Spreadsheet Calculator 46254 | Cpt Revenue Calc Blank

Partial file snippet.

Sheet 1: Instructions

	
	
	
	
	
	
	
	
	
	
	
		

		 
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Clinic CPT Calculator Instructions
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Rates effective 4/1/20 reflect workforce salary increase. 
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Background
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		The CPT Calculator is an Excel tool enabling users to calculate the projected revenue for CPT procedures based on service weights and the base Medicaid rate.  The tool can accommodate any volume ranging from a single procedure, services for an episode of care or total Clinic visits.   The tool has been most often used to illustrate projected reimbursement for an episode of care, involving multiple services and various rate modifiers and discounting for multiple same day services.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		 
		

	
	
		

		Operation
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		APR REVENUE CALC TAB
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		To use the tool simply enter data into the yellow shaded cells.  
		

		 
		Base Rates Including Quality Improvement Add-On
		

		Base Rates Without Quality Improvement Add-On
		

		Hospital Art 28 Rates - Phase 2
		
	
		

		Gray shaded cells with an 'x' indicate ineligibility for service modifiers.
		

		Peer Groups
		Upstate Article 31 & DTCs
		 Downstate Article 31 & DTCs 
		 County Article 31 
		

		Upstate Article 31 & DTCs
		Downstate Article 31 & DTCs
		County Article 31
		

		Upstate Hosp Article 28
		Downstate Hosp Art 28
	
	
		

		Enter or link the applicable Peer Group rate in Cell H6 from the values on the right >
		

		Rates
		 $146.39 
		 $162.62 
		 $204.01 
		

		 $140.97 
		 $156.60 
		 $196.47 
		

		 $139.25 
		 $181.16 
	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Enter the number of services for any of the CPT codes in Column H.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Enter the number of services that will be eligible for modifiers in Columns J-M.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Enter the number of services that will include a second service discount in Column AE.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Totals for all entries will appear on lines 49-53.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Optional Use & Analysis
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		The calculator is an Excel tool and can be easily modified to meet the analytic needs of the user.  For example:
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		 - Columns can be hidden from view to streamline the visual display.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		 - The scenario totals can be copied to adjacent columns or another tab for comparative purposes.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		APG PHASE-IN TAB
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		This tab will calculate the Phase-In value for any timeframe related to the OMH Phase-In calendar.  APG New and Blend volume and revenue data is linked to the APG REVENUE CALC TAB and requires no new entry.   Users can also enter values to project the impact of Medicare and Third Party cross-over activity on Medicaid revenues.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		For non-hospital based clinics, user entry is limited to the OMH Blend Rate, CSP Rate and CSP Threshold.  An optional section to project the impact of Utilization Thresholds is also included.
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		APG reimbursement for hospital based clinics was fully phased-in as of 1/1/2012.  The Phase-In tab can be used by hospital based clinics to project the Medicare and 3rd Party cross-over impact on Medicaid revenues and to project the impact of Unitization Thresholds if desired.  Hospital based clinics can also consider adding their Capital Add-On rate to their Peer Group Base rate.
		

		

		

		

		

		

		

		

		

		

		

		

	



Sheet 2: APG REVENUE CALC

	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
		MENTAL HEALTH OUTPATIENT CLINIC - CPT REVENUE CALCULATOR
		

		

		

		

		

		

		All revenue, modifier and discount calculation cells in Columns N-AD,AF are Hidden.
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Update:
		4/1/2020
		OMH PROTOTYPE 
		

		

		

		

		To view the calculations, highlight the columns, right click and select Unhide.
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		 
		

		INDICATES 2013 CPT CODE/WEIGHT CHANGES
		

		

		 
		

		< Enter Data in Yellow Shaded (dashed) Cells >
		

		

		 
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		BASE RATE
		

		MODIFIERS
		

		

		
		The Multiple Same Day service  discount applies to all the lowest weighted same day service.

		2nd Service Discount
		Discounted
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		CPT SERVICES
		

		

		

		

		
		Enter the base rate from the selection on the Instructions tab

		 $161.19 
		

		10%
		
		Modifier value = .0759 x Peer Group Base Rate.

		 $12.23 
		
		Offsite reimbursement for Medicaid Fee-for-Service allowable services equals the base revenue plus a 50% modifier value.

Services with Offsite modifier are not eligible for any other modifiers and the entire payment is classified as FULL.

		50%
		
		Modifier % applied to Assessment and Individual Therapy services

		45%
		

		

		-10%
		Discount
		Total 
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		
		Modifier % applied to Group Therapy services for all Group attendees

		20%
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		
		Payment for Full procedures will be phased-in at 100% of CPT value in Year 1.
Payment for Blended procedures will be phased-in at 25% for Year 1, 50% for Year 2, 75% for Year 3 and 100% in Year 4.

		Blend/ Full Pay
		
		Comments reflect APG standard service description

		APG
		CPT Procedure - OMH Regulatory Name
		2012 CPT  Codes
		2013 CPT Codes
		Service Weight
		

		Units Of Service
		

		
		Language other than English
		LOE Modifier
		
		After hours = before 8 AM and after 6 PM.  Only 1 after-hours code per-client, per-day.


		After Hours Modifier
		
		Offsite modifier for Children is applicable to Assessment, Crisis-Brief, Medication & Individual/Family Therapy services.

Offsite modifier for Adults is limited to H2011 Crisis-Brief.
		Off-Site Modifier
		
		MD/NPP modifier adds 45% or 20% of applicable APG weight

		MD/NPP Modifier
		

		

		# Services
		
		The Discount amount = the projected volume X the discount %.

		Discount Amount
		Revenue
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Mental Hygiene Assessment
		323
		Initial Assessment Diagnostic & Treatment Plan
		
		[Deleted Code]

Psychiatric diagnostic interview examination
		90801
		
		This service may be provided to the client and/or collateral.
Sessions less than 45 minutes will not be reimbursed by Medicaid.
		90791
		1.0344
		

		

		

		

		

		

		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		323
		Initial Assessment Diagnostic & Treatment Plan with Medical Services
		

		
		This service must be provided by a physician or NPP. This code may not be claimed on the same day as an E&M code. 45 minute minimum
		90792
		1.0344
		

		

		

		

		

		

		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Counseling or Individual Brief Psychotherapy
		820-831
		Psychiatric Assessment - 30 mins
		
		[Deleted Code]

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility with medical evaluation and management services, minimum duration for Medicaid reimbursement is 30 minutes of face-to-face with the patient.

		90805
		
		99201-99205 New Patient, 
99212-99215 Established Patient

		Code Range
		
		Default weight value.  Use 'DX Wt' tab to calculate a custom weight for your clinic.

		0.6620
		

		

		

		 X 
		

		

		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		315
		Psychiatric Assessment - 30 mins - ADD ON
		

		90833
		0.3724
		

		

		

		

		

		

		 X 
		

		

		 X 
		 X 
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Individual Comprehensive Psychotherapy
		820-831
		Psychiatric Assessment - 45-50  mins
		
		[Deleted Code]

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility with medical evaluation and management services, approx. 45 to 50 min. face-to- face with the patient.
		90807
		
		99201-99205 New Patient, 
99212-99215 Established Patient

		Code Range
		
		Default weight value.  Use 'DX Wt' tab to calculate a custom weight for your clinic.

		0.6620
		

		

		

		 X 
		

		

		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		316
		Psychiatric Assessment - 45-50  mins - ADD ON
		

		90836
		0.5793
		

		

		

		

		

		

		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		APG is based on diagnosis (see descriptions for APG codes 820-831 on 'Consult Wt' tab)

		820-831
		
		30 minute minimum for CPT codes 99201,99202,9203,99212,99213,99214

		Psychiatric Consultation
		
		99201-99205 New Patient, 
99212-99215 Established Patient

		Code Range
		
		Default weight value.  Use 'DX Wt' tab to calculate a custom weight for your clinic.

		0.6620
		

		

		

		 X 
		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Crisis Intervention
		321
		
		Crisis intervention per 15 minutes, mental health services. Face-to-face or telephone services provided by 1 clinician, with a maximum of 6 units per day:
15 min = 1 unit
30 min = 2 units
45 min = 3 units
  1 hr   = 4 units
1 hr 15 min = 5 units
1 hr 30 min = 6 units (maximum)
		Crisis Intervention - 15 min
		
		Crisis intervention per 15 minutes, mental health services. Face-to-face or telephone services provided by 1 clinician, with a maximum of 6 units per day:
15 min = 1 unit
30 min = 2 units
45 min = 3 units
  1 hr   = 4 units
1 hr 15 min = 5 units
1 hr 30 min = 6 units (maximum)
		H2011
		0.4000
		

		

		

		

		

		

		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Crisis Intervention
		321
		Crisis Intervention - per hour
		
		Crisis intervention mental health services, per diem (1-3 hours). Requires a minimum of one hour of face-to-face contact by two or more clinicians.

		S9484
		2.4136
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Full day partial hospitalization for mental illness
		312
		Crisis Intervention - per diem
		
		Crisis intervention, mental health services, per diem. Requires a minimum 3 or more hours of face-to-face contact by two or more clinicians

		S9485
		5.7927
		

		

		

		

		

		 X 
		 X 
		

		

		

		 X 
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Injectable Med Admin with Monit & Edu
		
		Comprehensive Medication Services. 15 minute minimum time.
This code encompasses both the injection and the visit.

		H2010
		0.4138
		

		

		

		

		

		

		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		

		
		Injection Only - Medicaid fee schedule claim, J Code if applicable, CPT 96372

Payment for drug cost and $13.23 for Injection
No modifiers available

Note:  96372 is not a mental health carve-out service.
		Injection Only
		96372
		 $13.23 
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		 X 
		 X 
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Psychotropic Medication Management
		820-831
		Psychotropic Medication Treatment
		
		[Deleted Code]

Including prescription, use, and review of medication with no more than minimal medical psychotherapy.  15 minute minimum.   
		90862
		
		99201-99205 New Patient, 
99212-99215 Established Patient

		Code Range
		
		Default weight value.  Use 'DX Wt' tab to calculate a custom weight for your clinic.

		0.6620
		

		

		

		 X 
		

		

		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Counseling or individual brief psychotherapy
		315
		Psychotherapy - Indiv 30 mins
		
		[Deleted Code]

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, minimum duration for Medicaid reimbursement is 30 minutes of face-to-face with the patient.
		90804
		
		Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, minimum duration for Medicaid reimbursement is 30 minutes of face-to-face with the patient.


		90832
		0.6206
		

		

		

		

		

		

		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Individual Comprehensive Psychotherapy
		316
		Psychotherapy - Indiv 45 mins
		
		[Deleted Code]

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, minimum duration for Medicaid reimbursement is 45 minutes of face-to- face with the patient.
		90806
		
		Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, minimum duration for Medicaid reimbursement is 45 minutes of face-to- face with the patient.
		90834
		0.8275
		

		

		

		

		

		

		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Family Psychotherapy
		317
		Psychotherapy - Family 30 mins
		
		Family psychotherapy (without the patient present), minimum duration for Medicaid reimbursement is 30 minutes.
		90846
		0.6206
		

		

		

		

		

		

		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Family Psychotherapy
		317
		Psychotherapy - Family&Client 1 hr
		
		Family psychotherapy (conjoint psychotherapy) with patient present, minimum duration for Medicaid reimbursement is 1 hour.
		90847
		1.2413
		

		

		

		

		

		

		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Group Psychotherapy
		318
		Psychotherapy - Family Group 1hr
		
		Multiple-family group psychotherapy, minimum duration for Medicaid reimbursement of 1 hour.
		90849
		0.3207
		

		

		

		

		

		 X 
		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		
		Group Psychotherapy
		318
		Psychotherapy - Group 1 hr
		
		Group psychotherapy (other than of a multiple-family group), minimum duration for Medicaid reimbursement of 1 hour.
		90853
		0.3207
		

		

		

		

		

		 X 
		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Blend
		318
		School Based - Group <1 hr
		
		School based group psychotherapy, less than one hour.

		90853
		
		School based U5 modifier; 30% less than 60 minute group session.

		0.2245
		

		

		

		

		

		 X 
		

		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Developmental and Neuropsychological Testing
		310
		Developmental Testing - limited
		
		Developmental Testing on a limited basis.
		96110
		0.8275
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Developmental and Neuropsychological Testing
		310
		Developmental Testing - First Hour
		
		Developmental Testing on a extended basis.
		96112
		0.8275
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		310
		Developmental Testing - Additional 30 min.
		96113
		0.4598
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		310
		Psychological Testing Evaluation - First Hour
		96130
		0.4598
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		310
		Psychological Testing Evaluation - Additional Hour
		96131
		0.0000
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		310
		Psychological Testing Admin and Scoring - First Hour
		96136
		0.8275
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Developmental and Neuropsychological Testing
		310
		Psychological Testing Admin and Scoring - Additional Hour
		
		Psychological Testing by Psych and Physicians
		96137
		0.4598
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Developmental and Neuropsychological Testing
		310
		Psychological Testing - Neurobehavioral First Hour
		
		Neurobehavioral status exam
		96116
		1.2413
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Developmental and Neuropsychological Testing
		310
		Psychological Testing - Neurobehavioral Additional Hour
		
		Neurobehavioral Testing by Psych/Physicians
		96121
		0.4598
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Complex Care Management - 15 mins
		
		Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies or institutions.

		90882
		0.2896
		

		

		

		

		

		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		APG is based on diagnosis (see descriptions for APG codes 820-831 on 'Consult Wt' tab)

		820-831
		Health Physicals - New/Estab Patient
		
		99382-99387 New Patient, 
99392-99397 Established Patient

		Code Range
		
		Default weight value.  Use 'DX Wt' tab to calculate a custom weight for your clinic.

		0.6620
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Health Monitoring - 15 mins
		99401
		0.2500
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Health Monitoring - 30 mins
		99402
		0.3103
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Health Monitoring - 45 mins
		99403
		0.4482
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Health Monitoring - 60 mins
		99404
		0.5862
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Health Monitoring Group - 30 mins
		99411
		0.1379
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		
		Incidental to Medical, Significant Procedure or Therapy Visit
		490
		Health Monitoring Group - 60 mins
		99412
		0.2414
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		451
		Smoking Cessation Treatment - 3-10 mins; requires Dx code 305.1
		99406
		0.1267
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		451
		Smoking Cessation Treatment - >10 mins; requires Dx code 305.1
		99407
		0.1267
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		451
		Smoking Cessation Treatment (Group) - >10 mins; requires Dx code 305.1 (req HQ modifier)
		99407-HQ
		APROX $8.50 PER CLIENT
		

		

		   
		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		324
		Alcohol and/or Drug Screening
		H0049
		0.2803
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Full
		324
		Alcohol and/or Drug, brief intervention, per 15 mins
		H0050
		0.2803
		

		

		

		 X 
		 X 
		 X 
		 X 
		

		

		

		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		TOTALS
		

		

		TOTALS
		

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		 Totals 
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		TOTAL SERVICES
		TOTAL SERVICES
		

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		 Totals 
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		FULL SERVICES
		

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		BLEND SERVICES
		

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		BLEND 2ND SAME DAY
		

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Sheet 3: APG PHASE-IN

	
	
	
	
	
	
	
	
	
		Clinic Projection Model
		

		

		4/1/2020
		 
		ENTER DATA
		

		

		

		

		

		

	
	
		PROJECTION OF APG PHASE IN VALUE 
		

		

		

		

		LINKED DATA
		

		

		

		

		

		

	
	
		< enter data in yellow shaded cells >
		Phase-In Year
		

		

		

		FORMULA CELL
		

		

		

		

		

		

	
	
		SERVICE UNITS
		 
		 
		
		Enter desired Phase-In percentages from the Option table on the right.

		Enter Phase %
		

		

		

		PHASE IN OPTION TABLE
		

		

		

		

	
	
		New Services
		 -   
		

		

		

		ENTER PHASE-IN OPTIONS 
		

		

		

		

		

		

	
	
		Blend Services
		 -   
		

		

		

		

		

		

		PHASE 1
		PHASE 2
		PHASE 3
		PHASE 4
	
	
		TOTAL SERVICE UNITS
		 -   
		

		

		

		

		

		MONTHS
		OCT-SEP
		OCT-SEP
		OCT-SEP
		OCT-SEP
	
	
		APG FULL & BLEND COMPONENTS
		DATA
		

		ANNUAL
		

		

		

		PHASE-IN
		2010-11
		2011-12
		2012-13
		2013-14
	
	
		
		Full Services are phased in at 100%

		APG Full Services Amount
		 $-   
		

		 $-   
		

		FULL APG SERVICE VALUE
		

		APG
		25%
		50%
		75%
		100%
	
	
		
		Full Annual Amount

		APG Blend Services Amount
		 $-   
		

		

		

		

		

		BLEND
		75%
		50%
		25%
		0%
	
	
		APG Total from Revenue Calc Tab
		 $-   
		

		

		

		

		

		

		

		

		

		

	
	
		
		From cell E5 above

		APG Phase-In % X Blend Amount
		0%
		

		 $-   
		

		

		

		MONTHS
		JAN-DEC
		JAN-DEC
		JAN-DEC
		JAN-DEC
	
	
		EXISTING OPERATING/BLEND COMPONENT
		DATA
		

		   
		

		

		

		CALENDAR
		2011
		2012
		2013
		2014
	
	
		# Blend Services
		 -   
		

		

		

		TOTAL BLEND SERVICES
		

		APG
		31%
		56%
		81%
		100%
	
	
		less 2nd same day Blend Services
		 -   
		

		

		

		EXCLUDE 2 SAME DAY BLEND SERVICES
		

		BLEND
		69%
		44%
		19%
		0%
	
	
		Blend Pay Services
		 -   
		

		

		

		BLEND SERVICES FOR EOC BLEND PAYMENT
		

		 
		

		

		

		

	
	
		Blend Rate
		
		Enter OMH Blend Rate

		 $-   
		

		

		

		ENTER OMH BLEND RATE @ 100%
		

		MONTHS
		JUL-JUN
		JUL-JUN
		JUL-JUN
		JUL-JUN
	
	
		
		From cell E6 above


		Blend Pay %
		0%
		

		

		

		

		

		FISCAL
		2011-12
		2012-13
		2013-14
		2014-15
	
	
		Blend Rate Phase-Out Rate
		 $-   
		

		

		

		

		

		APG
		44%
		69%
		94%
		100%
	
	
		Blend Pay Services X Phase-Out Amt
		   
		

		 $-   
		

		 
		

		BLEND
		56%
		31%
		6%
		0%
	
	
		CSP Rate in Blend
		 $-   
		

		

		

		
		CSP Rate subject to appeal and change.

		CSP RATE @ 100%
		

		

		

		

		

		

	
	
		Blend Phase-Out %
		0%
		

		

		

		CSP RATE IN BLEND X PHASE-OUT 5
		

		

		

		

		

		

	
	
		CSP Add-Back Rate X Blend Pay Services
		 $-   
		

		 $-   
		

		CSP PHASE-OUT AMOUNT IN CAPITAL ADD-ON FOR A31S
		

		

		

		

		

		

	
	
		MEDICARE & THIRD PARTY CROSS-OVER ADJUSTMENT
		DATA
		

		

		

		

		

		

		

		

		

		

	
	
		# Projected Cross-Over Services
		 -   
		

		

		

		

		

		

		

		

		

		

	
	
		Average Mcare/3rd Payment per Service
		 $-   
		

		

		

		

		

		

		

		

		

		

	
	
		# Services X Crossover Payment
		

		

		 $-   
		

		ENTER PROJECTED OR PRIOR ACTUAL AMOUNT
		

		

		

		

		

		

	
	
		UTILIZATION THRESHOLD ADJUSTMENT
		DATA
		

		

		

		

		

		

		

		

		

		

	
	
		Enter Projected Services > Threshold:
		 
		

		

		

		

		

		

		

		

		

		

	
	
		Adults >20 Yrs, -25%, 31-50 Visits
		 -   
		0.25
		 $-   
		 
		ENTER # VISITS MEETING THRESHOLD CRITERIA
		

		

		

		

		

		

	
	
		Adults >20 Yrs, -50%,     >50 Visits
		 -   
		0.5
		 $-   
		 
		ENTER # VISITS MEETING THRESHOLD CRITERIA
		

		

		

		

		

		

	
	
		C&Y     <21 Yrs, -50%,     >50 Visits
		 -   
		0.5
		 $-   
		

		ENTER # VISITS MEETING THRESHOLD CRITERIA
		

		

		

		

		

		

	
	
		Simple Average Payment Per Service
		 $-   
		

		

		

		USE SIMPLE AVERAGE OR SUBSTITUTE YOUR CLINIC'S EST
		

		

		

		

		

		

	
	
		THRESHOLD ADJUSTMENT AMOUNT
		 $-   
		

		

		

		

		

		

		

		

		

		

	
	
		APG REVENUE INCLUDING;
		

		

		

		

		

		

		

		

		

		

		

	
	
		CSP ADD-ON, CROSSOVER ADJ, UTLIZ THRESHOLD ADJ
		

		

		 $-   
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		CSP THRESHOLD ADJUSTMENT
		

		

		

		

		

		

		

		

		

		

		

	
	
		CPSP THRESHOLD AMOUNT
		

		

		 $-   
		

		
		CSP Threshold subject to appeal and change.

		ENTER OMH THRESHOLD AMOUNT
		

		

		

		

		

		

	
	
		CSP RATE
		 $-   
		

		

		

		 FROM CELL C20 ABOVE 
		

		

		

		

		

		

	
	
		BLEND VISITS
		 -   
		

		

		

		 FROM CELL C15 ABOVE
		

		

		

		

		

		

	
	
		CSP PAID - INCLUDING BLEND & ADD-ON COMPONENTS
		

		

		 $-   
		

		

		

		

		

		

		

		

	
	
		CPS (UNDER)/OVER THRESHOLD
		

		

		 $-

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Clinic Projection Model			4/1/2020	ENTER DATA
PROJECTION OF APG PHASE IN VALUE				LINKED DATA
< enter data in yellow shaded cells >	Phase-In Year			FORMULA CELL
SERVICE UNITS			Enter desired Phase-In percentages from the Option table on the right. Enter Phase %		PHASE IN OPTION TABLE
New Services	-			ENTER PHASE-IN OPTIONS
Blend Services	-					PHASE 1	PHASE 2	PHASE 3	PHASE 4
TOTAL SERVICE UNITS	-				MONTHS	OCT-SEP	OCT-SEP	OCT-SEP	OCT-SEP
APG FULL & BLEND COMPONENTS	DATA		ANNUAL		PHASE-IN	2010-11	2011-12	2012-13	2013-14
Full Services are phased in at 100% APG Full Services Amount	$-		$-	FULL APG SERVICE VALUE	APG	25%	50%	75%	100%
Full Annual Amount APG Blend Services Amount	$-				BLEND	75%	50%	25%	0%
APG Total from Revenue Calc Tab	$-
From cell E5 above APG Phase-In % X Blend Amount	0%		$-		MONTHS	JAN-DEC	JAN-DEC	JAN-DEC	JAN-DEC
EXISTING OPERATING/BLEND COMPONENT	DATA				CALENDAR	2011	2012	2013	2014
# Blend Services	-			TOTAL BLEND SERVICES	APG	31%	56%	81%	100%
less 2nd same day Blend Services	-			EXCLUDE 2 SAME DAY BLEND SERVICES	BLEND	69%	44%	19%	0%
Blend Pay Services	-			BLEND SERVICES FOR EOC BLEND PAYMENT
Blend Rate	Enter OMH Blend Rate $-			ENTER OMH BLEND RATE @ 100%	MONTHS	JUL-JUN	JUL-JUN	JUL-JUN	JUL-JUN
From cell E6 above Blend Pay %	0%				FISCAL	2011-12	2012-13	2013-14	2014-15
Blend Rate Phase-Out Rate	$-				APG	44%	69%	94%	100%
Blend Pay Services X Phase-Out Amt			$-		BLEND	56%	31%	6%	0%
CSP Rate in Blend	$-			CSP Rate subject to appeal and change. CSP RATE @ 100%
Blend Phase-Out %	0%			CSP RATE IN BLEND X PHASE-OUT 5
CSP Add-Back Rate X Blend Pay Services	$-		$-	CSP PHASE-OUT AMOUNT IN CAPITAL ADD-ON FOR A31S
MEDICARE & THIRD PARTY CROSS-OVER ADJUSTMENT	DATA
# Projected Cross-Over Services	-
Average Mcare/3rd Payment per Service	$-
# Services X Crossover Payment			$-	ENTER PROJECTED OR PRIOR ACTUAL AMOUNT
UTILIZATION THRESHOLD ADJUSTMENT	DATA
Enter Projected Services > Threshold:
Adults >20 Yrs, -25%, 31-50 Visits	-	0.25	$-	ENTER # VISITS MEETING THRESHOLD CRITERIA
Adults >20 Yrs, -50%, >50 Visits	-	0.5	$-	ENTER # VISITS MEETING THRESHOLD CRITERIA
C&Y <21 Yrs, -50%, >50 Visits	-	0.5	$-	ENTER # VISITS MEETING THRESHOLD CRITERIA
Simple Average Payment Per Service	$-			USE SIMPLE AVERAGE OR SUBSTITUTE YOUR CLINIC'S EST
THRESHOLD ADJUSTMENT AMOUNT	$-
APG REVENUE INCLUDING;
CSP ADD-ON, CROSSOVER ADJ, UTLIZ THRESHOLD ADJ			$-

CSP THRESHOLD ADJUSTMENT
CPSP THRESHOLD AMOUNT			$-	CSP Threshold subject to appeal and change. ENTER OMH THRESHOLD AMOUNT
CSP RATE	$-			FROM CELL C20 ABOVE
BLEND VISITS	-			FROM CELL C15 ABOVE
CSP PAID - INCLUDING BLEND & ADD-ON COMPONENTS			$-
CPS (UNDER)/OVER THRESHOLD			$-

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