24-hour access: 812-537-1302
Toll free crisis: 877-849-1248
24-hour access: 812-537-1302         Toll free crisis: 877-849-1248

Charge Master

CODE DESCRIPTION
RATE
5 CLINICAL ASSESSMENT
$240.00/HOUR
9 INDIVIDUAL THERAPY
$260.00/HOUR
10 MARITAL/COUPLES THERAPY $260.00/HOUR
11 FAMILY THERAPY $260.00/HOUR
12 FAMILY SUPPORT GROUP $25.00/EVENT
13 FAMILY GROUP THERAPY $25.00/EVENT
14 GROUP PSYCHOTHERAPY $65.00/EVENT
171 SUD GROUP $35.00/EVENT
175 IOP GROUP $35.00/EVENT
18 PSYCHOLOGICAL INTERVIEW/TESTING $120.00/HOUR
19 ANGER MANAGEMENT GROUP $25.00/EVENT
20 FAMILY W/O CLIENT PRESENT $260.00/HOUR
21 EMERGENCY SERVICES/DAYTIME $100.00/HOUR
22 EMERGENCY SERVICES/AFTER HOURS $200.00/HOUR
24 DBT GROUP $65.00/EVENT
30 SSA CHILD MSE $148.00/EVENT
31 SSA ADULT MSE $148.00/EVENT
32 SSA WAIS IV $125.00/EVENT
33 SSA WISC IV $125.00/EVENT
34 SSA BAYLEY $160.00/EVENT
35 SSA STANFORD BINET V $140.00/EVENT
36 SSA WPPSI $95.00/EVENT
37 SSA WMS IV $200.00/EVENT
38 SSA VINELAND ADAPT $160.00/EVENT
39 AT RISK ASSESSMENT $65.00/HOUR
50 HB FAM CENTERED THERAPY $98.40/HOUR
51 DCS HOME BASED ASSESSMENT $80.00/HOUR
52 DCS REPORT $78.76/HOUR
53 PARENT EDUCATION GROUP $25.00/GROUP
54 HOMEMAKER SERVICES $54.36/HOUR
55 PARENT EDUCATION INDIVIDUAL $80.32/HOUR
56 PARENTING/FAM FUNCT ASSESS $68.40/HOUR
57 HB FAM CENTER CASEWK SUPER VISIT $79.32/HOUR
58 VISIT FACILITAT P/C/S SUPERVISED VIS $54.36/HOUR
59 COUNSELING SUPERVISED VISITATION $67.12/HOUR
60 HOMEMAKER SUPERVISED VISITATION $54.36/HOUR
61 HB FAM CASEWORK FACE TO FACE $79.32/HOUR
62 HB FAM CEN THERAPY SUP VISITATION $98.36/HOUR
63 CARE NETWORK $60.00/HOUR
64 DCS COUNSELING TEAM MTG $64.00/HOUR
65 DCS WRAPAROUND PER DIEM $965.49/EVENT
66 COUNSELING THERAPY $68.40/HOUR
67 RECOVERY COACH $80.00/HOUR
250 WRAPAROUND FACILITATION $115.00/HOUR
251 WRAPAROUND TECHNICIAN $104.56/HOUR
252 HABILITATION $85.60/HOUR
253 RESPITE CARE $16.00/HOUR
254 CRISIS RESPITE $15.00/HOUR
255 NON-MEDICAID TRANSPORATION $5.00/ONE WAY TRIP
256 THERAPEUTIC SERVICES $90.00/HOUR
257 TRAINING AND SUPPORT $60.00/HOUR
258 FLEX FUNDS COST*
331 INITIAL HOSPITAL CONSULT $165.00/HOUR
336 SUBSEQUENT HOSPITAL CONSULT $165.00/HOUR
361 IPU PHYSICAL $125.00/EVENT
366 IPU PHYSICAL FOLLOW UP $60.00/EVENT
381 INITIAL IPU PHYSICIAN ROUND $85.00/EVENT
382 INITIAL IPU PHYSICIAN ROUND $140.00/EVENT
383 INITIAL IPU PHYSICIAN ROUND $190.00/EVENT
391 SUBSEQUENT IPU PHYSICIAN ROUND $45.00/EVENT
392 SUBSEQUENT IPU PHYSICIAN ROUND $75.00/EVENT
393 SUBSEQUENT IPU PHYSICIAN ROUND $100.00/EVENT
41 INPATIENT DAY OF CARE $1000.00/EVENT
42 THERAPEUTIC LEAVE DAY $85.00/EVENT
43 ISOLATION MONITORING $45.00/HOUR
490 MEDICINAL SUPPLIES COST*
491 PHARMACY SERVICES COST*
492 LABORATORY SERVICES COST*
493 RADIOLOGY SERVICES COST*
494 ELECTROCARDIOLOGY SERVICES COST*
495 RESPIRATORY THERAPY COST*
496 PHYSICAL THERAPY COST*
497 NUCLEAR MEDICINE SERVICES COST*
499 OTHER HOSPITAL SERVICES COST*
9500 FACILITY CHG FOR SERVICE 05 $100.00/HOUR
9501 FACILITY CHG FOR SERVICE 09 1/2 HR $120.00/HOUR
9502 FACILITY CHG FOR SERVICE 09 1 HR $120.00/HOUR
9503 FACILITY CHG FOR SERVICE 09 1 1/2 HR $120.00/HOUR
9504 FACILITY CHG FOR SERVICE 10 $100.00/HOUR
9505 FACILITY CHG FOR SERVICE 11 $100.00/HOUR
9506 FACILITY CHG FOR SERVICE 13 $50.00/EVENT
9507 FACILITY CHG FOR SERVICE 14 $50.00/EVENT
9508 FACILITY CHG FOR SERVICE 20 $100.00/HOUR
9509 FACILITY CHG FOR SERVICE 171/175 $50.00/EVENT
9510 FACILITY CHG FOR SERVICE 311 $60.00/EVENT
9600 FACILITY CHG FOR SERVICE 99201 $27.00/EVENT
9601 FACILITY CHG FOR SERVICE 99202 $51.00/EVENT
9602 FACILITY CHG FOR SERVICE 99203 $78.00/EVENT
9603 FACILITY CHG FOR SERVICE 99204 $132.00/EVENT
9604 FACILITY CHG FOR SERVIC E 99205 $170.00/EVENT
9605 FACILITY CHG FOR SERVICE 99211 $10.00/EVENT
9606 FACILITY CHG FOR SERVICE 99212 $26.00/EVENT
9607 FACILITY CHG FOR SERVICE 99213 $55.00/EVENT
9608 FACILITY CHG FOR SERVICE 99214 $110.16/EVENT
9609 FACILITY CHG FOR SERVICE 99215 $113.00/EVENT

* Actual charge for supplies/services received

CODE DESCRIPTION RATE
100 MRO LON DETERMINATION $77.72/EVENT
101 MRO INDIVIDUAL COUNSELING $114.60/HOUR
102 MRO GROUP COUNSELING $28.64/HOUR
103 MRO FAMILY WITH CONSUMER $114.60/HOUR
104 MRO FAMILY WITHOUT CONSUMER $114.60/HOUR
105 MRO FAMILY GROUP WITH CONSUMER $28.64/HOUR
106 MRO FAMILY GROUP W/O CONSUMER $28.64/HOUR
107 MRO MED TRAINING AND SUPPORT $74.48/HOUR
108 MRO MED TRAINING GROUP $13.40/HOUR
109 MRO MED TRAINING FAMILY $74.48/HOUR
110 MRO MED TRAIN FAM GRP W/O CON $13.40/HOUR
111 MRO MED TRAIN FAM WITH CON $84/48/HOUR
112 MRO MED TRAIN FAM GRP WITH CON $13.40/HOUR
113 MRO SKILLS TRAINING AND DEV IND $104.56/HOUR
114 MRO SKILLS TRAINING GROUP $18.84/HOUR
115 MRO SKILLS TRAIN FAMILY W/O CON $104.56/HOUR
116 MRO SKILLS TRAIN FAM GRP W/O CONS $18.84/HOUR
117 MRO SKILLS TRAIN FAMILY WITH CON $104.56/HOUR
118 MRO SKILLS TRAIN FAM GRP WITH CON $18.84/HOUR
119 MRO CASE MANAGEMENT $58.12/HOUR
120 MRO CRISIS INTERVENTION 134.88/HOUR
121 MRO PSYCH INTERVENT FACE TO FACE $122.48/HOUR
122 MRO PSYCH INTERVENT NON FACE TO $73.48/HOUR
123 MRO CAIRS $58.48/HOUR
124 MRO AIRS $58.48/HOUR
125 MRO INTENSIVE OUTPATIENT $174.96/3 HOUR
126 MRO ADDICTION COUNSELING IND $58.32/HOUR
127 MRO ADDICT FAMILY WITH CON $58.32/HOUR
128 MRO ADDICT FAMILY W/O CON $14.58/HOUR
129 MRO ADDICTION GROUP $14.58/HOUR
130 MRO ADDICT FAM GROUP WITH CON $14.58/HOUR
131 MRO ADDICT FAM GROUP W/O CON $14.58/HOUR
132 MRO PEER RECOVERY SERVICES $34.20/HOUR
133 MRO PSYCH INTERVENT – APN $122.48/HOUR
134 MRO PSYCH INTERVENT – APN NON FTF $73.48/HOUR
135 MRO SKILLS TRN SUPERVISED VISIT $104.56/HOUR
136 BPHC Care Coordination $58.12/HOUR
142 PRIME FOR LIFE 260.00/EVENT
581 DISCOVERY $42.00/HOUR
582 WORK EXPERIENCE DEVELOPMENT $42.00/HOUR
583 WORK EXPERIENCE A 1-5 HOURS/WEEK $200.00/WEEK
584 WORK EXPERIENCE B 6-10 HOURS/WEEK $325.00/WEEK
585 WORK EXPERIENCE C 11+ HOURS/WEEK $450.00/WEEK
586 JOB READINESS TRAINING $42.00/HOUR
587 JOB SEARCH AND PLACEMENT ASSISST $42.00/HOUR
588 EMPLOYMENT MILESTONE 1 $1300.00/EVENT
589 EMPLOYMENT MILESTONE 2 $1500.00/EVENT
590 EMPLOYMENT MILESTONE 3 $1300.00/EVENT
591 ON THE JOB SUPPORTS SHORT TERM $42.00/HOUR
592 SUPPORT EMPLOYMENT 1-5 HRS/MTH $176.00/MONTH
593 SUPPORT EMPLOYMENT 6-10 HRS/MTH $352.00/MONTH
594 SUPPORT EMPLOYMENT 11-15 HRS/MTH $528.00/MONTH
595 SUPPORT EMPLOYMENT 16-20 HRS/MTH $720.00/MONTH
596 SUPPORT EMPLOYMENT 21-25 HRS/MTH $920.00/MONTH
597 SUPPORT EMPLOYMENT 26-30 HRS/MTH $1120.00/MTH
598 SUPPORTED EMPLOYMENT HOURLY $42.00/HOUR
599 BENEFITS ANALYSIS $500.00/EVENT
600 LEVEL OF CARE CONSULTATION $100.00/HOUR
601 COMPETENCY EVALUATION $100.00/HOUR
602 ADHD EVALUATION $97.00/HOUR
603 WALK IN CLINIC EVALUATION $240.00/HOUR
604 BARIATRIC EVALUATION $100.00/HOUR
605 MEDICAID DISABILITY EVALUATION $80.00/HOUR
606 SOCIAL SECURITY DISABILITY EVAL $100.00/EVENT
607 STERLING EVALUATION $93.48/HOUR
608 PARENTING ASSESSMENT $97.00/HOUR
609 JAIL CONSULTS $100.00/HOUR
610 PASARR EVALUATION $100.00/HOUR
611 DRUG AND ALCOHOL EVALUATION $100.00/EVENT
84 TESTIMONY/DEPOSITION $200.00/EVENT
85 BRIDGE DEVICE $800.00/EVENT
88 INTERPRETER SERVICES $75.00/HOUR
89 DRUG TESTING $15.00/EVENT
99201 NEW PATIENT STRAIGHTFORWARD $32.00/EVENT
99202 NEW PATIENT EXPANDED $54.00/EVENT
99203 NEW PATIENT DETAILED $78.00/EVENT
99204 NEW PATIENT COMPREHENSIVE $126.00/EVENT
99205 NEW PATIENT HIGH COMPLEXITY $164.00/EVENT
99211 ESTABLISHED PATIENT MINIMAL COMPLEX $16.00/EVENT
99212 ESTABLISHED PATIENT STRAIGHTFORWARD $32.00/EVENT
99213 ESTABLISHED PATIENT LOW COMPLEX $52.00/EVENT
99214 ESTABLISHED PATIENT MODERATE $78.00/EVENT
99215 ESTABLISHED PATIENT HIGH COMPLEX $108.00/EVENT
T9201 TELEHEALTH NEW PT STRAIGHTFORWARD $32.00/EVENT
T9202 TELEHEALTH NEW PT EXPANDED $54.00/EVENT
T9203 TELEHEALTH NEW PT DETAILED $78.00/EVENT
T9204 TELEHEALTH NEW PT COMPREHENSIVE $126.00/EVENT
T9205 TELEHEALTH NEW PT HIGH COMPLEXITY $164.00/EVENT
T9211 TELEHEALTH ESTAB PT MINIMAL COMPLEX $16.00/EVENT
T9212 TELEHEALTH ESTAB PT STRAIGHTFORWARD $32.00/EVENT
T9213 TELEHEALTH ESTAB PT LOW COMPLEX $52.00/EVENT
T9214 TELEHEALTH ESTAB PT MODERATE $78.00/EVENT
T9215 TELEHEALTH ESTAB PT HIGH COMPLEXITY $108.00/EVENT
T3014 TELEHEALTH SPOKE SITE $35.00/EVENT