Medicaid Reimbursement Survey, 2010/11

Nebraska

Nebraska - 2010/11 AAP Medicaid Reimbursement Survey

Survey Summary
As part of its effort to monitor the impact of the Medicaid program on pediatrics, the American Academy of Pediatrics (AAP) conducts its Medicaid Reimbursement Survey periodically. The Survey, which collects state-administered fee-for-service program payment rates for commonly reported pediatric Current Procedural Terminology/CPT codes and dental codes, was most recently mailed to State Medicaid Directors in the 50 states and the District of Columbia between July 2010 and February 2011 to request payment rates effective July 1, 2010, the beginning of the 2010-11 fiscal year for most states. As of publication of this report, 46 states have responded to the survey. Tennessee, which does not have a state-administered fee-for-service Medicaid program, is not included in this report series. This and earlier AAP Medicaid Reimbursement Survey reports can be found at URL: http://www.aap.org/research/medreimintro.htm

In this Report...
This report provides state-reported fees paid for pediatric services represented by over 200 CPT and dental codes used by state-administered fee-for-service Medicaid programs to reimburse providers. Medicaid fees are compared to Medicare where available, or to other benchmark fees (such as prices listed in the Clinical Diagnostic Lab Fee Schedule, or prices based on the Ingenix Essential RBRVS) where Medicare comparisons are unavailable. Codes are selected for inclusion in the survey based on (i) utilization, and (ii) importance to Academy priorities, such as Bright Futures and the pediatric medical home. Also included in this report are summary updates on Medicaid managed care (MMC) enrollment, state-monitoring of MMC physician reimbursement, coverage of Bright Futures benefits, availability of enhanced payment for pediatric services, availability of pediatric medical home program and provider payment, availability of Pediatric Primary Care Case Management (PCCM) program and provider payment, and reimbursement of pediatricians for providing certain mental and preventive oral health services to children.

Copyright 2011 American Academy of Pediatrics.

Nebraska - 2010/11 AAP Medicaid Reimbursement Survey

Caveats and Notes
Medicaid fees shown in this report represent fee-for-service payments reported by states for state-administered Medicaid programs at the time of the study. The rates are subject to change. Nationally, the majority of children enrolled in Medicaid programs are enrolled in managed care plans, which may or may not benchmark provider payment rates to fees shown in this report. Depending on managed care penetration levels, the impact of state-administered fee-for-service Medicaid payment rates varies by state. Unless noted otherwise, non-facility rates and enhanced payment rates for pediatric services, where available and reported by the state, are included in this report. 21% of Nebraska' Medicaid children were enrolled in HMOs according to FY2008 CMS data. Rates shown in this report may not apply to payment of services for Medicaid children enrolled in these and other prepaid plans. Nebraska did not provide information regarding monitoring of Medicaid managed care plan-to-provider payment rates

Medicare rates in this report are (a) based on non-facility Medicare payment published by the Centers for Medicare and Medicaid Services for 2011, and (b) adjusted with Geographic Practice Cost Index (GPCIs) published by CMS. Certain codes, including not not limited to 99381-5 and 99391-5, are assigned RVUs but not covered by Medicare. CPT is a trademark of the American Medical Association. Dental codes (CDT Codes) are copyright 2006 American Dental Association. Reprinted with permission. Contact Information Contact Suk-fong Tang, Department of Practice, for comments on this report. Contact Dan Walter, Division of State Government Affairs, for Medicaid questions and advocacy advice. Contact Elizabeth Sobczyk, Division of Pediatric Practice, for pediatric immunization questions and advocacy advice. Contact the Division of Health Care Finance and Quality Improvement at dhcfqi@aap.org for information on child health financing or RBRVS. Suggested Citation 2010/11 AAP Medicaid Reimbursement Survey. American Academy of Pediatrics. Elk Grove Village, Illinois. Available for download at the AAP Website, at URL: http://www.aap.org/research/medreimintro.htm

Copyright 2011 American Academy of Pediatrics.

Nebraska - 2010/11 AAP Medicaid Reimbursement Survey

Abbreviations
AAP: American Academy of Pediatrics BC: Billed amount / billed charges BI / BR/ IC/ MP/ PR: By invoice/ by report/ individual consideration/manually priced/per review, i.e., Carrier will establish payment amounts for these services on a case-by-case basis following review of documentation, such as an operative report. BO: Bundled with other services, i.e., Payment for covered services is always bundled into payment for other services not specified. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. CMS: Centers for Medicare and Medicaid Services FFS: Discounted fee-for-service IER: RVUs not published for this code in the Medicare RBRVS; values are based on the Ingenix Essential RBRVS. Ratio (percentage listed under %Medicare column) represents Medicaid payment as a percentage of the rate calculated using the RVUs published in the Ingenix Essential RBRVS. LFS: Amount per Clinical Diagnostic Lab Fee Schedule. Ratio (percentage listed under %Medicare column) represents Medicaid payment as a percentage of the mount listed for the state in the Clinical Diagnostic Lab Fee Schedule. NA: Not applicable NC: Not covered NIS: Not priced by the current Physician Fee Schedule, or RVUs not included in RBRVS NL: Payment information specific to procedure code not listed on state Medicaid website or physician fee schedule. Note: absence of such information from fee schedule often indicates that the service is either not covered, or covered under alternate code(s). NP: Information not provided by state in returned AAP survey OM: Other method used P2010: 2010 pricing; code replaced prior to publication of this report QMB: Qualified Medicare Beneficiary RBRVS: Resource-Based Relative Value Scale, the physician payment schedule for Medicare RNE: Rate not established RVU(s): Relative Value Unit(s), the numeric value of the resources needed to provide services according to the Resource-Based Relative Value Scale UCF: Usual and customary fees VFC: Vaccines for Children Program. Providers are typically paid a vaccine administration fee for administering vaccines made available free of charge through VFC programs.

Copyright 2011 American Academy of Pediatrics.

List of CPT and Dental Codes Included in Report

Service Type
Preventive Medicine Services

Code
99381 99382 99383 99384 99385 99391 99392 99393 99394 99395 99401 99402 99403 99404 99078 99411 99412 99420 99450 99455

Description

Page#
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Home Services

99341 99342 99343 99344 99345 99347 99348 99349 99350

Office and Other Outpatient Services

99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 92551 92567 99173 96110 99174

New patient, under 1 year New patient, 1 through 4 years New patient, 5 through 11 years New patient, 12 though 17 years New patient, 18 though 39 years Established patient, under 1 year Established patient, 1 through 4 years Established patient, 5 through 11 years Established patient, 12 though 17 years Established patient, 18 though 39 years Individual counseling, 15 min Individual counseling, 30 min Individual counseling, 45 min Individual counseling, 60 min Group health education Preventive counseling group - 30 min Preventive counseling group - 60 min Health risk assessment test Basic life and/or disability evaluation Work related or medical disability evaluation New patient, problem focused New patient, expanded New patient, detailed New patient, moderate complexity New patient, high complexity Established patient, problem focused Established patient, expanded Established patient, detailed Established patient, comprehensive New patient, problem-focused New patient, expanded New patient, low complexity New patient, moderate complexity New patient, high complexity Established patient, nurse only Established patient, problemfocused Established patient, low complexity Established patient, moderate complexity Established patient, high complexity Screening test, hearing evaluation Tympanometry, hearing evaluation Screening test, visual acuity Developmental testing; limited Ocular photoscreening

Service Type Newborn Care

Immunizations

Code 99460 99462 99463 99464 99465 54150 90465

Evaluation and Management

Description Page# Initial newborn care 2 Subsequent newborn care 2 Admit and discharge on same day 2 Physician attendance at delivery 2 Newborn resuscitation 2 Circumcision w/ regional block 2 One immunization administration, physician counseling < 8 yrs 2 90466 Each additional immunization administration, physician counseling < 8 yrs 2 90467 One immunization administration, oral or intranasal, physician counseling < 8 yrs.. 2 90468 Each additional immunization administration, oral or intranasal, physician counseling < 8 yrs 2 90471 One immunization administration 2 90472 Each additional immunization administration 2 90473 One immunization administration, oral or intranasal 3 90474 Each additional administration, oral or intranasal 3 90470 Immune admin H1N1 im/nasal 3 90645-8 Hemophilus Influenza B 3 90649 Hpv vaccine 4 valent im 3 90650 Hpv vaccine 2 valent im 3 90657 Influenza virus (6-35 months) 3 90658 Influenza virus (3+ years) 3 90660 Influenza virus, intranasal use 3 90663 Flu vacc pandemic H1N1 3 90669 Pneumococcal vacc 7 val im 3 90670 Pneumococcal vacc 13 val im 3 90680 Rotavirus 3 90700 DTaP (< 7 years) 3 90701 DTP 3 90702 DT (< 7 years) 3 90707 Measles-Mumps-Rubella 3 90713 IPV 3 90715 Tdap 3 90716 Varicella 3 90718 Td ( 7 years) 3 90721 DTaP-HIB 3 90723 DTaP-HepB-IPV 3 90734 Meningococcal vaccine im 3 90744 Hepatitis B, (pediatric/adolescent age) 3 99217 Observation care discharge, day management 3 99218 Initial observation care, low severity 3 99219 Initial observation care, intermediate severity 3 99220 Initial observation care, high severity 3 99354 Prolonged service outpatient, 1st hour, face-to-face 3

List of CPT and Dental Codes Included in Report (Continued)

Service Type Evaluation and Management (continued) Code 99355 99356 99357 99358 99359 99366 99367 99368 99339 99340 99374 99375 99377 99378 99379 99380 99441 99442 99443 99444 96150 96151 96153 96154 96155 97802 97803 97804 98966 98967 98968 98969 Hospital Care 99221 99222 99223 99231 99232 Description Page# Same as 99354, each additional 30 min 3 Prolonged service, inpatient, 1st hour, face-to-face 3 Same as 99356, each additional 30 min 3 Prolonged service, 1st hour, nonface-to-face 3 Same as 99358, each additional 30 min 3 Medical team conference by hc pro(face-to-face), 30 min 4 Team conf w/o patient by physicians 4 Team conf w/o pat by hc pro, 30 min 4 Care plan oversight, 15-29 min/mo 4 Same as 99339, 30 min or more 4 Home health care supervision, 1529 min/mo 4 Same as 99374, 30 min or more 4 Hospice care supervision, 15-29 min 4 Same as 99377, 30 min or more 4 Nursing facility supervision, 15-29 min 4 Same as 99379, 30 min or more 4 Phone e/m by phys 5-10 min 4 Phone e/m by phys 11-20 min 4 Phone e/m by phys 21-30 min 4 Online e/m by physician 4 Health and Behavior assessment 4 Health and Behavior intervention 4 same as above, group 4 same as above, patient present 4 same as above, patient not present 4 Medical Nutrition Therapy, individual, initial 4 Medical Nutrition Therapy, individual, follow-up 4 Medical Nutrition Therapy, group, 30 min 4 Telephone assessment / management, 5-10 min 4 Telephone assessment / management, 11-20 min 4 Telephone assessment / management, 21-30 min 4 On-line assessment and management service 4 Initial hospitalization, per day, low 5 complexity Initial hospitalization, per day, moderate complexity 5 Initial hospitalization, per day, high complexity 5 Subsequent hospitalization, per day, low complexity 5 Subsequent hospitalization, per day, mod Complexity 5 Service Type Hospital Care (Continued) Code 99233 99238 99239 Consultation 99241 99242 99243 99244 99245 99252 99253 99254 Pathology and Laboratory 81000 81002 86580 87081 87880 90801 90804 90806 90808 90862 96111 90887 90889 95004 95010 95015 95024 95115 95117 Cardiology 32551 92950 93303 93307 93320 93501 93510 Description Page# Subsequent hospitalization, per day, high complexity 5 Hospital discharge, day management, =<30 min 5 Hospital discharge, day management, > 30 min 5 Office consultation, problem focused 5 Office consultation, expanded 5 Office consultation, low complexity 5 Office consultation, moderate complexity 5 Office consultation, high 5 complexity Initial inpatient consultation, low severity problem 5 Same as above, moderate severity problem 5 Same as above, moderate to high severity problem 5 Urinalysis, non-automated with microscopy 5 Urinalysis, non-automated without microscopy 5 Tuberculosis, intradermal 5 Throat culture 5 Rapid Streptococcus screen 5 Psychiatric diagnostic interview examination 5 Individual psychotherapy, 20-30 min face-to-face 5 Individual psychotherapy, 45-50 min face-to-face 5 Individual psychotherapy, 75-80 min face-to-face 5 Pharmacologic management 5 Developmental testing, extended 5 Consultation with family 5 Preparation of report 5 Percutaneous tests with allergenic extracts 6 Percutaneous tests, sequential and incremental 6 Intracutaneous tests, with biologicals 6 Intracutaneous tests, with allergenic extracts 6 Allergen immunotherapy, single injection 6 Allergen immunotherapy, two or more injections 6 Tube thoracostomy, includes water seal 6 Cardiopulmonary resuscitation 6 Transthoracic echocardiography 6 Echocardiography, real-time w/ image documentation 6 Doppler echocardiograph 6 Right heart catheterization 6 Left heart catheterization 6

Mental Health

Non-physician Provider (NPP) Services

Allergy/ Immunology

List of CPT and Dental Codes Included in Report (continued)

Service Type Critical Care Code 31500 36555 36568 36600 36620 99291 99292 10120 12015 36400 36410 36415 36416 62270 99143 99144 99145 99148 99149 99150 99282 99283 99284 43239 Description Page# Intubation, endotracheal 6 Insertion of non-tunneled center venous cathether; < 5 yrs 6 Insertion of peripherally inserted CVC; under 5 years 6 Arterial puncture, diagnostic 6 Arterial line placement 6 Critical care, first hour 6 Critical care, additional 30 min 6 Simple surgical removal of foreign body 6 Simple surgical repair of facial wounds (7.6 - 12.5 cm) 6 Venipuncture necessitating physician skill; < 3 yrs 6 Venipuncture necessitating physician skill; >= 3 yrs 6 Routine venipuncture 6 Finger, heel, ear stick 6 Lumbar puncture, diagnostic 6 Moderate sedation by same phys < 5 yrs 6 Moderate sedation by same phys 5 yrs + 6 Moderate sedation by same phys add-on 6 Moderate sedation diff phys < 5 yrs 7 Moderate sedation diff phys 5 yrs + 7 Moderate sedation diff phys addon 7 ED visit, problem focused 7 ED visit, expanded 7 ED visit, detailed 7 Upper gastrointestinal endoscopy with biopsy 7 Colonoscopy with biopsy 7 Sigmoidoscopy with biopsy 7 Strabismus surgery, horizontal 7 Strabismus surgery, vertical 7 Nasolacrimal probing 7 Tonsillectomy/adenoidectomy, under 12 years 7 Tonsillectomy/adenoidectomy, over 12 years 7 Tympanostomy and tubes 7 Umbilical vein catheterization 7 Umbilical artery catheterization 7 Initial pediatric critical care (29d24m) 7 Subsequent pediatric critical care (29d-24m) 7 Service Type Neonatal and Pediatric Critical Care (continued) Code 99475 99476 99468 99469 99477 99478 99479 99480 Pulmonology 31622 32421 94010 94640 94644 94645 94664 71010 40700 42200 28262 44950 49500 49505 Urology and Dialysis 50200 90957 90958 90959 90965 90966 90945 D0120 D1203 D1120 D2150 D2330 D1351 D2930 D3220 D7140 D0145 Description Page# Initial pediatric critical care (2-5 yrs) 7 Subsequent pediatric critical care (2-5 yrs) 7 Initial neonatal critical care 7 Subsequent neonatal critical care 7 Initial neonatal intensive care 7 Subsq intensive care, < 1500 gm 7 Subsq intensive care, 1500-2500 gm 7 Subsq intensive care, 2501-5000 gm 7 Bronchoscopy 8 Thoracentesis for aspiration 8 Spirometry, including graphic record 8 Inhalation treatment 8 Continuous inhalation treatment, first hour 8 Same as 94644, each additional hour 8 Demonstration/evaluation 8 Frontal chest x-ray 8 Cleft lip repair 8 Cleft palate repair 8 Extensive clubfoot release 8 Appendectomy 8 Bilateral inguinal hernia, 6 mos to < 5 years 8 Bilateral inguinal hernia, 5 years or over 8 Renal biopsy; percutaneous, by trocar or needle 8 ESRD services; 12-19 yrs, 4+ physician visits/mo 8 Same as above, 2-3 physician visits/mo 8 Same as above, 1 physician visits/mo 8 Same as above, home dialysis for full month 8 Same as above, for dialysis per day 8 Peritoneal dialysis 8 Periodic exam 9 Topical fluoride treatment, child 9 Prophylaxis, child 9 Amalgam two surfaces, primary or permanent 9 Resin-based composite one surface anterior 9 Sealant, per tooth 9 Stainless steel crown on a primary tooth 9 Pulpotomy 9 Extraction 9 Caries Risk Assessment 9

Emergency Care

Initial and Continuing Intensive Care Services

Radiology Plastic Surgery Surgery

Gastrointestinal

44389 45331 Ophthalmology 67311 67314 68810 Otolaryngology 42820 42821 69436 36510 36660 99471 99472

Dental Services

Neonatal and Pediatric Critical Care

AAP Medicaid Reimbursement Survey: Nebraska

2010/11 Medicaid Payments for Commonly Reported Pediatric CPT
Preventive Medicine Services
TM

Codes %Medicare
107.0% 103.3% 114.4% 114.7% 124.2% 106.3% 102.0% 108.4% 104.0% 109.5% ----------95.6% 82.3% 76.0% 65.8% 72.3% 77.0% 74.4% 73.4% 76.9%

Medicaid **
$95.16 $100.17 $110.19 $120.21 $130.22 $80.14 $85.15 $90.16 $95.16 $100.17 NL NL NC NC NC NC NC NC NC NC $49.70 $62.12 $93.60 $109.34 $144.13 $39.76 $58.29 $85.23 $124.25

Medicare
$88.93 $96.95 $96.31 $104.84 $104.84 $75.37 $83.49 $83.17 $91.50 $91.50 $34.54 $58.95 $82.60 $106.48 NIS $14.80 $19.48 $9.39 NIS NIS $51.96 $75.44 $123.24 $166.27 $199.43 $51.62 $78.30 $116.06 $161.60

99381 - New Patient, under 1 year 99382 - New Patient, 1 through 4 years 99383 - New Patient, 5 through 11 years 99384 - New Patient, 12 through 17 years 99385 - New Patient, 18 through 39 years 99391 - Established Patient, under 1 year 99392 - Established Patient, 1 through 4 years 99393 - Established Patient, 5 through 11 years 99394 - Established Patient, 12 through 17 years 99395 - Established Patient, 18 through 39 years 99401 - Individual Counseling, 15 min 99402 - Individual Counseling, 30 min 99403 - Individual Counseling, 45 min 99404 - Individual Counseling, 60 min 99078 - Group health education 99411 - Preventive counseling group, 30 min 99412 - Preventive counseling group, 60 min 99420 - Health risk assessment test 99450 - Basic life and/or disability evaluation 99455 - Work related or medical disability evaluation
Home Services

99341 - Individual Counseling, 15 min 99342 - Individual Counseling, 30 min 99343 - Individual Counseling, 45 min 99344 - Individual Counseling, 60 min 99345 - New patient, high complexity 99347 - Established patient, problem focused 99348 - Established patient, expanded 99349 - Established patient, detailed 99350 - Established patient, comprehensive

** State did not provide information regarding coverage of AAP-recommended services (i.e., Bright Futures).

Copyright 2011 American Academy of Pediatrics.

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 2 of 9)

Office and Other Outpatient Services

Medicaid
$32.30 $47.22 $69.58 $104.22 $131.19 $17.40 $29.82 $45.07 $67.78 $96.92 $13.30 $12.76 $1.90 $13.68 NC $109.34 $49.70 $126.74 $96.90 $106.40 $87.43

Medicare
$39.12 $67.19 $97.00 $149.15 $186.21 $18.71 $39.12 $65.34 $97.41 $131.01 $10.67 $14.58 $2.34 $7.46 $26.05 $55.61 $29.78 $76.08 $68.93 $131.44 $157.74

%Medicare
82.6% 70.3% 71.7% 69.9% 70.5% 93.0% 76.2% 69.0% 69.6% 74.0% 124.7% 87.5% 81.3% 183.3% -196.6% 166.9% 166.6% 140.6% 80.9% 55.4%

99201 - New Patient, office visit 99202 - New Patient, expanded office visit 99203 - New Patient, low complexity 99204 - New Patient, moderate complexity 99205 - New Patient, high complexity 99211 - Established Patient, office visit 99212 - Established Patient, expanded office visit 99213 - Established Patient, low complexity 99214 - Established Patient, moderate complexity 99215 - Established Patient, high complexity 92551 - Screening test, hearing evaluation 92567 - Tympanometry, hearing evaluation 99173 - Screening test, visual acuity 96110 - Developmental testing; limited 99174 - Ocular photoscreening
Newborn Care

Note: State did not provide information whether it pays for multiple units of 96110 on the same day.

99460 - Initial newborn care 99462 - Subsequent newborn care 99463 - Admit and discharge on same day 99464 - Physician attendance at delivery 99465 - Newborn resuscitation 54150 - Circumcision w/regionl block
Immunizations

Immunization administration of vaccines provided by VFC 90465 - One immunization admin, phys counseling < 8 yrs 90466 - Each additional immunization administration, physician counseling < 8 yrs 90467 - One immunization administration, oral or intranasal, physician counseling < 8 yrs 90468 - Each additional immunization administration, oral or intranasal, physician counseling < 8 yrs 90471 - One immunization administration 90472 - Each additional immunization administration
Copyright 2011 American Academy of Pediatrics.

NA NC NC NC NC $5.80 $5.80

NA $20.22 (P2010) $10.28 (P2010) $13.73 (P2010) $9.94 (P2010) $21.89 $10.96

NA ----26.5% 52.9%

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 3 of 9)

Immunizations (Continued)

Medicaid
$5.80 $5.80 NP NC $120.75 NC $10.50 $10.50 Payment rates, if shown, apply where service recipient is not eligible for free vaccine provided by VFC (Vaccine for Children program), such as when recipient is 19 or older. $11.22 NC $10.50 NC $10.50 $10.50 NC NC $48.07 $10.50 $41.22 $74.56 $19.14 $10.50 $10.50 $10.50 $10.50 $34.20 $45.60 $81.70 $102.60 $76.00 $38.00 $83.60 $41.80 NC NC

Medicare
$21.89 $10.96 $19.71

%Medicare
26.5% 52.9% --

90473 - One immunization administration, oral or intranasal 90474 - Each additional administration, oral or intranasal 90470 - Immune admin H1N1 im/nasal, incl counseling 90645-8 - Hemophilus Influenza B 90649 - Hpv vaccine 4 valent im 90650 - Hpv vaccine 2 valent im 90657 - Influenza virus (6-35 months) 90658 - Influenza virus (3+ years) 90660 - Influenza virus, intranasal use 90663 - Flu vacc pandemic H1N1 90669 - Pneumococcal vacc 7 val im 90670 - Pneumococcal vacc 13 val im 90680 - Rotavirus 90700 - DTaP (< 7 years) 90701 - DTP 90702 - DT (< 7 years) 90707 - Measles, mumps, rubella 90713 - IPV 90715 - Tdap 90716 - Varicella 90718 - Td (>= 7 years) 90721 - DTaP, HIB 90723 - DTaP-HepB-IPV 90734 - Meningococcal vaccine im 90744 - Hepatitis B, (pediatric/adolescent age)
Evaluation and Management

Medicare reimburses for vaccine products using 106% of the product's average sale price (ASP)

99217 - Observation care discharge, day management 99218 - Initial observation care, low severity 99219 - Initial observation care, intermediate severity 99220 - Initial observation care, high severity 99354 - Prolonged service, outpatient, 1st hour, face-to-face 99355 - Same as 99354, each additional 30 min 99356 - Prolonged service, inpatient, 1st hour, face-to-face 99357 - Same as 99356, each additional 30 min 99358 - Prolonged service, 1st hour, non face-to-face 99359 - Same as 99358, each additional 30 min
Copyright 2011 American Academy of Pediatrics.

$66.04 $61.55 $102.56 $143.22 $90.98 $90.02 $83.50 $83.50 $102.80 $49.70

51.8% 74.1% 79.7% 71.6% 83.5% 42.2% 100.1% 50.1% ---

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 4 of 9)

Evaluation and Management (Continued)

Medicaid
NC NC NC NC NC NC NC NL NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

Medicare
$40.19 $53.10 $34.78 $72.39 $101.39 $65.27 $100.84 $65.27 $102.76 $65.27 $98.27 $13.40 $25.28 $37.49 $29.04 (IER) $20.61 $19.93 $4.45 $18.59 $21.64 $30.47 $26.47 $13.40 $13.40 $25.28 $37.49 $19.76 (IER)

%Medicare
----------------------------

99366 - Medical team conference by hc pro(face-to-face), 30 min 99367 - Team conf w/o patient by physicians 99368 - Team conf w/o patient by hc pro, 30 min 99339 - Care plan oversight, 15-29 min/mo 99340 - Same as 99339, 30 minutes or more per month 99374 - Home health care supervision, 15-29 min/mo 99375 - Same as 99374, 30 min or more per month 99377 - Hospice care supervision, 15-29 min 99378 - Same as 99377, 30 min or more 99379 - Nursing facility supervision, 15-29 min 99380 - Same as 99379, 30 min or more 99441 - Phone e/m by physician 5-10 min 99442 - Phone e/m by physician 11-20 min 99443 - Phone e/m by physician 21-30 min 99444 - Online e/m by physician
Non-physician Provider (NPP) Services

96150 - Health and Behavior assessment, by NPP 96151 - Health and Behavior intervention, by NPP 96153 - same as above, group 96154 - same as above, patient present 96155 - same as above, patient not present 97802 - Medical Nutrition Therapy, by NPP, individual, initial 97803 - Medical Nutrition Therapy, by NPP, individual, follow-up 97804 - Medical Nutrition Therapy, by NPP, group, 30 min 98966 - Telephone assessment/management, by NPP, 5-10 min 98967 - Same as above, 11-20 min 98968 - Same as above, 21-30 min 98969 - On-line assessment and management service, by NPP

Medical Home and Primary Care Case Management: Program Availability and Provider Payment Summary
State did not provide information regarding the availability of any medical home program covering Medicaid-enrolled children. State did not provide information regarding the availability of any Primary Care Case Management (PCCM) program covering Medicaid-enrolled children.

Copyright 2011 American Academy of Pediatrics.

AAP Medicaid Reimbursement Survey Report, 2010/11 Nebraska, Continued (page 5 of 9)

Hospital Care

Medicaid
$47.50 $83.60 $108.30 $28.50 $45.60 $76.00 $68.40 $114.00 $45.60 $64.60 $83.60 $106.40 $144.40 $68.40 $87.40 $114.00 $4.54 $3.66 $6.98 $9.50 NL $163.28 NL NL NL NL $138.70 NL NL

Medicare
$91.30 $124.73 $183.89 $36.55 $66.57 $95.37 $66.26 $97.00 $43.56 $82.10 $112.37 $167.50 $204.54 $68.77 $105.47 $152.90 $4.45 (LFS) $3.60 (LFS) $6.82 $9.33 (LFS) $16.88 (LFS) $148.08 $61.04 $82.45 $121.06 $55.41 $119.66 $82.96 $62.99 (IER)

%Medicare
52.0% 67.0% 58.9% 78.0% 68.5% 79.7% 103.2% 117.5% 104.7% 78.7% 74.4% 63.5% 70.6% 99.5% 82.9% 74.6% 102.0% 101.7% 102.3% 101.8% -110.3% ----115.9% ---

99221 - Initial hosptialization, per day, low complexity 99222 - Initial hosptialization, per day, moderate complexity 99223 - Initial hosptialization, per day, high complexity 99231 - Subsequent hosptialization, per day, low complexity 99232 - Same as above, moderate complexity 99233 - Same as above, high complexity 99238 - Hospital discharge, day management, <= 30 min 99239 - Hospital discharge, day management, >30 min
Consultations

99241 - Office consultation, problem focused 99242 - Office consultation, expanded 99243 - Office consultation, low complexity 99244 - Office consultation, moderate complexity 99245 - Office consultation, high complexity 99252 - Initial inpatient consultation, low severity problem 99253 - Same as above, moderate severity problem 99254 - Same as above, moderate to high severity problem
Pathology and Laboratory

81000 - Urinalysis, non-automated with microscopy 81002 - Urinalysis, non-automated without microscopy 86580 - Tuberculosis, intradermal 87081 - Throat culture 87880 - Rapid Streptococcus screen
Mental Health

90801 - Psychiatric diagnostic interview examination 90804 - Individual psychotherapy, 20-30 min face-to-face 90806 - Individual psychotherapy, 45-50 min face-to-face 90808 - Individual psychotherapy, 75-80 min face-to-face 90862 - Pharmacological management 96111 - Developmental testing, extended 90887 - Consultation with family 90889 - Preparation of report

Medicaid Reimbursement for Mental Health Services Provided by Pediatricians:

State did not provide information regarding reimbursement of general pediatricians and developmental/behavioral pediatric subspecialists for mental health services.

Copyright 2011 American Academy of Pediatrics.

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 6 of 9)

Specialty Care Codes

Allergy/Immunology

Medicaid
$2.66 $5.32 $6.08 $3.80 $5.28 $5.28

Medicare
$5.88 $17.37 $13.52 $6.84 $9.39 $11.63

%Medicare
45.2% 30.6% 45.0% 55.5% 56.3% 45.4%

95004 - Percutaneous tests with allergenic extracts 95010 - Percutaneous tests, sequential and incremental 95015 - Intracutaneous tests, with biologicals 95024 - Intracutaneous tests with allergenic extracts 95115 - Allergenic immunotherapy, single injection 95117 - Allergen immunotherapy, two or more injections
Cardiology

32551 - Tube thoracostomy, includes water seal 92950 - Cardiopulmonary resuscitation 93303 - Transthoracic echocardiography 93307 - Echocardiography, real-time with image documentation 93320 - Doppler echocardiograph 93501 - Right heart catheterization 93510 - Left heart catheterization
Critical Care

$154.29 $140.60 $209.00 $224.20 $106.40 $798.00 $1558.00 $77.14 $66.86 $51.43 $20.57 $56.57 $159.60 $79.80 $66.86 $118.29 $20.57 $15.43 $4.40 NC $102.86 $104.12 $78.09 $26.03

$159.66 $266.19 $200.36 $140.89 $59.56 $695.97 (P2010) $1114.19 (P2010) $101.34 $256.23 $283.54 $29.10 $48.03 $250.65 $112.44 $125.69 $165.25 $27.16 $16.97 $3.00 NIS $144.21 $59.38 (IER) $58.92 (IER) $19.76 (IER)

96.6% 52.8% 104.3% 159.1% 178.6% 114.7% 139.8% 76.1% 26.1% 18.1% 70.7% 117.8% 63.7% 71.0% 53.2% 71.6% 75.7% 90.9% 146.7% -71.3% 175.3% 132.5% 131.7%

31500 - Intubuation, endotracheal 36555 - Insertion of non-tunneled CVC~ ; <5 yrs old 36568 - Insertion of peripherally inserted CVC~; <5 yrs old 36600 - Arterial puncture, diagnostic 36620 - Arterial line placement 99291 - Critical care, first hour 99292 - Critical care, additional 30 minutes
Emergency Care

10120 - Simple surgical removal of foreign body 12015 - Simple surgical repair of facial wound(7.6-12.5cm) 36400 - Venipuncture necessitating physician skill, < 3 yrs, 36410 - Venipuncture necessitating physician skill, >= 3 years 36415 - Routine venipuncture 36416 - Finger, heel, ear stick 62270 - Lumbar puncture, diagnostic 99143 - Moderate sedation by same physician < 5 yrs 99144 - Moderate sedation by same physician 5 yrs + 99145 - Moderate sedation by same physician add-on

Copyright 2011 American Academy of Pediatrics.

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 7 of 9)

Emergency Care

(Continued)

Medicaid
$104.12 $78.09 $26.03 $34.20 $51.31 $60.80 $221.15 $252.01 $92.57 $925.74 $925.74 $102.86 $313.72 $339.44 $205.72 $51.43 $72.00 $543.40 $271.70 $361.00 $220.40 $627.00 $334.40

Medicare
$54.40 (IER) $44.52 (IER) $19.76 (IER) $38.25 $58.01 $108.94 $322.58 $372.77 $160.29 $536.21 $602.69 $214.53 $275.94 $287.07 $153.11 $97.63 $68.10 $742.50 $372.48 $518.90 $314.39 $849.92 $375.43

%Medicare
191.4% 175.4% 131.7% 89.4% 88.4% 55.8% 68.6% 67.6% 57.8% 172.6% 153.6% 47.9% 113.7% 118.2% 134.4% 52.7% 105.7% 73.2% 72.9% 69.6% 70.1% 73.8% 89.1%

99148 - Moderate sedation diff physician < 5 yrs 99149 - Moderate sedation diff physician 5 yrs + 99150 - Moderate sedation diff physician add-on 99282 - ED visit, problem focused 99283 - ED visit, expanded 99284 - ED visit, detailed
Gastrointestinal

43239 - Upper gastrointestinal endoscopy with biopsy 44389 - Colonoscopy with biopsy 45331 - Sigmoidoscopy with biopsy
Ophthalmology

67311 - Strabismus surgery, horizontal 67314 - Strabismus surgery, vertical 68810 - Nasolacrimal probing
Otolaryngology

42820 - Tonsillectomy/adenoidectomy, under 12 years 42821 - Tonsillectomy/adenoidectomy, 12 years or over 69436 - Tympanostomy and tubes
Neonatal and Pediatric Critical Care

36510 - Umbilical vein catheterization 36660 - Umbilical artery catheterization 99471 - Initial pediatric critical care (29d-24m) 99472 - Subsequent pediatric critical care (29d-24m) 99475 - Initial pediatric critical care (2-5 yrs) 99476 - Subsequent pediatric critical care (2-5 yrs) 99468 - Initial neonatal critical care 99469 - Subsequent neonatal critical care
Initial and Continuing Intensive Care Services

99477 - Initial neonatal intensive care 99478 - Subsq intensive care, < 1500 gm 99479 - Subsq intensive care, 1500-2500 gm 99480 - Subsq intensive care, 2501-5000 gm
Copyright 2011 American Academy of Pediatrics.

$255.38 $133.80 $91.96 $91.96

$331.48 $130.71 $120.10 $112.22

77.0% 102.4% 76.6% 81.9%

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 8 of 9)

Pulmonology

Medicaid
$241.72 $66.86 $39.90 $17.10 $22.80 $11.40 $32.30

Medicare
$294.41 $146.57 $33.20 $14.83 $37.58 $13.55 $14.83

%Medicare
82.1% 45.6% 120.2% 115.3% 60.7% 84.1% 217.8%

31622 - Bronchoscopy 32421 - Thoracentesis for aspiration 94010 - Spriometry, including graphic record 94640 - Inhalation treatmen 94644 - Continuous inhalation treatment, first ho 94645 - Same as 94644, each additional hour 94664 - Demonstration/evaluation
Radiology

71010 - Frontal chest x-ray

Plastic Surgery

$23.29 $822.88 $833.17 $1028.60 $591.45 $534.87 $504.01

$22.33 $901.18 $816.45 $1244.46 $566.87 $338.70 $457.02

104.3% 91.3% 102.0% 82.7% 104.3% 157.9% 110.3%

40700 - Cleft lip repair 42200 - Cleft palate repair

Surgery

28262 - Extensive clubfoot release 44950 - Appendectomy 49500 - Bilateral inguinal hernia, 6 mos to under 5 yrs 49505 - Bilateral inguinal hernia, 5 years or over
Urology and Dialysis

50200 - Renal biopsy 90957 - ESRD services for 12-19 yrs, 4+ physician visits/mo 90958 - Same as above, 2-3 physician visits/mo 90959 - Same as above, 1 physician visits/mo 90965 - Same as above, home dialysis for full month 90966 - Same as above, dialysis for day 90945 - Peritoneal dialysis

$144.00 $380.00 $254.60 $163.40 $254.60 $133.00 $176.32

$545.99 $613.26 $415.45 $276.65 $423.27 $222.51 $74.91

26.4% 62.0% 61.3% 59.1% 60.2% 59.8% 235.4%

Copyright 2011 American Academy of Pediatrics.

AAP Medicaid Reimbursement Survey Report, 2010/11 - Nebraska, Continued (page 9 of 9)

Dental and Oral Health Services

Dental codes (CDT Codes) are copyright 2006 American Dental Association.

Medicaid
$17.00 $9.00 $22.00 $63.00 $62.00 $23.00 $123.00 $70.00 $56.00 $28.00

Medicare

%Medicare
-----

D0120 - Periodic exam D1203 - Topical fluoride treatment, child D1120 - Prophylaxis, child D2150 - Amalgam two surfaces, primary or permanent D2330 - Resin-based composite one surface anterior D1351 - Sealant, per tooth D2930 - Stainless steel crown on a primary tooth D3220 - Pulpotomy D7140 - Extraction D0145 - Caries Risk Assessment

NIS

-------

Medicaid Reimbursement for Preventive Oral Health Services Performed by Non-dental Medical Providers
State did not provide information regarding reimbursement of non-dental medical providers (e.g., pediatricians and family physicians) for periodic oral exam (D0120), topical fluoride treatment to children (D1203/6) or caries risk assessment (D0145).

Copyright 2011 American Academy of Pediatrics.