Filetype PDF | Posted on 17 Aug 2022 | 4 years ago
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399x Filetype PDF File size 0.35 MB Source: health.maryland.gov
MARYLAND DEPARTMENT OF HEALTH
COMAR 10.09.09
MEDICAL ASSISTANCE PROGRAM
2021 MEDICAL LABORATORY FEE
SCHEDULE
EFFECTIVE FEBRUARY 2021
2021 2021 2021 2021
CPT CODE PA Medicaid Medicaid Medicaid Medicaid
Required Non Facility Fee MOD 26 MOD TC
Facility Fee Fee Fee Notes
36415 $2.39 $2.39
80047 $10.92 $10.92
80048 $8.30 $8.30
80051 $6.88 $6.88
80053 $10.37 $10.37
80055 $46.92 $46.92
80061 $13.14 $13.14
80069 $8.52 $8.52
80074 $46.75 $46.75
80076 $8.02 $8.02
80081 $73.47 $73.47
80143 $14.82 $14.82 Effective 02/01/2021
80150 $14.79 $14.79
80151 $14.82 $14.82 Effective 02/01/2021
80155 $30.66 $30.66
80156 $14.29 $14.29
80157 $13.01 $13.01
80158 $17.71 $17.71
80159 $18.15 $18.15
80161 $14.82 $14.82 Effective 02/01/2021
80162 $13.03 $13.03
80163 $13.03 $13.03
80164 $13.29 $13.29
80165 $13.29 $13.29
80167 $14.82 $14.82 Effective 02/01/2021
80168 $16.04 $16.04
80169 $13.48 $13.48
80170 $16.07 $16.07
80171 $17.23 $17.23
80173 $14.29 $14.29
80175 $13.01 $13.01
80176 $14.42 $14.42
80177 $13.01 $13.01
80178 $6.49 $6.49
80179 $14.82 $14.82 Effective 02/01/2021
80180 $17.71 $17.71
80181 $14.82 $14.82 Effective 02/01/2021
80183 $13.01 $13.01
80184 $12.16 $12.16
80185 $13.01 $13.01
80186 $13.51 $13.51
80188 $16.28 $16.28
80189 $21.55 $21.55 Effective 02/01/2021
80190 $47.70 $47.70
80192 $16.44 $16.44
80194 $14.33 $14.33
80195 $13.48 $13.48
80197 $13.48 $13.48
80198 $13.88 $13.88
80199 $21.55 $21.55
80200 $15.83 $15.83
80201 $11.70 $11.70
80202 $13.29 $13.29
80203 $13.01 $13.01
80210 $21.55 $21.55 Effective 02/01/2021
80280 $30.66 $30.66
80285 $21.55 $21.55
80305 $10.02 $10.02 Reimbursed by Optum
80306 $13.63 $13.63 Reimbursed by Optum
80307 $51.40 $51.40 Reimbursed by Optum
80400 $32.01 $32.01
80402 $85.34 $85.34
80406 $76.81 $76.81
80408 $123.18 $123.18
80410 $71.00 $71.00
80412 $637.29 $637.29
80414 $50.68 $50.68
80415 $54.85 $54.85
80416 $166.41 $166.41
80417 $43.18 $43.18
80418 $568.77 $568.77
80420 $128.69 $128.69
80422 $45.22 $45.22
80424 $49.56 $49.56
80426 $145.66 $145.66
80428 $65.47 $65.47
80430 $102.82 $102.82
80432 $132.60 $132.60
80434 $226.60 $226.60
80435 $101.11 $101.11
80436 $89.48 $89.48
80438 $49.48 $49.48
80439 $65.97 $65.97
80500 $19.74 $16.92
80502 $63.54 $60.71
81000 $3.20 $3.20
81001 $3.12 $3.12
81002 $2.77 $2.77
81003 $2.20 $2.20
81005 $2.12 $2.12
81007 $23.83 $23.83
81015 $2.99 $2.99
81020 $3.74 $3.74
81025 $6.84 $6.84
81050 $2.95 $2.95
81105 $119.96 $119.96
81106 $119.96 $119.96
81107 $119.96 $119.96
81108 $119.96 $119.96
81109 $119.96 $119.96
81110 $120.96 $120.96
81111 $120.96 $120.96
81112 $119.96 $119.96
81121 $235.15 $235.15
81161 $221.81 $221.81
81162 $1,791.08 $1,791.08
81163 $372.06 $372.06
81164 $464.46 $464.46
81165 $224.89 $224.89
81166 $239.57 $239.57
81167 $224.89 $224.89
81168 P $164.81 $164.81 Effective 02/01/2021
81170 $238.50 $238.50
81173 P $239.57 $239.57
81174 P $147.23 $147.23
81177 $108.92 $108.92
81178 $108.92 $108.92
81179 $108.92 $108.92
81180 $108.92 $108.92
81181 $108.92 $108.92
81182 P $108.92 $108.92
81183 $108.92 $108.92
81184 P $108.92 $108.92
81185 P $672.78 $672.78
81186 P $147.23 $147.23
81187 $108.92 $108.92
81191 P $164.81 $164.81 Effective 02/01/2021
81192 P $164.81 $164.81 Effective 02/01/2021
81193 P $164.81 $164.81 Effective 02/01/2021
81194 P $412.03 $412.03 Effective 02/01/2021
81200 $37.56 $37.56
81201 $620.10 $620.10
81202 $222.60 $222.60
81203 $159.00 $159.00
81204 $108.92 $108.92
81205 $75.52 $75.52
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