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First CHoice Agreement
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05. May
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2018-05-15 10:00 AM - Commissioners' Agenda
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First CHoice Agreement
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Entry Properties
Last modified
5/14/2018 12:18:38 PM
Creation date
5/14/2018 12:17:07 PM
Metadata
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Template:
Meeting
Date
5/15/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
e
Item
Request to Approve a Preferred Provider/Group Agreement with First Choice Health Network
Order
5
Placement
Consent Agenda
Row ID
44613
Type
Agreement
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First Choice Health Network Physician, Nurse Practitioner and Physician Assistant Fee Schedule <br />Sample Reimbursement Rates <br />Effective January 1, 2017 <br />EVALUATION AND MANAGEMENT SERVICES <br />CPT <br />Code <br />Non - <br />Facility <br />Rate <br />Facility <br />Rate <br />99201 <br />$58.43 <br />$35.63 <br />99202 <br />$99.75 <br />$67.45 <br />99203 <br />$144.40 <br />$103.08 <br />99204 <br />$220.40 <br />$174.33 <br />99205 <br />$276.45 <br />$226.58 <br />99211 <br />$26.60 <br />$12.35 <br />99212 <br />$57.95 <br />$33.73 <br />99213 <br />$97.38 <br />$68.40 <br />99214 <br />$143.45 <br />$104.98 <br />99215 <br />$193.33 <br />$148.68 <br />99217 <br />$97.38 <br />$97.38 <br />99218 <br />$133.48 <br />$133.48 <br />99219 <br />$181.45 <br />$181.45 <br />99220 <br />$247.95 <br />$247.95 <br />99221 <br />$135.85 <br />$135.85 <br />99222 <br />1 $183.35 <br />$183.35 <br />CPT <br />Code <br />Non - <br />Facility <br />Rate <br />Facility <br />Rate <br />10060 <br />$157.70 <br />$131.10 <br />11100 <br />$138.70 <br />$66.50 <br />17110 <br />$148.68 <br />$94.53 <br />20550 <br />$79.33 <br />$57.00 <br />20610 <br />$81.23 <br />$62.70 <br />25605 <br />$739.10 <br />$695.88 <br />29075 <br />$117.80 <br />$85.03 <br />29881 <br />$740.53 <br />$740.53 <br />42820 <br />$401.38 <br />$401.38 <br />43239 <br />$535.80 <br />$200.93 <br />45300 <br />$166.25 <br />$74.10 <br />45330 <br />$225.15 <br />$77.43 <br />49505 <br />$715.83 <br />$715.83 <br />52000 <br />$275.50 <br />$172.43 <br />54150 <br />$208.05 <br />$133.48 <br />55250 <br />$518.23 <br />$309.70 <br />57454 j <br />$205.68 <br />$183.35 <br />CPT <br />Code <br />Non - <br />Facility <br />Rate <br />Facility <br />Rate <br />99223 <br />$271.23 <br />$271.23 <br />99231 <br />$52.73 <br />$52.73 <br />99232 <br />$96.43 <br />$96.43 <br />99233 <br />$139.18 <br />$139.18 <br />99234 <br />$179.08 <br />$179.08 <br />99235 <br />$226.10 <br />$226.10 <br />99236 <br />$291.18 <br />$291.18 <br />99238 <br />$96.90 <br />$96.90 <br />99239 <br />$143.45 <br />$143.45 <br />99281 <br />$28.50 <br />$28.50 <br />99282 <br />$55.58 <br />$55.58 <br />99283 <br />$83.13 <br />$83.13 <br />99284 <br />$157.70 <br />$157.70 <br />99285 <br />$232.75 <br />$232.75 <br />99291 <br />$368.13 <br />$299.73 <br />99292 <br />$164.35 <br />$150.10 <br />MEDICAL / SURGICAL SERVICES <br />CPT <br />Code <br />Non - <br />Facility <br />Rate <br />Facility <br />Rate <br />58100 <br />$146.78 <br />$118.28 <br />59025 <br />$65.55 <br />$65.55 <br />59400 <br />$2,858.08 <br />$2,858.08 <br />69210 <br />$66.50 <br />$44.65 <br />69436 <br />$219.93 <br />$219.93 <br />70210 <br />$39.43 <br />$39.43 <br />70220 <br />$49.88 <br />$49.88 <br />70450 <br />$155.33 <br />$155.33 <br />71020 <br />$37.05 <br />$37.05 <br />72040 <br />$44.18 <br />$44.18 <br />72050 <br />$59.85 <br />$59.85 <br />73030 <br />$38.48 <br />$38.48 <br />73140 <br />$41.80 <br />$41.80 <br />73610 <br />$41.33 <br />$41.33 <br />76805 <br />$191.43 <br />$191.43 <br />81000 <br />$5.70 <br />$5.70 <br />82270 <br />$5.70 <br />$5.70 <br />FCHN-PRO-102013 Page 2 <br />Sch B - RBRVS <br />CPT <br />Code <br />Non - <br />Facility <br />Rate <br />Facility <br />Rate <br />99315 <br />$97.85 <br />$97.85 <br />99316 <br />$141.55 <br />$141.55 <br />99381 <br />$147.25 <br />$102.60 <br />99382 <br />$153.90 <br />$109.25 <br />99383 <br />$160.55 <br />$116.38 <br />99384 <br />$181.45 <br />$136.80 <br />99385 <br />$175.28 <br />$131.10 <br />99386 <br />$203.78 <br />$159.60 <br />99387 <br />$220.88 <br />$171.48 <br />99391 <br />$132.53 <br />$93.58 <br />99392 <br />$141.55 <br />$102.60 <br />99393 <br />$141.08 <br />$102.60 <br />99394 <br />$154.85 <br />$116.38 <br />99395 <br />$158.18 <br />$119.70 <br />99396 <br />$168.63 <br />$130.15 <br />99397 <br />$181.45 <br />$136.80 <br />CPT <br />Code <br />Non - <br />Facility <br />Rate <br />Facility <br />Rate <br />82977 <br />$12.83 <br />$12.83 <br />83540 <br />$11.88 11 <br />$11.88 <br />85014 <br />$4.28 <br />$4.28 <br />85025 <br />$14.25 <br />$14.25 <br />86403 <br />$18.53 <br />$18.53 <br />87081 <br />$11.88 <br />$11.88 <br />87086 <br />$14.73 <br />$14.73 <br />88150 <br />$19.00 <br />$19.00 <br />88305 <br />$98.33 <br />$98.33 <br />90837 <br />$170.05 <br />$168.63 <br />92004 <br />$198.55 <br />$133.95 <br />92014 <br />$165.30 <br />$107.35 <br />92015 <br />$26.60 <br />$26.13 <br />93000 <br />$22.80 <br />$22.80 <br />93015 <br />$102.13 <br />$102.13 <br />94010 <br />$48.45 <br />$48.45 <br />95165 <br />$17.10 <br />$4.28 <br />
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