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  • PROCEDURE CODE PRICING MEDICAID HOSPITAL …...NEW MEXICO MEDICAID FEE FOR SERVICE MEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD PROCEDURE CODE PRICING CODE Tax Rate SOURCE NOTE VFC
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NEW MEXICO MEDICAID FEE FOR SERVICE MEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD PROCEDURE CODE PRICING Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2015 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. Current Procedural Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2015 American Medical Association. All rights reserved. For some HCPCS codes the fee schedule source was determined by the New Mexico Medical Assistance Division. As explained in the Hospital Outpatient Payment Method Procedure Disclaimer & Agreement this table is not to be used as a guide to coverage of services by the Medicaid Program. All dental service codes in the range D0000 through D9999 are significant procedures for which multiple reduction applies. The reimbursement amount will be $0.00 for vaccination antigen HCPCS for which the Fee Schedule Source is "VFC Antigen" and the recipient is 18 years old or younger because the antigen is distributed for free for children by the New Mexico Department of Health Vaccines for Children (VFC) Program. Please be reminded that for services where the submitted charges on the line item are less than $1.01, the reimbursement will be $0.00 because the billing is considered to be 'token' billing'. Current OPPS APC status indicators are in the CMS Addendum B. The APC Medicare CLAB NM FEE identifies the HCPCS laboratory services that are excluded from the OPPS percentage multiplier. This multiplier is the provider specific institutional percent multiplied by the HCPCS pricing span value, currently set at 100% until June 30, 2016 and 97% effective July 1, 2016 for most hospitals except critical access hospitals. The HCPCS codes with Ambulatory Payment Classification do involve the OPPS percentage multiplier. Molecular pathology procedure codes in the range 81200 through 81479 may require diagnosis codes and/or clinical documentation relevant to the clinical utility for those laboratory tests. For the current maximum units please refer to the CMS Medically Unlikely Edits (MUEs). Some procedure codes are only payable for Alternative Benefit Plan (ABP) recipients. Please refer to the appropriate ABP resources on the HSD website. Only laboratory molecular pathology tests that involve clinical utility are reimbursed by New Mexico Medicaid and are subject to retrospective review. A test that has clinical utility means that the test results can be used to pursue effective treatment or provide other concrete clinical benefits for recipients who have a disease diagnosis relevant for the specific molecular pathology testing. CODE Tax Rate SOURCE NOTE VFC START 0001F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011 0001U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 2/1/2017 0002M Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2015 0002U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 2/1/2017 0003M Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2015 0003U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 2/1/2017 0004M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016 0005F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011 0005U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 5/1/2017 0006M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016 0006U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017 0007M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016 0007U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017 0008U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017 0009M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2016 0009U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017 OPPS FEES 04/01/2020 at 7:10:01 AM - 1 - REF-FeeSchedF-1017

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  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2015 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. Current Procedural Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2015 American Medical Association. All rights reserved.

    For some HCPCS codes the fee schedule source was determined by the New Mexico Medical Assistance Division. As explained in the Hospital Outpatient Payment Method Procedure Disclaimer & Agreement this table is not to be used as a guide to coverage of services by the Medicaid Program. All dental service codes in the range D0000 through D9999 are significant procedures for which multiple reduction applies. The reimbursement amount will be $0.00 for vaccination antigen HCPCS for which the Fee Schedule Source is "VFC Antigen" and the recipient is 18 years old or younger because the antigen is distributed for free for children by the New Mexico Department of Health Vaccines for Children (VFC) Program. Please be reminded that for services where the submitted charges on the line item are less than $1.01, the reimbursement will be $0.00 because the billing is considered to be 'token' billing'. Current OPPS APC status indicators are in the CMS Addendum B. The APC Medicare CLAB NM FEE identifies the HCPCS laboratory services that are excluded from the OPPS percentage multiplier. This multiplier is the provider specific institutional percent multiplied by the HCPCS pricing span value, currently set at 100% until June 30, 2016 and 97% effective July 1, 2016 for most hospitals except critical access hospitals. The HCPCS codes with Ambulatory Payment Classification do involve the OPPS percentage multiplier. Molecular pathology procedure codes in the range 81200 through 81479 may require diagnosis codes and/or clinical documentation relevant to the clinical utility for those laboratory tests. For the current maximum units please refer to the CMS Medically Unlikely Edits (MUEs). Some procedure codes are only payable for Alternative Benefit Plan (ABP) recipients. Please refer to the appropriate ABP resources on the HSD website. Only laboratory molecular pathology tests that involve clinical utility are reimbursed by New Mexico Medicaid and are subject to retrospective review. A test that has clinical utility means that the test results can be used to pursue effective treatment or provide other concrete clinical benefits for recipients who have a disease diagnosis relevant for the specific molecular pathology testing.

    CODE Tax Rate SOURCE NOTE VFC START

    0001F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0001U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 2/1/2017

    0002M Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2015

    0002U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 2/1/2017

    0003M Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2015

    0003U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 2/1/2017

    0004M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016

    0005F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0005U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 5/1/2017

    0006M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016

    0006U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    0007M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016

    0007U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    0008U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    0009M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2016

    0009U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    OPPS FEES04/01/2020 at 7:10:01 AM - 1 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    00100 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00102 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00103 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00104 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0010U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    0011M Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2018

    0011U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    00120 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00124 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00126 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0012F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0012M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0012U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    0013M Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0013U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    00140 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00142 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00144 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00145 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00147 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00148 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0014F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0014U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    0015F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    00160 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00162 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00164 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0016U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    00170 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00172 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00174 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00176 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0017U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017

    OPPS FEES04/01/2020 at 7:10:01 AM - 2 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0018U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2017

    00190 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00192 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0019U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2017

    00210 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00211 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00212 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00214 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00215 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00216 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00218 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0021U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2017

    00220 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00222 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0022U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2017

    0023U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2017

    0024U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0025U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0026U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0027U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0029U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    00300 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0030U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0031U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    00320 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00322 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00326 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0032U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0033U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    0034U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2018

    00350 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00352 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0035U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    OPPS FEES04/01/2020 at 7:10:01 AM - 3 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0036U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0037U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0038U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0039U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    00400 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00402 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00404 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00406 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0040U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    00410 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0041U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0042T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0042U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0043U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    0044U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 4/1/2018

    00450 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00454 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0045U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0046U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00470 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00472 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00474 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0047U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0048U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0049U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00500 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0050U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0051U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00520 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00522 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00524 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00528 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00529 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 4 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0052U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00530 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00532 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00534 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00537 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00539 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0053U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00540 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00541 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00542 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00546 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00548 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0054T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0054U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00550 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0055T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0055U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00560 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00561 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00562 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00563 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00566 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00567 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0056U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00580 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0058T Y $183.62 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0058U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0059U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00600 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00604 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0060U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0061U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    00620 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 5 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    00625 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00626 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0062U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    00630 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00632 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00635 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0063U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    00640 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0064U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    0065U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    0066U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    00670 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    0067U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    0068U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    0069U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    00700 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00702 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0070U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    0071T Y $1,861.18 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0071U Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 10/1/2018

    0072T Y $1,861.18 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0072U Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 10/1/2018

    00730 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00731 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    00732 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0073U Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 10/1/2018

    0074U Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 10/1/2018

    00750 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00752 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00754 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00756 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0075T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0075U Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 10/1/2018

    OPPS FEES04/01/2020 at 7:10:01 AM - 6 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0076T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0076U Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 10/1/2018

    00770 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0077U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    0078U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2018

    00790 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00792 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00794 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00796 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00797 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0079U Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 10/1/2018

    00800 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00802 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0080U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2019

    00811 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    00812 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    00813 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0081U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2019

    00820 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0082U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2019

    00830 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00832 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00834 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00836 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0083U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2019

    00840 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00842 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00844 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00846 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00848 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0084U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00851 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0085T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 7 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0085U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00860 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00862 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00864 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00865 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00866 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00868 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0086U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00870 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00872 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00873 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0087U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00880 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00882 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0088U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0089U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00902 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00904 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00906 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00908 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0090U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00910 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00912 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00914 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00916 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00918 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0091U Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 7/1/2019

    00920 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00921 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00922 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00924 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00926 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00928 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 8 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0092U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00930 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00932 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00934 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00936 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00938 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0093U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00940 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00942 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00944 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    00948 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0094U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    00950 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    00952 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0095T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0095U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0096U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0097U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0098T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0098U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0099U Y $0.00 OPPS NM Medicaid Covered Not Available 1/1/2020

    0100T Y $2,693.83 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 11/1/2010

    0100U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0101T Y $2,141.60 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 11/1/2010

    0101U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0102T Y $2,141.60 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 11/1/2010

    0102U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0103U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2019

    0106T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0107T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0108T Y $131.69 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0109T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0110T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    OPPS FEES04/01/2020 at 7:10:01 AM - 9 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    01112 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0111T Y $0.00 OPPS NM Medicaid Price Review Ambulatory Payment Classificat 11/1/2010

    01120 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01130 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01140 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01150 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01160 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01170 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01173 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01200 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01202 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01210 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01212 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01214 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01215 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01220 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01230 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01232 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01234 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01250 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01260 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0126T Y $45.11 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 11/1/2010

    01270 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01272 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01274 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01320 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01340 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01360 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01380 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01382 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01390 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01392 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01400 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 10 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    01402 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    01404 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01420 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01430 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01432 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01440 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01442 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01444 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01462 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01464 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01470 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01472 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01474 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01480 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01482 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01484 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01486 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01490 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01500 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01502 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01520 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01522 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01610 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01620 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01622 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01630 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01634 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01636 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01638 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0163T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0164T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01650 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01652 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 11 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    01654 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01656 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    0165T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01670 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01680 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01710 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01712 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01714 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01716 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01730 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01732 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01740 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01742 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01744 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0174T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01756 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01758 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0175T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01760 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01770 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01772 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01780 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01782 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01810 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01820 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01829 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01830 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01832 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01840 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01842 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01844 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0184T Y $1,643.62 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2012

    01850 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 12 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    01852 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01860 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01916 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0191T Y $1,644.85 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 11/1/2010

    01920 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01922 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01924 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01925 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01926 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01930 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01931 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01932 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01933 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01935 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01936 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01951 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01952 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01953 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01958 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01960 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01961 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01962 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01963 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01965 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01966 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01967 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01968 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01969 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0198T Y $100.81 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    01990 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010

    01991 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01992 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    01996 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 13 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    01999 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0200T Y $1,483.94 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0201T Y $2,141.60 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0202T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2014

    0205T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010

    0206T Y $45.11 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2014

    0207T Y $52.04 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0208T Y $43.31 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0209T Y $43.31 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0210T Y $43.31 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0211T Y $43.31 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0212T Y $117.90 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0213T Y $485.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0214T Y $172.28 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0215T Y $172.28 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0216T Y $485.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0217T Y $172.28 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0218T Y $172.28 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0219T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2014

    0220T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2014

    0221T Y $2,141.60 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0222T Y $2,141.60 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0228T Y $485.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0229T Y $250.89 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0230T Y $485.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0231T Y $250.89 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0232T Y $131.69 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0234T Y $6,250.23 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0235T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2015

    0236T Y $6,250.23 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0237T Y $6,250.23 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0238T Y $6,250.23 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2011

    0249T Y $1,086.09 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    OPPS FEES04/01/2020 at 7:10:01 AM - 14 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0253T Y $1,645.71 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0254T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2015

    0263T Y $2,120.09 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2011

    0264T Y $2,120.09 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2011

    0265T Y $2,120.09 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2011

    0266T Y $18,707.16 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0267T Y $1,464.22 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2011

    0268T Y $14,428.91 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2011

    0269T Y $2,946.39 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2015

    0270T Y $2,127.98 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2015

    0271T Y $2,127.98 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2015

    0272T Y $79.05 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2011

    0273T Y $79.05 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2011

    0274T Y $3,460.46 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2011

    0275T Y $3,535.92 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2011

    0278T Y $94.93 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0290T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2014

    0295T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2014

    0296T Y $78.44 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0297T Y $78.44 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0298T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2014

    0308T Y $1,584.76 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2013

    0312T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2014

    0313T Y $1,428.29 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014

    0314T Y $2,455.91 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2014

    0315T Y $2,455.91 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2014

    0316T Y $15,496.52 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2014

    0317T Y $35.14 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0329T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 10/1/2013

    0330T Y $52.04 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0331T Y $292.06 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2015

    0332T Y $292.06 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2015

    0333T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 10/1/2013

    OPPS FEES04/01/2020 at 7:10:01 AM - 15 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0335T Y $1,866.38 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0338T Y $2,389.74 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2014

    0339T Y $2,389.74 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2014

    0341T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2014

    0342T Y $2,843.54 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2014

    0345T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2014

    0347T Y $131.69 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0348T Y $94.98 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0349T Y $94.98 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0350T Y $94.98 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0351T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2015

    0352T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2015

    0353T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2015

    0354T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2015

    0355T Y $852.09 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0356T Y $100.81 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2015

    0357T Y $183.62 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0358T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0362T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019

    0373T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019

    0375T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2015

    0376T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2015

    0377T Y $2,600.04 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    0378T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2015

    0379T Y $52.04 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0380T Y $52.04 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    0381T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2015

    0382T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2015

    0383T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2015

    0384T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2015

    0385T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2015

    0386T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2015

    0394T Y $194.35 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2016

    OPPS FEES04/01/2020 at 7:10:01 AM - 16 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0395T Y $696.21 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2016

    0396T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2016

    0397T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2016

    0398T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2016

    0399T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2016

    0400T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2016

    0401T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2016

    0402T Y $696.71 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0403T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2016

    0404T Y $5,698.95 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0405T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2016

    0408T Y $21,930.03 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0409T Y $21,930.03 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0410T Y $6,696.85 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0411T Y $6,696.85 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0412T Y $2,489.69 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2016

    0413T Y $2,489.69 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2016

    0414T Y $21,930.03 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0415T Y $862.51 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0416T Y $1,411.21 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0417T Y $33.62 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2016

    0418T Y $33.62 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2016

    0419T Y $428.67 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0420T Y $428.67 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0421T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2016

    0422T Y $92.07 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2016

    0423T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2016

    0424T Y $26,728.39 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0425T Y $5,244.37 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0426T Y $17,359.37 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0427T Y $17,359.37 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0428T Y $2,188.64 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2016

    0429T Y $2,188.64 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2016

    OPPS FEES04/01/2020 at 7:10:01 AM - 17 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0430T Y $2,188.64 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2016

    0431T Y $17,359.37 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0432T Y $2,188.64 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0433T Y $2,188.64 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    0434T Y $106.44 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2016

    0435T Y $106.44 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2016

    0436T Y $856.44 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2016

    0437T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2016

    0439T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2016

    0440T Y $4,566.06 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0441T Y $4,566.06 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0442T Y $4,566.06 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0443T Y $0.00 OPPS NM Medicaid Price Review Ambulatory Payment Classificat 7/1/2016

    0444T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2016

    0445T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2016

    0446T Y $452.91 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0447T Y $153.05 OPPS Price Mcare APC St Ind Q2 Not Available 1/1/2017

    0448T Y $452.91 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0449T Y $3,417.32 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0450T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2017

    0451T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2017

    0452T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2017

    0453T Y $6,973.62 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0454T Y $6,973.62 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0455T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2017

    0456T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2017

    0457T Y $2,558.51 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2017

    0458T Y $2,558.51 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2017

    0459T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2017

    0460T Y $2,558.51 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0461T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2017

    0462T Y $252.53 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2017

    0463T Y $252.53 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2017

    OPPS FEES04/01/2020 at 7:10:01 AM - 18 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0464T Y $127.05 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2017

    0465T Y $279.33 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2017

    0466T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2017

    0467T Y $2,689.33 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2017

    0468T Y $2,689.33 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2017

    0469T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 7/1/2017

    0470T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2017

    0471T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2017

    0472T Y $280.41 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0473T Y $117.54 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0474T Y $0.00 OPPS NM Medicaid Price Review Ambulatory Payment Classificat 7/1/2017

    0475T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2017

    0476T Y $106.48 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0477T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2017

    0478T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2017

    0479T Y $310.78 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2018

    0480T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0481T Y $329.99 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2018

    0482T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0483T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2018

    0484T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2018

    0485T Y $31.80 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2018

    0486T Y $31.80 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2018

    0487T Y $105.03 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2018

    0488T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2018

    0489T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2018

    0490T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2018

    0491T Y $310.78 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2018

    0492T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0493T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0494T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2018

    0495T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2018

    0496T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 1/1/2018

    OPPS FEES04/01/2020 at 7:10:01 AM - 19 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0497T Y $37.73 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2018

    0498T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2018

    0499T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2018

    0500F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0500T Y $0.00 OPPS NM Medicaid Price Review Ambulatory Payment Classificat 1/1/2018

    0501F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0501T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2018

    0502F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0502T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2018

    0503F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0503T Y $1,450.50 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2018

    0504T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2018

    0505F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    0505T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0506T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0507F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    0507T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0508T Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 7/1/2018

    0509F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0509T Y $135.95 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2019

    0510T Y $2,623.34 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2019

    0511T Y $5,699.59 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0512T Y $314.08 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2019

    0513F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0513T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    0514F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    0514T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    0515T Y $21,996.46 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0516F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0516T Y $7,404.11 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0517F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0517T Y $7,404.11 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0518F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    OPPS FEES04/01/2020 at 7:10:01 AM - 20 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0518T Y $3,130.53 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0519F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0519T Y $3,130.53 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0520F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0520T Y $21,996.46 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0521F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0521T Y $17.17 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2019

    0522T Y $37.16 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2019

    0523T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    0524T Y $2,641.52 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0525F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    0525T Y $9,879.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0526F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0526T Y $7,404.11 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0527T Y $7,404.11 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    0528F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2013

    0528T Y $37.16 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2019

    0529F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0529T Y $37.16 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2019

    0530T Y $3,130.53 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2019

    0531T Y $3,130.53 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2019

    0532T Y $3,130.53 OPPS Price Mcare APC St Ind Q2 Ambulatory Payment Classificat 1/1/2019

    0533T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2019

    0534T Y $37.16 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2019

    0535F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 11/1/2010

    0535T Y $37.16 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2019

    0536T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2019

    0537T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2019

    0538T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2019

    0539T Y $0.00 OPPS Not Payable APC St Ind B Ambulatory Payment Classificat 1/1/2019

    0540F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 11/1/2010

    0540T Y $288.38 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 1/1/2019

    0541T Y $252.31 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2019

    OPPS FEES04/01/2020 at 7:10:01 AM - 21 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    0542T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2019

    0543T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 7/1/2019

    0544T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 7/1/2019

    0545F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 11/1/2010

    0545T Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 7/1/2019

    0546T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2019

    0547T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 7/1/2019

    0548T Y $16,319.55 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2019

    0549T Y $4,020.54 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2019

    0550F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    0550T Y $2,926.86 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2019

    0551F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    0551T Y $231.42 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 7/1/2019

    0552T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2019

    0553T Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 7/1/2019

    0554T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2019

    0555F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    0555T Y $17.17 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2019

    0556F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2015

    0556T Y $230.56 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2019

    0557F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2012

    0557T Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 7/1/2019

    0558T Y $62.30 OPPS Price Mcare APC St Ind S Ambulatory Payment Classificat 7/1/2019

    0559T Y $55.90 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 7/1/2019

    0560T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2019

    0561T Y $55.90 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 7/1/2019

    0562T Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 7/1/2019

    0575F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2014

    0580F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2013

    0581F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2016

    0582F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2013

    0583F Y $0.00 OPPS Not Payable APC St Ind M Ambulatory Payment Classificat 1/1/2016

    0584F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2013

    OPPS FEES04/01/2020 at 7:10:01 AM - 22 - REF-FeeSchedF-1017

  • NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD

    PROCEDURE CODE PRICING

    CODE Tax Rate SOURCE NOTE VFC START

    10004 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    10005 Y $579.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    10006 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    10007 Y $579.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    10008 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    10009 Y $579.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    1000F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    10010 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    10011 Y $579.34 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2019

    10012 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2019

    10021 Y $101.86 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2015

    1002F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    10030 Y $148.09 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    10035 Y $480.64 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2016

    10036 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 1/1/2016

    1003F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    10040 Y $98.46 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015

    1004F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2011

    1005F Y $0.00 OPPS Not Covered APC St Ind E Ambulatory Payment Classificat 1/1/2012

    10060 Y $98.12 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 11/1/2010

    10061 Y $98.12 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 11/1/2010

    1006F Y $0.00 OPPS Not Payable APC St Ind M Ambulat


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