1HNPR3600 MASS - MEDICARE CARRIER 31143 PAGE 1 MEDICARE FEE SCHEDULE EFFECTIVE 07/01/2008 0AREA 01 URBAN MASS MENTAL HEALTH CODES 0 PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ 90804 72.24 68.63 78.92 # 90804 60.70 57.67 66.32 90805 79.57 75.59 86.93 # 90805 68.04 64.64 74.34 90806 100.73 95.69 110.04 # 90806 92.86 88.22 101.45 90807 111.52 105.94 121.83 # 90807 100.52 95.49 109.81 90808 148.21 140.80 161.92 # 90808 139.82 132.83 152.75 90809 157.95 150.05 172.56 # 90809 146.95 139.60 160.54 90810 76.26 72.45 83.32 # 90810 66.30 62.99 72.44 90811 88.31 83.89 96.47 # 90811 73.63 69.95 80.44 90812 110.20 104.69 120.39 # 90812 98.14 93.23 107.21 90813 120.88 114.84 132.07 # 90813 106.20 100.89 116.02 90814 156.63 148.80 171.12 # 90814 146.15 138.84 159.67 90815 166.37 158.05 181.76 # 90815 151.69 144.11 165.73 90816 66.65 63.32 72.82 90817 72.94 69.29 79.68 90818 98.93 93.98 108.08 90819 105.42 100.15 115.17 90821 146.30 138.99 159.84 90822 152.17 144.56 166.24 90823 71.82 68.23 78.46 90824 78.95 75.00 86.25 90826 105.35 100.08 115.09 90827 110.17 104.66 120.36 90828 152.51 144.88 166.61 90829 157.02 149.17 171.55 0 ** END OF REPORT ** 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1 1HNPR3600 MASS - MEDICARE CARRIER 31143 PAGE 2 MEDICARE FEE SCHEDULE EFFECTIVE 07/01/2008 0AREA 99 RURAL MASS MENTAL HEALTH CODES 0 PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ 90804 67.03 63.68 73.23 # 90804 57.30 54.44 62.61 90805 74.00 70.30 80.85 # 90805 64.27 61.06 70.22 90806 94.28 89.57 103.01 # 90806 87.65 83.27 95.76 90807 104.22 99.01 113.86 # 90807 94.93 90.18 103.71 90808 139.00 132.05 151.86 # 90808 131.92 125.32 144.12 90809 148.04 140.64 161.74 # 90809 138.76 131.82 151.59 90810 70.97 67.42 77.53 # 90810 62.57 59.44 68.36 90811 81.92 77.82 89.49 # 90811 69.53 66.05 75.96 90812 102.77 97.63 112.27 # 90812 92.60 87.97 101.17 90813 112.67 107.04 123.10 # 90813 100.29 95.28 109.57 90814 146.60 139.27 160.16 # 90814 137.75 130.86 150.49 90815 155.65 147.87 170.05 # 90815 143.26 136.10 156.52 90816 62.50 59.38 68.29 90817 68.58 65.15 74.92 90818 92.88 88.24 101.48 90819 99.24 94.28 108.42 90821 137.55 130.67 150.27 90822 143.38 136.21 156.64 90823 67.40 64.03 73.63 90824 74.25 70.54 81.12 90826 98.95 94.00 108.10 90827 103.74 98.55 113.33 90828 143.35 136.18 156.61 90829 147.97 140.57 161.66 0 ** END OF REPORT ** 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. HNPR3600 MAINE - MEDICARE CARRIER 31143 PAGE 1 MEDICARE FEE SCHEDULE EFFECTIVE 07/0/2008 0AREA 03 URBAN MAINE MENTAL HEALTH CODES 0 PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ 90804 64.67 61.44 70.66 # 90804 55.70 52.92 60.86 90805 71.49 67.92 78.11 # 90805 62.52 59.39 68.30 90806 91.36 86.79 99.81 # 90806 85.24 80.98 93.13 90807 100.85 95.81 110.18 # 90807 92.28 87.67 100.82 90808 134.80 128.06 147.27 # 90808 128.27 121.86 140.14 90809 143.47 136.30 156.75 # 90809 134.90 128.16 147.38 90810 68.49 65.07 74.83 # 90810 60.74 57.70 66.36 90811 78.99 75.04 86.30 # 90811 67.57 64.19 73.82 90812 99.45 94.48 108.65 # 90812 90.07 85.57 98.41 90813 108.94 103.49 119.01 # 90813 97.51 92.63 106.52 90814 142.07 134.97 155.22 # 90814 133.91 127.21 146.29 90815 150.75 143.21 164.69 # 90815 139.32 132.35 152.20 90816 60.56 57.53 66.16 90817 66.57 63.24 72.73 90818 90.12 85.61 98.45 90819 96.35 91.53 105.26 90821 133.55 126.87 145.90 90822 139.19 132.23 152.06 90823 65.38 62.11 71.43 90824 72.02 68.42 78.68 90826 95.97 91.17 104.85 90827 100.76 95.72 110.08 90828 139.18 132.22 152.05 90829 143.78 136.59 157.08 0 ** END OF REPORT ** 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1 1HNPR3600 MAINE - MEDICARE CARRIER 31143 PAGE 2 MEDICARE FEE SCHEDULE EFFECTIVE 07/0/2008 0AREA 99 RURAL MAINE MENTAL HEALTH CODES 0 PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ 90804 61.95 58.85 67.88 # 90804 54.13 51.42 59.13 90805 68.62 65.19 74.97 # 90805 60.80 57.76 66.42 90806 88.17 83.76 96.32 # 90806 82.83 78.69 90.49 90807 97.19 92.33 106.18 # 90807 89.72 85.23 98.01 90808 130.29 123.78 142.35 # 90808 124.60 118.37 136.13 90809 138.60 131.67 151.42 # 90809 131.13 124.57 143.26 90810 65.77 62.48 71.85 # 90810 59.01 56.06 64.47 90811 75.63 71.85 82.63 # 90811 65.68 62.40 71.76 90812 95.68 90.90 104.54 # 90812 87.50 83.13 95.60 90813 104.74 99.50 114.43 # 90813 94.78 90.04 103.55 90814 137.09 130.24 149.78 # 90814 129.98 123.48 142.00 90815 145.40 138.13 158.85 # 90815 135.45 128.68 147.98 90816 58.53 55.60 63.94 90817 64.48 61.26 70.45 90818 87.19 82.83 95.25 90819 93.41 88.74 102.05 90821 129.36 122.89 141.32 90822 135.05 128.30 147.55 90823 63.23 60.07 69.08 90824 69.77 66.28 76.22 90826 92.87 88.23 101.46 90827 97.72 92.83 106.75 90828 134.78 128.04 147.25 90829 139.53 132.55 152.43 0 ** END OF REPORT ** 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. HNPR3600 NEW HAMPSHIRE - MEDICARE CARRIER 31144 PAGE 1 MEDICARE FEE SCHEDULE EFFECTIVE 07/01/2008 0AREA 40 NEW HAMPSHIRE MENTAL HEALTH CODES 0 PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ 90804 65.12 61.86 71.14 # 90804 56.03 53.23 61.21 90805 71.97 68.37 78.63 # 90805 62.86 59.72 68.68 90806 91.92 87.32 100.42 # 90806 85.71 81.42 93.63 90807 101.51 96.43 110.89 # 90807 92.83 88.19 101.42 90808 135.61 128.83 148.15 # 90808 128.99 122.54 140.92 90809 144.38 137.16 157.73 # 90809 135.69 128.91 148.25 90810 69.01 65.56 75.39 # 90810 61.14 58.08 66.79 90811 79.56 75.58 86.92 # 90811 67.99 64.59 74.28 90812 100.07 95.07 109.33 # 90812 90.55 86.02 98.92 90813 109.65 104.17 119.80 # 90813 98.07 93.17 107.15 90814 142.93 135.78 156.15 # 90814 134.65 127.92 147.11 90815 151.69 144.11 165.73 # 90815 140.11 133.10 153.07 90816 60.95 57.90 66.59 90817 66.96 63.61 73.15 90818 90.65 86.12 99.04 90819 96.93 92.08 105.89 90821 134.33 127.61 146.75 90822 140.06 133.06 153.02 90823 65.77 62.48 71.85 90824 72.48 68.86 79.19 90826 96.57 91.74 105.50 90827 101.36 96.29 110.73 90828 139.98 132.98 152.93 90829 144.61 137.38 157.99 0 ** END OF REPORT ** 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1 1HNPR3600 VERMONT - MEDICARE CARRIER 31145 PAGE 2 MEDICARE FEE SCHEDULE EFFECTIVE 07/01/2008 0AREA 50 VERMONT MENTAL HEALTH CODES 0 PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ 90804 63.68 60.50 69.58 # 90804 55.09 52.34 60.19 90805 70.46 66.94 76.98 # 90805 61.87 58.78 67.60 90806 90.20 85.69 98.54 # 90806 84.34 80.12 92.14 90807 99.50 94.53 108.71 # 90807 91.31 86.74 99.75 90808 133.14 126.48 145.45 # 90808 126.89 120.55 138.63 90809 141.67 134.59 154.78 # 90809 133.48 126.81 145.83 90810 67.48 64.11 73.73 # 90810 60.07 57.07 65.63 90811 77.76 73.87 84.95 # 90811 66.83 63.49 73.01 90812 98.08 93.18 107.16 # 90812 89.10 84.65 97.35 90813 107.40 102.03 117.33 # 90813 96.47 91.65 105.40 90814 140.25 133.24 153.23 # 90814 132.45 125.83 144.70 90815 148.79 141.35 162.55 # 90815 137.85 130.96 150.60 90816 59.81 56.82 65.34 90817 65.79 62.50 71.88 90818 89.04 84.59 97.28 90819 95.24 90.48 104.05 90821 132.00 125.40 144.21 90822 137.60 130.72 150.33 90823 64.59 61.36 70.56 90824 71.17 67.61 77.75 90826 94.80 90.06 103.57 90827 99.61 94.63 108.82 90828 137.56 130.68 150.28 90829 142.18 135.07 155.33 0 ** END OF REPORT ** 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION.