California Code of Regulations › Title 17 - Public Health › Division 1 - State Department of Health Services › Chapter 4 - Preventive Medical Service › Subchapter 13 - Child Health and Disability Prevention Program › Article 6 - Claiming for Services › Section 6868 - Schedule of Maximum Allowances

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Health
					 screening procedures. Reimbursement for the procedures listed in this subsection,
					 when billed in accordance with this subchapter, shall be the amount billed by the
					 provider for the procedures performed, up to the maximum allowances specified in
					 this subsection. For purposes of this subsection:
new patient
means
					 a person who has not previously received a health assessment from the examiner, and
					 there is no health assessment record for the person established with the provider;
extended visit
means a visit in which the patient requires as much
					 or more time to be given a health assessment as does a new patient;
routine
					 visit
means a visit in which the patient requires less time than ordinarily
					 needed with a new patient or an extended visit.
HEALTH SCREENING
								PROCEDURE
MAXIMUM
								ALLOWANCE
History and Physical Examination by
								Comprehensive Care Provider
New Patient or Extended
								Visit
Adolescent
..........................(age
								12 through 20 years)
..........................$49.51
Late
								childhood
..........................(age 5 through 11
								years)
..........................43.32
Early
								childhood
..........................(age 1 through 4
								years)
..........................40.84
Infant
..........................(birth through 11
								months)
..........................38.37
Routine
								Visit
Adolescent
..........................(age
								12 through 20 years)
..........................39.60
Late
								childhood
..........................(age 5 through 11
								years)
..........................33.43
Early
								childhood
..........................(age 1 through 4
								years)
..........................30.95
Infant
..........................(birth through 11
								months)
..........................28.46
By Health Assessment--Only Provider
New Patient or Extended
								Visit
Adolescent
..........................(age
								12 through 20 years)
..........................43.32
Late
								childhood
..........................(age 5 through 11
								years)
..........................37.13
Early
								childhood
..........................(age 1 through 4
								years)
..........................34.65
Infant
..........................(birth through 11
								months)
..........................32.18
Routine
								Visit
Adolescent
..........................(age
								12 through 20 years)
..........................37.13
Late
								childhood
..........................(age 5 through 11
								years)
..........................30.95
Early
								childhood
..........................(age 1 through 4
								years)
..........................28.46
Infant
..........................(birth through 11
								months)
..........................25.99
Pelvic
								Exam..........................
..........................10.00
Vision Screening
Snellen eye test or equivalent
								visual acuity test
..........................Age 7 years
								and older
..........................$ 2.02
..........................Age 3
								through 6 years
..........................4.00
Hearing Screening
..........................Pure Tone
								Audiometry
..........................9.21
Tuberculin Testing
..........................Multiple
								Puncture
..........................4.54
..........................Mantoux
								(intracutaneous)
..........................7.53
(b)
					 Laboratory Tests. For laboratory tests listed in this subsection that the provider
					 performs, reimbursement shall be either the provider's usual charge to the general
					 public for the test or the maximum allowance specified in this subsection, whichever
					 is less. If a laboratory test is performed by other than the screening provider, for
					 instance by an outside laboratory, the screening provider may bill the Department's
					 Child Health and Disability Prevention Program for the charge made to the provider
					 by the laboratory (except for cytologic examination of a gynecologic slide as
					 described below), plus a charge not to exceed $4.63 for the provider's collection
					 and handling of the specimen. The total shall not exceed the maximum allowance
					 specified in this subsection for the laboratory test.
If a clinical laboratory performs a cytologic examination of a
						gynecologic slide taken during the course of a CHDP health assessment, or other
						laboratory services resulting from a CHDP health assessment, the clinical laboratory
						may bill the Department's Child Health and Disability Prevention Program the
						clinical laboratory's usual charge to the general public not to exceed the maximum
						allowance specified in this subsection. The health assessment provider may bill the
						program a charge not to exceed $4.63 for the provider's collection and handling of
						the specimen. The total charge from the clinical laboratory and the health
						assessment provider shall not exceed the maximum allowance specified in this
						subsection for cytologic tests. Clinical laboratory tests shall be performed in the
						manner and by persons and laboratories that meet the relevant standards established
						in the Health and Safety Code, the Business and Professions Code and Title 17 of the
						California Code of Regulations.
LABORATORY
								TEST
MAXIMUM
								ALLOWANCE
Blood Tests
Hematocrit..........................
..........................$3.01
Hemoglobin..........................
..........................3.01
Sickle Cell Status
								(Electrophoresis)..........................
..........................30.11
Blood Lead Screening Blood Lead Level
								Determination..........................
..........................22.45
Phenylalanine (PKU)
								Blood..........................
..........................4.54
Urine Tests
Urinalysis, routine,
								complete..........................
..........................4.54
Urine
								"Dipstick"..........................
..........................2.87
Tests for Microorganisms
Culture for Neisseria
								Gonorrhea..........................
..........................6.02
Cytologic Tests
Papanicolaou (Pap)
								Smear..........................
..........................11.22
Ova and Parasites, direct smears,
								concentration and identification..........................
..........................12.39
VDRL, RPR or
								ART..........................
..........................4.56
Chlamydia
								Test..........................
..........................19.25
(c)
					 Immunizations. Reimbursement for the immunizations listed in this subsection, when
					 billed in accordance with this subchapter, shall be the amount billed by the
					 provider for the immunizations given, up to the maximum allowances specified in this
					 subsection. However, if the provider uses vaccine supplied at no cost to the
					 provider by the Department's Immunization Assistance Program, the maximum
					 reimbursement for administration of the vaccine shall be the amount determined by
					 the Department rather than the amount specified in this subsection. The maximum
					 reimbursement rate for the professional component of administering an immunization
					 under this subsection shall be $4.52. The maximum allowable reimbursement for the
					 ingredient component of an immunization shall be based on prevailing market
					 acquisition costs as determined by the Department's fiscal intermediary.
IMMUNIZATION
DPT (diphtheria and tetanus toxoids with pertussis vaccine)
						First, second, third of series; booster.
Td (combined tetanus and diphtheria toxoids, adult
						type)
Dd (combined tetanus and diphtheria toxoids, pediatric
						type)
Hib (Haemophillus Influenza Type b) vaccine
Hib (Haemophillus Influenza Type b) conjugate vaccine
HibTITER
Polio: IPV (inactivated trivalent poliovirus vaccine)
First, second, third of series, or booster
TOPV (trivalent oral polio virus vaccine) First, second, third
						of series; booster.
Measles vaccine
Rubella vaccine
Mumps vaccine
MR (measles, rubella) vaccine
MMR (measles, mumps, rubella) vaccine
MuR (mumps, rubella) vaccine
HBVAC (hepatitis B vaccine) (Pre-exposure)
HBIG (hepatitis B immune globulin) (Post
						exposure)
1. Amendment
						filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A
						Certificate of Compliance must be transmitted to OAL within 120 days or emergency
						language will be repealed on 11-29-84. For prior history, see Register 81, No.
						52.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed
						12-27-84 (Register 84, No. 52).
3. Amendment filed 8-1-85 as an
						emergency; effective on filing (Register 85, No. 32). A Certificate of Compliance
						must be transmitted to OAL within 120 days or emergency language will be repealed on
						11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85 and
						filed 12-27-85 (Register 85, No. 52).
5. Amendment of section and NOTE
						filed 2-23-93; operative 3-25-93 (Register 93, No.
						9).
Note: Authority cited: Sections
						  208 and
						  321,
						  Health and Safety Code, and Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  323 and
						  323.2
						  (a), Health and Safety Code; and Section
						  14105,
						  Welfare and Institutions Code; Items 4260-111-001, Chapter 258, Statutes of 1984,
						  and Statutes of 1985, Chapter 111, Items 4260-111-001 and 890; and Section
						  655.6,
						  Business and Professions Code.