 RVUs, $27.276 conversion factor)
I / 95813 / $64.64 (2.37 RVUs, $27.276 conversion factor)
T / 95813 / $153.29 (5.62 RVUs, $27.276 conversion factor)
5 / 95816 / $163.11 (5.98 RVUs, $27.276 conversion factor)
I / 95816 / $40.64 (1.49 RVUs, $27.276 conversion factor)
T / 95816 / $122.47 (4.49 RVUs, $27.276 conversion factor)
5 / 95819 / $175.11 (6.42 RVUs, $27.276 conversion factor)
I / 95819 / $40.64 (1.49 RVUs, $27.276 conversion factor)
T / 95819 / $134.47 (4.93 RVUs, $27.276 conversion factor)
5 / 95822 / $174.57 (6.40 RVUs, $27.276 conversion factor)
I / 95822 / $40.64 (1.49 RVUs, $27.276 conversion factor)
T / 95822 / $133.93 (4.91 RVUs, $27.276 conversion factor)
5 / 95824 / $117.38
I / 95824 / $27.82 (1.02 RVUs, $27.276 conversion factor)
T / 95824 / $89.56
5 / 95827 / $281.76 (10.33 RVUs, $27.276 conversion factor)
I / 95827 / $40.10 (1.47 RVUs, $27.276 conversion factor)
T / 95827 / $241.67 (1.23 RVUs, $27.276 conversion factor)
5 / 95829 / $905.56 (33.20 RVUs, $27.276 conversion factor)
I / 95829 / $237.03 (8.69 RVUs, $27.276 conversion factor)
T / 95829 / $668.53 (24.51 RVUs, $27.276 conversion factor)
5 / 95950 / $179.48 (6.58 RVUs, $27.276 conversion factor)
I / 95950 / $56.73 (2.08 RVUs, $27.276 conversion factor)
T / 95950 / $122.74 (4.50 RVUs, $27.276 conversion factor)
5 / 95951 / $1,367.09
I / 95951 / $225.57 (8.27 RVUs, $27.276 conversion factor)
T / 95951 / $1,141.52
5 / 95953 / $301.67 (11.06 RVUs, $27.276 conversion factor)
I / 95953 / $123.29 (4.52 RVUs, $27.276 conversion factor)
T / 95953 / $178.39 (6.54 RVUs, $27.276 conversion factor)
5 / 95954 / $184.11 (6.75 RVUs, $27.276 conversion factor)
I / 95954 / $85.65 (3.14 RVUs, $27.276 conversion factor)
T / 95954 / $98.47 (3.61 RVUs, $27.276 conversion factor)
5 / 95955 / $103.38 (3.79 RVUs, $27.276 conversion factor)
I / 95955 / $37.37 (1.37 RVUs, $27.276 conversion factor)
T / 95955 / $66.01 (2.42 RVUs, $27.276 conversion factor)
5 / 95956 / $529.70 (19.42 RVUs, $27.276 conversion factor)
I / 95956 / $115.92 (4.25 RVUs, $27.276 conversion factor)
T / 95956 / $413.78 (15.17 RVUs, $27.276 conversion factor)
5 / 95958 / $299.86 (10.47 RVUs, $28.640 conversion factor)
I / 95958 / $167.54 (5.85 RVUs, $28.640 conversion factor)
T / 95958 / $132.32 (4.62 RVUs, $28.640 conversion factor)
Gastroenterology
5/I / 89100 / $180.57 (6.62 RVUs, $27.276 conversion factor)
5/I / 89105 / $185.48 (6.80 RVUs, $27.276 conversion factor)
5/I / 89130 / $157.11 (5.76 RVUs, $27.276 conversion factor)
5/I / 89132 / $178.93 (6.56 RVUs, $27.276 conversion factor)
5/I / 89135 / $213.84 (7.84 RVUs, $27.276 conversion factor)
5/I / 89136 / $151.65 (5.56 RVUs, $27.276 conversion factor)
5/I / 89140 / $177.57 (6.51 RVUs, $27.276 conversion factor)
5/I / 89141 / $183.57 (6.73 RVUs, $27.276 conversion factor)
5 / 91030 / $110.84
I / 91030 / $40.68
5 / 91052 / $119.74
I / 91052 / $40.39
5 / 91065 / $43.53
I / 91065 / $7.27
Audiology
5/I / 92551 / $15.75
5/I / 92552 / $17.18
5/I / 92553 / $22.63 (0.79 RVU, $28.640 conversion factor)
5/I / 92555 / $12.60 (0.44 RVU, $28.640 conversion factor)
5/I / 92556 / $19.48 (0.68 RVU, $28.640 conversion factor)
5/I / 92557 / $39.52
I / 92562 / $20.33
5/I / 92563 / $16.04 (0.56 RVU, $28.640 conversion factor)
5/I / 92565 / $12.32
5/I / 92567 / $16.91
5/I / 92568 / $14.32 (0.50 RVU, $28.640 conversion factor)
5/I / 92569 / $12.88
5/I / 92571 / $12.27 (0.45 RVU, $27.276 conversion factor)
5/I / 92572 / $12.82 (0.47 RVU, $27.276 conversion factor)
5/I / 92575 / $25.91 (0.95 RVU, $27.276 conversion factor)
5/I / 92576 / $16.90
5/I / 92577 / $22.91
5 / 92579 / $34.65 (0.79 RVU, $28.640 conversion factor)
5/I / 92582 / $32.36
5 / 92583 / $24.82 (0.91 RVU, $27.276 conversion factor)
5/I / 92584 / $78.76
5 / 92585 / $100.00
I / 92585 / $25.72
T / 92585 / $74.28
5 / 92586 / $48.97 (1.71 RVUs, $28.640 conversion factor)
5 / 92587 / $46.11
I / 92587 / $8.21
T / 92587 / $37.90
5 / 92588 / $63.58
I / 92588 / $18.03
T / 92588 / $45.55
Cardiovascular
5 / 93000 / $15.82 (0.58 RVU, $27.276 conversion factor)
T / 93005 / $9.00 (0.33 RVU, $27.276 conversion factor)
I / 93010 / $6.82 (0.25 RVU, $27.276 conversion factor)
5 / 93012 / $137.74 (5.05 RVUs, $27.276 conversion factor)
5 / 93015 / $75.83 (2.78 RVUs, $27.276 conversion factor)
5 / 93016 / $18.55 (0.68 RVU, $27.276 conversion factor)
5 / 93025 / $161.20 (5.91 RVUs, $27.276 conversion factor)
5 / 93040 / $10.09 (0.37 RVU, $27.276 conversion factor)
T / 93041 / $4.09 (0.15 RVU, $27.276 conversion factor)
I / 93042 / $6.00 (0.22 RVU, $27.276 conversion factor)
5 / 93224 / $90.28 (3.31 RVUs, $27.276 conversion factor)
5 / 93230 / $92.47 (3.39 RVUs, $27.276 conversion factor)
5 / 93235 / $117.29
5 / 93268 / $200.75 (3.39 RVUs, $27.276 conversion factor)
5 / 93270 / $16.37 (3.39 RVUs, $27.276 conversion factor)
5 / 93271 / $163.66 (3.39 RVUs, $27.276 conversion factor)
5 / 93278 / $30.82 (1.13 RVUs, $27.276 conversion factor)
I / 93278 / $9.82 (0.36 RVU, $27.276 conversion factor)
T / 93278 / $21.00 (0.77 RVU, $27.276 conversion factor)
5 / 93561 / $35.43
I / 93561 / $18.00 (0.66 RVU, $27.276 conversion factor)
T / 93561 / $17.43
5 / 93562 / $16.56
I / 93562 / $5.73 (0.21 RVU, $27.276 conversion factor)
T / 93562 / $10.83
5 / 93701 / $25.64 (0.94 RVU, $27.276 conversion factor)
5 / 93720 / $34.91 (1.28 RVUs, $27.276 conversion factor)
T / 93721 / $21.28 (0.78 RVU, $27.276 conversion factor)
I / 93722 / $6.27 (0.23 RVU, $27.276 conversion factor)
5 / 93724 / $253.12 (9.28 RVUs, $27.276 conversion factor)
I / 93724 / $202.12 (7.41 RVUs, $27.276 conversion factor)
T / 93724 / $51.01 (1.87 RVUs, $27.276 conversion factor)
5 / 93740 / $7.36 (0.27 RVU, $27.276 conversion factor)
I / 93740 / $6.00 (0.22 RVU, $27.276 conversion factor)
T / 93740 / $1.36 (0.05 RVU, $27.276 conversion factor)
5 / 93770 / $6.55 (0.24 RVU, $27.276 conversion factor)
I / 93770 / $6.00 (0.22 RVU, $27.276 conversion factor)
T / 93770 / $0.55 (0.55 RVU, $27.276 conversion factor)
5/I/T / 93799 / Manually priced
5 / 93990 / $145.93 (5.35 RVUs, $27.276 conversion factor)
Pulmonology
5 / 89220 / $11.18 (0.41 RVU, $27.276 conversion factor)
5 / 94010 / $24.82 (0.91 RVU, $27.276 conversion factor)
I / 94010 / $6.27 (0.23 RVU, $27.276 conversion factor)
T / 94010 / $18.55 (0.68 RVU, $27.276 conversion factor)
5 / 94014 / $36.55 (1.34 RVUs, $27.276 conversion factor)
5 / 94015 / $17.73 (0.65 RVU, $27.276 conversion factor)