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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/01/15

Reimbursement Rate Reductions Effective May 1, 2015 through June 30, 2015

To:​ Enrolled Physicians and Advanced Practice Nurses​
​Date: ​May 1, 2015
​Re: Reimbursement Rate Reductions Effective May 1, 2015 through June 30, 2015​

As a result of Public Act 099-0002 (pdf), the department is required to reduce reimbursement rates paid to providers for certain services delivered on or after May 1, 2015 through June 30, 2015 by 16.75 percent. 

This rate reduction includes all services provided by a physician, mid-level or ancillary staff services billed under the physician’s NPI and services rendered by an advanced practice nurse, except the following codes:

  • 99213    Office or Other Outpatient Visit, Established Patient, Expanded Focus

  • 99214    Office or Other Outpatient Visit, Established Outpatient. Detailed to Moderate Complex

  • 99381    Initial Evaluation Healthy Infant less than one Year; Preventative

  • 99382    Initial Evaluation Healthy Child, one Year through four Years; Preventative

  • 99383    Initial Evaluation Healthy Child, five Years through eleven Years; Preventative

  • 99384    Initial Evaluation Healthy Adolescent 12 through 17 Years; Preventative

  • 99385    Initial Evaluation Healthy. 18-39 Years; Preventative

  • 99391    Periodic Re-Evaluation Establish Infant, Preventative less than one Year

  • 99392    Periodic Re-Evaluation Healthy Child one through four Years; Preventative

  • 99393    Periodic Re-Evaluation Healthy Child 5 through 11 Years; Preventative

  • 99394    Periodic Re-Evaluation Healthy Adolescent 12 through 17 Years; Preventative

  • 99395    Periodic Comprehensive Preventive.  Evaluation Management; 18-39 Years

In addition, dispensing fees for practitioner dispensed 340B and family planning drugs will be reduced by $1.00.   

There are no changes in the procedures for billing the department. Providers should continue to bill their usual and customary charge for each procedure code. A revised fee schedule reflecting the rate reductions is posted to the HFS website. 

These reductions apply to fee-for-service reimbursement.  If services are being provided under a Managed Care Organization (MCO) or Managed Care Community Network

(MCCN) contract, please refer to those contractual terms.

Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood

Director