New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.37 - Computation of basic rates of payment for services provided to medicaid patients by preferred primary care providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For payments made pursuant to this
					 section and pursuant to section 86- 1.11(h) of this Part, for ambulatory care
					 services to Medicaid patients, reimbursement shall be based upon a uniform
					 payment schedule with a discrete price set forth in subdivision (c) of this
					 section.
(b) To be eligible to
					 receive reimbursement pursuant to this section, facilities must be licensed
					 pursuant to article 28 of the Public Health Law, and certified to provide
					 general medical services, and enter into a written agreement with the
					 commissioner to provide the discrete services described in subdivision (c) of
					 this section. These clinic services are defined on the basis of patient
					 characteristics and provider services. Patient characteristics include age, sex
					 and diagnoses. Provider services include diagnostic examinations, treatments,
					 and ancillary services including significant diagnostic technologies.
					 Diagnostic technologies are defined as: diagnostic nuclear medicine, diagnostic
					 radiology, diagnostic ultrasound, cardiography, cardiac fluoroscopy,
					 echocardiography, and neurological and neuromuscular procedures.
(c) The 71 clinic services for which
					 reimbursement shall be available at prices established pursuant to this section
					 are:
(1) Diagnostic investigation exams NEC.
					 This visit shall be for any patient for the purpose of diagnostic investigation
					 of problems attendant to physical medicine nowhere else categorized. This visit
					 shall include a physical examination and history with appropriate treatment and
					 diagnostic measures and shall include necessary laboratory tests and the use of
					 diagnostic technologies, and any other services specified in the agreement
					 referenced in subdivision (b) of this section. This visit shall only occur
					 after a complete physical and history and shall include all other laboratory
					 and diagnostic technology ancillaries that are required to complete the
					 diagnostic investigation. This visit is not for the sole purpose of receiving
					 an x-ray.
(2) Diagnostic
					 investigation with nuclear imaging. This visit shall be for patients requiring
					 diagnostic nuclear imaging including contrast imaging in order to complete a
					 diagnostic investigation. This visit shall only occur after a complete physical
					 and history and shall include all other laboratory and diagnostic technology
					 ancillaries that are required to complete the diagnostic investigation, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section. This visit is not for the sole purpose of receiving diagnostic nuclear
					 medicine.
(3) Diagnostic
					 investigation with computerized axial tomography imaging. This visit shall be
					 for patients requiring a CAT scan in order to complete a diagnostic
					 investigation. This visit shall only occur after a complete physical and
					 history and shall include all other laboratory and diagnostic technology
					 ancillaries that are required to complete the diagnostic investigation, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section. This visit is not for the sole purpose of receiving a CAT
					 scan.
(4) Diagnostic investigation
					 with magnetic resonance imaging. This visit shall be for patients requiring a
					 MRI in order to complete a diagnostic investigation. This visit shall only
					 occur after a complete physical and history and shall include all other
					 laboratory and diagnostic technology ancillaries that are required to complete
					 the diagnostic investigation, and any other services specified in the agreement
					 referenced in subdivision (b) of this section. This visit is not for the sole
					 purpose of receiving an MRI.
(5)
					 Management exam NEC. This visit shall be for any patient for the treatment of
					 problems attendant to physical medicine nowhere else categorized. This visit
					 shall include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(6) Medication administration. This visit
					 shall be for the sole purpose of administering drugs, injectables or renewal of
					 a prescription with a concomitant brief provider assessment, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(7) Pediatric annual well
					 care exam. This visit shall be for healthy children ages three years through 17
					 years. This visit shall include a physical examination, developmental
					 appraisal, nutritional assessment, hearing and vision screening, immunizations
					 as indicated, selected laboratory tests such as hematocrit, blood counts, lead
					 screening, TB Tine, urinalysis, VD for teenagers, on an appropriate schedule,
					 and other services specified in the agreement referenced in subdivision (b) of
					 this section.
(8) Adult annual well
					 care exam. This visit shall be for generally healthy patients over 17 years of
					 age. This visit shall include an annual physical examination, health education,
					 nutritional assessment, blood pressure, hearing and vision screening, selected
					 ancillaries when appropriate, including standard laboratory tests, chest
					 x-rays, mammograms, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(9) First prenatal--routine. This visit shall
					 be for females with a confirmed diagnosis of a normal pregnancy for the purpose
					 of initiating a prenatal care treatment regimen. This visit shall include a
					 complete physical examination and history, nutritional counseling, health
					 education, appropriate treatment measures including laboratory ancillaries and
					 the use of key technologies, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(10) First prenatal--complicated. This visit
					 shall be for females with a confirmed diagnosis of a complicated pregnancy for
					 the purpose of initiating a prenatal care treatment regimen. This visit shall
					 include a complete physical examination and history, nutritional counseling,
					 health education, appropriate treatment measures including laboratory
					 ancillaries and the use of key technologies, and any other services specified
					 in the agreement referenced in subdivision (b) of this section.
(11) Prenatal management
					 revisit--complicated. This visit shall be for females with a confirmed
					 pregnancy and complications primarily related to pregnancy. This visit shall be
					 for the purpose of providing ongoing prenatal care including a limited physical
					 examination, nutritional counseling, health education, appropriate treatment
					 and diagnostic measures including laboratory ancillaries and the use of key
					 technologies, and any other services specified in the agreement referenced in
					 subdivision (b) of this section.
(12) Post partum management--complicated.
					 This visit shall be for females with a confirmed pregnancy and complications
					 primarily related to pregnancy. This visit shall be for the purpose of
					 providing post partum care including a limited physical examination,
					 nutritional counseling, health education, appropriate treatment and diagnostic
					 measures including laboratory ancillaries and the use of key technologies, and
					 any other services specified in the agreement referenced in subdivision (b) of
					 this section.
(13) Prenatal revisit
					 well care--normal. This visit shall be for female patients with a confirmed
					 normal pregnancy. This visit shall be for the purpose of providing ongoing
					 routine or uncomplicated prenatal care including a limited physical
					 examination, nutritional counseling, health education, appropriate treatment
					 and diagnostic measures including laboratory ancillaries and the use of key
					 technologies, and any other services specified in the agreement referenced in
					 subdivision (b) of this section.
(14) Post partum management--normal. This
					 visit shall be for females of all ages for the purpose of providing post partum
					 care following a normal pregnancy and delivery. This visit shall be for the
					 purpose of post partum care including a limited physical examination,
					 nutritional counseling, health education, appropriate treatment and diagnostic
					 measures including laboratory ancillaries and the use of key technologies, and
					 any other services specified in the agreement referenced in subdivision (b) of
					 this section.
(15) Neonatal and
					 congenital diagnostic investigation. This visit shall be for the purpose of
					 investigation of problems of congenital disorders and newborns with medical
					 conditions. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic measures including laboratory ancillaries
					 and the use of diagnostic technologies, and other services specified in the
					 agreement referenced in subdivision (b) of this section.
(16) Management of neonatal and congenital
					 problems. This visit shall be for the treatment of problems associated with
					 congenital disorders and newborns with problems. This visit shall include a
					 physical examination and history with appropriate treatment and diagnostic
					 measures including laboratory ancillaries, and other services specified in the
					 agreement referenced in subdivision (b) of this section.
(17) Pediatric well care exam. This visit
					 shall be for healthy newborns and children under three years of age. This visit
					 shall include a physical examination, developmental checks, health education
					 for the parents as warranted, immunizations as indicated, selected laboratory
					 tests and screening procedures such as PKU, sickle cell, lead, TB Tine,
					 urinalysis, hematocrit, on an appropriate schedule, and other services
					 specified in the agreement referenced in subdivision (b) of this
					 section.
(18) Female reproductive
					 diagnostic investigation. This visit shall be for the purpose of investigating
					 female reproductive problems. This visit shall include a physical examination
					 and history with appropriate diagnostic and treatment measures including
					 laboratory ancillaries and the use of diagnostic technologies, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(19) Management of female
					 reproductive problems. This visit shall be for the treatment of female
					 reproductive problems. This visit shall include a physical examination and
					 history with appropriate diagnostic and treatment measures including
					 appropriate laboratory ancillaries, and any other services specified in the
					 agreement referenced in subdivision (b) of this section.
(20) Annual gynecological examination. This
					 visit shall be for an annual gynecological examination. This visit shall
					 include a physical examination and history, health education, a full pelvic
					 examination, pap smear, appropriate laboratory ancillaries and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(21) Contraceptive well
					 care exam. This visit shall be for the purpose of providing contraceptives and
					 family planning. This exam shall include a physical examination and history,
					 health and family planning education, appropriate laboratory ancillaries and
					 any other services specified in the agreement referenced in subdivision (b) of
					 this section.
(22) Ear, nose and
					 throat diagnostic investigation--adult. This visit shall be for patients over
					 17 years of age for the purpose of investigation of ear and nasopharynx
					 problems. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic measures, and shall include necessary
					 laboratory tests and the use of key diagnostic technologies, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(23) Ear, nose and throat
					 diagnostic investigation--pediatric. This visit shall be for children up to and
					 including 17 years of age for the purpose of investigation of ear and
					 nasopharynx problems. This visit shall include a physical examination and
					 history with appropriate treatment and diagnostic measures, and shall include
					 necessary laboratory tests and the use of key diagnostic technologies, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section.
(24) Management of ear,
					 nose and throat problems--adult. This visit shall be for patients over 17 years
					 of age for the treatment of problems of the ear and nasopharynx. This visit
					 shall include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(25) Management of ear, nose and throat
					 problems--pediatric. This visit shall be for children up to and including 17
					 years of age for the treatment of problems of the ear and nasopharynx. This
					 visit shall include a physical examination and history with appropriate
					 treatment and diagnostic laboratory tests, and any other services specified in
					 the agreement referenced in subdivision (b) of this section.
(26) Ophthalmological services. This visit
					 shall be for any patient for eye examinations and treatment of eye disorders.
					 This visit shall include appropriate ophthalmological procedures as well as any
					 laboratory ancillaries or diagnostic technologies required, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(27) Respiratory
					 diagnostic investigation--adult. This visit shall be for patients over 17 years
					 of age for the purpose of investigation of respiratory problems. This visit
					 shall include a physical examination and history with appropriate treatment and
					 diagnostic measures, and shall include necessary laboratory tests and the use
					 of key diagnostic technologies, and any other services specified in the
					 agreement referenced in subdivision (b) of this section.
(28) Respiratory diagnostic
					 investigation--pediatric. This visit shall be for children up to and including
					 17 years of age for the purpose of investigation of respiratory problems. This
					 visit shall include a physical examination and history with appropriate
					 treatment and diagnostic measures, and shall include necessary laboratory tests
					 and the use of key diagnostic technologies, and any other services specified in
					 the agreement referenced in subdivision (b) of this section.
(29) Management of respiratory
					 problems--adult. This visit shall be for patients over 17 years of age for the
					 treatment of respiratory problems. This visit shall include a physical
					 examination and history with appropriate treatment and diagnostic laboratory
					 tests, and any other services specified in the agreement referenced in
					 subdivision (b) of this section.
(30) Management of respiratory
					 problems--pediatric. This visit shall be for children up to an including 17
					 years of age for the treatment of respiratory problems. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(31) Systemic infection diagnostic
					 investigation. This visit shall be for the purpose of investigation of systemic
					 infections. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic measures, and shall include necessary
					 laboratory tests and the use of key diagnostic technologies, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(32) Management of
					 systemic infections. This visit shall be for the treatment of systemic
					 infections. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic laboratory tests, and any other services
					 specified in the agreement referenced in subdivision (b) of this
					 section.
(33) Gastrointestinal
					 diagnostic investigation. This visit shall be for the purpose of investigation
					 of gastrointestinal problems. This visit shall include a physical examination
					 and history with appropriate treatment and diagnostic measures, and shall
					 include necessary laboratory tests and the use of key diagnostic technologies,
					 and any other services specified in the agreement referenced in subdivision (b)
					 of this section.
(34) Management of
					 gastrointestinal problems--adult. This visit shall be for patients over 17
					 years of age for the treatment of gastrointestinal problems. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(35) Management of gastrointestinal
					 problems--pediatric. This visit shall be for children up to and including 17
					 years of age for the treatment of gastrointestinal problems. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(36) Hepatobiliary diagnostic investigation.
					 This visit shall be for the purpose of investigation of hepatobiliary problems.
					 This visit shall include a physical examination and history with appropriate
					 treatment and diagnostic measures, and shall include necessary laboratory tests
					 and the use of key diagnostic technologies, and any other services specified in
					 the agreement referenced in subdivision (b) of this section.
(37) Management of hepatobiliary problems.
					 This visit shall be for the treatment of hepatobiliary problems. This visit
					 shall include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(38) Genito-urological diagonstic
					 investigation. This visit shall be for male patients for the purpose of
					 investigation of genito-urological and reproductive problems. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic measures, and shall include necessary laboratory tests and the use
					 of key diagnostic technologies, and any other services specified in the
					 agreement referenced in subdivision (b) of this section.
(39) Management of genito-urological
					 problems. This visit shall be for male patients for the treatment of
					 genito-urological problems. This visit shall include a physical examination and
					 history with appropriate treatment and diagnostic laboratory tests, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section.
(40) Cardiac diagnostic
					 investigation. This visit shall be for the purpose of investigation of cardiac
					 and circulatory problems. This visit shall include a physical examination and
					 history with appropriate treatment and diagnostic measures, and shall include
					 necessary laboratory tests and the use of diagnostic technologies, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section.
(41) Management of cardiac
					 problems. This visit shall be for the treatment of cardiac and circulatory
					 problems. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic laboratory tests, and any other services
					 specified in the agreement referenced in subdivision (b) of this
					 section.
(42) Endocrinal diagnostic
					 investigation. This visit shall be for the purpose of investigation of diabetes
					 and other metabolic problems and diseases of the endocrine system and pancreas.
					 This visit shall include a physical examination and history with appropriate
					 treatment and diagnostic measures, and shall include necessary laboratory tests
					 and the use of key diagnostic technologies, and any other services specified in
					 the agreement referenced in subdivision (b) of this section.
(43) Management of other endocrinal problems.
					 This visit shall be for the treatment of other metabolic problems and diseases
					 of the endocrine system and pancreas, excluding diabetes. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(44) Management of diabetes--pediatric. This
					 visit shall be for children up to and including 17 years of age for the
					 treatment of problems associated with diabetes. This visit shall include a
					 physical examination and history with appropriate treatment and diagnostic
					 laboratory tests, and any other services specified in the agreement referenced
					 in subdivision (b) of this section.
(45) Management of diabetes--adult. This
					 visit shall be for patients over 17 years of age for the treatment of problems
					 associated with diabetes. This visit shall include a physical examination and
					 history with appropriate treatment and diagnostic laboratory tests, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section.
(46) Skin and soft tissue
					 diagnostic investigation. This visit shall be for the purpose of investigation
					 of skin and soft tissue injuries and problems. This visit shall include a
					 physical examination and history with appropriate treatment and diagnostic
					 measures, and shall include necessary laboratory tests and the use of
					 diagnostic technologies, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(47) Inflammatory muscular/skeletal
					 diagnostic investigation. This visit shall be for the purpose of investigation
					 of muscular/skeletal problems including arthritis, rheumatism and other
					 inflammatory/degenerative diseases of the joints and bones. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic measures, and shall include necessary laboratory tests and the use
					 of diagnostic technologies, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(48) Other muscular/skeletal diagnostic
					 investigation. This visit shall be for the purpose of investigation of other
					 muscular/skeletal problems, excluding arthritis, rheumatism and other
					 inflammatory/degenerative diseases of the joints and bones. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic measures, and shall include necessary laboratory tests and the use
					 of key diagnostic technologies, and any other services specified in the
					 agreement referenced in subdivision (b) of this section.
(49) Rehabilitation therapy. This visit shall
					 be for therapy and treatment planning for any patient with diagnosed physical
					 disabilities requiring physical, rehabilitation or occupational services. This
					 visit shall include the necessary laboratory ancillaries to manage the course
					 of treatment, and any other services specified in the agreement referenced in
					 subdivision (b) of this section.
(50) Management of skin and soft tissue
					 problems. This visit shall be for the treatment of skin and soft tissue
					 injuries and problems. This visit shall include a physical examination and
					 history with appropriate treatment and diagnostic laboratory tests, and any
					 other services specified in the agreement referenced in subdivision (b) of this
					 section.
(51) Management of
					 poisoning. This visit shall be for the treatment of problems associated with
					 poisoning. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic laboratory tests, and any other services
					 specified in the agreement referenced in subdivision (b) of this
					 section.
(52) Management of
					 inflammatory muscular/skeletal problems. This visit shall be for the treatment
					 of muscular/skeletal problems including arthritis, rheumatism and other
					 inflammatory/degenerative diseases of the joints and bones. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(53) Management of other muscular/skeletal
					 problems. This visit shall be for the treatment of other muscular/skeletal
					 problems, excluding arthritis, rheumatism and other inflammatory/degenerative
					 diseases of the joints and bones. This visit shall include a physical
					 examination and history with appropriate treatment and diagnostic laboratory
					 tests, and any other services specified in the agreement referenced in
					 subdivision (b) of this section.
(54) Oncological diagnostic investigation.
					 This visit shall be for the purpose of investigation of malignancies, excluding
					 benign tumors and malignancies of the skin. This visit shall include a physical
					 examination and history with appropriate treatment and diagnostic measures
					 including laboratory ancillaries and the use of diagnostic technologies, and
					 other services specified in the agreement referenced in subdivision (b) of this
					 section.
(55) AIDS diagnostic
					 investigation. This visit shall be for the purpose of investigation of the AIDS
					 virus. This visit shall include a physical examination and history with
					 appropriate treatment and diagnostic measures including laboratory ancillaries
					 and the use of diagnostic technologies, and other services specified in the
					 agreement referenced in subdivision (b) of this section.
(56) Other hematological diagnostic
					 investigation. This visit shall be for the purpose of investigation of other
					 myeloproliferative diseases of the blood and blood forming organs, and anemias.
					 This visit shall include a physical examination and history with appropriate
					 treatment and diagnostic measures including laboratory ancillaries and the use
					 of diagnostic technologies, and other services specified in the agreement
					 referenced in subdivision (b) of this section.
(57) Therapeutic IV push and chemotherapy
					 injection. This visit shall be for therapy and treatment planning for any
					 patient diagnosed with an oncological/hematological problem requiring a
					 therapeutic regime, either IV push and/or chemotherapy injection to ameliorate
					 symptoms, or reverse or cure malignancies, excluding benign tumors and
					 malignancies of the skin, and myeloproliferative diseases of the blood and
					 blood forming organs. Therapies will include IV push and chemotherapy
					 injection. This visit shall include necessary laboratory ancillaries to manage
					 the course of treatment, and any other services specified in the agreement
					 references in subdivision (b) of this section.
(58) Therapeutic infusions. This visit shall
					 be for therapy and treatment planning for any patient diagnosed with an
					 oncological/hematological problem requiring a therapeutic regime of infusions,
					 including blood product transfusions to ameliorate symptoms, or reverse or cure
					 malignancies, excluding benign tumors and malignancies of the skin, and
					 myeloproliferative diseases of the blood and blood forming organs. Therapies
					 will include infusions including transfusions of blood products. This visit
					 shall include necessary laboratory ancillaries to manage the course of
					 treatment, and any other services specified in the agreement references in
					 subdivision (b) of this section.
(59) Therapeutic radio therapy. This visit
					 shall be for therapy and treatment planning for any patient diagnosed with an
					 oncological/hematological problem requiring a therapeutic regime of radio
					 therapy to ameliorate symptoms, or reverse or cure malignancies, excluding
					 benign tumors and malignancies of the skin, and myeloproliferative diseases of
					 the blood and blood forming organs. Therapies will include radiation therapy or
					 hyperthermia as an adjunct to radiation therapy. This visit shall include
					 necessary laboratory ancillaries to manage the course of treatment, and any
					 other services specified in the agreement references in subdivision (b) of this
					 section.
(60) Oncological
					 management. This visit shall be for the management of patients currently
					 undergoing a therapeutic regime to ameliorate symptoms, or reverse or cure
					 malignancies, excluding benign tumors and malignancies of the skin, and
					 myeloproliferative diseases of the blood and blood forming organs. Therapies
					 will include IV push and chemotherapy injection, infusions including blood
					 product transfusions, and radiation therapy or hyperthermia as an adjunct to
					 radiation therapy, and other services specified in the agreement referenced in
					 subdivision (b) of this section. Patients need not receive therapy every visit.
					 When the patient does not receive therapy, the visit shall include observation
					 of the therapy's effects and the use of laboratory ancillaries necessary for
					 managing and assessing the course of therapy.
(61) Management of anemias--pediatric. This
					 visit shall be for children up to and including 17 years of age for the
					 treatment of anemias. This visit shall include a physical examination and
					 history with appropriate treatment and diagnostic measures including laboratory
					 ancillaries, and other services specified in the agreement referenced in
					 subdivision (b) of this section.
(62) Management of anemias--adult. This visit
					 shall be for patients over 17 years of age for the treatment of anemias. This
					 visit shall include a physical examination and history with appropriate
					 treatment and diagnostic laboratory tests, and any other services specified in
					 the agreement referenced in subdivision (b) of this section.
(63) Management of AIDS--pediatric. This
					 visit shall be for children up to and including 17 years of age for the
					 treatment of AIDS. This visit shall include a physical examination and history
					 with appropriate treatment and diagnostic laboratory tests, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(64) Management of
					 AIDS--adult. This visit shall be for patients over 17 years of age for the
					 treatment of AIDS. This visit shall include a physical examination and history
					 with appropriate treatment and diagnostic laboratory tests, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(65) Management of other
					 hematological problems. This visit shall be for the treatment of other
					 myeloproliferative diseases of the blood and blood form organs. This visit
					 shall include a physical examination and history with appropriate treatment and
					 diagnostic laboratory tests, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(66) Neurological and psycho/social
					 diagnostic investigation. This visit shall be for the purpose of investigation
					 of problems related to the central nervous system, medical conditions attendant
					 to mental illness, substance abuse, and social problems. This visit shall
					 include a physical examination and history with appropriate treatment and
					 diagnostic measures including laboratory ancillaries and the use of diagnostic
					 technologies, and other services specified in the agreement referenced in
					 subdivision (b) of this section.
(67) Speech and hearing services--adult. This
					 visit shall be for patients over 17 years of age for the purpose of an
					 audiology examination, and speech therapy and treatment planning, and any other
					 services specified in the agreement referenced in subdivision (b) of this
					 section.
(68) Speech and hearing
					 services--pediatrics. This visit shall be for children up to and including 17
					 years of age for the purpose of an audiology examination, and speech therapy
					 and treatment planning, and any other services specified in the agreement
					 referenced in subdivision (b) of this section.
(69) Neurological and psycho/social
					 management. This visit shall be for the treatment of problems associated with
					 the central nervous system, medical problems attendant to mental illness,
					 substance abuse, and social problems. This visit shall include a physical
					 examination and history with appropriate treatment and diagnostic measures
					 including laboratory ancillaries, and other services specified in the agreement
					 referenced in subdivision (b) of this section.
(70) Counseling. This visit shall be for the
					 primary purpose of providing supportive counseling, extended individual and
					 family counseling, somatotherapy and health education to patients with
					 diagnosed mental illness or substance abuse problems and any other service
					 specified in the agreement referenced in subdivision (b) of this section. This
					 visit shall not be for a medical work up although ancillaries necessary to
					 monitor and provide treatment of the patient are included.
(71) Diagnostic investigation of vascular
					 systems. This visit shall be for patients requiring radiologic exams of cardiac
					 vessels and other arterial and various radiologic procedures. This visit shall
					 only occur after a complete physical and history and shall include all other
					 laboratory and diagnostic technology ancillaries that are required to complete
					 the diagnostic investigation, and any other services specified in the agreement
					 referred in subdivision (b) of this section. This visit is not for the sole
					 purpose of receiving diagnostic radiologic procedures.