2012 Specialty Pricing

(Effective for dates of service 01/01/2012 and after)

Ambulance(external link)

Ambulatory Surgical Center (ASC)

Anesthesia

Average Sales Price (ASP) Drug Pricing(external link)

Chiropractic and Clinical Psychologist

The chiropractic and clinical psychologist fees are available in the Medicare Physician Fee Schedule.

Clinical Social Worker

The clinical social worker fees are available in the Medicare Physician Fee Schedule. To determine the fee, multiply the fee amount by 75%.

Durable Medical Equipment, Prosthetics, and Orthotics (DMEPOS)(external link)

Labs

For Clinical Lab Fee Schedules that are linked to below, the localities for KS and MO are defined as follows:
KS Lab locality 12 (Western Kansas) = Rest of State
KS Lab Locality 15 (Eastern Kansas) = Johnson and Wyandotte Counties

MO2 Lab Locality 07 (Eastern Missouri) = City of St. Louis plus counties of Adair, Audrain, Barry, Barton, Bollinger, Boone, Butler, Callaway, Camden, Cape Girardeau, Carter, Cedar, Chariton, Christian, Clark, Cole, Cooper, Crawford, Dade, Dallas, Dent, Douglas, Dunklin, Franklin, Gasconade, Greene, Hickory, Howard, Howell, Iron, Jasper, Jefferson, Knox, Laclede, Lawrence, Lewis, Lincoln, Linn, Macon, Madison, Maries, Marion, McDonald, Miller, Mississippi, Moniteau, Monroe, Montgomery, Morgan, New Madrid, Newton, Oregon, Osage, Ozark, Pemiscot, Perry, Phelps, Pike, Polk, Pulaski, Putnam, Ralls, Randolph, Reynolds, Ripley, St. Charles, St. Francois, St. Louis, Ste. Genevieve, Schuyler, Scotland, Scott, Shannon, Shelby, Stoddard, Stone, Sullivan, Taney, Texas, Warren, Washington, Wayne, Webster, Wright.

MO1 Lab Locality 15 (Western Missouri) = Kansas City plus counties of Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton, Daviess, DeKalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson, Johnson, LaFayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, St. Clair, Vernon, Worth

Note: Pricing is statewide for Nebraska and Iowa

Medical Nutrition Therapy

The medical nutrition therapy fees are available in the Medicare Physician Fee Schedule. To determine the fee, multiply the fee amount by 85%. (Exception - The 85% calculation does not apply to Codes G0108 and G0109).

Nurse Practitioner / Physician Assistant / Clinical Nurse Specialist

The NP, PA and CNS fees are available in the Medicare Physician Fee Schedule. To determine the fee, multiply the fee amount by 85%. (Exception - The 85% calculation does not apply to codes with a TC modifier, Technical Component Only codes or CPT codes G0108 and G0109)

Splints and Casts

Vaccinations (Influenza (flu) and Pneumococcal)

Note: Administration codes G0008, G0009, G0010, G9141 are priced based on the MPFSDB fee for code 90471.

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Page Last Updated: Tuesday, 15-May-2012 07:53:14 CDT