Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
90785	PSYTX COMPLEX INTERACTIVE	MAXFEE	MSP					4.61	1/1/2013	12/31/2299	N
90804	PSYTX OFFICE 20-30 MIN	MAXFEE	MSP					NA			N
90806	PSYTX OFF 45-50 MIN	MAXFEE	MSP					NA			N
90810	INTAC PSYTX OFF 20-30 MIN	MAXFEE	MSP					NA			N
90812	INTAC PSYTX OFF 45-50 MIN	MAXFEE	MSP					NA			N
90832	PSYTX W PT 30 MINUTES	MAXFEE	MSP					36.69	1/1/2013	12/31/2299	N
90834	PSYTX W PT 45 MINUTES	MAXFEE	MSP					57.10	1/1/2013	12/31/2299	N
90846	FAMILY PSYTX W/O PT 50 MIN	MAXFEE	MSP					55.86	7/1/2005	12/31/2299	N
90847	FAMILY PSYTX W/PT 50 MIN	MAXFEE	MSP					63.39	7/1/2005	12/31/2299	N
90853	GROUP PSYCHOTHERAPY	MAXFEE	MSP					27.88	7/1/2005	12/31/2299	N
92506	SPEECH/HEARING EVALUATION	MAXFEE	MSP					NA			S
92507	SPEECH/HEARING THERAPY	MAXFEE	MSP					57.23	7/1/2005	12/31/2299	N
92508	SPEECH/HEARING THERAPY	MAXFEE	MSP					30.43	7/1/2005	12/31/2299	N
92521	EVALUATION OF SPEECH FLUENCY	MAXFEE	MSP					77.67	1/1/2014	12/31/2299	S
92522	EVALUATE SPEECH PRODUCTION	MAXFEE	MSP					63.20	1/1/2014	12/31/2299	S
92523	SPEECH SOUND LANG COMPREHEN	MAXFEE	MSP					131.09	1/1/2014	12/31/2299	S
92524	BEHAVRAL QUALIT ANALYS VOICE	MAXFEE	MSP					66	1/1/2014	12/31/2299	S
92526	ORAL FUNCTION THERAPY	MAXFEE	MSP					55.16	7/1/2005	12/31/2299	N
92551	PURE TONE HEARING TEST AIR	MAXFEE	MSP					10.26	7/1/2005	12/31/2299	N
92552	PURE TONE AUDIOMETRY AIR	MAXFEE	MSP					19.56	7/1/2005	12/31/2299	N
92555	SPEECH THRESHOLD AUDIOMETRY	MAXFEE	MSP					13.23	7/1/2005	12/31/2299	N
92557	COMPREHENSIVE HEARING TEST	MAXFEE	MSP					47.82	7/1/2005	12/31/2299	N
92567	TYMPANOMETRY	MAXFEE	MSP					28.26	7/1/2005	12/31/2299	N
92606	NON-SPEECH DEVICE SERVICE	MAXFEE	MSP					35	1/1/2020	12/31/2299	N
92609	USE OF SPEECH DEVICE SERVICE	MAXFEE	MSP					60.76	7/1/2005	12/31/2299	N
92610	EVALUATE SWALLOWING FUNCTION	MAXFEE	MSP					43.54	7/1/2005	12/31/2299	N
92630	AUD REHAB PRE-LING HEAR LOSS	MAXFEE	MSP					20.61	7/1/2005	12/31/2299	N
92633	AUD REHAB POSTLING HEAR LOSS	MAXFEE	MSP					20.61	7/1/2005	12/31/2299	N
96101	PSYCHO TESTING BY PSYCH/PHYS	MAXFEE	MSP					NA			S
96110	DEVELOPMENTAL SCREEN W/SCORE	MAXFEE	MSP					50	7/1/2005	12/31/2299	S
96111	DEVELOPMENTAL TEST EXTEND	MAXFEE	MSP					NA			S
96112	DEVEL TST PHYS/QHP 1ST HR	MAXFEE	MSP					56.11	1/1/2019	12/31/2299	S
96113	DEVEL TST PHYS/QHP EA ADDL	MAXFEE	MSP					28.06	1/1/2019	12/31/2299	S
96116	NUBHVL XM PHYS/QHP 1ST HR	MAXFEE	MSP					54.32	7/1/2005	12/31/2299	S
96118	NEUROPSYCH TST BY PSYCH/PHYS	MAXFEE	MSP					NA			S
96121	NUBHVL XM PHY/QHP EA ADDL HR	MAXFEE	MSP					64.10	1/1/2019	12/31/2299	S
96130	PSYCL TST EVAL PHYS/QHP 1ST	MAXFEE	MSP					59.26	1/1/2019	12/31/2299	S
96131	PSYCL TST EVAL PHYS/QHP EA	MAXFEE	MSP					59.26	1/1/2019	12/31/2299	S
96132	NRPSYC TST EVAL PHYS/QHP 1ST	MAXFEE	MSP					97.37	1/1/2019	12/31/2299	S
96133	NRPSYC TST EVAL PHYS/QHP EA	MAXFEE	MSP					78.31	1/1/2019	12/31/2299	S
96136	PSYCL/NRPSYC TST PHY/QHP 1ST	MAXFEE	MSP					30.86	1/1/2019	12/31/2299	S
96137	PSYCL/NRPSYC TST PHY/QHP EA	MAXFEE	MSP					28.39	1/1/2019	12/31/2299	S
96150	ASSESS HLTH/BEHAVE INIT	MAXFEE	MSP					NA			N
96151	ASSESS HLTH/BEHAVE SUBSEQ	MAXFEE	MSP					NA			N
96152	INTERVENE HLTH/BEHAVE INDIV	MAXFEE	MSP					NA			N
96153	INTERVENE HLTH/BEHAVE GROUP	MAXFEE	MSP					NA			N
96154	INTERV HLTH/BEHAV FAM W/PT	MAXFEE	MSP					NA			N
96155	INTERV HLTH/BEHAV FAM NO PT	MAXFEE	MSP					NA			N
96156	HLTH BHV ASSMT/REASSESSMENT	MAXFEE	MSP					23.08	1/1/2020	12/31/2299	N
96158	HLTH BHV IVNTJ INDIV 1ST 30	MAXFEE	MSP					21.21	1/1/2020	12/31/2299	N
96159	HLTH BHV IVNTJ INDIV EA ADDL	MAXFEE	MSP					18.46	1/1/2020	12/31/2299	N
96164	HLTH BHV IVNTJ GRP 1ST 30	MAXFEE	MSP					5.19	1/1/2020	12/31/2299	N
96165	HLTH BHV IVNTJ GRP EA ADDL	MAXFEE	MSP					4.15	1/1/2020	12/31/2299	N
96167	HLTH BHV IVNTJ FAM 1ST 30	MAXFEE	MSP					19.17	1/1/2020	12/31/2299	N
96168	HLTH BHV IVNTJ FAM EA ADDL	MAXFEE	MSP					15.34	1/1/2020	12/31/2299	N
96170	HLTH BHV IVNTJ FAM WO PT 1ST	MAXFEE	MSP					22.58	1/1/2020	12/31/2299	N
96171	HLTH BHV IVNTJ FAM W/O PT EA	MAXFEE	MSP					18.06	1/1/2020	12/31/2299	N
97001	PT EVALUATION	MAXFEE	MSP					NA			N
97002	PT RE-EVALUATION	MAXFEE	MSP					NA			N
97003	OT EVALUATION	MAXFEE	MSP					NA			N
97004	OT RE-EVALUATION	MAXFEE	MSP					NA			N
97012	MECHANICAL TRACTION THERAPY	MAXFEE	MSP					17.14	7/1/2005	12/31/2299	N
97016	VASOPNEUMATIC DEVICE THERAPY	MAXFEE	MSP					15.89	7/1/2005	12/31/2299	N
97032	ELECTRICAL STIMULATION	MAXFEE	MSP					18.63	7/1/2005	12/31/2299	N
97110	THERAPEUTIC EXERCISES	MAXFEE	MSP					16.95	7/1/2005	12/31/2299	N
97112	NEUROMUSCULAR REEDUCATION	MAXFEE	MSP					18.50	7/1/2005	12/31/2299	N
97113	AQUATIC THERAPY/EXERCISES	MAXFEE	MSP					18.11	7/1/2005	12/31/2299	N
97116	GAIT TRAINING THERAPY	MAXFEE	MSP					16.43	7/1/2005	12/31/2299	N
97124	MASSAGE THERAPY	MAXFEE	MSP					15.02	7/1/2005	12/31/2299	N
97127	THER IVNTJ W/FOCUS COG FUNCJ	MAXFEE	MSP					NA			N
97129	THER IVNTJ 1ST 15 MIN	MAXFEE	MSP					19.15	1/1/2020	12/31/2299	N
97130	THER IVNTJ EA ADDL 15 MIN	MAXFEE	MSP					18.31	1/1/2020	12/31/2299	N
97140	MANUAL THERAPY 1/> REGIONS	MAXFEE	MSP					14.13	7/1/2005	12/31/2299	N
97150	GROUP THERAPEUTIC PROCEDURES	MAXFEE	MSP					19.21	7/1/2005	12/31/2299	N
97161	PT EVAL LOW COMPLEX 20 MIN	MAXFEE	MSP					63.15	1/1/2017	12/31/2299	S
97162	PT EVAL MOD COMPLEX 30 MIN	MAXFEE	MSP					63.15	1/1/2017	12/31/2299	S
97163	PT EVAL HIGH COMPLEX 45 MIN	MAXFEE	MSP					63.15	1/1/2017	12/31/2299	S
97164	PT RE-EVAL EST PLAN CARE	MAXFEE	MSP					42.78	1/1/2017	12/31/2299	S
97165	OT EVAL LOW COMPLEX 30 MIN	MAXFEE	MSP					61.31	1/1/2017	12/31/2299	S
97166	OT EVAL MOD COMPLEX 45 MIN	MAXFEE	MSP					61.31	1/1/2017	12/31/2299	S
97167	OT EVAL HIGH COMPLEX 60 MIN	MAXFEE	MSP					61.31	1/1/2017	12/31/2299	S
97168	OT RE-EVAL EST PLAN CARE	MAXFEE	MSP					40.39	1/1/2017	12/31/2299	S
97530	THERAPEUTIC ACTIVITIES	MAXFEE	MSP					17.75	7/1/2005	12/31/2299	N
97532	COGNITIVE SKILLS DEVELOPMENT	MAXFEE	MSP					NA			N
97533	SENSORY INTEGRATION	MAXFEE	MSP					22.04	7/1/2005	12/31/2299	N
97535	SELF CARE MNGMENT TRAINING	MAXFEE	MSP					23.50	7/1/2005	12/31/2299	N
97537	COMMUNITY/WORK REINTEGRATION	MAXFEE	MSP					20.83	7/1/2005	12/31/2299	N
97760	ORTHOTIC MGMT&TRAING 1ST ENC	MAXFEE	MSP					38.36	7/1/2005	12/31/2299	N
97761	PROSTHETIC TRAING 1ST ENC	MAXFEE	MSP					38.36	7/1/2005	12/31/2299	N
97763	ORTHC/PROSTC MGMT SBSQ ENC	MAXFEE	MSP					37.24	1/1/2018	12/31/2299	N
G0515	COGNITIVE SKILLS DEVELOPMENT	MAXFEE	MSP					NA			N
H0004	ALCOHOL AND/OR DRUG SERVICES	MAXFEE	MSP					11.25	7/1/2005	12/31/2299	N
H0031	MH HEALTH ASSESS BY NON-MD	MAXFEE	MSP					48.50	7/1/2005	12/31/2299	N
H2000	COMP MULTIDISIPLN EVALUATION	MAXFEE	MSP					26	7/1/2005	12/31/2299	N
T1001	NURSING ASSESSMENT/EVALUATN	MAXFEE	MSP					11.25	7/1/2005	12/31/2299	N
T1002	RN SERVICES UP TO 15 MINUTES	MAXFEE	MSP					11.25	7/1/2005	12/31/2299	N
T1003	LPN/LVN SERVICES UP TO 15MIN	MAXFEE	MSP					9.56	7/1/2005	12/31/2299	N
T1017	TARGETED CASE MANAGEMENT	MAXFEE	MSP					10.56	7/1/2005	12/31/2299	N
T1024	TEAM EVALUATION & MANAGEMENT	MAXFEE	MSP					23.59	7/1/2005	12/31/2299	N
T2003	N-ET; ENCOUNTER/TRIP	MAXFEE	MSP					5.20	7/1/2005	12/31/2299	N