Preventative Medicine Services payment for Medicaid

 Code    Service    Medicaid Payment as of 7/1/2010    Additional Medical Home Incentive    Total  
 Preventative Medicine Services  
 99381    New patient, under 1 year    $77.68   $10    $87.68 
 99382    New patient, 1 - 4 years    $83.97   $10    $93.97 
 99383    New patient, 5-11 years    $82.65   $40    $122.65 
 99384    New patient, 12-17 years    $89.91   $40    $129.91 
 99385    New patient, 18-39 years    $89.91   $40    $129.91 
 99391    Established patient, < 1 year    $66.56   $10    $76.56 
 99392    Established patient, 1-4 years    $74.55   $10    $84.55 
 99393    Established patient, 5-11 years    $68.74   $40    $108.74 
 99394    Established patient, 12-17 years    $75.36   $40    $115.36 
 99395    Estab. patient, 18 up to19 years    $76.03   $40    $116.03 
 96110    Developmental screening    $36.10   N/A    $36.10 
 99460/99461    Newborn Care    $55.62/70.52   $10    $65.62/80.52 




You will bill Medicaid as you normally do for your Medicaid patients, and you will be paid at the higher rate. You do not need to add a modifier.

Medicaid pays whichever amount is least between (1) your practice’s charge and (2) the Medicaid allowable. Please charge at least the current Medicaid allowable as shown in the table above. Some practices have been charging less than the Medicaid allowable, and are only receiving that amount. When you bill Medicaid, bill the max amount. You will get the max that Medicaid pays plus the incentive fee. DON’T under bill Medicaid.
Use code 96110 to bill for your developmental screening of all children up to 6 years if you are using an approved, standardized screening tool. This is recommended by Medicaid, and is reimbursed at $36.10 (see Chapter 11). We suggest you consider adding this code to your super bill.

Vision and Hearing: Hearing and vision screening is an expected part of a well child check-up and bundled with the well visit code. So, if you bill for this service as a separate line item on the same claim as the well visit, you will not be reimbursed. If you do these at a sick visit, however, you will get reimbursed for them in addition to the E&M code. Strange but true.

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