Evaluation & Management Preventive Services CPT® Code CPT ... - Alaska

Evaluation & Management Preventive Services

CPT? Code

CPT? Description

Initial comprehensive preventive medicine evaluation and management of an individual

99381

including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic

procedures, new patient; infant (age younger than 1 year)

Initial comprehensive preventive medicine evaluation and management of an individual

99382

including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic

procedures, new patient; early childhood (age 1 through 4 years)

Initial comprehensive preventive medicine evaluation and management of an individual

99383

including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic

procedures, new patient; late childhood (age 5 through 11 years)

Initial comprehensive preventive medicine evaluation and management of an individual

99384

including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic

procedures, new patient; adolescent (age 12 through 17 years)

99391

Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)

99392

Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)

ACP Charge $340.00 $335.00 $340.00 $385.00 $285.00

$300.00

99393

Evaluation & Management Preventive Services (continued)

Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)

$300.00

99394 99395

Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)

Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years

$330.00 $365.00

Office Evaluation & Management Problem-Oriented Services

CPT? Code

CPT? Description

Office or other outpatient visit for the evaluation and management of a new patient, which

99202

requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on

the date of the encounter.

Office or other outpatient visit for the evaluation and management of a new patient, which

99203

requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date

of the encounter.

ACP Charge $215.00

$305.00

99204

Office Evaluation & Management Problem-Oriented Services (continued)

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.

99211

Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.

99212 99213 99214 99215

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.

$465.00 $95.00 $150.00 $210.00 $305.00 $565.00

Hospital Evaluation & Management Services

CPT? Code

CPT? Description

99238 Hospital discharge day management; 30 minutes or less

99460

Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant

99462 Subsequent hospital care, per day, for evaluation and management of normal newborn

99463

Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date

CPT? Code

Behavioral Health Services CPT? Description

90832 Psychotherapy, 30 minutes with patient

90834 Psychotherapy, 45 minutes with patient

90837 Psychotherapy, 60 minutes with patient

90846 Family psychotherapy (without the patient present), 50 minutes

90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes

ACP Charge $355.00 $415.00

$235.00

$500.00

ACP Charge $130.00 $150.00 $255.00 $205.00 $215.00

Immunization & Medication Administration

CPT? Code

CPT? Description

Immunization administration through 18 years of age via any route of administration, with

90460 counseling by physician or other qualified health care professional; first or only component of

each vaccine or toxoid administered

ACP Charge $105.00

90461

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

$65.00

90471 90472 96372

Immunization & Medication Administration (continued) Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

$105.00 $65.00 $105.00

Laboratory Services

CPT? Code

CPT? Description

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones,

81002 leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these

constituents; non-automated, without microscopy

83655 Assay of Lead

85018 Blood count; hemoglobin (Hgb)

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay

87426

[EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute

respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

87804

Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza

87807

Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus

87880

Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A

99173 Screening test of visual acuity, quantitative, bilateral

99177

Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with on-site analysis

ACP Charge $15.00 $55.00 $15.00

$100.00

$60.00 $55.00 $60.00 $20.00 $30.00

Screening Services

CPT? Code

CPT? Description

ACP Charge

96110

Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

$55.00

Brief emotional/behavioral assessment (eg, depression inventory, attention-

96127 deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized $35.00

instrument

96160

Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument

$20.00

Administration of caregiver-focused health risk assessment instrument (eg, depression

96161 inventory) for the benefit of the patient, with scoring and documentation, per standardized

$20.00

instrument

Outpatient Procedural Services

CPT? Code

CPT? Description

ACP Charge

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical

17110 curettement), of benign lesions other than skin tags or cutaneous vascular proliferative

$290.00

lesions; up to 14 lesions

17250 Chemical cauterization of granulation tissue

$355.00

54150 Circumcision, using clamp or other device with regional dorsal penile or ring block

$800.00

69209 Removal impacted cerumen using irrigation/lavage, unilateral

$70.00

69210 Removal impacted cerumen requiring instrumentation, unilateral

$275.00

Pressurized or nonpressurized inhalation treatment for acute airway obstruction for

94640

therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB)

$125.00

device

99188 Application of topical fluoride varnish by a physician or other qualified health care professional $50.00

Alaska Center for Pediatrics - charges published as of 12/2020

Alaska Center for Pediatrics - charges published as of 12/2020 *all charges are undiscounted*

CPT? Copyright 2021. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. The CPT codes are provided "as is" without warranty of any kind. The AMA specifically disclaims all liability for use or accuracy of any CPT

codes.

*The undiscounted price may be higher or lower than the amount an individual actually pays for the health care services described in the list. "undiscounted price" means an amount billed

for a service rendered without complications or exceptional circumstances; "undiscounted price" does not include a negotiated discount for an in-network or out-of-network service

rendered or the cost paid by a third party for that service

You will be provided with an estimate of the anticipated charges for your nonemergency care upon receipt of a written request. Please do not hesitate to ask for more information.

Requests can be, emailed to info@, faxed to 907-278-2066, or mailed to our office at 2925 DeBarr Road Suite 230 Anchorage, AK 99508. Good Faith Estimate Requests must

include the following; Patient's full name, medical condition for which the patient is needing medical treatment for, method preferred for receiving statement, parent/guardian's contact including e-mail address, mailing address and phone number. Please give up to 10 business

days for estimates.

This posting is made public on Alaska Center for Pediatrics website at in accordance with Alaska's Department of Health And Social Services Regulations re: Health Care

Services Price Transparency (7 AAC 86) and SB 105.

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