Medical Evaluations and Diagnostic Procedures
Medical Evidence Fee Schedule
Revised On: January 1, 2023
Medical Evaluations and Diagnostic Procedures
You must be enrolled in ProviderOne to claim reimbursement for these services. Please visit the Health Care Authority’s New Providers page for information about ProviderOne enrollment.
NOTE: We only pay for non-invasive diagnostic services and exams necessary to establish a diagnosis or the severity of an impairment that limits work activity. We reimburse for the costs of obtaining the objective evidence necessary to determine disability based on our published fee schedule and established Medicaid rates.
For services not included on this fee schedule, you may need to submit a separate claim to ProviderOne using established CPT codes.
The maximum payment for all evaluation and report services includes the cost of providing chart notes and medical records.
|
Service Type ⃰ |
Reimbursement Fee |
ProviderOne Service Code |
|---|---|---|
|
General physical evaluation |
$180.00 |
99455 |
|
Comprehensive physical evaluation |
$200.00 |
99456 |
|
Report from records |
$31.00 |
99080 |
|
Missed appointment |
$30.00 |
99199 |
|
Non-Invasive Diagnostic Testing |
Established Medicaid Rates |
Established CPT Codes |
⃰ This section details Aged, Blind, or Disabled (ABD) program medical evidence reimbursement rates. For a detailed service descriptions visit the Medical Evidence Reimbursements section of the ESA Social Services Manual.