N.Y. Comp. Codes R. & Regs. Tit. 18 § 508.11 - Payment
(a) Examinations
performed in accordance with section
508.8
of this Part by providers who are certified under article 28 of the Public
Health Law will be reimbursed at the clinic rate established pursuant to such
article. Reimbursement will be based upon a complete examination performed
according to the periodicity schedule. The appropriate rate code identifying
the C/THP examination must be used on the claim form. Clinics billing for C/THP
examinations should use specialty code 908 and rate code 3110R on claims
submitted to the department.
(b)
Except for examinations covered under subdivision (a) of this section, the
reimbursable fees for services performed under the C/THP will be those
established by the State Department of Health and approved by the Division of
the Budget. The C/THP fee for a private physician will be based upon a complete
physical examination performed according to the periodicity schedule. Services
performed during a C/THP examination or as a follow-up to that examination
which are not part of the examination fee, such as immunizations, urinalysis,
and pure-tone conduction screening, are eligible for separate reimbursement on
a fee-for-service basis. These services should be billed on the same claim form
as the C/THP examination. In addition to the C/THP examination, children are
eligible to receive all the care and services available under the State medical
assistance program. However, only visits rendered in accordance with the
recommended C/THP periodicity schedule can be billed as a C/THP exam.
(c) If the child is brought back to complete
a component of the examination, a second visit fee or rate cannot be claimed
for reimbursement under the medical assistance program. Providers certified
pursuant to the provisions of article 28 of the Public Health Law cannot claim
an additional fee to complete a component of the previous C/THP examination,
regardless of the date of service. However, private physicians are eligible to
seek reimbursement for ancillary services (e.g., Mantoux test, immunizations)
on a fee-for-service basis, regardless of date of service.
Notes
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