procedure code pricing medicaid hospital outpatient ... · new mexico medicaid fee for service...
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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
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
0009U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 8/1/2017
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
OPPS FEES08/05/2020 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
CODE Tax Rate SOURCE NOTE VFC START
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
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
OPPS FEES08/05/2020 at 7:10:01 AM - 2 - REF-FeeSchedF-1017
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NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD
PROCEDURE CODE PRICING
CODE Tax Rate SOURCE NOTE VFC START
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
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
OPPS FEES08/05/2020 at 7:10:01 AM - 3 - REF-FeeSchedF-1017
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NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD
PROCEDURE CODE PRICING
CODE Tax Rate SOURCE NOTE VFC START
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
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
OPPS FEES08/05/2020 at 7:10:01 AM - 4 - REF-FeeSchedF-1017
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NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD
PROCEDURE CODE PRICING
CODE Tax Rate SOURCE NOTE VFC START
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
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
OPPS FEES08/05/2020 at 7:10:01 AM - 5 - REF-FeeSchedF-1017
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NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD
PROCEDURE CODE PRICING
CODE Tax Rate SOURCE NOTE VFC START
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
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
OPPS FEES08/05/2020 at 7:10:01 AM - 6 - REF-FeeSchedF-1017
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NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD
PROCEDURE CODE PRICING
CODE Tax Rate SOURCE NOTE VFC START
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
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
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
OPPS FEES08/05/2020 at 7:10:01 AM - 7 - REF-FeeSchedF-1017
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NEW MEXICO MEDICAID FEE FOR SERVICEMEDICAID HOSPITAL OUTPATIENT PAYMENT METHOD
PROCEDURE CODE PRICING
CODE Tax Rate SOURCE NOTE VFC START
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
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
OPPS FEES08/05/2020 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
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 Price Review 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
0105U Y $893.00 OPPS NM Fee Sched APC St Ind A APC Medicare CLAB NM FEE 10/1/2019
0106T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015
0106U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0107T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015
0107U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0108T Y $131.69 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015
0108U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
0109T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015
0109U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
OPPS FEES08/05/2020 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
0110T Y $52.35 OPPS Price Mcare APC St Ind Q1 Ambulatory Payment Classificat 1/1/2015
0110U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
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
0111U Y $641.35 OPPS NM Fee Sched APC St Ind A APC Medicare CLAB NM FEE 10/1/2019
01120 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0112U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
01130 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0113U Y $714.40 OPPS NM Fee Sched APC St Ind A APC Medicare CLAB NM FEE 10/1/2019
01140 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010
0114U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
01150 Y $0.00 OPPS NotCvrd Inpt APC St Ind C Ambulatory Payment Classificat 11/1/2010
0115U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
01160 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0116U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
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
0117U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0118U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0119U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
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
0120U Y $2,621.77 OPPS NM Fee Sched APC St Ind A APC Medicare CLAB NM FEE 10/1/2019
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
0121U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
01220 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0122U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
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
OPPS FEES08/05/2020 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
0123U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0124U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
01250 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0125U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
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
0126U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
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
0127U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0128U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0129U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0130U Y $549.81 OPPS NM Fee Sched APC St Ind A APC Medicare CLAB NM FEE 10/1/2019
0131U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
01320 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0132U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
0133U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
01340 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0134U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
0135U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
01360 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0136U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 10/1/2019
0137U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
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
0138U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 10/1/2019
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
0139U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
01400 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
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
OPPS FEES08/05/2020 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
0140U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0141U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
01420 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0142U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0143U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0144U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0145U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0146U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0147U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0148U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
01490 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0149U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0150U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0151U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
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
0152U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
OPPS FEES08/05/2020 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
0153U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 1/1/2020
0154U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0155U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0156U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0157U Y $0.00 OPPS NM Medicaid Not Covered Ambulatory Payment Classificat 1/1/2020
0158U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 1/1/2020
0159U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 1/1/2020
0160U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 1/1/2020
01610 Y $0.00 OPPS PackagdServ APC St Ind N Ambulatory Payment Classificat 11/1/2010
0161U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 1/1/2020
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
0162U Y $0.00 OPPS NM Medicaid Price Review APC Medicare CLAB NM FEE 1/1/2020
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
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
OPPS FEES08/05/2020 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
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
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
OPPS FEES08/05/2020 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
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
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
0202U Y $0.00 OPPS NM Medicaid Price Review Ambulatory Payment Classificat 5/20/2020
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
OPPS FEES08/05/2020 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
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
0253T Y $1,645.71 OPPS Multi Reduct APC St Ind T Ambulatory Payment Classificat 1/1/2014
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
OPPS FEES08/05/2020 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
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
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
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
OPPS FEES08/05/2020 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
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
0376T Y $0.00 OPPS PackagdServ APC St Ind N 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
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
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
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
OPPS FEES08/05/2020 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
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
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
OPPS FEES08/05/2020 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
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
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
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
OPPS FEES08/05/2020 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
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
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
OPPS FEES08/05/2020 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
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
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
OPPS FEES08/05/2020 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
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
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