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900K 15 Pt,`- 487 <br />APPROVED MEDICAID SERVICES AND REIMBURSEMENT RATES <br />EFFECTIVE JULY 1, 1993 <br />P• EDURE SERVICE <br />CODE <br />LOCAL <br />REIMBURSEMENT <br />Y2011 <br />MATERNAL HEALTH (PRENATAL) <br />Y2033 <br />NON STRESS <br />INTRAPARTUM CARE (VAGINAL DELIVERY) <br />Y2032 <br />Y2135 <br />ULTRASOUND <br />W8204 <br />MATERNITY HOME VISIT <br />RNAL CARE COORD-INT <br />W8201 <br />W8202 <br />MATE <br />MATERNAL CARE COORD-SUB <br />CARE COORD HOME VISIT <br />Y2044 <br />MATERNITY <br />CHILDBIRTH CLASS <br />W8203 <br />REFRESHER CHILDBIRTH CLASSES <br />Y2045 <br />W8205 <br />PARENTING CLASS <br />J2790 <br />RHO D IMMUNE GLOBULIN <br />ORAL GLUCOSE TOLERANCE TEST <br />82951 <br />84703 <br />PREGNANCY TEST <br />POSTPARTUM/NEWBORN HOME VST:MAT ASSMT <br />Y2046 <br />ENHANCED-PSYCBOSOCIAL COUNSELING <br />Y2049 <br />Y2041 <br />EHRANCED NUTRITION COUNSELING <br />W8010 <br />CHILD SCREENING (EPSDT) <br />T <br />Y2023 <br />Y 005 <br />CHILD TREATMEN <br />DENTAL HEALTH CARE <br />26 <br />CARDIOLOGY DIAG/EVAL <br />16 <br />ORTHOPEDIC DIAG/EVAL <br />Y2031 <br />PHYSICAL THERAPY <br />NEUROLOGY & SENSORY <br />Y2025 <br />Y2014 <br />DIAG/EVAL <br />SPEECH & HEARING <br />Y2030 <br />SPEECH THERAPY <br />NEUROMUSCULAR DIAG/EVAL <br />Y2134 <br />Y2155 <br />CHILD SERVICE COORDINATION <br />Y2035 <br />MYELODYSPLASIA CLINIC <br />W8012 <br />IMMUNIZATION UPDATE <br />POSTPARTUM/NEWBORN HOME VST:NEWBORN ASSMT <br />Y2047 <br />HOME VST:EPSDT SCREEN <br />POSTPARTUM/NmoRN <br />Y2048 <br />Y2001 <br />NI <br />FAMILY PLANNIN <br />Y2002 <br />G HIIT~ <br />FAMILY PLANNI <br />FAMILY PLANNING EXTENDED <br />Y2003 <br />Y2004 <br />FAMILY PLANNING ANNUAL <br />W5131 <br />NORPLANT INSERTION <br />W5132 <br />NORPLANT REMOVAL <br />NORPLANT REMOVAL/REINSERTION <br />W5133 <br />DEPO PROVERA CONTRACEPTIVE INJECTION <br />W5141 <br />TB CONTROL/TREATMENT <br />Y2012 <br />Y2013 <br />STD CONTROL GLOBULIN (RIG)/UNIT <br />RABIES IMMUNE <br />Y2225 <br />90726 <br />RABIES VACCINE/UNIT <br />COMPREHENSIVE ADULT HEALTH ASSESSMENT <br />f 39 <br />40 <br />LIMITED ADULT HEALTH ASSESSMENT <br />38 <br />CHRONIC DISEASE MONITORING <br />Y2027 <br />Y2034 <br />ADULT TREATMENT <br />ASSESSMENT <br />REFUGEE <br />79.20 <br />40.05 <br />738.50 <br />38.14 <br />141.82 <br />86.06 <br />43.52 <br />46.98 <br />87.00 <br />30.00 <br />92.38 <br />46.38 <br />19.65 <br />10.51 <br />36.92 <br />43.22 <br />33.89 <br />82.85 <br />52.69 <br />95.36 <br />133.48 <br />68.76 <br />33.91 <br />93.76 <br />94.87 <br />50.24 <br />136.61 <br />80.00 <br />199.36 <br />16.48 <br />36.92 <br />54.76 <br />136.38 <br />43.28 <br />74.14 <br />87.80 <br />555.80 <br />232.47 <br />703.11 <br />26.35 <br />83.75 <br />87.06 <br />42.00 <br />90.00 <br />128.57 <br />20.61 <br />28.13 <br />99.54 <br />140.40 <br />39 <br />