cpt code fee schedule new mexico medicaid fee for … · 11057 y $56.92 general fee schedule -...
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NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2015 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. Current Procedural Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2015 American Medical Association. All rights reserved.Some procedure codes may be on other fee schedule tables. As explained in the CPT Disclaimer and Agreement, this table is not to be used as a guide to coverage of services by the Medicaid Program. The reimbursement amount will be $0.00 for vaccination antigen procedure codes for which "VFC Antigen" is listed and the recipient is 18 years old or younger because the antigen is distributed for free for children by the New Mexico Department of Health Vaccines for Children (VFC) Program. Use modifier 26 for professional component pricing and modifier TC for technical component pricing. The pricing notes "TC Fee Schedule" and "TC by Report" are for the technical component rates when modifier TC is used. The pricing notes "General Fee Schedule" and "General by Report" and "Manual Review Fee Schedule" are for the global rates. Rates that are $0.00 are priced and/or reviewed by the State. Some procedure codes are only payable for Alternative Benefit Plan (ABP) recipients. Please refer to the appropriate ABP resources on the HSD website. Only laboratory molecular pathology tests that involve clinical utility are reimbursed by New Mexico Medicaid and are subject to retrospective review. A test that has clinical utility means that the test results can be used to pursue effective treatment or provide other concrete clinical benefits for recipients who have a disease diagnosis relevant for the specific molecular pathology testing.
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
0437T Y $0.00 General Fee Schedule - 7/1/2016
0440T Y $0.00 General Fee Schedule - 7/1/2016
0441T Y $0.00 General Fee Schedule - 7/1/2016
0442T Y $0.00 General Fee Schedule - 7/1/2016
0443T Y $0.00 General Fee Schedule - 7/1/2016
0444T Y $0.00 General Fee Schedule - 7/1/2016
0445T Y $0.00 General Fee Schedule - 7/1/2016
10021 Y $113.18 General Fee Schedule - 1/1/2017
10022 Y $128.02 General Fee Schedule - 1/1/2017
10030 Y $706.70 General Fee Schedule - 8/1/2016
10035 Y $475.85 General Fee Schedule - 8/1/2016
10036 Y $411.29 General Fee Schedule - 8/1/2016
10040 Y $81.86 General Fee Schedule - 12/1/2009
10060 Y $90.72 General Fee Schedule - 12/1/2009
10061 Y $164.27 General Fee Schedule - 12/1/2009
10080 Y $149.21 General Fee Schedule - 8/1/2016
10081 Y $232.85 General Fee Schedule - 8/1/2016
10120 Y $125.88 General Fee Schedule - 12/1/2009
10121 Y $235.74 General Fee Schedule - 12/1/2009
10140 Y $126.56 General Fee Schedule - 12/1/2009
10160 Y $105.93 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 1 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
10180 Y $201.30 General Fee Schedule - 12/1/2009
11000 Y $45.43 General Fee Schedule - 12/1/2009
11001 Y $20.01 General Fee Schedule - 8/1/2016
11004 Y $532.76 General Fee Schedule - 8/1/2016
11005 Y $724.73 General Fee Schedule - 8/1/2016
11006 Y $669.44 General Fee Schedule - 8/1/2016
11008 Y $272.23 General Fee Schedule - 8/1/2016
11010 Y $420.42 General Fee Schedule - 12/1/2009
11011 Y $476.44 General Fee Schedule - 8/1/2016
11012 Y $663.64 General Fee Schedule - 1/1/2017
11042 Y $80.93 General Fee Schedule - 12/1/2009
11043 Y $210.23 General Fee Schedule - 8/1/2016
11044 Y $274.23 General Fee Schedule - 8/1/2016
11045 Y $30.13 General Fee Schedule - 1/1/2011
11046 Y $52.53 General Fee Schedule - 1/1/2011
11047 Y $86.62 General Fee Schedule - 1/1/2011
11055 Y $37.50 General Fee Schedule - 12/1/2009
11056 Y $47.88 General Fee Schedule - 12/1/2009
11057 Y $56.92 General Fee Schedule - 8/1/2016
11100 Y $75.10 General Fee Schedule - 12/1/2009
11101 Y $27.82 General Fee Schedule - 12/1/2009
11200 Y $66.72 General Fee Schedule - 12/1/2009
11201 Y $16.67 General Fee Schedule - 8/1/2016
11300 Y $54.61 General Fee Schedule - 12/1/2009
11301 Y $72.19 General Fee Schedule - 12/1/2009
11302 Y $86.77 General Fee Schedule - 12/1/2009
11303 Y $104.37 General Fee Schedule - 12/1/2009
11305 Y $57.39 General Fee Schedule - 12/1/2009
11306 Y $78.29 General Fee Schedule - 12/1/2009
11307 Y $90.59 General Fee Schedule - 12/1/2009
11308 Y $108.56 General Fee Schedule - 12/1/2009
11310 Y $67.56 General Fee Schedule - 12/1/2009
11311 Y $84.36 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 2 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
11312 Y $97.01 General Fee Schedule - 12/1/2009
11313 Y $127.95 General Fee Schedule - 12/1/2009
11400 Y $103.35 General Fee Schedule - 12/1/2009
11401 Y $121.45 General Fee Schedule - 12/1/2009
11402 Y $139.13 General Fee Schedule - 12/1/2009
11403 Y $157.13 General Fee Schedule - 12/1/2009
11404 Y $179.55 General Fee Schedule - 12/1/2009
11406 Y $222.69 General Fee Schedule - 12/1/2009
11420 Y $101.53 General Fee Schedule - 12/1/2009
11421 Y $130.17 General Fee Schedule - 12/1/2009
11422 Y $145.82 General Fee Schedule - 12/1/2009
11423 Y $173.16 General Fee Schedule - 12/1/2009
11424 Y $198.64 General Fee Schedule - 12/1/2009
11426 Y $280.20 General Fee Schedule - 12/1/2009
11440 Y $114.57 General Fee Schedule - 8/1/2016
11441 Y $141.74 General Fee Schedule - 12/1/2009
11442 Y $159.23 General Fee Schedule - 12/1/2009
11443 Y $195.96 General Fee Schedule - 12/1/2009
11444 Y $240.68 General Fee Schedule - 8/1/2016
11446 Y $326.44 General Fee Schedule - 12/1/2009
11450 Y $289.67 General Fee Schedule - 12/1/2009
11451 Y $397.03 General Fee Schedule - 12/1/2009
11462 Y $283.23 General Fee Schedule - 12/1/2009
11463 Y $404.92 General Fee Schedule - 12/1/2009
11470 Y $312.84 General Fee Schedule - 12/1/2009
11471 Y $419.94 General Fee Schedule - 12/1/2009
11600 Y $144.40 General Fee Schedule - 12/1/2009
11601 Y $166.40 General Fee Schedule - 12/1/2009
11602 Y $176.31 General Fee Schedule - 12/1/2009
11603 Y $195.51 General Fee Schedule - 12/1/2009
11604 Y $215.27 General Fee Schedule - 12/1/2009
11606 Y $283.78 General Fee Schedule - 12/1/2009
11620 Y $138.06 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 3 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
11621 Y $164.86 General Fee Schedule - 12/1/2009
11622 Y $187.19 General Fee Schedule - 12/1/2009
11623 Y $222.00 General Fee Schedule - 12/1/2009
11624 Y $255.83 General Fee Schedule - 12/1/2009
11626 Y $339.99 General Fee Schedule - 12/1/2009
11640 Y $146.98 General Fee Schedule - 12/1/2009
11641 Y $192.64 General Fee Schedule - 12/1/2009
11642 Y $223.28 General Fee Schedule - 12/1/2009
11643 Y $259.08 General Fee Schedule - 12/1/2009
11644 Y $328.52 General Fee Schedule - 12/1/2009
11646 Y $447.90 General Fee Schedule - 12/1/2009
11719 Y $12.93 General Fee Schedule - 1/1/2017
11720 Y $25.38 General Fee Schedule - 12/1/2009
11721 Y $38.32 General Fee Schedule - 12/1/2009
11730 Y $83.72 General Fee Schedule - 12/1/2009
11732 Y $32.70 General Fee Schedule - 1/1/2017
11740 Y $34.49 General Fee Schedule - 12/1/2009
11750 Y $153.70 General Fee Schedule - 12/1/2009
11755 Y $109.15 General Fee Schedule - 12/1/2009
11760 Y $158.28 General Fee Schedule - 12/1/2009
11762 Y $222.93 General Fee Schedule - 12/1/2009
11765 Y $90.68 General Fee Schedule - 12/1/2009
11770 Y $231.63 General Fee Schedule - 12/1/2009
11771 Y $440.52 General Fee Schedule - 12/1/2009
11772 Y $557.25 General Fee Schedule - 12/1/2009
11900 Y $43.01 General Fee Schedule - 12/1/2009
11901 Y $54.51 General Fee Schedule - 12/1/2009
11920 Y $157.24 General Fee Schedule - 1/1/2017
11921 Y $183.67 General Fee Schedule - 1/1/2017
11950 Y $67.55 General Fee Schedule - 1/1/2017
11951 Y $90.69 General Fee Schedule - 1/1/2017
11960 Y $752.09 General Fee Schedule - 12/1/2009
11970 Y $518.95 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 4 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
11971 Y $406.20 General Fee Schedule - 12/1/2009
11976 Y $134.85 General Fee Schedule - 12/1/2009
11980 Y $98.59 General Fee Schedule - 12/1/2009
11981 Y $119.47 General Fee Schedule - 12/1/2009
11982 Y $141.34 General Fee Schedule - 12/1/2009
11983 Y $205.17 General Fee Schedule - 8/1/2016
12001 Y $81.18 General Fee Schedule - 1/1/2017
12002 Y $99.35 General Fee Schedule - 1/1/2017
12004 Y $117.59 General Fee Schedule - 1/1/2017
12005 Y $149.10 General Fee Schedule - 1/1/2017
12006 Y $177.12 General Fee Schedule - 1/1/2017
12007 Y $207.97 General Fee Schedule - 1/1/2017
12011 Y $99.78 General Fee Schedule - 1/1/2017
12013 Y $104.68 General Fee Schedule - 1/1/2017
12014 Y $123.06 General Fee Schedule - 1/1/2017
12015 Y $149.43 General Fee Schedule - 1/1/2017
12016 Y $190.31 General Fee Schedule - 1/1/2017
12017 Y $149.32 General Fee Schedule - 1/1/2017
12018 Y $169.25 General Fee Schedule - 1/1/2017
12020 Y $242.62 General Fee Schedule - 12/1/2009
12021 Y $141.97 General Fee Schedule - 12/1/2009
12031 Y $167.26 General Fee Schedule - 12/1/2009
12032 Y $232.67 General Fee Schedule - 12/1/2009
12034 Y $230.91 General Fee Schedule - 12/1/2009
12035 Y $323.85 General Fee Schedule - 12/1/2009
12036 Y $365.64 General Fee Schedule - 12/1/2009
12037 Y $411.86 General Fee Schedule - 12/1/2009
12041 Y $185.35 General Fee Schedule - 12/1/2009
12042 Y $223.59 General Fee Schedule - 12/1/2009
12044 Y $240.77 General Fee Schedule - 12/1/2009
12045 Y $335.05 General Fee Schedule - 12/1/2009
12046 Y $405.54 General Fee Schedule - 12/1/2009
12047 Y $416.89 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 5 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
12051 Y $214.54 General Fee Schedule - 12/1/2009
12052 Y $223.38 General Fee Schedule - 12/1/2009
12053 Y $239.64 General Fee Schedule - 12/1/2009
12054 Y $265.76 General Fee Schedule - 12/1/2009
12055 Y $339.88 General Fee Schedule - 12/1/2009
12056 Y $454.04 General Fee Schedule - 12/1/2009
12057 Y $459.57 General Fee Schedule - 12/1/2009
13100 Y $268.42 General Fee Schedule - 12/1/2009
13101 Y $319.79 General Fee Schedule - 12/1/2009
13102 Y $92.41 General Fee Schedule - 12/1/2009
13120 Y $278.44 General Fee Schedule - 12/1/2009
13121 Y $341.78 General Fee Schedule - 12/1/2009
13122 Y $112.46 General Fee Schedule - 12/1/2009
13131 Y $304.50 General Fee Schedule - 12/1/2009
13132 Y $425.30 General Fee Schedule - 8/1/2016
13133 Y $147.59 General Fee Schedule - 12/1/2009
13151 Y $346.77 General Fee Schedule - 12/1/2009
13152 Y $446.29 General Fee Schedule - 8/1/2016
13153 Y $166.58 General Fee Schedule - 12/1/2009
13160 Y $702.77 General Fee Schedule - 12/1/2009
14000 Y $516.79 General Fee Schedule - 12/1/2009
14001 Y $678.07 General Fee Schedule - 12/1/2009
14020 Y $571.55 General Fee Schedule - 12/1/2009
14021 Y $758.22 General Fee Schedule - 12/1/2009
14040 Y $627.11 General Fee Schedule - 12/1/2009
14041 Y $831.54 General Fee Schedule - 12/1/2009
14060 Y $652.82 General Fee Schedule - 12/1/2009
14061 Y $898.04 General Fee Schedule - 12/1/2009
14301 Y $964.40 General Fee Schedule - 1/1/2010
14302 Y $206.94 General Fee Schedule - 8/1/2016
14350 Y $635.50 General Fee Schedule - 8/1/2016
15002 Y $257.38 General Fee Schedule - 12/1/2009
15003 Y $57.06 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 6 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
15004 Y $310.86 General Fee Schedule - 12/1/2009
15005 Y $96.75 General Fee Schedule - 12/1/2009
15040 Y $232.28 General Fee Schedule - 8/1/2016
15050 Y $422.54 General Fee Schedule - 12/1/2009
15100 Y $792.21 General Fee Schedule - 8/1/2016
15101 Y $172.59 General Fee Schedule - 1/1/2017
15110 Y $747.15 General Fee Schedule - 8/1/2016
15111 Y $111.46 General Fee Schedule - 1/1/2017
15115 Y $735.08 General Fee Schedule - 12/1/2009
15116 Y $147.81 General Fee Schedule - 1/1/2017
15120 Y $755.67 General Fee Schedule - 8/1/2016
15121 Y $193.41 General Fee Schedule - 1/1/2017
15130 Y $616.61 General Fee Schedule - 8/1/2016
15131 Y $95.34 General Fee Schedule - 1/1/2017
15135 Y $755.25 General Fee Schedule - 8/1/2016
15136 Y $91.47 General Fee Schedule - 8/1/2016
15150 Y $622.22 General Fee Schedule - 8/1/2016
15151 Y $118.15 General Fee Schedule - 1/1/2017
15152 Y $144.94 General Fee Schedule - 1/1/2017
15155 Y $625.99 General Fee Schedule - 8/1/2016
15156 Y $152.98 General Fee Schedule - 1/1/2017
15157 Y $166.36 General Fee Schedule - 1/1/2017
15200 Y $666.27 General Fee Schedule - 12/1/2009
15201 Y $139.68 General Fee Schedule - 8/1/2016
15220 Y $647.73 General Fee Schedule - 12/1/2009
15221 Y $125.98 General Fee Schedule - 8/1/2016
15240 Y $730.57 General Fee Schedule - 12/1/2009
15241 Y $163.62 General Fee Schedule - 12/1/2009
15260 Y $761.95 General Fee Schedule - 12/1/2009
15261 Y $185.76 General Fee Schedule - 12/1/2009
15271 Y $131.68 General Fee Schedule - 8/1/2016
15272 Y $24.96 General Fee Schedule - 8/1/2016
15273 Y $271.95 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 7 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
15274 Y $63.82 General Fee Schedule - 8/1/2016
15275 Y $137.38 General Fee Schedule - 1/1/2017
15276 Y $31.16 General Fee Schedule - 8/1/2016
15277 Y $286.19 General Fee Schedule - 2/3/2012
15278 Y $75.23 General Fee Schedule - 8/1/2016
15570 Y $789.31 General Fee Schedule - 12/1/2009
15572 Y $724.81 General Fee Schedule - 12/1/2009
15574 Y $789.10 General Fee Schedule - 12/1/2009
15576 Y $699.92 General Fee Schedule - 12/1/2009
15600 Y $294.85 General Fee Schedule - 1/1/2017
15610 Y $266.41 General Fee Schedule - 12/1/2009
15620 Y $376.92 General Fee Schedule - 8/1/2016
15630 Y $379.68 General Fee Schedule - 12/1/2009
15650 Y $412.49 General Fee Schedule - 12/1/2009
15730 Y $1,426.74 General Fee Schedule - 1/1/2018
15731 Y $859.02 General Fee Schedule - 12/1/2009
15733 Y $996.26 General Fee Schedule - 1/1/2018
15734 Y $1,341.52 General Fee Schedule - 8/1/2016
15736 Y $1,252.29 General Fee Schedule - 1/1/2017
15738 Y $1,343.06 General Fee Schedule - 8/1/2016
15740 Y $764.48 General Fee Schedule - 12/1/2009
15750 Y $799.23 General Fee Schedule - 12/1/2009
15756 Y $2,134.20 General Fee Schedule - 8/1/2016
15757 Y $2,144.17 General Fee Schedule - 8/1/2016
15758 Y $2,149.98 General Fee Schedule - 8/1/2016
15760 Y $710.42 General Fee Schedule - 12/1/2009
15770 Y $555.54 General Fee Schedule - 12/1/2009
15777 Y $200.32 General Fee Schedule - 8/1/2016
15781 Y $435.83 General Fee Schedule - 12/1/2009
15782 Y $516.37 General Fee Schedule - 12/1/2009
15786 Y $197.19 General Fee Schedule - 12/1/2009
15787 Y $44.16 General Fee Schedule - 1/1/2017
15788 Y $314.89 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 8 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
15789 Y $474.09 General Fee Schedule - 12/1/2009
15792 Y $319.71 General Fee Schedule - 12/1/2009
15793 Y $366.23 General Fee Schedule - 12/1/2009
15819 Y $641.68 General Fee Schedule - 12/1/2009
15830 Y $935.62 General Fee Schedule - 12/1/2009
15834 Y $737.61 General Fee Schedule - 12/1/2009
15840 Y $899.02 General Fee Schedule - 12/1/2009
15841 Y $1,439.02 General Fee Schedule - 8/1/2016
15842 Y $2,419.97 General Fee Schedule - 12/1/2009
15845 Y $831.83 General Fee Schedule - 12/1/2009
15847 Y $0.00 General by Report - 1/1/2007
15850 Y $17.39 General Fee Schedule - 12/1/2009
15851 Y $89.08 General Fee Schedule - 8/1/2016
15852 Y $45.27 General Fee Schedule - 1/1/2017
15860 Y $108.49 General Fee Schedule - 8/1/2016
15920 Y $533.10 General Fee Schedule - 12/1/2009
15922 Y $678.33 General Fee Schedule - 12/1/2009
15931 Y $594.60 General Fee Schedule - 12/1/2009
15933 Y $739.98 General Fee Schedule - 12/1/2009
15934 Y $826.48 General Fee Schedule - 12/1/2009
15935 Y $988.16 General Fee Schedule - 12/1/2009
15936 Y $787.20 General Fee Schedule - 8/1/2016
15937 Y $917.88 General Fee Schedule - 8/1/2016
15940 Y $617.30 General Fee Schedule - 12/1/2009
15941 Y $789.44 General Fee Schedule - 8/1/2016
15944 Y $793.68 General Fee Schedule - 12/1/2009
15945 Y $883.68 General Fee Schedule - 12/1/2009
15946 Y $1,433.93 General Fee Schedule - 12/1/2009
15950 Y $512.48 General Fee Schedule - 12/1/2009
15951 Y $734.27 General Fee Schedule - 12/1/2009
15952 Y $760.16 General Fee Schedule - 12/1/2009
15953 Y $857.38 General Fee Schedule - 12/1/2009
15956 Y $1,044.38 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 9 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
15958 Y $1,053.47 General Fee Schedule - 12/1/2009
15999 Y $764.36 General Fee Schedule - 12/1/2009
16000 Y $63.90 General Fee Schedule - 8/1/2016
16020 Y $74.69 General Fee Schedule - 8/1/2016
16025 Y $133.02 General Fee Schedule - 8/1/2016
16030 Y $163.21 General Fee Schedule - 12/1/2009
16035 Y $187.99 General Fee Schedule - 1/1/2017
16036 Y $78.63 General Fee Schedule - 1/1/2017
17000 Y $57.40 General Fee Schedule - 12/1/2009
17003 Y $5.14 General Fee Schedule - 1/1/2017
17004 Y $137.21 General Fee Schedule - 1/1/2017
17106 Y $314.83 General Fee Schedule - 1/1/2017
17107 Y $400.93 General Fee Schedule - 1/1/2017
17108 Y $593.57 General Fee Schedule - 1/1/2017
17110 Y $82.29 General Fee Schedule - 12/1/2009
17111 Y $94.42 General Fee Schedule - 12/1/2009
17250 Y $63.14 General Fee Schedule - 12/1/2009
17260 Y $80.33 General Fee Schedule - 12/1/2009
17261 Y $102.01 General Fee Schedule - 12/1/2009
17262 Y $127.77 General Fee Schedule - 12/1/2009
17263 Y $142.04 General Fee Schedule - 12/1/2009
17264 Y $154.00 General Fee Schedule - 12/1/2009
17266 Y $179.37 General Fee Schedule - 12/1/2009
17270 Y $110.88 General Fee Schedule - 12/1/2009
17271 Y $120.53 General Fee Schedule - 12/1/2009
17272 Y $139.20 General Fee Schedule - 12/1/2009
17273 Y $157.55 General Fee Schedule - 12/1/2009
17274 Y $191.42 General Fee Schedule - 12/1/2009
17276 Y $230.04 General Fee Schedule - 12/1/2009
17280 Y $102.01 General Fee Schedule - 12/1/2009
17281 Y $134.20 General Fee Schedule - 12/1/2009
17282 Y $155.45 General Fee Schedule - 12/1/2009
17283 Y $193.01 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 10 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
17284 Y $228.71 General Fee Schedule - 12/1/2009
17286 Y $304.93 General Fee Schedule - 12/1/2009
17311 Y $536.86 General Fee Schedule - 12/1/2009
17312 Y $322.31 General Fee Schedule - 12/1/2009
17313 Y $489.94 General Fee Schedule - 12/1/2009
17314 Y $298.51 General Fee Schedule - 12/1/2009
17315 Y $63.83 General Fee Schedule - 12/1/2009
17340 Y $43.74 General Fee Schedule - 12/1/2009
17999 Y $0.00 General by Report - 7/1/1975
19000 Y $99.18 General Fee Schedule - 8/1/2016
19001 Y $25.10 General Fee Schedule - 8/1/2016
19020 Y $370.36 General Fee Schedule - 12/1/2009
19030 Y $149.85 General Fee Schedule - 1/1/2017
19081 Y $614.41 General Fee Schedule - 8/1/2016
19082 Y $491.53 General Fee Schedule - 8/1/2016
19083 Y $609.38 General Fee Schedule - 8/1/2016
19084 Y $484.50 General Fee Schedule - 8/1/2016
19085 Y $917.95 General Fee Schedule - 8/1/2016
19086 Y $725.58 General Fee Schedule - 8/1/2016
19100 Y $126.10 General Fee Schedule - 12/1/2009
19101 Y $290.63 General Fee Schedule - 12/1/2009
19105 Y $1,549.51 General Fee Schedule - 12/1/2009
19110 Y $384.20 General Fee Schedule - 12/1/2009
19112 Y $366.02 General Fee Schedule - 12/1/2009
19120 Y $395.22 General Fee Schedule - 12/1/2009
19125 Y $425.15 General Fee Schedule - 12/1/2009
19126 Y $154.04 General Fee Schedule - 8/1/2016
19260 Y $1,051.54 General Fee Schedule - 12/1/2009
19271 Y $1,435.12 General Fee Schedule - 12/1/2009
19272 Y $1,583.75 General Fee Schedule - 12/1/2009
19281 Y $216.76 General Fee Schedule - 1/1/2017
19282 Y $153.25 General Fee Schedule - 8/1/2016
19283 Y $243.63 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 11 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
19284 Y $183.25 General Fee Schedule - 8/1/2016
19285 Y $421.78 General Fee Schedule - 8/1/2016
19286 Y $366.05 General Fee Schedule - 1/1/2014
19287 Y $763.96 General Fee Schedule - 1/1/2017
19288 Y $617.55 General Fee Schedule - 8/1/2016
19294 Y $159.47 General Fee Schedule - 1/1/2018
19296 Y $3,492.86 General Fee Schedule - 1/1/2017
19297 Y $90.40 General Fee Schedule - 8/1/2016
19298 Y $935.61 General Fee Schedule - 1/1/2017
19300 Y $412.26 General Fee Schedule - 12/1/2009
19301 Y $321.17 General Fee Schedule - 12/1/2009
19302 Y $686.22 General Fee Schedule - 12/1/2009
19303 Y $699.51 General Fee Schedule - 12/1/2009
19304 Y $425.98 General Fee Schedule - 12/1/2009
19305 Y $849.01 General Fee Schedule - 12/1/2009
19306 Y $882.75 General Fee Schedule - 12/1/2009
19307 Y $887.74 General Fee Schedule - 12/1/2009
19316 Y $697.26 General Fee Schedule - 8/1/2016
19318 Y $1,043.01 General Fee Schedule - 8/1/2016
19324 Y $422.20 General Fee Schedule - 12/1/2009
19325 Y $571.80 General Fee Schedule - 8/1/2016
19328 Y $422.50 General Fee Schedule - 12/1/2009
19330 Y $543.24 General Fee Schedule - 12/1/2009
19340 Y $387.38 General Fee Schedule - 12/1/2009
19342 Y $801.17 General Fee Schedule - 12/1/2009
19350 Y $773.89 General Fee Schedule - 1/1/2017
19357 Y $1,337.15 General Fee Schedule - 12/1/2009
19361 Y $1,270.06 General Fee Schedule - 12/1/2009
19364 Y $2,499.30 General Fee Schedule - 8/1/2016
19366 Y $1,276.45 General Fee Schedule - 8/1/2016
19367 Y $1,635.78 General Fee Schedule - 8/1/2016
19368 Y $2,006.02 General Fee Schedule - 8/1/2016
19369 Y $1,859.14 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 12 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
19370 Y $591.82 General Fee Schedule - 12/1/2009
19371 Y $684.89 General Fee Schedule - 12/1/2009
19380 Y $666.46 General Fee Schedule - 12/1/2009
19396 Y $131.11 General Fee Schedule - 12/1/2009
19499 Y $0.00 General by Report - 7/1/1975
20005 Y $267.34 General Fee Schedule - 12/1/2009
20100 Y $559.81 General Fee Schedule - 8/1/2016
20101 Y $342.86 General Fee Schedule - 12/1/2009
20102 Y $424.71 General Fee Schedule - 12/1/2009
20103 Y $503.56 General Fee Schedule - 8/1/2016
20150 Y $805.58 General Fee Schedule - 8/1/2016
20200 Y $168.38 General Fee Schedule - 12/1/2009
20205 Y $235.63 General Fee Schedule - 12/1/2009
20206 Y $210.88 General Fee Schedule - 1/1/2017
20220 Y $152.38 General Fee Schedule - 1/1/2017
20225 Y $468.43 General Fee Schedule - 1/1/2017
20240 Y $148.95 General Fee Schedule - 1/1/2017
20245 Y $497.26 General Fee Schedule - 1/1/2017
20250 Y $349.17 General Fee Schedule - 12/1/2009
20251 Y $380.85 General Fee Schedule - 8/1/2016
20500 Y $96.09 General Fee Schedule - 1/1/2017
20501 Y $106.32 General Fee Schedule - 1/1/2017
20520 Y $178.64 General Fee Schedule - 12/1/2009
20525 Y $447.63 General Fee Schedule - 8/1/2016
20526 Y $71.02 General Fee Schedule - 8/1/2016
20527 Y $72.80 General Fee Schedule - 2/3/2012
20550 Y $54.12 General Fee Schedule - 8/1/2016
20551 Y $52.79 General Fee Schedule - 8/1/2016
20552 Y $49.79 General Fee Schedule - 8/1/2016
20553 Y $56.06 General Fee Schedule - 8/1/2016
20555 Y $247.73 General Fee Schedule - 12/1/2009
20600 Y $44.46 General Fee Schedule - 1/1/2017
20604 Y $67.97 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 13 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
20605 Y $46.77 General Fee Schedule - 1/1/2017
20606 Y $75.38 General Fee Schedule - 8/1/2016
20610 Y $56.37 General Fee Schedule - 1/1/2017
20611 Y $85.09 General Fee Schedule - 1/1/2017
20612 Y $52.60 General Fee Schedule - 8/1/2016
20615 Y $206.82 General Fee Schedule - 8/1/2016
20650 Y $177.92 General Fee Schedule - 12/1/2009
20660 Y $222.03 General Fee Schedule - 12/1/2009
20661 Y $396.19 General Fee Schedule - 12/1/2009
20662 Y $404.22 General Fee Schedule - 1/1/2017
20663 Y $407.38 General Fee Schedule - 12/1/2009
20664 Y $612.55 General Fee Schedule - 12/1/2009
20665 Y $97.37 General Fee Schedule - 1/1/2017
20670 Y $344.21 General Fee Schedule - 1/1/2017
20680 Y $449.90 General Fee Schedule - 12/1/2009
20690 Y $242.14 General Fee Schedule - 12/1/2009
20692 Y $412.72 General Fee Schedule - 12/1/2009
20693 Y $428.73 General Fee Schedule - 8/1/2016
20694 Y $393.77 General Fee Schedule - 1/1/2017
20696 Y $963.44 General Fee Schedule - 12/1/2009
20697 Y $1,030.37 General Fee Schedule - 12/1/2009
20802 Y $2,339.47 General Fee Schedule - 8/1/2016
20805 Y $3,141.62 General Fee Schedule - 8/1/2016
20808 Y $3,900.20 General Fee Schedule - 8/1/2016
20816 Y $1,999.20 General Fee Schedule - 1/1/2017
20822 Y $1,724.20 General Fee Schedule - 1/1/2017
20824 Y $1,978.71 General Fee Schedule - 1/1/2017
20827 Y $1,760.97 General Fee Schedule - 1/1/2017
20838 Y $2,303.62 General Fee Schedule - 8/1/2016
20900 Y $381.97 General Fee Schedule - 1/1/2017
20902 Y $274.76 General Fee Schedule - 1/1/2017
20910 Y $391.95 General Fee Schedule - 8/1/2016
20912 Y $448.77 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 14 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
20920 Y $357.30 General Fee Schedule - 8/1/2016
20922 Y $537.77 General Fee Schedule - 12/1/2009
20924 Y $468.15 General Fee Schedule - 8/1/2016
20926 Y $389.85 General Fee Schedule - 8/1/2016
20930 Y $89.91 General Fee Schedule - 12/1/2009
20931 Y $111.90 General Fee Schedule - 8/1/2016
20936 Y $138.65 General Fee Schedule - 12/1/2009
20937 Y $160.92 General Fee Schedule - 1/1/2017
20938 Y $178.96 General Fee Schedule - 1/1/2017
20939 Y $64.95 General Fee Schedule - 1/1/2018
20950 Y $228.78 General Fee Schedule - 1/1/2017
20955 Y $2,412.86 General Fee Schedule - 8/1/2016
20956 Y $2,500.84 General Fee Schedule - 8/1/2016
20957 Y $2,362.00 General Fee Schedule - 8/1/2016
20962 Y $2,032.69 General Fee Schedule - 1/1/2017
20969 Y $2,661.59 General Fee Schedule - 8/1/2016
20970 Y $2,648.72 General Fee Schedule - 8/1/2016
20972 Y $2,261.51 General Fee Schedule - 1/1/2017
20973 Y $2,542.61 General Fee Schedule - 1/1/2017
20974 Y $55.42 General Fee Schedule - 7/1/2009
20975 Y $161.04 General Fee Schedule - 7/1/2009
20979 Y $48.46 General Fee Schedule - 1/1/2017
20982 Y $2,683.06 General Fee Schedule - 1/1/2017
20983 Y $6,216.33 General Fee Schedule - 8/1/2016
20985 Y $143.05 General Fee Schedule - 1/1/2017
20999 Y $0.00 General by Report - 7/1/1975
21010 Y $672.39 General Fee Schedule - 12/1/2009
21011 Y $283.99 General Fee Schedule - 1/1/2010
21012 Y $296.76 General Fee Schedule - 8/1/2016
21013 Y $443.82 General Fee Schedule - 1/1/2010
21014 Y $458.83 General Fee Schedule - 8/1/2016
21015 Y $399.85 General Fee Schedule - 12/1/2009
21016 Y $927.86 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 15 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
21025 Y $819.42 General Fee Schedule - 8/1/2016
21026 Y $477.33 General Fee Schedule - 12/1/2009
21029 Y $651.51 General Fee Schedule - 12/1/2009
21030 Y $409.37 General Fee Schedule - 12/1/2009
21031 Y $318.98 General Fee Schedule - 12/1/2009
21032 Y $324.81 General Fee Schedule - 12/1/2009
21034 Y $1,180.03 General Fee Schedule - 8/1/2016
21040 Y $411.43 General Fee Schedule - 12/1/2009
21044 Y $784.83 General Fee Schedule - 8/1/2016
21045 Y $1,100.07 General Fee Schedule - 12/1/2009
21046 Y $973.37 General Fee Schedule - 12/1/2009
21047 Y $1,207.02 General Fee Schedule - 8/1/2016
21048 Y $997.77 General Fee Schedule - 12/1/2009
21049 Y $1,147.85 General Fee Schedule - 8/1/2016
21050 Y $758.34 General Fee Schedule - 8/1/2016
21060 Y $707.74 General Fee Schedule - 8/1/2016
21070 Y $579.62 General Fee Schedule - 8/1/2016
21073 Y $269.07 General Fee Schedule - 12/1/2009
21076 Y $969.75 General Fee Schedule - 8/1/2016
21077 Y $2,432.33 General Fee Schedule - 8/1/2016
21079 Y $1,639.78 General Fee Schedule - 8/1/2016
21080 Y $1,817.26 General Fee Schedule - 1/1/2017
21081 Y $1,687.75 General Fee Schedule - 8/1/2016
21082 Y $1,512.99 General Fee Schedule - 8/1/2016
21083 Y $1,428.78 General Fee Schedule - 8/1/2016
21084 Y $1,644.81 General Fee Schedule - 8/1/2016
21085 Y $675.39 General Fee Schedule - 12/1/2009
21086 Y $1,827.53 General Fee Schedule - 8/1/2016
21087 Y $1,803.46 General Fee Schedule - 8/1/2016
21088 Y $1,338.31 General Fee Schedule - 12/1/2009
21089 Y $0.00 General by Report - 1/1/1997
21100 Y $570.02 General Fee Schedule - 12/1/2009
21110 Y $553.92 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 16 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
21116 Y $131.78 General Fee Schedule - 1/1/2017
21120 Y $573.88 General Fee Schedule - 12/1/2009
21121 Y $659.76 General Fee Schedule - 12/1/2009
21122 Y $634.79 General Fee Schedule - 8/1/2016
21123 Y $849.15 General Fee Schedule - 12/1/2009
21125 Y $2,332.48 General Fee Schedule - 12/1/2009
21127 Y $1,950.41 General Fee Schedule - 12/1/2009
21137 Y $689.58 General Fee Schedule - 12/1/2009
21138 Y $822.87 General Fee Schedule - 8/1/2016
21139 Y $908.83 General Fee Schedule - 1/1/2017
21141 Y $1,197.48 General Fee Schedule - 8/1/2016
21142 Y $1,247.39 General Fee Schedule - 12/1/2009
21143 Y $1,303.25 General Fee Schedule - 12/1/2009
21145 Y $1,343.87 General Fee Schedule - 12/1/2009
21146 Y $1,373.94 General Fee Schedule - 8/1/2016
21147 Y $1,419.33 General Fee Schedule - 12/1/2009
21150 Y $1,570.85 General Fee Schedule - 8/1/2016
21151 Y $1,880.04 General Fee Schedule - 8/1/2016
21154 Y $1,973.50 General Fee Schedule - 8/1/2016
21155 Y $2,066.12 General Fee Schedule - 1/1/2017
21159 Y $2,408.68 General Fee Schedule - 1/1/2017
21160 Y $2,875.72 General Fee Schedule - 12/1/2009
21172 Y $1,599.62 General Fee Schedule - 8/1/2016
21175 Y $1,973.78 General Fee Schedule - 8/1/2016
21179 Y $1,381.95 General Fee Schedule - 8/1/2016
21180 Y $1,480.26 General Fee Schedule - 1/1/2017
21181 Y $656.09 General Fee Schedule - 8/1/2016
21182 Y $1,869.43 General Fee Schedule - 1/1/2017
21183 Y $2,141.40 General Fee Schedule - 8/1/2016
21184 Y $2,060.75 General Fee Schedule - 1/1/2017
21188 Y $1,509.03 General Fee Schedule - 8/1/2016
21193 Y $1,125.42 General Fee Schedule - 8/1/2016
21194 Y $1,306.55 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 17 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
21195 Y $1,180.51 General Fee Schedule - 8/1/2016
21196 Y $1,339.14 General Fee Schedule - 12/1/2009
21198 Y $1,031.71 General Fee Schedule - 12/1/2009
21199 Y $977.75 General Fee Schedule - 12/1/2009
21206 Y $1,023.19 General Fee Schedule - 12/1/2009
21208 Y $1,198.32 General Fee Schedule - 12/1/2009
21209 Y $660.87 General Fee Schedule - 12/1/2009
21210 Y $1,292.87 General Fee Schedule - 12/1/2009
21215 Y $1,905.75 General Fee Schedule - 12/1/2009
21230 Y $681.64 General Fee Schedule - 1/1/2017
21235 Y $617.99 General Fee Schedule - 12/1/2009
21240 Y $1,032.51 General Fee Schedule - 12/1/2009
21242 Y $917.44 General Fee Schedule - 8/1/2016
21243 Y $1,512.05 General Fee Schedule - 12/1/2009
21244 Y $915.49 General Fee Schedule - 12/1/2009
21245 Y $992.49 General Fee Schedule - 12/1/2009
21246 Y $804.21 General Fee Schedule - 8/1/2016
21247 Y $1,503.18 General Fee Schedule - 8/1/2016
21248 Y $912.55 General Fee Schedule - 12/1/2009
21249 Y $1,334.91 General Fee Schedule - 12/1/2009
21255 Y $1,229.17 General Fee Schedule - 8/1/2016
21256 Y $1,081.67 General Fee Schedule - 12/1/2009
21260 Y $1,108.61 General Fee Schedule - 12/1/2009
21261 Y $2,016.20 General Fee Schedule - 1/1/2017
21263 Y $1,767.25 General Fee Schedule - 8/1/2016
21267 Y $1,407.36 General Fee Schedule - 8/1/2016
21268 Y $1,692.88 General Fee Schedule - 8/1/2016
21270 Y $818.85 General Fee Schedule - 12/1/2009
21275 Y $757.71 General Fee Schedule - 12/1/2009
21280 Y $450.24 General Fee Schedule - 12/1/2009
21282 Y $297.02 General Fee Schedule - 12/1/2009
21295 Y $151.54 General Fee Schedule - 12/1/2009
21296 Y $343.85 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 18 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
21299 Y $0.00 General by Report - 1/1/1997
21310 Y $102.52 General Fee Schedule - 12/1/2009
21315 Y $208.29 General Fee Schedule - 12/1/2009
21320 Y $211.84 General Fee Schedule - 12/1/2009
21325 Y $433.57 General Fee Schedule - 8/1/2016
21330 Y $537.36 General Fee Schedule - 8/1/2016
21335 Y $660.37 General Fee Schedule - 8/1/2016
21336 Y $569.45 General Fee Schedule - 12/1/2009
21337 Y $324.11 General Fee Schedule - 12/1/2009
21338 Y $677.49 General Fee Schedule - 1/1/2017
21339 Y $721.61 General Fee Schedule - 1/1/2017
21340 Y $713.21 General Fee Schedule - 8/1/2016
21343 Y $1,080.87 General Fee Schedule - 12/1/2009
21344 Y $1,354.15 General Fee Schedule - 8/1/2016
21345 Y $684.28 General Fee Schedule - 12/1/2009
21346 Y $834.83 General Fee Schedule - 8/1/2016
21347 Y $1,052.01 General Fee Schedule - 8/1/2016
21348 Y $1,110.13 General Fee Schedule - 12/1/2009
21355 Y $370.86 General Fee Schedule - 12/1/2009
21356 Y $420.15 General Fee Schedule - 12/1/2009
21360 Y $478.24 General Fee Schedule - 12/1/2009
21365 Y $1,006.47 General Fee Schedule - 12/1/2009
21366 Y $1,113.30 General Fee Schedule - 8/1/2016
21385 Y $644.02 General Fee Schedule - 8/1/2016
21386 Y $629.42 General Fee Schedule - 12/1/2009
21387 Y $690.03 General Fee Schedule - 8/1/2016
21390 Y $689.06 General Fee Schedule - 12/1/2009
21395 Y $848.25 General Fee Schedule - 12/1/2009
21400 Y $148.92 General Fee Schedule - 12/1/2009
21401 Y $396.66 General Fee Schedule - 8/1/2016
21406 Y $484.07 General Fee Schedule - 8/1/2016
21407 Y $575.96 General Fee Schedule - 8/1/2016
21408 Y $798.60 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 19 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
21421 Y $543.69 General Fee Schedule - 12/1/2009
21422 Y $606.99 General Fee Schedule - 8/1/2016
21423 Y $734.05 General Fee Schedule - 8/1/2016
21431 Y $622.89 General Fee Schedule - 12/1/2009
21432 Y $611.10 General Fee Schedule - 8/1/2016
21433 Y $1,570.72 General Fee Schedule - 8/1/2016
21435 Y $1,122.48 General Fee Schedule - 8/1/2016
21436 Y $1,813.01 General Fee Schedule - 12/1/2009
21440 Y $361.11 General Fee Schedule - 12/1/2009
21445 Y $569.06 General Fee Schedule - 12/1/2009
21450 Y $379.40 General Fee Schedule - 12/1/2009
21451 Y $530.49 General Fee Schedule - 12/1/2009
21452 Y $511.57 General Fee Schedule - 8/1/2016
21453 Y $607.75 General Fee Schedule - 12/1/2009
21454 Y $492.29 General Fee Schedule - 12/1/2009
21461 Y $1,185.56 General Fee Schedule - 12/1/2009
21462 Y $1,369.40 General Fee Schedule - 12/1/2009
21465 Y $847.64 General Fee Schedule - 12/1/2009
21470 Y $1,071.60 General Fee Schedule - 12/1/2009
21480 Y $83.10 General Fee Schedule - 8/1/2016
21485 Y $453.36 General Fee Schedule - 12/1/2009
21490 Y $823.20 General Fee Schedule - 8/1/2016
21497 Y $455.86 General Fee Schedule - 12/1/2009
21499 Y $0.00 General by Report - 1/1/1997
21501 Y $382.02 General Fee Schedule - 12/1/2009
21502 Y $481.32 General Fee Schedule - 8/1/2016
21510 Y $425.54 General Fee Schedule - 8/1/2016
21550 Y $207.95 General Fee Schedule - 12/1/2009
21552 Y $399.44 General Fee Schedule - 8/1/2016
21554 Y $656.71 General Fee Schedule - 8/1/2016
21555 Y $361.15 General Fee Schedule - 8/1/2016
21556 Y $377.78 General Fee Schedule - 12/1/2009
21557 Y $563.54 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 20 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
21558 Y $1,235.81 General Fee Schedule - 8/1/2016
21600 Y $496.62 General Fee Schedule - 12/1/2009
21610 Y $973.57 General Fee Schedule - 12/1/2009
21615 Y $599.91 General Fee Schedule - 1/1/2017
21616 Y $730.78 General Fee Schedule - 1/1/2017
21620 Y $480.61 General Fee Schedule - 8/1/2016
21627 Y $493.53 General Fee Schedule - 8/1/2016
21630 Y $1,118.59 General Fee Schedule - 8/1/2016
21632 Y $1,125.08 General Fee Schedule - 8/1/2016
21685 Y $879.99 General Fee Schedule - 12/1/2009
21700 Y $362.80 General Fee Schedule - 1/1/2017
21705 Y $541.40 General Fee Schedule - 1/1/2017
21720 Y $334.85 General Fee Schedule - 12/1/2009
21725 Y $478.22 General Fee Schedule - 8/1/2016
21740 Y $969.61 General Fee Schedule - 8/1/2016
21742 Y $377.02 General Fee Schedule - 12/1/2009
21743 Y $414.72 General Fee Schedule - 12/1/2009
21750 Y $653.88 General Fee Schedule - 8/1/2016
21811 Y $601.07 General Fee Schedule - 8/1/2016
21812 Y $720.97 General Fee Schedule - 8/1/2016
21813 Y $941.97 General Fee Schedule - 1/1/2017
21820 Y $117.58 General Fee Schedule - 12/1/2009
21825 Y $521.69 General Fee Schedule - 8/1/2016
21899 Y $0.00 General by Report - 7/1/1975
21920 Y $196.99 General Fee Schedule - 12/1/2009
21925 Y $371.00 General Fee Schedule - 12/1/2009
21930 Y $411.59 General Fee Schedule - 12/1/2009
21931 Y $418.85 General Fee Schedule - 8/1/2016
21932 Y $601.46 General Fee Schedule - 8/1/2016
21933 Y $664.30 General Fee Schedule - 8/1/2016
21935 Y $992.26 General Fee Schedule - 1/1/2017
21936 Y $1,288.95 General Fee Schedule - 8/1/2016
22010 Y $791.34 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 21 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
22015 Y $784.33 General Fee Schedule - 12/1/2009
22100 Y $707.25 General Fee Schedule - 12/1/2009
22101 Y $709.92 General Fee Schedule - 12/1/2009
22102 Y $692.36 General Fee Schedule - 8/1/2016
22103 Y $135.99 General Fee Schedule - 1/1/2017
22110 Y $900.96 General Fee Schedule - 12/1/2009
22112 Y $899.13 General Fee Schedule - 12/1/2009
22114 Y $902.25 General Fee Schedule - 12/1/2009
22116 Y $136.18 General Fee Schedule - 1/1/2017
22206 Y $1,770.44 General Fee Schedule - 12/1/2009
22207 Y $1,747.57 General Fee Schedule - 12/1/2009
22208 Y $450.40 General Fee Schedule - 12/1/2009
22210 Y $1,634.76 General Fee Schedule - 12/1/2009
22212 Y $1,338.85 General Fee Schedule - 12/1/2009
22214 Y $1,358.84 General Fee Schedule - 12/1/2009
22216 Y $349.27 General Fee Schedule - 1/1/2017
22220 Y $1,466.17 General Fee Schedule - 12/1/2009
22222 Y $1,353.90 General Fee Schedule - 12/1/2009
22224 Y $1,403.63 General Fee Schedule - 8/1/2016
22226 Y $347.50 General Fee Schedule - 1/1/2017
22310 Y $214.22 General Fee Schedule - 12/1/2009
22315 Y $737.18 General Fee Schedule - 12/1/2009
22318 Y $1,470.57 General Fee Schedule - 12/1/2009
22319 Y $1,638.13 General Fee Schedule - 12/1/2009
22325 Y $1,253.50 General Fee Schedule - 12/1/2009
22326 Y $1,343.86 General Fee Schedule - 12/1/2009
22327 Y $1,301.97 General Fee Schedule - 12/1/2009
22328 Y $270.47 General Fee Schedule - 8/1/2016
22505 Y $116.80 General Fee Schedule - 12/1/2009
22510 Y $1,612.06 General Fee Schedule - 8/1/2016
22511 Y $1,595.55 General Fee Schedule - 8/1/2016
22512 Y $895.41 General Fee Schedule - 8/1/2016
22513 Y $6,620.05 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 22 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
22514 Y $6,582.36 General Fee Schedule - 8/1/2016
22515 Y $3,989.68 General Fee Schedule - 8/1/2016
22526 Y $1,668.66 General Fee Schedule - 12/1/2009
22527 Y $1,350.20 General Fee Schedule - 12/1/2009
22532 Y $1,583.52 General Fee Schedule - 12/1/2009
22533 Y $1,466.71 General Fee Schedule - 12/1/2009
22534 Y $345.28 General Fee Schedule - 1/1/2017
22548 Y $1,730.84 General Fee Schedule - 12/1/2009
22551 Y $1,649.28 General Fee Schedule - 8/1/2016
22552 Y $385.64 General Fee Schedule - 8/1/2016
22554 Y $1,212.33 General Fee Schedule - 1/1/2017
22556 Y $1,497.21 General Fee Schedule - 8/1/2016
22558 Y $1,424.02 General Fee Schedule - 12/1/2009
22585 Y $318.07 General Fee Schedule - 1/1/2017
22586 Y $1,509.21 General Fee Schedule - 1/31/2013
22590 Y $1,413.04 General Fee Schedule - 12/1/2009
22595 Y $1,339.90 General Fee Schedule - 12/1/2009
22600 Y $1,134.85 General Fee Schedule - 12/1/2009
22610 Y $1,130.86 General Fee Schedule - 12/1/2009
22612 Y $1,451.01 General Fee Schedule - 12/1/2009
22614 Y $377.55 General Fee Schedule - 1/1/2017
22630 Y $1,433.28 General Fee Schedule - 12/1/2009
22632 Y $308.62 General Fee Schedule - 1/1/2017
22633 Y $1,735.56 General Fee Schedule - 8/1/2016
22634 Y $470.74 General Fee Schedule - 8/1/2016
22800 Y $1,220.54 General Fee Schedule - 8/1/2016
22802 Y $1,992.20 General Fee Schedule - 8/1/2016
22804 Y $2,321.66 General Fee Schedule - 8/1/2016
22808 Y $1,672.50 General Fee Schedule - 8/1/2016
22810 Y $1,895.02 General Fee Schedule - 8/1/2016
22812 Y $2,131.50 General Fee Schedule - 12/1/2009
22818 Y $2,013.36 General Fee Schedule - 8/1/2016
22819 Y $2,357.38 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 23 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
22830 Y $739.53 General Fee Schedule - 8/1/2016
22840 Y $729.32 General Fee Schedule - 1/1/2017
22841 Y $622.25 General Fee Schedule - 12/1/2009
22842 Y $732.84 General Fee Schedule - 1/1/2017
22843 Y $791.50 General Fee Schedule - 1/1/2017
22844 Y $955.70 General Fee Schedule - 1/1/2017
22845 Y $701.23 General Fee Schedule - 1/1/2017
22846 Y $726.81 General Fee Schedule - 1/1/2017
22847 Y $795.93 General Fee Schedule - 1/1/2017
22848 Y $347.61 General Fee Schedule - 1/1/2017
22849 Y $1,200.30 General Fee Schedule - 8/1/2016
22850 Y $650.45 General Fee Schedule - 8/1/2016
22852 Y $620.01 General Fee Schedule - 8/1/2016
22853 Y $261.62 General Fee Schedule - 1/1/2017
22854 Y $338.65 General Fee Schedule - 1/1/2017
22855 Y $994.78 General Fee Schedule - 8/1/2016
22856 Y $1,476.01 General Fee Schedule - 12/1/2009
22857 Y $1,228.13 General Fee Schedule - 12/1/2009
22858 Y $502.15 General Fee Schedule - 8/1/2016
22859 Y $338.65 General Fee Schedule - 1/1/2017
22861 Y $1,793.93 General Fee Schedule - 12/1/2009
22862 Y $1,495.69 General Fee Schedule - 12/1/2009
22864 Y $1,673.73 General Fee Schedule - 12/1/2009
22865 Y $1,456.38 General Fee Schedule - 12/1/2009
22867 Y $963.43 General Fee Schedule - 1/1/2017
22868 Y $244.08 General Fee Schedule - 1/1/2017
22869 Y $525.03 General Fee Schedule - 1/1/2017
22870 Y $142.03 General Fee Schedule - 1/1/2017
22899 Y $0.00 General by Report - 7/1/1975
22900 Y $360.33 General Fee Schedule - 12/1/2009
22901 Y $593.42 General Fee Schedule - 8/1/2016
22902 Y $380.82 General Fee Schedule - 1/1/2010
22903 Y $390.78 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 24 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
22904 Y $971.80 General Fee Schedule - 1/1/2010
22905 Y $1,209.77 General Fee Schedule - 8/1/2016
22999 Y $0.00 General by Report - 7/1/1975
23000 Y $484.13 General Fee Schedule - 12/1/2009
23020 Y $630.73 General Fee Schedule - 8/1/2016
23030 Y $389.17 General Fee Schedule - 8/1/2016
23031 Y $375.78 General Fee Schedule - 8/1/2016
23035 Y $639.89 General Fee Schedule - 8/1/2016
23040 Y $652.59 General Fee Schedule - 8/1/2016
23044 Y $516.59 General Fee Schedule - 8/1/2016
23065 Y $179.78 General Fee Schedule - 12/1/2009
23066 Y $445.23 General Fee Schedule - 12/1/2009
23071 Y $371.20 General Fee Schedule - 8/1/2016
23073 Y $616.08 General Fee Schedule - 8/1/2016
23075 Y $229.64 General Fee Schedule - 12/1/2009
23076 Y $502.91 General Fee Schedule - 8/1/2016
23077 Y $1,051.35 General Fee Schedule - 12/1/2009
23078 Y $1,311.74 General Fee Schedule - 1/1/2010
23100 Y $443.92 General Fee Schedule - 8/1/2016
23101 Y $414.07 General Fee Schedule - 8/1/2016
23105 Y $586.35 General Fee Schedule - 8/1/2016
23106 Y $441.31 General Fee Schedule - 8/1/2016
23107 Y $612.00 General Fee Schedule - 8/1/2016
23120 Y $516.86 General Fee Schedule - 8/1/2016
23125 Y $650.44 General Fee Schedule - 8/1/2016
23130 Y $557.51 General Fee Schedule - 8/1/2016
23140 Y $482.27 General Fee Schedule - 12/1/2009
23145 Y $631.07 General Fee Schedule - 8/1/2016
23146 Y $568.88 General Fee Schedule - 8/1/2016
23150 Y $585.72 General Fee Schedule - 8/1/2016
23155 Y $716.91 General Fee Schedule - 8/1/2016
23156 Y $614.23 General Fee Schedule - 8/1/2016
23170 Y $489.48 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 25 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
23172 Y $495.87 General Fee Schedule - 8/1/2016
23174 Y $682.17 General Fee Schedule - 8/1/2016
23180 Y $632.79 General Fee Schedule - 1/1/2017
23182 Y $613.45 General Fee Schedule - 1/1/2017
23184 Y $708.24 General Fee Schedule - 8/1/2016
23190 Y $510.15 General Fee Schedule - 8/1/2016
23195 Y $674.24 General Fee Schedule - 8/1/2016
23200 Y $831.75 General Fee Schedule - 12/1/2009
23210 Y $859.92 General Fee Schedule - 12/1/2009
23220 Y $1,018.36 General Fee Schedule - 12/1/2009
23330 Y $206.03 General Fee Schedule - 12/1/2009
23333 Y $433.84 General Fee Schedule - 8/1/2016
23334 Y $1,029.27 General Fee Schedule - 8/1/2016
23335 Y $1,229.33 General Fee Schedule - 8/1/2016
23350 Y $117.98 General Fee Schedule - 1/1/2017
23395 Y $1,144.42 General Fee Schedule - 8/1/2016
23397 Y $1,062.18 General Fee Schedule - 8/1/2016
23400 Y $908.89 General Fee Schedule - 8/1/2016
23405 Y $585.96 General Fee Schedule - 8/1/2016
23406 Y $735.87 General Fee Schedule - 8/1/2016
23410 Y $782.07 General Fee Schedule - 1/1/2017
23412 Y $810.34 General Fee Schedule - 1/1/2017
23415 Y $663.46 General Fee Schedule - 1/1/2017
23420 Y $925.97 General Fee Schedule - 8/1/2016
23430 Y $693.69 General Fee Schedule - 8/1/2016
23440 Y $720.09 General Fee Schedule - 8/1/2016
23450 Y $897.14 General Fee Schedule - 8/1/2016
23455 Y $958.44 General Fee Schedule - 8/1/2016
23460 Y $1,031.69 General Fee Schedule - 8/1/2016
23462 Y $1,006.40 General Fee Schedule - 8/1/2016
23465 Y $1,046.55 General Fee Schedule - 8/1/2016
23466 Y $982.45 General Fee Schedule - 8/1/2016
23470 Y $1,137.15 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 26 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
23472 Y $1,377.06 General Fee Schedule - 8/1/2016
23473 Y $1,525.66 General Fee Schedule - 8/1/2016
23474 Y $1,649.08 General Fee Schedule - 8/1/2016
23480 Y $767.11 General Fee Schedule - 8/1/2016
23485 Y $900.23 General Fee Schedule - 8/1/2016
23490 Y $774.08 General Fee Schedule - 8/1/2016
23491 Y $960.38 General Fee Schedule - 8/1/2016
23500 Y $189.25 General Fee Schedule - 12/1/2009
23505 Y $314.44 General Fee Schedule - 12/1/2009
23515 Y $554.79 General Fee Schedule - 12/1/2009
23520 Y $193.04 General Fee Schedule - 12/1/2009
23525 Y $310.24 General Fee Schedule - 12/1/2009
23530 Y $505.85 General Fee Schedule - 8/1/2016
23532 Y $571.95 General Fee Schedule - 8/1/2016
23540 Y $194.35 General Fee Schedule - 12/1/2009
23545 Y $281.33 General Fee Schedule - 12/1/2009
23550 Y $519.39 General Fee Schedule - 8/1/2016
23552 Y $602.41 General Fee Schedule - 8/1/2016
23570 Y $201.91 General Fee Schedule - 12/1/2009
23575 Y $344.12 General Fee Schedule - 12/1/2009
23585 Y $660.92 General Fee Schedule - 12/1/2009
23600 Y $285.80 General Fee Schedule - 12/1/2009
23605 Y $410.74 General Fee Schedule - 8/1/2016
23615 Y $719.82 General Fee Schedule - 12/1/2009
23616 Y $1,189.48 General Fee Schedule - 1/1/2017
23620 Y $230.39 General Fee Schedule - 12/1/2009
23625 Y $330.16 General Fee Schedule - 8/1/2016
23630 Y $554.86 General Fee Schedule - 12/1/2009
23650 Y $270.24 General Fee Schedule - 12/1/2009
23655 Y $342.96 General Fee Schedule - 12/1/2009
23660 Y $530.30 General Fee Schedule - 8/1/2016
23665 Y $379.85 General Fee Schedule - 12/1/2009
23670 Y $586.04 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 27 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
23675 Y $482.45 General Fee Schedule - 8/1/2016
23680 Y $726.34 General Fee Schedule - 12/1/2009
23700 Y $179.63 General Fee Schedule - 8/1/2016
23800 Y $945.02 General Fee Schedule - 8/1/2016
23802 Y $1,082.45 General Fee Schedule - 12/1/2009
23900 Y $1,271.81 General Fee Schedule - 12/1/2009
23920 Y $988.79 General Fee Schedule - 12/1/2009
23921 Y $412.74 General Fee Schedule - 12/1/2009
23929 Y $0.00 General by Report - 7/1/1975
23930 Y $331.58 General Fee Schedule - 8/1/2016
23931 Y $261.89 General Fee Schedule - 1/1/2017
23935 Y $455.02 General Fee Schedule - 8/1/2016
24000 Y $425.93 General Fee Schedule - 8/1/2016
24006 Y $649.74 General Fee Schedule - 8/1/2016
24065 Y $196.40 General Fee Schedule - 12/1/2009
24066 Y $535.11 General Fee Schedule - 12/1/2009
24071 Y $359.77 General Fee Schedule - 8/1/2016
24073 Y $619.02 General Fee Schedule - 8/1/2016
24075 Y $422.60 General Fee Schedule - 12/1/2009
24076 Y $442.34 General Fee Schedule - 12/1/2009
24077 Y $778.25 General Fee Schedule - 12/1/2009
24079 Y $1,208.63 General Fee Schedule - 1/1/2010
24100 Y $374.36 General Fee Schedule - 12/1/2009
24101 Y $456.49 General Fee Schedule - 8/1/2016
24102 Y $567.42 General Fee Schedule - 8/1/2016
24105 Y $310.67 General Fee Schedule - 12/1/2009
24110 Y $535.47 General Fee Schedule - 8/1/2016
24115 Y $649.48 General Fee Schedule - 8/1/2016
24116 Y $803.95 General Fee Schedule - 8/1/2016
24120 Y $477.75 General Fee Schedule - 8/1/2016
24125 Y $552.37 General Fee Schedule - 12/1/2009
24126 Y $577.41 General Fee Schedule - 8/1/2016
24130 Y $464.23 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 28 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
24134 Y $706.42 General Fee Schedule - 8/1/2016
24136 Y $579.42 General Fee Schedule - 8/1/2016
24138 Y $598.72 General Fee Schedule - 8/1/2016
24140 Y $666.86 General Fee Schedule - 1/1/2017
24145 Y $563.53 General Fee Schedule - 1/1/2017
24147 Y $589.91 General Fee Schedule - 1/1/2017
24149 Y $1,027.03 General Fee Schedule - 12/1/2009
24150 Y $934.63 General Fee Schedule - 12/1/2009
24152 Y $704.00 General Fee Schedule - 12/1/2009
24155 Y $774.33 General Fee Schedule - 8/1/2016
24160 Y $583.33 General Fee Schedule - 12/1/2009
24164 Y $473.89 General Fee Schedule - 12/1/2009
24200 Y $184.25 General Fee Schedule - 8/1/2016
24201 Y $504.19 General Fee Schedule - 1/1/2017
24220 Y $145.77 General Fee Schedule - 1/1/2017
24300 Y $362.99 General Fee Schedule - 12/1/2009
24301 Y $701.78 General Fee Schedule - 8/1/2016
24305 Y $535.02 General Fee Schedule - 8/1/2016
24310 Y $437.11 General Fee Schedule - 8/1/2016
24320 Y $696.08 General Fee Schedule - 8/1/2016
24330 Y $668.07 General Fee Schedule - 8/1/2016
24331 Y $738.55 General Fee Schedule - 8/1/2016
24332 Y $539.64 General Fee Schedule - 8/1/2016
24340 Y $567.17 General Fee Schedule - 8/1/2016
24341 Y $623.36 General Fee Schedule - 12/1/2009
24342 Y $734.83 General Fee Schedule - 8/1/2016
24343 Y $636.11 General Fee Schedule - 8/1/2016
24344 Y $975.92 General Fee Schedule - 8/1/2016
24345 Y $632.16 General Fee Schedule - 8/1/2016
24346 Y $969.00 General Fee Schedule - 8/1/2016
24357 Y $329.90 General Fee Schedule - 12/1/2009
24358 Y $388.15 General Fee Schedule - 12/1/2009
24359 Y $478.59 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 29 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
24360 Y $836.74 General Fee Schedule - 8/1/2016
24361 Y $942.01 General Fee Schedule - 8/1/2016
24362 Y $971.91 General Fee Schedule - 8/1/2016
24363 Y $1,287.27 General Fee Schedule - 12/1/2009
24365 Y $594.59 General Fee Schedule - 8/1/2016
24366 Y $636.83 General Fee Schedule - 8/1/2016
24370 Y $1,441.08 General Fee Schedule - 8/1/2016
24371 Y $1,661.48 General Fee Schedule - 8/1/2016
24400 Y $764.62 General Fee Schedule - 8/1/2016
24410 Y $973.49 General Fee Schedule - 8/1/2016
24420 Y $916.66 General Fee Schedule - 8/1/2016
24430 Y $904.52 General Fee Schedule - 12/1/2009
24435 Y $959.51 General Fee Schedule - 12/1/2009
24470 Y $538.34 General Fee Schedule - 1/1/2017
24495 Y $627.90 General Fee Schedule - 8/1/2016
24498 Y $814.62 General Fee Schedule - 8/1/2016
24500 Y $307.57 General Fee Schedule - 12/1/2009
24505 Y $438.30 General Fee Schedule - 8/1/2016
24515 Y $807.22 General Fee Schedule - 8/1/2016
24516 Y $798.35 General Fee Schedule - 8/1/2016
24530 Y $333.12 General Fee Schedule - 12/1/2009
24535 Y $551.66 General Fee Schedule - 8/1/2016
24538 Y $690.37 General Fee Schedule - 8/1/2016
24545 Y $755.83 General Fee Schedule - 12/1/2009
24546 Y $993.13 General Fee Schedule - 1/1/2017
24560 Y $277.00 General Fee Schedule - 12/1/2009
24565 Y $473.34 General Fee Schedule - 12/1/2009
24566 Y $625.27 General Fee Schedule - 12/1/2009
24575 Y $695.03 General Fee Schedule - 1/1/2017
24576 Y $289.59 General Fee Schedule - 12/1/2009
24577 Y $474.11 General Fee Schedule - 8/1/2016
24579 Y $787.30 General Fee Schedule - 8/1/2016
24582 Y $693.69 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 30 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
24586 Y $1,020.50 General Fee Schedule - 8/1/2016
24587 Y $1,007.76 General Fee Schedule - 8/1/2016
24600 Y $333.01 General Fee Schedule - 8/1/2016
24605 Y $423.75 General Fee Schedule - 12/1/2009
24615 Y $659.43 General Fee Schedule - 8/1/2016
24620 Y $499.83 General Fee Schedule - 8/1/2016
24635 Y $639.16 General Fee Schedule - 1/1/2017
24640 Y $113.81 General Fee Schedule - 12/1/2009
24650 Y $225.22 General Fee Schedule - 12/1/2009
24655 Y $382.10 General Fee Schedule - 8/1/2016
24665 Y $595.51 General Fee Schedule - 8/1/2016
24666 Y $670.91 General Fee Schedule - 8/1/2016
24670 Y $253.26 General Fee Schedule - 12/1/2009
24675 Y $399.25 General Fee Schedule - 8/1/2016
24685 Y $623.94 General Fee Schedule - 8/1/2016
24800 Y $756.59 General Fee Schedule - 8/1/2016
24802 Y $927.29 General Fee Schedule - 8/1/2016
24900 Y $665.42 General Fee Schedule - 12/1/2009
24920 Y $661.75 General Fee Schedule - 12/1/2009
24925 Y $499.90 General Fee Schedule - 8/1/2016
24930 Y $701.12 General Fee Schedule - 12/1/2009
24931 Y $721.93 General Fee Schedule - 8/1/2016
24935 Y $948.67 General Fee Schedule - 12/1/2009
24940 Y $565.66 General Fee Schedule - 12/1/2009
24999 Y $0.00 General by Report - 7/1/1975
25000 Y $316.14 General Fee Schedule - 1/1/2017
25001 Y $294.25 General Fee Schedule - 12/1/2009
25020 Y $540.84 General Fee Schedule - 1/1/2017
25023 Y $1,039.16 General Fee Schedule - 8/1/2016
25024 Y $669.72 General Fee Schedule - 12/1/2009
25025 Y $1,042.90 General Fee Schedule - 12/1/2009
25028 Y $489.89 General Fee Schedule - 8/1/2016
25031 Y $337.65 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 31 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
25035 Y $549.95 General Fee Schedule - 1/1/2017
25040 Y $544.41 General Fee Schedule - 8/1/2016
25065 Y $192.57 General Fee Schedule - 12/1/2009
25066 Y $337.14 General Fee Schedule - 1/1/2017
25071 Y $376.47 General Fee Schedule - 8/1/2016
25073 Y $467.92 General Fee Schedule - 8/1/2016
25075 Y $365.31 General Fee Schedule - 12/1/2009
25076 Y $491.86 General Fee Schedule - 1/1/2017
25077 Y $806.73 General Fee Schedule - 8/1/2016
25078 Y $1,053.63 General Fee Schedule - 1/1/2010
25085 Y $425.14 General Fee Schedule - 1/1/2017
25100 Y $324.28 General Fee Schedule - 1/1/2017
25101 Y $379.76 General Fee Schedule - 1/1/2017
25105 Y $457.23 General Fee Schedule - 1/1/2017
25107 Y $545.50 General Fee Schedule - 8/1/2016
25109 Y $408.21 General Fee Schedule - 12/1/2009
25110 Y $322.71 General Fee Schedule - 1/1/2017
25111 Y $297.63 General Fee Schedule - 8/1/2016
25112 Y $363.92 General Fee Schedule - 8/1/2016
25115 Y $722.75 General Fee Schedule - 1/1/2017
25116 Y $568.08 General Fee Schedule - 1/1/2017
25118 Y $360.61 General Fee Schedule - 1/1/2017
25119 Y $468.43 General Fee Schedule - 1/1/2017
25120 Y $471.09 General Fee Schedule - 1/1/2017
25125 Y $549.50 General Fee Schedule - 1/1/2017
25126 Y $563.72 General Fee Schedule - 1/1/2017
25130 Y $422.06 General Fee Schedule - 1/1/2017
25135 Y $524.87 General Fee Schedule - 8/1/2016
25136 Y $472.26 General Fee Schedule - 8/1/2016
25145 Y $490.70 General Fee Schedule - 1/1/2017
25150 Y $539.24 General Fee Schedule - 1/1/2017
25151 Y $553.24 General Fee Schedule - 1/1/2017
25170 Y $1,008.49 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 32 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
25210 Y $461.59 General Fee Schedule - 1/1/2017
25215 Y $586.42 General Fee Schedule - 1/1/2017
25230 Y $409.84 General Fee Schedule - 1/1/2017
25240 Y $404.22 General Fee Schedule - 1/1/2017
25246 Y $147.47 General Fee Schedule - 1/1/2017
25248 Y $393.93 General Fee Schedule - 1/1/2017
25250 Y $478.84 General Fee Schedule - 8/1/2016
25251 Y $657.00 General Fee Schedule - 8/1/2016
25259 Y $362.30 General Fee Schedule - 12/1/2009
25260 Y $598.15 General Fee Schedule - 1/1/2017
25263 Y $589.85 General Fee Schedule - 1/1/2017
25265 Y $712.64 General Fee Schedule - 1/1/2017
25270 Y $463.20 General Fee Schedule - 1/1/2017
25272 Y $524.49 General Fee Schedule - 1/1/2017
25274 Y $632.16 General Fee Schedule - 1/1/2017
25275 Y $607.83 General Fee Schedule - 8/1/2016
25280 Y $534.16 General Fee Schedule - 1/1/2017
25290 Y $414.03 General Fee Schedule - 1/1/2017
25295 Y $496.80 General Fee Schedule - 1/1/2017
25300 Y $645.89 General Fee Schedule - 8/1/2016
25301 Y $619.24 General Fee Schedule - 8/1/2016
25310 Y $587.09 General Fee Schedule - 1/1/2017
25312 Y $679.15 General Fee Schedule - 1/1/2017
25315 Y $736.56 General Fee Schedule - 1/1/2017
25316 Y $875.13 General Fee Schedule - 1/1/2017
25320 Y $861.53 General Fee Schedule - 12/1/2009
25332 Y $785.13 General Fee Schedule - 8/1/2016
25335 Y $769.65 General Fee Schedule - 1/1/2017
25337 Y $794.66 General Fee Schedule - 8/1/2016
25350 Y $641.55 General Fee Schedule - 1/1/2017
25355 Y $716.99 General Fee Schedule - 1/1/2017
25360 Y $620.38 General Fee Schedule - 1/1/2017
25365 Y $871.09 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 33 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
25370 Y $964.27 General Fee Schedule - 1/1/2017
25375 Y $912.63 General Fee Schedule - 1/1/2017
25390 Y $733.26 General Fee Schedule - 1/1/2017
25391 Y $955.31 General Fee Schedule - 1/1/2017
25392 Y $830.53 General Fee Schedule - 1/1/2017
25393 Y $1,092.63 General Fee Schedule - 1/1/2017
25394 Y $702.93 General Fee Schedule - 8/1/2016
25400 Y $766.71 General Fee Schedule - 1/1/2017
25405 Y $991.18 General Fee Schedule - 1/1/2017
25415 Y $921.59 General Fee Schedule - 1/1/2017
25420 Y $1,119.64 General Fee Schedule - 1/1/2017
25425 Y $922.78 General Fee Schedule - 1/1/2017
25426 Y $1,080.03 General Fee Schedule - 1/1/2017
25430 Y $652.51 General Fee Schedule - 12/1/2009
25431 Y $725.88 General Fee Schedule - 8/1/2016
25440 Y $731.42 General Fee Schedule - 1/1/2017
25441 Y $875.57 General Fee Schedule - 8/1/2016
25442 Y $744.89 General Fee Schedule - 8/1/2016
25443 Y $718.92 General Fee Schedule - 8/1/2016
25444 Y $766.91 General Fee Schedule - 8/1/2016
25445 Y $673.36 General Fee Schedule - 8/1/2016
25446 Y $1,087.19 General Fee Schedule - 8/1/2016
25447 Y $752.29 General Fee Schedule - 12/1/2009
25449 Y $961.15 General Fee Schedule - 8/1/2016
25450 Y $491.66 General Fee Schedule - 1/1/2017
25455 Y $582.84 General Fee Schedule - 1/1/2017
25490 Y $684.38 General Fee Schedule - 1/1/2017
25491 Y $706.37 General Fee Schedule - 1/1/2017
25492 Y $865.09 General Fee Schedule - 1/1/2017
25500 Y $229.22 General Fee Schedule - 12/1/2009
25505 Y $438.14 General Fee Schedule - 8/1/2016
25515 Y $638.36 General Fee Schedule - 8/1/2016
25520 Y $493.54 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 34 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
25525 Y $746.91 General Fee Schedule - 1/1/2017
25526 Y $907.72 General Fee Schedule - 1/1/2017
25530 Y $221.49 General Fee Schedule - 12/1/2009
25535 Y $435.21 General Fee Schedule - 12/1/2009
25545 Y $590.47 General Fee Schedule - 1/1/2017
25560 Y $232.96 General Fee Schedule - 12/1/2009
25565 Y $459.96 General Fee Schedule - 8/1/2016
25574 Y $559.18 General Fee Schedule - 12/1/2009
25575 Y $791.73 General Fee Schedule - 12/1/2009
25600 Y $256.40 General Fee Schedule - 12/1/2009
25605 Y $486.36 General Fee Schedule - 8/1/2016
25606 Y $554.11 General Fee Schedule - 12/1/2009
25607 Y $560.63 General Fee Schedule - 12/1/2009
25608 Y $642.11 General Fee Schedule - 12/1/2009
25609 Y $819.64 General Fee Schedule - 12/1/2009
25622 Y $261.43 General Fee Schedule - 12/1/2009
25624 Y $417.10 General Fee Schedule - 12/1/2009
25628 Y $640.75 General Fee Schedule - 12/1/2009
25630 Y $270.16 General Fee Schedule - 12/1/2009
25635 Y $382.73 General Fee Schedule - 8/1/2016
25645 Y $526.64 General Fee Schedule - 8/1/2016
25650 Y $281.17 General Fee Schedule - 12/1/2009
25651 Y $424.51 General Fee Schedule - 12/1/2009
25652 Y $552.10 General Fee Schedule - 8/1/2016
25660 Y $364.98 General Fee Schedule - 12/1/2009
25670 Y $565.96 General Fee Schedule - 8/1/2016
25671 Y $477.00 General Fee Schedule - 12/1/2009
25675 Y $379.59 General Fee Schedule - 8/1/2016
25676 Y $582.58 General Fee Schedule - 8/1/2016
25680 Y $420.39 General Fee Schedule - 12/1/2009
25685 Y $672.12 General Fee Schedule - 8/1/2016
25690 Y $414.04 General Fee Schedule - 8/1/2016
25695 Y $586.13 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 35 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
25800 Y $696.98 General Fee Schedule - 1/1/2017
25805 Y $814.81 General Fee Schedule - 8/1/2016
25810 Y $772.68 General Fee Schedule - 8/1/2016
25820 Y $574.81 General Fee Schedule - 8/1/2016
25825 Y $694.23 General Fee Schedule - 8/1/2016
25830 Y $898.37 General Fee Schedule - 8/1/2016
25900 Y $675.48 General Fee Schedule - 1/1/2017
25905 Y $622.53 General Fee Schedule - 1/1/2017
25907 Y $554.08 General Fee Schedule - 1/1/2017
25909 Y $653.40 General Fee Schedule - 1/1/2017
25915 Y $1,133.83 General Fee Schedule - 1/1/2017
25920 Y $624.70 General Fee Schedule - 8/1/2016
25922 Y $544.09 General Fee Schedule - 8/1/2016
25924 Y $578.65 General Fee Schedule - 1/1/2017
25927 Y $752.71 General Fee Schedule - 8/1/2016
25929 Y $533.62 General Fee Schedule - 12/1/2009
25931 Y $626.97 General Fee Schedule - 1/1/2017
25999 Y $0.00 General by Report - 7/1/1975
26010 Y $238.65 General Fee Schedule - 1/1/2017
26011 Y $355.40 General Fee Schedule - 1/1/2017
26020 Y $388.94 General Fee Schedule - 12/1/2009
26025 Y $372.05 General Fee Schedule - 8/1/2016
26030 Y $438.54 General Fee Schedule - 8/1/2016
26034 Y $473.35 General Fee Schedule - 8/1/2016
26035 Y $687.60 General Fee Schedule - 12/1/2009
26037 Y $514.14 General Fee Schedule - 8/1/2016
26040 Y $274.41 General Fee Schedule - 8/1/2016
26045 Y $422.53 General Fee Schedule - 8/1/2016
26055 Y $509.73 General Fee Schedule - 1/1/2017
26060 Y $234.74 General Fee Schedule - 8/1/2016
26070 Y $274.01 General Fee Schedule - 12/1/2009
26075 Y $293.97 General Fee Schedule - 12/1/2009
26080 Y $338.36 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 36 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
26100 Y $289.60 General Fee Schedule - 8/1/2016
26105 Y $296.03 General Fee Schedule - 8/1/2016
26110 Y $281.13 General Fee Schedule - 8/1/2016
26111 Y $378.48 General Fee Schedule - 1/1/2010
26113 Y $497.82 General Fee Schedule - 1/1/2010
26115 Y $466.01 General Fee Schedule - 1/1/2017
26116 Y $448.19 General Fee Schedule - 12/1/2009
26117 Y $615.56 General Fee Schedule - 12/1/2009
26118 Y $942.12 General Fee Schedule - 8/1/2016
26121 Y $547.24 General Fee Schedule - 8/1/2016
26123 Y $711.61 General Fee Schedule - 12/1/2009
26125 Y $266.54 General Fee Schedule - 1/1/2017
26130 Y $407.81 General Fee Schedule - 8/1/2016
26135 Y $506.01 General Fee Schedule - 8/1/2016
26140 Y $457.95 General Fee Schedule - 8/1/2016
26145 Y $465.48 General Fee Schedule - 8/1/2016
26160 Y $525.57 General Fee Schedule - 1/1/2017
26170 Y $361.96 General Fee Schedule - 8/1/2016
26180 Y $395.91 General Fee Schedule - 8/1/2016
26185 Y $437.37 General Fee Schedule - 12/1/2009
26200 Y $409.49 General Fee Schedule - 8/1/2016
26205 Y $551.86 General Fee Schedule - 8/1/2016
26210 Y $395.45 General Fee Schedule - 8/1/2016
26215 Y $503.28 General Fee Schedule - 8/1/2016
26230 Y $462.60 General Fee Schedule - 8/1/2016
26235 Y $452.11 General Fee Schedule - 8/1/2016
26236 Y $399.13 General Fee Schedule - 8/1/2016
26250 Y $548.83 General Fee Schedule - 12/1/2009
26260 Y $518.13 General Fee Schedule - 12/1/2009
26262 Y $432.04 General Fee Schedule - 12/1/2009
26320 Y $308.66 General Fee Schedule - 8/1/2016
26340 Y $277.39 General Fee Schedule - 12/1/2009
26341 Y $89.67 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 37 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
26350 Y $654.77 General Fee Schedule - 1/1/2017
26352 Y $754.20 General Fee Schedule - 1/1/2017
26356 Y $813.96 General Fee Schedule - 1/1/2017
26357 Y $812.35 General Fee Schedule - 1/1/2017
26358 Y $903.98 General Fee Schedule - 1/1/2017
26370 Y $698.99 General Fee Schedule - 1/1/2017
26372 Y $811.52 General Fee Schedule - 1/1/2017
26373 Y $779.30 General Fee Schedule - 1/1/2017
26390 Y $778.93 General Fee Schedule - 1/1/2017
26392 Y $897.36 General Fee Schedule - 1/1/2017
26410 Y $519.04 General Fee Schedule - 1/1/2017
26412 Y $629.07 General Fee Schedule - 1/1/2017
26415 Y $708.25 General Fee Schedule - 1/1/2017
26416 Y $671.74 General Fee Schedule - 1/1/2017
26418 Y $528.18 General Fee Schedule - 1/1/2017
26420 Y $653.47 General Fee Schedule - 1/1/2017
26426 Y $475.41 General Fee Schedule - 1/1/2017
26428 Y $695.58 General Fee Schedule - 1/1/2017
26432 Y $457.20 General Fee Schedule - 1/1/2017
26433 Y $488.58 General Fee Schedule - 1/1/2017
26434 Y $594.89 General Fee Schedule - 1/1/2017
26437 Y $575.53 General Fee Schedule - 1/1/2017
26440 Y $568.71 General Fee Schedule - 1/1/2017
26442 Y $867.34 General Fee Schedule - 8/1/2016
26445 Y $527.73 General Fee Schedule - 1/1/2017
26449 Y $657.86 General Fee Schedule - 1/1/2017
26450 Y $374.98 General Fee Schedule - 1/1/2017
26455 Y $368.54 General Fee Schedule - 1/1/2017
26460 Y $362.80 General Fee Schedule - 1/1/2017
26471 Y $565.89 General Fee Schedule - 1/1/2017
26474 Y $552.19 General Fee Schedule - 1/1/2017
26476 Y $536.39 General Fee Schedule - 1/1/2017
26477 Y $535.97 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 38 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
26478 Y $571.98 General Fee Schedule - 1/1/2017
26479 Y $568.67 General Fee Schedule - 1/1/2017
26480 Y $690.31 General Fee Schedule - 1/1/2017
26483 Y $779.50 General Fee Schedule - 1/1/2017
26485 Y $744.95 General Fee Schedule - 1/1/2017
26489 Y $792.65 General Fee Schedule - 8/1/2016
26490 Y $730.99 General Fee Schedule - 1/1/2017
26492 Y $816.36 General Fee Schedule - 1/1/2017
26494 Y $731.41 General Fee Schedule - 1/1/2017
26496 Y $799.60 General Fee Schedule - 1/1/2017
26497 Y $806.41 General Fee Schedule - 1/1/2017
26498 Y $1,073.72 General Fee Schedule - 1/1/2017
26499 Y $771.78 General Fee Schedule - 1/1/2017
26500 Y $575.30 General Fee Schedule - 1/1/2017
26502 Y $648.79 General Fee Schedule - 1/1/2017
26508 Y $590.96 General Fee Schedule - 1/1/2017
26510 Y $545.13 General Fee Schedule - 1/1/2017
26516 Y $645.83 General Fee Schedule - 1/1/2017
26517 Y $764.07 General Fee Schedule - 1/1/2017
26518 Y $771.66 General Fee Schedule - 1/1/2017
26520 Y $597.36 General Fee Schedule - 1/1/2017
26525 Y $598.14 General Fee Schedule - 1/1/2017
26530 Y $484.48 General Fee Schedule - 8/1/2016
26531 Y $566.21 General Fee Schedule - 8/1/2016
26535 Y $354.79 General Fee Schedule - 12/1/2009
26536 Y $610.06 General Fee Schedule - 12/1/2009
26540 Y $607.48 General Fee Schedule - 1/1/2017
26541 Y $743.67 General Fee Schedule - 1/1/2017
26542 Y $626.72 General Fee Schedule - 1/1/2017
26545 Y $638.68 General Fee Schedule - 1/1/2017
26546 Y $873.23 General Fee Schedule - 8/1/2016
26548 Y $705.09 General Fee Schedule - 1/1/2017
26550 Y $1,446.63 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 39 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
26551 Y $2,713.80 General Fee Schedule - 1/1/2017
26553 Y $2,645.40 General Fee Schedule - 12/1/2009
26554 Y $3,158.64 General Fee Schedule - 1/1/2017
26555 Y $1,267.09 General Fee Schedule - 1/1/2017
26556 Y $2,714.76 General Fee Schedule - 1/1/2017
26560 Y $517.39 General Fee Schedule - 1/1/2017
26561 Y $858.88 General Fee Schedule - 8/1/2016
26562 Y $1,194.03 General Fee Schedule - 8/1/2016
26565 Y $626.29 General Fee Schedule - 1/1/2017
26567 Y $630.39 General Fee Schedule - 1/1/2017
26568 Y $832.62 General Fee Schedule - 1/1/2017
26580 Y $1,247.69 General Fee Schedule - 12/1/2009
26587 Y $874.31 General Fee Schedule - 8/1/2016
26590 Y $1,215.73 General Fee Schedule - 8/1/2016
26591 Y $397.81 General Fee Schedule - 1/1/2017
26593 Y $553.56 General Fee Schedule - 1/1/2017
26596 Y $669.57 General Fee Schedule - 8/1/2016
26600 Y $209.96 General Fee Schedule - 12/1/2009
26605 Y $283.40 General Fee Schedule - 12/1/2009
26607 Y $433.83 General Fee Schedule - 8/1/2016
26608 Y $433.51 General Fee Schedule - 8/1/2016
26615 Y $417.20 General Fee Schedule - 12/1/2009
26641 Y $321.97 General Fee Schedule - 12/1/2009
26645 Y $370.33 General Fee Schedule - 12/1/2009
26650 Y $449.56 General Fee Schedule - 1/1/2017
26665 Y $551.05 General Fee Schedule - 12/1/2009
26670 Y $301.71 General Fee Schedule - 12/1/2009
26675 Y $393.28 General Fee Schedule - 12/1/2009
26676 Y $454.90 General Fee Schedule - 8/1/2016
26685 Y $517.59 General Fee Schedule - 12/1/2009
26686 Y $562.41 General Fee Schedule - 8/1/2016
26700 Y $283.20 General Fee Schedule - 12/1/2009
26705 Y $367.31 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 40 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
26706 Y $383.84 General Fee Schedule - 8/1/2016
26715 Y $441.94 General Fee Schedule - 12/1/2009
26720 Y $167.89 General Fee Schedule - 12/1/2009
26725 Y $298.08 General Fee Schedule - 8/1/2016
26727 Y $426.70 General Fee Schedule - 8/1/2016
26735 Y $453.96 General Fee Schedule - 12/1/2009
26740 Y $193.10 General Fee Schedule - 12/1/2009
26742 Y $325.85 General Fee Schedule - 8/1/2016
26746 Y $446.35 General Fee Schedule - 12/1/2009
26750 Y $158.47 General Fee Schedule - 12/1/2009
26755 Y $274.40 General Fee Schedule - 8/1/2016
26756 Y $374.50 General Fee Schedule - 8/1/2016
26765 Y $334.02 General Fee Schedule - 12/1/2009
26770 Y $233.91 General Fee Schedule - 8/1/2016
26775 Y $339.84 General Fee Schedule - 12/1/2009
26776 Y $400.89 General Fee Schedule - 8/1/2016
26785 Y $341.04 General Fee Schedule - 12/1/2009
26820 Y $728.64 General Fee Schedule - 1/1/2017
26841 Y $670.42 General Fee Schedule - 1/1/2017
26842 Y $727.78 General Fee Schedule - 1/1/2017
26843 Y $684.70 General Fee Schedule - 1/1/2017
26844 Y $758.73 General Fee Schedule - 1/1/2017
26850 Y $640.25 General Fee Schedule - 1/1/2017
26852 Y $737.65 General Fee Schedule - 1/1/2017
26860 Y $518.72 General Fee Schedule - 1/1/2017
26861 Y $100.51 General Fee Schedule - 1/1/2017
26862 Y $672.69 General Fee Schedule - 1/1/2017
26863 Y $223.96 General Fee Schedule - 1/1/2017
26910 Y $669.36 General Fee Schedule - 1/1/2017
26951 Y $549.83 General Fee Schedule - 12/1/2009
26952 Y $597.56 General Fee Schedule - 1/1/2017
26989 Y $0.00 General by Report - 7/1/1975
26990 Y $554.89 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 41 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
26991 Y $651.75 General Fee Schedule - 8/1/2016
26992 Y $895.49 General Fee Schedule - 8/1/2016
27000 Y $381.77 General Fee Schedule - 1/1/2017
27001 Y $498.73 General Fee Schedule - 8/1/2016
27003 Y $522.39 General Fee Schedule - 8/1/2016
27005 Y $672.30 General Fee Schedule - 8/1/2016
27006 Y $677.31 General Fee Schedule - 8/1/2016
27025 Y $786.96 General Fee Schedule - 12/1/2009
27027 Y $759.47 General Fee Schedule - 12/1/2009
27030 Y $874.12 General Fee Schedule - 8/1/2016
27033 Y $899.39 General Fee Schedule - 8/1/2016
27035 Y $1,058.72 General Fee Schedule - 8/1/2016
27036 Y $917.85 General Fee Schedule - 12/1/2009
27040 Y $299.85 General Fee Schedule - 12/1/2009
27041 Y $629.76 General Fee Schedule - 8/1/2016
27043 Y $418.23 General Fee Schedule - 8/1/2016
27045 Y $665.04 General Fee Schedule - 8/1/2016
27047 Y $436.24 General Fee Schedule - 1/1/2017
27048 Y $437.31 General Fee Schedule - 12/1/2009
27049 Y $885.92 General Fee Schedule - 12/1/2009
27050 Y $340.31 General Fee Schedule - 12/1/2009
27052 Y $479.38 General Fee Schedule - 12/1/2009
27054 Y $606.73 General Fee Schedule - 8/1/2016
27057 Y $834.05 General Fee Schedule - 12/1/2009
27059 Y $1,637.44 General Fee Schedule - 8/1/2016
27060 Y $386.80 General Fee Schedule - 12/1/2009
27062 Y $400.69 General Fee Schedule - 8/1/2016
27065 Y $449.17 General Fee Schedule - 12/1/2009
27066 Y $719.45 General Fee Schedule - 8/1/2016
27067 Y $924.11 General Fee Schedule - 8/1/2016
27070 Y $755.26 General Fee Schedule - 8/1/2016
27071 Y $821.17 General Fee Schedule - 8/1/2016
27075 Y $2,024.70 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 42 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27076 Y $1,478.61 General Fee Schedule - 12/1/2009
27077 Y $2,531.25 General Fee Schedule - 12/1/2009
27078 Y $936.03 General Fee Schedule - 12/1/2009
27080 Y $444.10 General Fee Schedule - 12/1/2009
27086 Y $236.93 General Fee Schedule - 12/1/2009
27087 Y $580.40 General Fee Schedule - 8/1/2016
27090 Y $766.32 General Fee Schedule - 8/1/2016
27091 Y $1,466.42 General Fee Schedule - 12/1/2009
27093 Y $169.96 General Fee Schedule - 1/1/2017
27095 Y $219.20 General Fee Schedule - 1/1/2017
27096 Y $148.09 General Fee Schedule - 1/1/2017
27097 Y $589.12 General Fee Schedule - 8/1/2016
27098 Y $589.72 General Fee Schedule - 8/1/2016
27100 Y $756.80 General Fee Schedule - 8/1/2016
27105 Y $794.49 General Fee Schedule - 8/1/2016
27110 Y $863.32 General Fee Schedule - 8/1/2016
27111 Y $814.88 General Fee Schedule - 8/1/2016
27120 Y $1,158.53 General Fee Schedule - 8/1/2016
27122 Y $1,004.74 General Fee Schedule - 8/1/2016
27125 Y $1,018.62 General Fee Schedule - 12/1/2009
27130 Y $1,298.96 General Fee Schedule - 8/1/2016
27132 Y $1,511.61 General Fee Schedule - 8/1/2016
27134 Y $1,805.50 General Fee Schedule - 8/1/2016
27137 Y $1,364.21 General Fee Schedule - 8/1/2016
27138 Y $1,422.02 General Fee Schedule - 8/1/2016
27140 Y $833.05 General Fee Schedule - 8/1/2016
27146 Y $1,142.92 General Fee Schedule - 8/1/2016
27147 Y $1,316.68 General Fee Schedule - 8/1/2016
27151 Y $1,275.64 General Fee Schedule - 12/1/2009
27156 Y $1,580.28 General Fee Schedule - 8/1/2016
27158 Y $1,246.56 General Fee Schedule - 12/1/2009
27161 Y $1,114.59 General Fee Schedule - 8/1/2016
27165 Y $1,240.60 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 43 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27170 Y $1,060.30 General Fee Schedule - 8/1/2016
27175 Y $605.64 General Fee Schedule - 12/1/2009
27176 Y $816.51 General Fee Schedule - 8/1/2016
27177 Y $1,003.52 General Fee Schedule - 8/1/2016
27178 Y $822.83 General Fee Schedule - 12/1/2009
27179 Y $884.18 General Fee Schedule - 8/1/2016
27181 Y $931.53 General Fee Schedule - 8/1/2016
27185 Y $580.04 General Fee Schedule - 1/1/2017
27187 Y $919.76 General Fee Schedule - 8/1/2016
27197 Y $110.11 General Fee Schedule - 1/1/2017
27198 Y $284.96 General Fee Schedule - 1/1/2017
27200 Y $157.04 General Fee Schedule - 12/1/2009
27202 Y $505.05 General Fee Schedule - 1/1/2017
27215 Y $698.28 General Fee Schedule - 12/1/2009
27216 Y $1,005.75 General Fee Schedule - 12/1/2009
27217 Y $975.30 General Fee Schedule - 12/1/2009
27218 Y $1,288.15 General Fee Schedule - 12/1/2009
27220 Y $471.63 General Fee Schedule - 12/1/2009
27222 Y $871.15 General Fee Schedule - 8/1/2016
27226 Y $928.48 General Fee Schedule - 12/1/2009
27227 Y $1,509.24 General Fee Schedule - 8/1/2016
27228 Y $1,740.24 General Fee Schedule - 8/1/2016
27230 Y $416.70 General Fee Schedule - 8/1/2016
27232 Y $692.67 General Fee Schedule - 8/1/2016
27235 Y $831.41 General Fee Schedule - 8/1/2016
27236 Y $1,074.33 General Fee Schedule - 12/1/2009
27238 Y $402.96 General Fee Schedule - 8/1/2016
27240 Y $846.32 General Fee Schedule - 8/1/2016
27244 Y $1,098.09 General Fee Schedule - 12/1/2009
27245 Y $1,183.58 General Fee Schedule - 1/1/2017
27246 Y $347.93 General Fee Schedule - 8/1/2016
27248 Y $717.01 General Fee Schedule - 8/1/2016
27250 Y $176.56 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 44 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27252 Y $684.17 General Fee Schedule - 8/1/2016
27253 Y $874.72 General Fee Schedule - 8/1/2016
27254 Y $1,176.68 General Fee Schedule - 8/1/2016
27256 Y $283.56 General Fee Schedule - 8/1/2016
27257 Y $321.48 General Fee Schedule - 12/1/2009
27258 Y $1,016.82 General Fee Schedule - 8/1/2016
27259 Y $1,386.85 General Fee Schedule - 8/1/2016
27265 Y $365.41 General Fee Schedule - 8/1/2016
27266 Y $528.99 General Fee Schedule - 8/1/2016
27267 Y $310.47 General Fee Schedule - 12/1/2009
27268 Y $383.10 General Fee Schedule - 12/1/2009
27269 Y $916.36 General Fee Schedule - 12/1/2009
27275 Y $166.40 General Fee Schedule - 8/1/2016
27279 Y $563.40 General Fee Schedule - 1/1/2015
27280 Y $955.76 General Fee Schedule - 12/1/2009
27282 Y $744.74 General Fee Schedule - 8/1/2016
27284 Y $1,483.88 General Fee Schedule - 8/1/2016
27286 Y $1,491.54 General Fee Schedule - 8/1/2016
27290 Y $1,438.70 General Fee Schedule - 8/1/2016
27295 Y $1,160.52 General Fee Schedule - 8/1/2016
27299 Y $0.00 General by Report - 7/1/1975
27301 Y $606.57 General Fee Schedule - 8/1/2016
27303 Y $583.94 General Fee Schedule - 8/1/2016
27305 Y $423.40 General Fee Schedule - 8/1/2016
27306 Y $331.51 General Fee Schedule - 1/1/2017
27307 Y $426.52 General Fee Schedule - 8/1/2016
27310 Y $646.31 General Fee Schedule - 8/1/2016
27323 Y $216.80 General Fee Schedule - 12/1/2009
27324 Y $358.10 General Fee Schedule - 12/1/2009
27325 Y $413.84 General Fee Schedule - 12/1/2009
27326 Y $391.11 General Fee Schedule - 12/1/2009
27327 Y $400.03 General Fee Schedule - 12/1/2009
27328 Y $393.59 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 45 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27329 Y $928.78 General Fee Schedule - 12/1/2009
27330 Y $377.97 General Fee Schedule - 12/1/2009
27331 Y $433.42 General Fee Schedule - 8/1/2016
27332 Y $588.17 General Fee Schedule - 8/1/2016
27333 Y $531.79 General Fee Schedule - 8/1/2016
27334 Y $616.30 General Fee Schedule - 8/1/2016
27335 Y $698.71 General Fee Schedule - 8/1/2016
27337 Y $371.75 General Fee Schedule - 8/1/2016
27339 Y $671.51 General Fee Schedule - 8/1/2016
27340 Y $328.59 General Fee Schedule - 8/1/2016
27345 Y $437.52 General Fee Schedule - 8/1/2016
27347 Y $442.81 General Fee Schedule - 12/1/2009
27350 Y $587.74 General Fee Schedule - 8/1/2016
27355 Y $550.05 General Fee Schedule - 8/1/2016
27356 Y $664.30 General Fee Schedule - 8/1/2016
27357 Y $741.05 General Fee Schedule - 8/1/2016
27358 Y $271.03 General Fee Schedule - 1/1/2017
27360 Y $763.89 General Fee Schedule - 8/1/2016
27364 Y $1,407.38 General Fee Schedule - 8/1/2016
27365 Y $1,124.53 General Fee Schedule - 12/1/2009
27370 Y $139.69 General Fee Schedule - 1/1/2017
27372 Y $546.65 General Fee Schedule - 8/1/2016
27380 Y $546.00 General Fee Schedule - 8/1/2016
27381 Y $741.52 General Fee Schedule - 8/1/2016
27385 Y $541.91 General Fee Schedule - 1/1/2017
27386 Y $765.47 General Fee Schedule - 8/1/2016
27390 Y $395.92 General Fee Schedule - 8/1/2016
27391 Y $523.49 General Fee Schedule - 8/1/2016
27392 Y $642.72 General Fee Schedule - 8/1/2016
27393 Y $465.16 General Fee Schedule - 8/1/2016
27394 Y $601.31 General Fee Schedule - 8/1/2016
27395 Y $808.87 General Fee Schedule - 8/1/2016
27396 Y $566.04 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 46 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27397 Y $808.03 General Fee Schedule - 12/1/2009
27400 Y $616.25 General Fee Schedule - 8/1/2016
27403 Y $592.70 General Fee Schedule - 8/1/2016
27405 Y $617.07 General Fee Schedule - 8/1/2016
27407 Y $713.33 General Fee Schedule - 8/1/2016
27409 Y $879.57 General Fee Schedule - 8/1/2016
27412 Y $1,492.80 General Fee Schedule - 8/1/2016
27415 Y $1,243.20 General Fee Schedule - 8/1/2016
27416 Y $718.10 General Fee Schedule - 12/1/2009
27418 Y $757.16 General Fee Schedule - 8/1/2016
27420 Y $687.79 General Fee Schedule - 8/1/2016
27422 Y $685.95 General Fee Schedule - 8/1/2016
27424 Y $686.06 General Fee Schedule - 8/1/2016
27425 Y $404.99 General Fee Schedule - 8/1/2016
27427 Y $657.55 General Fee Schedule - 8/1/2016
27428 Y $1,009.06 General Fee Schedule - 12/1/2009
27429 Y $1,117.81 General Fee Schedule - 12/1/2009
27430 Y $677.59 General Fee Schedule - 8/1/2016
27435 Y $715.32 General Fee Schedule - 12/1/2009
27437 Y $601.14 General Fee Schedule - 8/1/2016
27438 Y $761.40 General Fee Schedule - 8/1/2016
27440 Y $670.11 General Fee Schedule - 12/1/2009
27441 Y $712.22 General Fee Schedule - 12/1/2009
27442 Y $802.98 General Fee Schedule - 8/1/2016
27443 Y $754.87 General Fee Schedule - 8/1/2016
27445 Y $1,163.39 General Fee Schedule - 8/1/2016
27446 Y $1,050.47 General Fee Schedule - 8/1/2016
27447 Y $1,301.36 General Fee Schedule - 1/1/2017
27448 Y $730.58 General Fee Schedule - 1/1/2017
27450 Y $946.26 General Fee Schedule - 8/1/2016
27454 Y $1,165.20 General Fee Schedule - 8/1/2016
27455 Y $874.30 General Fee Schedule - 8/1/2016
27457 Y $902.28 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 47 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27465 Y $970.84 General Fee Schedule - 12/1/2009
27466 Y $1,086.04 General Fee Schedule - 8/1/2016
27468 Y $1,183.57 General Fee Schedule - 1/1/2017
27470 Y $1,075.75 General Fee Schedule - 8/1/2016
27472 Y $1,175.39 General Fee Schedule - 8/1/2016
27475 Y $602.52 General Fee Schedule - 8/1/2016
27477 Y $676.72 General Fee Schedule - 8/1/2016
27479 Y $753.62 General Fee Schedule - 1/1/2017
27485 Y $621.81 General Fee Schedule - 8/1/2016
27486 Y $1,269.07 General Fee Schedule - 8/1/2016
27487 Y $1,626.08 General Fee Schedule - 8/1/2016
27488 Y $1,058.91 General Fee Schedule - 8/1/2016
27495 Y $1,041.33 General Fee Schedule - 8/1/2016
27496 Y $462.06 General Fee Schedule - 12/1/2009
27497 Y $502.68 General Fee Schedule - 12/1/2009
27498 Y $555.25 General Fee Schedule - 12/1/2009
27499 Y $631.96 General Fee Schedule - 12/1/2009
27500 Y $454.63 General Fee Schedule - 8/1/2016
27501 Y $444.11 General Fee Schedule - 8/1/2016
27502 Y $717.53 General Fee Schedule - 8/1/2016
27503 Y $725.45 General Fee Schedule - 8/1/2016
27506 Y $1,215.97 General Fee Schedule - 12/1/2009
27507 Y $922.31 General Fee Schedule - 8/1/2016
27508 Y $460.80 General Fee Schedule - 8/1/2016
27509 Y $592.05 General Fee Schedule - 8/1/2016
27510 Y $630.26 General Fee Schedule - 8/1/2016
27511 Y $952.39 General Fee Schedule - 8/1/2016
27513 Y $1,194.76 General Fee Schedule - 1/1/2017
27514 Y $929.54 General Fee Schedule - 1/1/2017
27516 Y $452.96 General Fee Schedule - 12/1/2009
27517 Y $610.95 General Fee Schedule - 8/1/2016
27519 Y $858.40 General Fee Schedule - 1/1/2017
27520 Y $282.41 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 48 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27524 Y $699.04 General Fee Schedule - 8/1/2016
27530 Y $279.42 General Fee Schedule - 1/1/2017
27532 Y $554.48 General Fee Schedule - 8/1/2016
27535 Y $825.00 General Fee Schedule - 8/1/2016
27536 Y $1,052.28 General Fee Schedule - 8/1/2016
27538 Y $410.08 General Fee Schedule - 8/1/2016
27540 Y $771.83 General Fee Schedule - 1/1/2017
27550 Y $454.65 General Fee Schedule - 12/1/2009
27552 Y $566.55 General Fee Schedule - 8/1/2016
27556 Y $838.75 General Fee Schedule - 1/1/2017
27557 Y $1,011.34 General Fee Schedule - 1/1/2017
27558 Y $1,147.86 General Fee Schedule - 1/1/2017
27560 Y $313.85 General Fee Schedule - 8/1/2016
27562 Y $419.22 General Fee Schedule - 12/1/2009
27566 Y $830.06 General Fee Schedule - 8/1/2016
27570 Y $132.93 General Fee Schedule - 8/1/2016
27580 Y $1,316.15 General Fee Schedule - 8/1/2016
27590 Y $752.72 General Fee Schedule - 12/1/2009
27591 Y $855.28 General Fee Schedule - 12/1/2009
27592 Y $622.08 General Fee Schedule - 8/1/2016
27594 Y $460.13 General Fee Schedule - 8/1/2016
27596 Y $668.59 General Fee Schedule - 8/1/2016
27598 Y $675.56 General Fee Schedule - 8/1/2016
27599 Y $0.00 General by Report - 6/1/1981
27600 Y $386.73 General Fee Schedule - 8/1/2016
27601 Y $394.89 General Fee Schedule - 8/1/2016
27602 Y $477.40 General Fee Schedule - 8/1/2016
27603 Y $472.97 General Fee Schedule - 12/1/2009
27604 Y $404.83 General Fee Schedule - 12/1/2009
27605 Y $313.64 General Fee Schedule - 1/1/2017
27606 Y $268.96 General Fee Schedule - 1/1/2017
27607 Y $541.84 General Fee Schedule - 8/1/2016
27610 Y $585.83 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 49 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27612 Y $509.54 General Fee Schedule - 8/1/2016
27613 Y $201.60 General Fee Schedule - 12/1/2009
27614 Y $489.82 General Fee Schedule - 12/1/2009
27615 Y $869.76 General Fee Schedule - 12/1/2009
27616 Y $1,146.65 General Fee Schedule - 8/1/2016
27618 Y $410.30 General Fee Schedule - 8/1/2016
27619 Y $447.75 General Fee Schedule - 1/1/2017
27620 Y $433.50 General Fee Schedule - 8/1/2016
27625 Y $562.61 General Fee Schedule - 8/1/2016
27626 Y $586.53 General Fee Schedule - 1/1/2017
27630 Y $469.97 General Fee Schedule - 12/1/2009
27632 Y $366.63 General Fee Schedule - 8/1/2016
27634 Y $624.20 General Fee Schedule - 1/1/2010
27635 Y $553.55 General Fee Schedule - 8/1/2016
27637 Y $692.80 General Fee Schedule - 8/1/2016
27638 Y $725.08 General Fee Schedule - 8/1/2016
27640 Y $797.63 General Fee Schedule - 1/1/2017
27641 Y $637.32 General Fee Schedule - 1/1/2017
27645 Y $1,043.00 General Fee Schedule - 12/1/2009
27646 Y $937.37 General Fee Schedule - 12/1/2009
27647 Y $793.36 General Fee Schedule - 12/1/2009
27648 Y $148.53 General Fee Schedule - 1/1/2017
27650 Y $625.15 General Fee Schedule - 1/1/2017
27652 Y $651.49 General Fee Schedule - 1/1/2017
27654 Y $658.27 General Fee Schedule - 8/1/2016
27656 Y $492.58 General Fee Schedule - 12/1/2009
27658 Y $351.63 General Fee Schedule - 1/1/2017
27659 Y $454.92 General Fee Schedule - 1/1/2017
27664 Y $344.78 General Fee Schedule - 8/1/2016
27665 Y $392.92 General Fee Schedule - 8/1/2016
27675 Y $460.79 General Fee Schedule - 1/1/2017
27676 Y $579.58 General Fee Schedule - 8/1/2016
27680 Y $411.45 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 50 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27681 Y $485.39 General Fee Schedule - 8/1/2016
27685 Y $534.29 General Fee Schedule - 12/1/2009
27686 Y $531.15 General Fee Schedule - 8/1/2016
27687 Y $429.19 General Fee Schedule - 1/1/2017
27690 Y $575.86 General Fee Schedule - 8/1/2016
27691 Y $678.79 General Fee Schedule - 8/1/2016
27692 Y $101.01 General Fee Schedule - 1/1/2017
27695 Y $444.00 General Fee Schedule - 1/1/2017
27696 Y $527.57 General Fee Schedule - 1/1/2017
27698 Y $607.28 General Fee Schedule - 1/1/2017
27700 Y $574.33 General Fee Schedule - 8/1/2016
27702 Y $929.18 General Fee Schedule - 8/1/2016
27703 Y $1,048.94 General Fee Schedule - 8/1/2016
27704 Y $508.49 General Fee Schedule - 8/1/2016
27705 Y $712.77 General Fee Schedule - 8/1/2016
27707 Y $364.02 General Fee Schedule - 12/1/2009
27709 Y $722.47 General Fee Schedule - 12/1/2009
27712 Y $1,003.31 General Fee Schedule - 12/1/2009
27715 Y $970.02 General Fee Schedule - 8/1/2016
27720 Y $813.72 General Fee Schedule - 8/1/2016
27722 Y $806.29 General Fee Schedule - 8/1/2016
27724 Y $1,185.64 General Fee Schedule - 8/1/2016
27725 Y $1,103.39 General Fee Schedule - 12/1/2009
27726 Y $673.79 General Fee Schedule - 12/1/2009
27727 Y $939.82 General Fee Schedule - 8/1/2016
27730 Y $542.91 General Fee Schedule - 8/1/2016
27732 Y $384.66 General Fee Schedule - 8/1/2016
27734 Y $589.27 General Fee Schedule - 12/1/2009
27740 Y $661.23 General Fee Schedule - 8/1/2016
27742 Y $649.67 General Fee Schedule - 12/1/2009
27745 Y $699.62 General Fee Schedule - 8/1/2016
27750 Y $305.43 General Fee Schedule - 12/1/2009
27752 Y $468.75 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 51 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27756 Y $502.65 General Fee Schedule - 8/1/2016
27758 Y $801.72 General Fee Schedule - 8/1/2016
27759 Y $927.92 General Fee Schedule - 8/1/2016
27760 Y $293.34 General Fee Schedule - 12/1/2009
27762 Y $431.06 General Fee Schedule - 8/1/2016
27766 Y $579.59 General Fee Schedule - 1/1/2017
27767 Y $186.73 General Fee Schedule - 12/1/2009
27768 Y $293.35 General Fee Schedule - 12/1/2009
27769 Y $508.84 General Fee Schedule - 12/1/2009
27780 Y $259.90 General Fee Schedule - 12/1/2009
27781 Y $367.98 General Fee Schedule - 8/1/2016
27784 Y $538.74 General Fee Schedule - 12/1/2009
27786 Y $278.55 General Fee Schedule - 12/1/2009
27788 Y $375.10 General Fee Schedule - 8/1/2016
27792 Y $579.86 General Fee Schedule - 12/1/2009
27808 Y $289.81 General Fee Schedule - 12/1/2009
27810 Y $422.66 General Fee Schedule - 8/1/2016
27814 Y $738.36 General Fee Schedule - 8/1/2016
27816 Y $276.70 General Fee Schedule - 12/1/2009
27818 Y $440.64 General Fee Schedule - 8/1/2016
27822 Y $799.74 General Fee Schedule - 1/1/2017
27823 Y $910.21 General Fee Schedule - 1/1/2017
27824 Y $266.44 General Fee Schedule - 12/1/2009
27825 Y $480.41 General Fee Schedule - 8/1/2016
27826 Y $683.03 General Fee Schedule - 12/1/2009
27827 Y $1,021.55 General Fee Schedule - 8/1/2016
27828 Y $1,153.00 General Fee Schedule - 8/1/2016
27829 Y $477.14 General Fee Schedule - 12/1/2009
27830 Y $315.19 General Fee Schedule - 12/1/2009
27831 Y $353.88 General Fee Schedule - 12/1/2009
27832 Y $497.63 General Fee Schedule - 12/1/2009
27840 Y $321.36 General Fee Schedule - 12/1/2009
27842 Y $449.50 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 52 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
27846 Y $680.07 General Fee Schedule - 8/1/2016
27848 Y $773.62 General Fee Schedule - 1/1/2017
27860 Y $165.04 General Fee Schedule - 8/1/2016
27870 Y $939.71 General Fee Schedule - 8/1/2016
27871 Y $641.95 General Fee Schedule - 8/1/2016
27880 Y $761.87 General Fee Schedule - 12/1/2009
27881 Y $813.72 General Fee Schedule - 8/1/2016
27882 Y $587.32 General Fee Schedule - 8/1/2016
27884 Y $533.96 General Fee Schedule - 8/1/2016
27886 Y $606.04 General Fee Schedule - 8/1/2016
27888 Y $655.18 General Fee Schedule - 8/1/2016
27889 Y $631.17 General Fee Schedule - 8/1/2016
27892 Y $494.32 General Fee Schedule - 8/1/2016
27893 Y $508.93 General Fee Schedule - 12/1/2009
27894 Y $727.83 General Fee Schedule - 12/1/2009
27899 Y $0.00 General by Report - 7/1/1975
28001 Y $219.14 General Fee Schedule - 12/1/2009
28002 Y $370.19 General Fee Schedule - 12/1/2009
28003 Y $576.90 General Fee Schedule - 12/1/2009
28005 Y $558.90 General Fee Schedule - 8/1/2016
28008 Y $347.18 General Fee Schedule - 12/1/2009
28010 Y $203.54 General Fee Schedule - 12/1/2009
28011 Y $281.39 General Fee Schedule - 8/1/2016
28020 Y $424.32 General Fee Schedule - 12/1/2009
28022 Y $379.67 General Fee Schedule - 12/1/2009
28024 Y $367.77 General Fee Schedule - 12/1/2009
28035 Y $421.23 General Fee Schedule - 12/1/2009
28039 Y $431.49 General Fee Schedule - 1/1/2010
28041 Y $413.57 General Fee Schedule - 1/1/2010
28043 Y $282.93 General Fee Schedule - 12/1/2009
28045 Y $388.10 General Fee Schedule - 12/1/2009
28046 Y $710.48 General Fee Schedule - 8/1/2016
28047 Y $876.98 General Fee Schedule - 1/1/2010
CPT FEES01/03/2018 at 6:55:00 AM - 53 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
28050 Y $352.15 General Fee Schedule - 12/1/2009
28052 Y $338.45 General Fee Schedule - 12/1/2009
28054 Y $310.61 General Fee Schedule - 12/1/2009
28055 Y $329.87 General Fee Schedule - 12/1/2009
28060 Y $413.63 General Fee Schedule - 12/1/2009
28062 Y $503.52 General Fee Schedule - 12/1/2009
28070 Y $400.75 General Fee Schedule - 12/1/2009
28072 Y $389.55 General Fee Schedule - 12/1/2009
28080 Y $329.32 General Fee Schedule - 12/1/2009
28086 Y $484.26 General Fee Schedule - 12/1/2009
28088 Y $367.22 General Fee Schedule - 12/1/2009
28090 Y $366.53 General Fee Schedule - 12/1/2009
28092 Y $336.10 General Fee Schedule - 12/1/2009
28100 Y $519.62 General Fee Schedule - 12/1/2009
28102 Y $541.42 General Fee Schedule - 12/1/2009
28103 Y $371.45 General Fee Schedule - 1/1/2017
28104 Y $409.72 General Fee Schedule - 12/1/2009
28106 Y $443.05 General Fee Schedule - 8/1/2016
28107 Y $463.69 General Fee Schedule - 12/1/2009
28108 Y $335.98 General Fee Schedule - 12/1/2009
28110 Y $354.82 General Fee Schedule - 12/1/2009
28111 Y $431.49 General Fee Schedule - 12/1/2009
28112 Y $393.26 General Fee Schedule - 12/1/2009
28113 Y $414.08 General Fee Schedule - 12/1/2009
28114 Y $825.41 General Fee Schedule - 12/1/2009
28116 Y $567.49 General Fee Schedule - 12/1/2009
28118 Y $473.00 General Fee Schedule - 12/1/2009
28119 Y $418.10 General Fee Schedule - 12/1/2009
28120 Y $484.57 General Fee Schedule - 12/1/2009
28122 Y $527.40 General Fee Schedule - 8/1/2016
28124 Y $377.18 General Fee Schedule - 12/1/2009
28126 Y $295.51 General Fee Schedule - 12/1/2009
28130 Y $563.14 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 54 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
28140 Y $524.14 General Fee Schedule - 8/1/2016
28150 Y $341.51 General Fee Schedule - 12/1/2009
28153 Y $305.02 General Fee Schedule - 12/1/2009
28160 Y $317.36 General Fee Schedule - 12/1/2009
28171 Y $602.35 General Fee Schedule - 12/1/2009
28173 Y $638.52 General Fee Schedule - 12/1/2009
28175 Y $436.02 General Fee Schedule - 8/1/2016
28190 Y $199.66 General Fee Schedule - 12/1/2009
28192 Y $387.75 General Fee Schedule - 12/1/2009
28193 Y $438.41 General Fee Schedule - 12/1/2009
28200 Y $372.85 General Fee Schedule - 12/1/2009
28202 Y $520.90 General Fee Schedule - 8/1/2016
28208 Y $353.35 General Fee Schedule - 12/1/2009
28210 Y $486.00 General Fee Schedule - 12/1/2009
28220 Y $354.39 General Fee Schedule - 12/1/2009
28222 Y $420.12 General Fee Schedule - 12/1/2009
28225 Y $303.66 General Fee Schedule - 12/1/2009
28226 Y $358.84 General Fee Schedule - 12/1/2009
28230 Y $342.50 General Fee Schedule - 12/1/2009
28232 Y $300.75 General Fee Schedule - 12/1/2009
28234 Y $305.12 General Fee Schedule - 12/1/2009
28238 Y $583.16 General Fee Schedule - 12/1/2009
28240 Y $346.80 General Fee Schedule - 12/1/2009
28250 Y $449.55 General Fee Schedule - 12/1/2009
28260 Y $563.30 General Fee Schedule - 12/1/2009
28261 Y $801.70 General Fee Schedule - 12/1/2009
28262 Y $1,165.00 General Fee Schedule - 12/1/2009
28264 Y $717.26 General Fee Schedule - 12/1/2009
28270 Y $372.53 General Fee Schedule - 12/1/2009
28272 Y $305.63 General Fee Schedule - 12/1/2009
28280 Y $439.49 General Fee Schedule - 12/1/2009
28285 Y $363.90 General Fee Schedule - 12/1/2009
28286 Y $359.66 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 55 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
28288 Y $408.74 General Fee Schedule - 12/1/2009
28289 Y $580.49 General Fee Schedule - 12/1/2009
28291 Y $685.11 General Fee Schedule - 1/1/2017
28292 Y $558.88 General Fee Schedule - 12/1/2009
28295 Y $871.21 General Fee Schedule - 1/1/2017
28296 Y $647.79 General Fee Schedule - 8/1/2016
28297 Y $706.65 General Fee Schedule - 12/1/2009
28298 Y $589.90 General Fee Schedule - 12/1/2009
28299 Y $755.87 General Fee Schedule - 12/1/2009
28300 Y $616.28 General Fee Schedule - 1/1/2017
28302 Y $653.52 General Fee Schedule - 12/1/2009
28304 Y $669.57 General Fee Schedule - 12/1/2009
28305 Y $627.54 General Fee Schedule - 1/1/2017
28306 Y $489.35 General Fee Schedule - 12/1/2009
28307 Y $627.22 General Fee Schedule - 8/1/2016
28308 Y $425.18 General Fee Schedule - 12/1/2009
28309 Y $802.43 General Fee Schedule - 8/1/2016
28310 Y $430.59 General Fee Schedule - 12/1/2009
28312 Y $383.60 General Fee Schedule - 12/1/2009
28313 Y $399.32 General Fee Schedule - 12/1/2009
28315 Y $376.73 General Fee Schedule - 12/1/2009
28320 Y $579.48 General Fee Schedule - 1/1/2017
28322 Y $680.38 General Fee Schedule - 12/1/2009
28340 Y $498.45 General Fee Schedule - 8/1/2016
28341 Y $597.06 General Fee Schedule - 12/1/2009
28344 Y $378.87 General Fee Schedule - 12/1/2009
28345 Y $449.63 General Fee Schedule - 8/1/2016
28360 Y $879.61 General Fee Schedule - 1/1/2017
28400 Y $220.08 General Fee Schedule - 12/1/2009
28405 Y $352.25 General Fee Schedule - 8/1/2016
28406 Y $494.08 General Fee Schedule - 8/1/2016
28415 Y $1,055.44 General Fee Schedule - 1/1/2017
28420 Y $1,134.35 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 56 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
28430 Y $207.78 General Fee Schedule - 12/1/2009
28435 Y $283.03 General Fee Schedule - 12/1/2009
28436 Y $395.92 General Fee Schedule - 8/1/2016
28445 Y $1,027.12 General Fee Schedule - 8/1/2016
28446 Y $879.17 General Fee Schedule - 12/1/2009
28450 Y $189.83 General Fee Schedule - 12/1/2009
28455 Y $251.91 General Fee Schedule - 12/1/2009
28456 Y $261.08 General Fee Schedule - 12/1/2009
28465 Y $524.92 General Fee Schedule - 12/1/2009
28470 Y $186.57 General Fee Schedule - 8/1/2016
28475 Y $234.42 General Fee Schedule - 8/1/2016
28476 Y $306.80 General Fee Schedule - 8/1/2016
28485 Y $435.63 General Fee Schedule - 12/1/2009
28490 Y $116.07 General Fee Schedule - 12/1/2009
28495 Y $142.53 General Fee Schedule - 12/1/2009
28496 Y $370.10 General Fee Schedule - 8/1/2016
28505 Y $444.03 General Fee Schedule - 12/1/2009
28510 Y $99.29 General Fee Schedule - 12/1/2009
28515 Y $127.62 General Fee Schedule - 12/1/2009
28525 Y $402.88 General Fee Schedule - 12/1/2009
28530 Y $95.06 General Fee Schedule - 12/1/2009
28531 Y $318.06 General Fee Schedule - 1/1/2017
28540 Y $170.24 General Fee Schedule - 12/1/2009
28545 Y $187.80 General Fee Schedule - 12/1/2009
28546 Y $378.74 General Fee Schedule - 12/1/2009
28555 Y $618.69 General Fee Schedule - 12/1/2009
28570 Y $155.22 General Fee Schedule - 12/1/2009
28575 Y $274.81 General Fee Schedule - 12/1/2009
28576 Y $327.52 General Fee Schedule - 12/1/2009
28585 Y $602.50 General Fee Schedule - 12/1/2009
28600 Y $178.83 General Fee Schedule - 12/1/2009
28605 Y $225.57 General Fee Schedule - 12/1/2009
28606 Y $362.87 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 57 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
28615 Y $620.39 General Fee Schedule - 12/1/2009
28630 Y $126.28 General Fee Schedule - 12/1/2009
28635 Y $152.20 General Fee Schedule - 12/1/2009
28636 Y $244.44 General Fee Schedule - 8/1/2016
28645 Y $352.00 General Fee Schedule - 12/1/2009
28660 Y $95.11 General Fee Schedule - 12/1/2009
28665 Y $132.05 General Fee Schedule - 12/1/2009
28666 Y $177.79 General Fee Schedule - 1/1/2017
28675 Y $373.39 General Fee Schedule - 12/1/2009
28705 Y $1,207.52 General Fee Schedule - 8/1/2016
28715 Y $877.76 General Fee Schedule - 8/1/2016
28725 Y $739.41 General Fee Schedule - 1/1/2017
28730 Y $697.53 General Fee Schedule - 1/1/2017
28735 Y $714.70 General Fee Schedule - 8/1/2016
28737 Y $629.74 General Fee Schedule - 8/1/2016
28740 Y $724.16 General Fee Schedule - 12/1/2009
28750 Y $729.21 General Fee Schedule - 12/1/2009
28755 Y $414.56 General Fee Schedule - 12/1/2009
28760 Y $608.59 General Fee Schedule - 12/1/2009
28800 Y $520.21 General Fee Schedule - 1/1/2017
28805 Y $558.00 General Fee Schedule - 12/1/2009
28810 Y $405.51 General Fee Schedule - 8/1/2016
28820 Y $450.09 General Fee Schedule - 12/1/2009
28825 Y $395.45 General Fee Schedule - 12/1/2009
28890 Y $300.00 General Fee Schedule - 1/1/2017
28899 Y $0.00 General by Report - 7/1/1975
29000 Y $202.69 General Fee Schedule - 12/1/2009
29010 Y $207.71 General Fee Schedule - 12/1/2009
29015 Y $204.72 General Fee Schedule - 12/1/2009
29035 Y $179.17 General Fee Schedule - 1/1/2017
29040 Y $182.69 General Fee Schedule - 12/1/2009
29044 Y $230.18 General Fee Schedule - 12/1/2009
29046 Y $209.71 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 58 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
29049 Y $78.24 General Fee Schedule - 1/1/2017
29055 Y $181.44 General Fee Schedule - 12/1/2009
29058 Y $109.84 General Fee Schedule - 12/1/2009
29065 Y $84.30 General Fee Schedule - 12/1/2009
29075 Y $77.36 General Fee Schedule - 12/1/2009
29085 Y $82.25 General Fee Schedule - 12/1/2009
29086 Y $59.22 General Fee Schedule - 12/1/2009
29105 Y $76.65 General Fee Schedule - 8/1/2016
29125 Y $57.71 General Fee Schedule - 8/1/2016
29126 Y $70.62 General Fee Schedule - 8/1/2016
29130 Y $35.96 General Fee Schedule - 8/1/2016
29131 Y $45.71 General Fee Schedule - 8/1/2016
29200 Y $27.22 General Fee Schedule - 1/1/2017
29240 Y $26.60 General Fee Schedule - 1/1/2017
29260 Y $27.08 General Fee Schedule - 1/1/2017
29280 Y $27.39 General Fee Schedule - 1/1/2017
29305 Y $205.14 General Fee Schedule - 12/1/2009
29325 Y $224.56 General Fee Schedule - 12/1/2009
29345 Y $118.02 General Fee Schedule - 8/1/2016
29355 Y $121.52 General Fee Schedule - 8/1/2016
29358 Y $134.70 General Fee Schedule - 12/1/2009
29365 Y $109.29 General Fee Schedule - 12/1/2009
29405 Y $76.61 General Fee Schedule - 8/1/2016
29425 Y $72.63 General Fee Schedule - 1/1/2017
29435 Y $101.64 General Fee Schedule - 8/1/2016
29440 Y $40.57 General Fee Schedule - 1/1/2017
29445 Y $125.95 General Fee Schedule - 1/1/2017
29450 Y $134.34 General Fee Schedule - 8/1/2016
29505 Y $69.80 General Fee Schedule - 12/1/2009
29515 Y $61.07 General Fee Schedule - 12/1/2009
29520 Y $28.77 General Fee Schedule - 1/1/2017
29530 Y $26.69 General Fee Schedule - 1/1/2017
29540 Y $24.21 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 59 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
29550 Y $17.56 General Fee Schedule - 1/1/2017
29580 Y $44.81 General Fee Schedule - 8/1/2016
29581 Y $54.92 General Fee Schedule - 1/1/2017
29584 Y $62.34 General Fee Schedule - 8/1/2016
29700 Y $53.02 General Fee Schedule - 8/1/2016
29705 Y $59.43 General Fee Schedule - 8/1/2016
29710 Y $106.58 General Fee Schedule - 8/1/2016
29720 Y $70.10 General Fee Schedule - 12/1/2009
29730 Y $58.40 General Fee Schedule - 8/1/2016
29740 Y $88.82 General Fee Schedule - 12/1/2009
29750 Y $83.90 General Fee Schedule - 1/1/2017
29799 Y $0.00 General by Report - 7/1/1975
29800 Y $484.65 General Fee Schedule - 1/1/2017
29804 Y $598.13 General Fee Schedule - 8/1/2016
29805 Y $438.73 General Fee Schedule - 8/1/2016
29806 Y $982.10 General Fee Schedule - 8/1/2016
29807 Y $956.45 General Fee Schedule - 8/1/2016
29819 Y $549.58 General Fee Schedule - 8/1/2016
29820 Y $507.15 General Fee Schedule - 8/1/2016
29821 Y $553.96 General Fee Schedule - 8/1/2016
29822 Y $537.94 General Fee Schedule - 8/1/2016
29823 Y $587.09 General Fee Schedule - 8/1/2016
29824 Y $600.57 General Fee Schedule - 8/1/2016
29825 Y $548.60 General Fee Schedule - 8/1/2016
29826 Y $168.03 General Fee Schedule - 1/1/2017
29827 Y $1,010.11 General Fee Schedule - 1/1/2017
29828 Y $678.77 General Fee Schedule - 12/1/2009
29830 Y $422.06 General Fee Schedule - 8/1/2016
29834 Y $460.44 General Fee Schedule - 8/1/2016
29835 Y $471.13 General Fee Schedule - 8/1/2016
29836 Y $543.68 General Fee Schedule - 8/1/2016
29837 Y $495.79 General Fee Schedule - 8/1/2016
29838 Y $555.54 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 60 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
29840 Y $408.29 General Fee Schedule - 8/1/2016
29843 Y $438.21 General Fee Schedule - 8/1/2016
29844 Y $462.11 General Fee Schedule - 8/1/2016
29845 Y $524.42 General Fee Schedule - 8/1/2016
29846 Y $484.74 General Fee Schedule - 8/1/2016
29847 Y $501.91 General Fee Schedule - 8/1/2016
29848 Y $431.71 General Fee Schedule - 12/1/2009
29850 Y $531.82 General Fee Schedule - 12/1/2009
29851 Y $848.35 General Fee Schedule - 1/1/2017
29855 Y $742.70 General Fee Schedule - 8/1/2016
29856 Y $954.15 General Fee Schedule - 8/1/2016
29860 Y $595.95 General Fee Schedule - 12/1/2009
29861 Y $633.32 General Fee Schedule - 8/1/2016
29862 Y $731.46 General Fee Schedule - 12/1/2009
29863 Y $722.84 General Fee Schedule - 12/1/2009
29866 Y $967.61 General Fee Schedule - 8/1/2016
29867 Y $1,157.95 General Fee Schedule - 8/1/2016
29868 Y $1,571.87 General Fee Schedule - 8/1/2016
29870 Y $392.44 General Fee Schedule - 12/1/2009
29871 Y $473.74 General Fee Schedule - 8/1/2016
29873 Y $473.04 General Fee Schedule - 8/1/2016
29874 Y $497.84 General Fee Schedule - 8/1/2016
29875 Y $462.53 General Fee Schedule - 8/1/2016
29876 Y $593.67 General Fee Schedule - 12/1/2009
29877 Y $558.97 General Fee Schedule - 12/1/2009
29879 Y $602.41 General Fee Schedule - 12/1/2009
29880 Y $535.40 General Fee Schedule - 1/1/2017
29881 Y $515.66 General Fee Schedule - 1/1/2017
29882 Y $633.88 General Fee Schedule - 12/1/2009
29883 Y $771.15 General Fee Schedule - 8/1/2016
29884 Y $556.49 General Fee Schedule - 12/1/2009
29885 Y $678.60 General Fee Schedule - 12/1/2009
29886 Y $570.77 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 61 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
29887 Y $674.97 General Fee Schedule - 12/1/2009
29888 Y $930.47 General Fee Schedule - 8/1/2016
29889 Y $1,094.18 General Fee Schedule - 8/1/2016
29891 Y $604.48 General Fee Schedule - 8/1/2016
29892 Y $555.02 General Fee Schedule - 1/1/2017
29893 Y $438.56 General Fee Schedule - 12/1/2009
29894 Y $474.55 General Fee Schedule - 1/1/2017
29895 Y $453.25 General Fee Schedule - 1/1/2017
29897 Y $483.32 General Fee Schedule - 1/1/2017
29898 Y $537.36 General Fee Schedule - 1/1/2017
29899 Y $941.69 General Fee Schedule - 8/1/2016
29900 Y $424.91 General Fee Schedule - 8/1/2016
29901 Y $468.34 General Fee Schedule - 8/1/2016
29902 Y $500.65 General Fee Schedule - 8/1/2016
29904 Y $454.32 General Fee Schedule - 12/1/2009
29905 Y $489.23 General Fee Schedule - 12/1/2009
29906 Y $515.25 General Fee Schedule - 12/1/2009
29907 Y $632.60 General Fee Schedule - 12/1/2009
29914 Y $972.06 General Fee Schedule - 8/1/2016
29915 Y $969.02 General Fee Schedule - 1/1/2017
29916 Y $990.37 General Fee Schedule - 8/1/2016
29999 Y $0.00 Manual Review Fee Schedule - 1/1/2002
30000 Y $199.02 General Fee Schedule - 12/1/2009
30020 Y $171.64 General Fee Schedule - 12/1/2009
30100 Y $106.50 General Fee Schedule - 12/1/2009
30110 Y $179.02 General Fee Schedule - 12/1/2009
30115 Y $379.57 General Fee Schedule - 12/1/2009
30117 Y $582.19 General Fee Schedule - 12/1/2009
30118 Y $687.60 General Fee Schedule - 8/1/2016
30120 Y $443.87 General Fee Schedule - 12/1/2009
30124 Y $252.23 General Fee Schedule - 12/1/2009
30125 Y $559.95 General Fee Schedule - 8/1/2016
30130 Y $332.86 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 62 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
30140 Y $356.71 General Fee Schedule - 12/1/2009
30150 Y $732.01 General Fee Schedule - 8/1/2016
30160 Y $720.36 General Fee Schedule - 8/1/2016
30200 Y $87.64 General Fee Schedule - 12/1/2009
30210 Y $117.04 General Fee Schedule - 12/1/2009
30220 Y $208.75 General Fee Schedule - 12/1/2009
30300 Y $168.46 General Fee Schedule - 1/1/2017
30310 Y $180.15 General Fee Schedule - 8/1/2016
30320 Y $412.09 General Fee Schedule - 8/1/2016
30400 Y $908.79 General Fee Schedule - 8/1/2016
30410 Y $1,104.74 General Fee Schedule - 1/1/2017
30420 Y $1,226.41 General Fee Schedule - 8/1/2016
30435 Y $1,035.03 General Fee Schedule - 1/1/2017
30450 Y $1,404.40 General Fee Schedule - 1/1/2017
30460 Y $673.12 General Fee Schedule - 1/1/2017
30462 Y $1,475.17 General Fee Schedule - 8/1/2016
30465 Y $860.14 General Fee Schedule - 8/1/2016
30520 Y $464.22 General Fee Schedule - 12/1/2009
30540 Y $614.69 General Fee Schedule - 8/1/2016
30545 Y $825.39 General Fee Schedule - 1/1/2017
30560 Y $215.74 General Fee Schedule - 12/1/2009
30580 Y $555.29 General Fee Schedule - 12/1/2009
30600 Y $514.30 General Fee Schedule - 12/1/2009
30620 Y $553.07 General Fee Schedule - 12/1/2009
30630 Y $545.64 General Fee Schedule - 8/1/2016
30801 Y $186.93 General Fee Schedule - 12/1/2009
30802 Y $242.05 General Fee Schedule - 12/1/2009
30901 Y $88.49 General Fee Schedule - 1/1/2017
30903 Y $157.05 General Fee Schedule - 12/1/2009
30905 Y $202.43 General Fee Schedule - 12/1/2009
30906 Y $235.00 General Fee Schedule - 12/1/2009
30915 Y $506.20 General Fee Schedule - 8/1/2016
30920 Y $714.80 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 63 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
30930 Y $108.24 General Fee Schedule - 12/1/2009
30999 Y $0.00 General by Report - 7/1/1975
31000 Y $145.07 General Fee Schedule - 12/1/2009
31002 Y $182.57 General Fee Schedule - 8/1/2016
31020 Y $416.22 General Fee Schedule - 12/1/2009
31030 Y $617.86 General Fee Schedule - 8/1/2016
31032 Y $500.94 General Fee Schedule - 8/1/2016
31040 Y $701.28 General Fee Schedule - 8/1/2016
31050 Y $420.89 General Fee Schedule - 8/1/2016
31051 Y $555.14 General Fee Schedule - 8/1/2016
31070 Y $381.66 General Fee Schedule - 12/1/2009
31075 Y $684.70 General Fee Schedule - 8/1/2016
31080 Y $909.24 General Fee Schedule - 8/1/2016
31081 Y $1,057.03 General Fee Schedule - 12/1/2009
31084 Y $1,025.38 General Fee Schedule - 12/1/2009
31085 Y $1,086.07 General Fee Schedule - 12/1/2009
31086 Y $988.60 General Fee Schedule - 12/1/2009
31087 Y $945.57 General Fee Schedule - 8/1/2016
31090 Y $830.97 General Fee Schedule - 12/1/2009
31200 Y $497.11 General Fee Schedule - 8/1/2016
31201 Y $639.34 General Fee Schedule - 8/1/2016
31205 Y $792.36 General Fee Schedule - 8/1/2016
31225 Y $1,407.83 General Fee Schedule - 12/1/2009
31230 Y $1,571.72 General Fee Schedule - 12/1/2009
31231 Y $161.64 General Fee Schedule - 12/1/2009
31233 Y $229.07 General Fee Schedule - 8/1/2016
31235 Y $268.15 General Fee Schedule - 8/1/2016
31237 Y $239.45 General Fee Schedule - 1/1/2017
31238 Y $239.68 General Fee Schedule - 1/1/2017
31239 Y $579.23 General Fee Schedule - 1/1/2017
31240 Y $154.13 General Fee Schedule - 1/1/2017
31241 Y $429.83 General Fee Schedule - 1/1/2018
31253 Y $481.09 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 64 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
31254 Y $262.01 General Fee Schedule - 1/1/2017
31255 Y $385.67 General Fee Schedule - 1/1/2017
31256 Y $189.84 General Fee Schedule - 1/1/2017
31257 Y $428.02 General Fee Schedule - 1/1/2018
31259 Y $453.89 General Fee Schedule - 1/1/2018
31267 Y $305.51 General Fee Schedule - 1/1/2017
31276 Y $486.58 General Fee Schedule - 1/1/2017
31287 Y $222.90 General Fee Schedule - 1/1/2017
31288 Y $258.02 General Fee Schedule - 1/1/2017
31290 Y $1,081.18 General Fee Schedule - 8/1/2016
31291 Y $1,139.81 General Fee Schedule - 8/1/2016
31292 Y $936.02 General Fee Schedule - 8/1/2016
31293 Y $1,017.38 General Fee Schedule - 8/1/2016
31294 Y $1,180.21 General Fee Schedule - 8/1/2016
31295 Y $1,853.95 General Fee Schedule - 8/1/2016
31296 Y $1,856.52 General Fee Schedule - 1/1/2017
31297 Y $1,821.82 General Fee Schedule - 1/1/2017
31298 Y $3,439.66 General Fee Schedule - 1/1/2018
31299 Y $0.00 General by Report - 1/1/1996
31300 Y $1,105.46 General Fee Schedule - 12/1/2009
31360 Y $1,279.92 General Fee Schedule - 12/1/2009
31365 Y $1,698.18 General Fee Schedule - 12/1/2009
31367 Y $1,655.61 General Fee Schedule - 12/1/2009
31368 Y $1,995.19 General Fee Schedule - 12/1/2009
31370 Y $1,648.36 General Fee Schedule - 12/1/2009
31375 Y $1,535.03 General Fee Schedule - 12/1/2009
31380 Y $1,544.99 General Fee Schedule - 12/1/2009
31382 Y $1,590.49 General Fee Schedule - 12/1/2009
31390 Y $1,975.21 General Fee Schedule - 12/1/2009
31395 Y $2,255.41 General Fee Schedule - 12/1/2009
31400 Y $862.72 General Fee Schedule - 8/1/2016
31420 Y $750.02 General Fee Schedule - 12/1/2009
31500 Y $106.75 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 65 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
31502 Y $33.69 General Fee Schedule - 1/1/2017
31505 Y $71.92 General Fee Schedule - 8/1/2016
31510 Y $185.24 General Fee Schedule - 8/1/2016
31511 Y $189.22 General Fee Schedule - 8/1/2016
31512 Y $188.18 General Fee Schedule - 8/1/2016
31513 Y $126.40 General Fee Schedule - 1/1/2017
31515 Y $169.88 General Fee Schedule - 1/1/2017
31520 Y $152.76 General Fee Schedule - 8/1/2016
31525 Y $224.38 General Fee Schedule - 8/1/2016
31526 Y $151.47 General Fee Schedule - 1/1/2017
31527 Y $191.59 General Fee Schedule - 8/1/2016
31528 Y $142.11 General Fee Schedule - 8/1/2016
31529 Y $156.27 General Fee Schedule - 1/1/2017
31530 Y $191.18 General Fee Schedule - 1/1/2017
31531 Y $205.59 General Fee Schedule - 1/1/2017
31535 Y $183.22 General Fee Schedule - 1/1/2017
31536 Y $203.88 General Fee Schedule - 1/1/2017
31540 Y $234.02 General Fee Schedule - 1/1/2017
31541 Y $255.01 General Fee Schedule - 1/1/2017
31545 Y $351.52 General Fee Schedule - 1/1/2017
31546 Y $535.98 General Fee Schedule - 1/1/2017
31551 Y $1,350.14 General Fee Schedule - 1/1/2017
31552 Y $1,360.07 General Fee Schedule - 1/1/2017
31553 Y $1,481.58 General Fee Schedule - 1/1/2017
31554 Y $1,555.46 General Fee Schedule - 1/1/2017
31560 Y $303.57 General Fee Schedule - 1/1/2017
31561 Y $332.70 General Fee Schedule - 1/1/2017
31570 Y $317.49 General Fee Schedule - 1/1/2017
31571 Y $241.68 General Fee Schedule - 1/1/2017
31572 Y $451.41 General Fee Schedule - 1/1/2017
31573 Y $243.61 General Fee Schedule - 1/1/2017
31574 Y $914.94 General Fee Schedule - 1/1/2017
31575 Y $106.52 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 66 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
31576 Y $198.26 General Fee Schedule - 8/1/2016
31577 Y $222.40 General Fee Schedule - 8/1/2016
31578 Y $253.86 General Fee Schedule - 8/1/2016
31579 Y $195.41 General Fee Schedule - 1/1/2017
31580 Y $1,058.05 General Fee Schedule - 12/1/2009
31584 Y $1,381.54 General Fee Schedule - 8/1/2016
31587 Y $813.60 General Fee Schedule - 12/1/2009
31590 Y $797.84 General Fee Schedule - 8/1/2016
31591 Y $980.76 General Fee Schedule - 1/1/2017
31592 Y $1,598.72 General Fee Schedule - 1/1/2017
31595 Y $678.96 General Fee Schedule - 8/1/2016
31599 Y $0.00 General by Report - 7/1/1975
31600 Y $387.74 General Fee Schedule - 1/1/2017
31601 Y $241.97 General Fee Schedule - 1/1/2017
31603 Y $218.42 General Fee Schedule - 1/1/2017
31605 Y $179.07 General Fee Schedule - 1/1/2017
31610 Y $622.57 General Fee Schedule - 8/1/2016
31611 Y $475.60 General Fee Schedule - 12/1/2009
31612 Y $72.53 General Fee Schedule - 8/1/2016
31613 Y $397.05 General Fee Schedule - 12/1/2009
31614 Y $593.71 General Fee Schedule - 12/1/2009
31615 Y $168.20 General Fee Schedule - 8/1/2016
31622 Y $277.75 General Fee Schedule - 1/1/2017
31623 Y $301.45 General Fee Schedule - 1/1/2017
31624 Y $285.97 General Fee Schedule - 1/1/2017
31625 Y $335.51 General Fee Schedule - 12/1/2009
31626 Y $390.16 General Fee Schedule - 1/1/2010
31627 Y $1,043.81 General Fee Schedule - 1/1/2010
31628 Y $378.17 General Fee Schedule - 8/1/2016
31629 Y $452.10 General Fee Schedule - 1/1/2017
31630 Y $193.11 General Fee Schedule - 1/1/2017
31631 Y $222.60 General Fee Schedule - 1/1/2017
31632 Y $70.76 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 67 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
31633 Y $84.46 General Fee Schedule - 8/1/2016
31634 Y $1,647.95 General Fee Schedule - 8/1/2016
31635 Y $321.23 General Fee Schedule - 1/1/2017
31636 Y $214.44 General Fee Schedule - 1/1/2017
31637 Y $71.52 General Fee Schedule - 1/1/2017
31638 Y $244.62 General Fee Schedule - 1/1/2017
31640 Y $245.82 General Fee Schedule - 1/1/2017
31641 Y $248.84 General Fee Schedule - 1/1/2017
31643 Y $169.90 General Fee Schedule - 1/1/2017
31645 Y $291.67 General Fee Schedule - 8/1/2016
31646 Y $265.51 General Fee Schedule - 8/1/2016
31647 Y $212.24 General Fee Schedule - 8/1/2016
31648 Y $197.31 General Fee Schedule - 1/1/2017
31649 Y $67.36 General Fee Schedule - 1/1/2017
31651 Y $73.74 General Fee Schedule - 8/1/2016
31652 Y $811.77 General Fee Schedule - 8/1/2016
31653 Y $863.38 General Fee Schedule - 8/1/2016
31654 Y $100.51 General Fee Schedule - 8/1/2016
31660 Y $201.54 General Fee Schedule - 1/1/2017
31661 Y $211.27 General Fee Schedule - 1/1/2017
31717 Y $236.43 General Fee Schedule - 1/1/2017
31720 Y $49.43 General Fee Schedule - 1/1/2017
31725 Y $87.29 General Fee Schedule - 1/1/2017
31730 Y $192.57 General Fee Schedule - 12/1/2009
31750 Y $1,140.63 General Fee Schedule - 12/1/2009
31755 Y $1,500.56 General Fee Schedule - 12/1/2009
31760 Y $1,277.56 General Fee Schedule - 8/1/2016
31766 Y $1,725.58 General Fee Schedule - 8/1/2016
31770 Y $1,264.40 General Fee Schedule - 8/1/2016
31775 Y $1,243.70 General Fee Schedule - 1/1/2017
31780 Y $1,074.39 General Fee Schedule - 8/1/2016
31781 Y $1,344.37 General Fee Schedule - 8/1/2016
31785 Y $1,025.65 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 68 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
31786 Y $1,427.74 General Fee Schedule - 8/1/2016
31800 Y $631.07 General Fee Schedule - 12/1/2009
31805 Y $783.77 General Fee Schedule - 8/1/2016
31820 Y $380.51 General Fee Schedule - 12/1/2009
31825 Y $521.96 General Fee Schedule - 8/1/2016
31830 Y $386.40 General Fee Schedule - 12/1/2009
31899 Y $0.00 General by Report - 7/1/1975
32035 Y $578.76 General Fee Schedule - 12/1/2009
32036 Y $643.48 General Fee Schedule - 12/1/2009
32096 Y $772.10 General Fee Schedule - 8/1/2016
32097 Y $772.10 General Fee Schedule - 8/1/2016
32098 Y $725.54 General Fee Schedule - 8/1/2016
32100 Y $792.31 General Fee Schedule - 1/1/2017
32110 Y $1,365.89 General Fee Schedule - 12/1/2009
32120 Y $743.71 General Fee Schedule - 12/1/2009
32124 Y $803.02 General Fee Schedule - 12/1/2009
32140 Y $868.24 General Fee Schedule - 12/1/2009
32141 Y $867.88 General Fee Schedule - 12/1/2009
32150 Y $875.38 General Fee Schedule - 12/1/2009
32151 Y $892.42 General Fee Schedule - 12/1/2009
32160 Y $584.61 General Fee Schedule - 12/1/2009
32200 Y $958.45 General Fee Schedule - 12/1/2009
32215 Y $731.51 General Fee Schedule - 12/1/2009
32220 Y $1,432.84 General Fee Schedule - 8/1/2016
32225 Y $871.83 General Fee Schedule - 12/1/2009
32310 Y $840.44 General Fee Schedule - 12/1/2009
32320 Y $1,463.43 General Fee Schedule - 12/1/2009
32400 Y $138.54 General Fee Schedule - 8/1/2016
32405 Y $101.24 General Fee Schedule - 12/1/2009
32440 Y $1,471.90 General Fee Schedule - 8/1/2016
32442 Y $1,650.64 General Fee Schedule - 12/1/2009
32445 Y $1,577.80 General Fee Schedule - 12/1/2009
32480 Y $1,391.68 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 69 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
32482 Y $1,471.90 General Fee Schedule - 8/1/2016
32484 Y $1,292.76 General Fee Schedule - 12/1/2009
32486 Y $1,497.65 General Fee Schedule - 12/1/2009
32488 Y $1,595.25 General Fee Schedule - 12/1/2009
32491 Y $1,355.45 General Fee Schedule - 12/1/2009
32501 Y $245.59 General Fee Schedule - 8/1/2016
32503 Y $1,753.19 General Fee Schedule - 8/1/2016
32504 Y $2,007.19 General Fee Schedule - 8/1/2016
32505 Y $889.97 General Fee Schedule - 8/1/2016
32506 Y $151.39 General Fee Schedule - 8/1/2016
32507 Y $151.39 General Fee Schedule - 8/1/2016
32540 Y $966.55 General Fee Schedule - 12/1/2009
32550 Y $644.32 General Fee Schedule - 12/1/2009
32551 Y $141.27 General Fee Schedule - 12/1/2009
32552 Y $164.74 General Fee Schedule - 8/1/2016
32553 Y $512.18 General Fee Schedule - 8/1/2016
32554 Y $182.54 General Fee Schedule - 1/1/2017
32555 Y $262.54 General Fee Schedule - 1/1/2017
32556 Y $483.55 General Fee Schedule - 1/1/2017
32557 Y $464.29 General Fee Schedule - 1/1/2017
32560 Y $221.26 General Fee Schedule - 1/1/2017
32561 Y $85.75 General Fee Schedule - 8/1/2016
32562 Y $76.23 General Fee Schedule - 8/1/2016
32601 Y $306.05 General Fee Schedule - 8/1/2016
32604 Y $480.14 General Fee Schedule - 8/1/2016
32606 Y $461.12 General Fee Schedule - 8/1/2016
32607 Y $296.54 General Fee Schedule - 8/1/2016
32608 Y $364.52 General Fee Schedule - 8/1/2016
32609 Y $251.66 General Fee Schedule - 8/1/2016
32650 Y $648.63 General Fee Schedule - 1/1/2017
32651 Y $810.02 General Fee Schedule - 12/1/2009
32652 Y $1,161.25 General Fee Schedule - 12/1/2009
32653 Y $800.26 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 70 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
32654 Y $794.20 General Fee Schedule - 12/1/2009
32655 Y $818.72 General Fee Schedule - 12/1/2009
32656 Y $784.11 General Fee Schedule - 1/1/2017
32658 Y $700.00 General Fee Schedule - 1/1/2017
32659 Y $727.98 General Fee Schedule - 8/1/2016
32661 Y $786.54 General Fee Schedule - 1/1/2017
32662 Y $873.10 General Fee Schedule - 1/1/2017
32663 Y $1,175.14 General Fee Schedule - 12/1/2009
32664 Y $833.89 General Fee Schedule - 1/1/2017
32665 Y $952.36 General Fee Schedule - 12/1/2009
32666 Y $831.77 General Fee Schedule - 8/1/2016
32667 Y $151.39 General Fee Schedule - 8/1/2016
32668 Y $152.34 General Fee Schedule - 8/1/2016
32669 Y $1,285.32 General Fee Schedule - 8/1/2016
32670 Y $1,535.10 General Fee Schedule - 8/1/2016
32671 Y $1,705.60 General Fee Schedule - 8/1/2016
32672 Y $1,457.90 General Fee Schedule - 8/1/2016
32673 Y $1,147.16 General Fee Schedule - 8/1/2016
32674 Y $207.50 General Fee Schedule - 8/1/2016
32701 Y $210.21 General Fee Schedule - 8/1/2016
32800 Y $850.43 General Fee Schedule - 12/1/2009
32810 Y $827.76 General Fee Schedule - 12/1/2009
32815 Y $1,381.97 General Fee Schedule - 12/1/2009
32820 Y $1,279.37 General Fee Schedule - 8/1/2016
32850 Y $0.00 General by Report - 1/1/1994
32851 Y $2,630.55 General Fee Schedule - 12/1/2009
32852 Y $2,957.10 General Fee Schedule - 12/1/2009
32853 Y $3,176.34 General Fee Schedule - 12/1/2009
32854 Y $3,405.87 General Fee Schedule - 12/1/2009
32855 Y $0.00 General by Report - 1/1/2005
32856 Y $184.60 General Fee Schedule - 1/1/2011
32900 Y $1,221.74 General Fee Schedule - 12/1/2009
32905 Y $1,256.43 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 71 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
32906 Y $1,519.50 General Fee Schedule - 8/1/2016
32940 Y $1,126.61 General Fee Schedule - 8/1/2016
32960 Y $130.68 General Fee Schedule - 8/1/2016
32994 Y $5,491.50 General Fee Schedule - 1/1/2018
32997 Y $315.94 General Fee Schedule - 12/1/2009
32998 Y $2,122.11 General Fee Schedule - 1/1/2017
32999 Y $0.00 General by Report - 7/1/1975
33010 Y $113.28 General Fee Schedule - 8/1/2016
33011 Y $114.60 General Fee Schedule - 8/1/2016
33015 Y $454.36 General Fee Schedule - 12/1/2009
33020 Y $780.61 General Fee Schedule - 12/1/2009
33025 Y $746.15 General Fee Schedule - 12/1/2009
33030 Y $1,145.75 General Fee Schedule - 12/1/2009
33031 Y $1,292.46 General Fee Schedule - 12/1/2009
33050 Y $896.53 General Fee Schedule - 12/1/2009
33120 Y $1,471.40 General Fee Schedule - 12/1/2009
33130 Y $1,275.27 General Fee Schedule - 12/1/2009
33140 Y $1,242.79 General Fee Schedule - 12/1/2009
33141 Y $128.39 General Fee Schedule - 1/1/2017
33202 Y $658.58 General Fee Schedule - 12/1/2009
33203 Y $675.00 General Fee Schedule - 12/1/2009
33206 Y $428.06 General Fee Schedule - 12/1/2009
33207 Y $470.61 General Fee Schedule - 8/1/2016
33208 Y $496.42 General Fee Schedule - 12/1/2009
33210 Y $169.33 General Fee Schedule - 8/1/2016
33211 Y $175.63 General Fee Schedule - 8/1/2016
33212 Y $329.18 General Fee Schedule - 8/1/2016
33213 Y $337.97 General Fee Schedule - 1/1/2017
33214 Y $467.09 General Fee Schedule - 8/1/2016
33215 Y $293.13 General Fee Schedule - 8/1/2016
33216 Y $364.12 General Fee Schedule - 8/1/2016
33217 Y $364.98 General Fee Schedule - 8/1/2016
33218 Y $369.93 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 72 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33220 Y $357.12 General Fee Schedule - 8/1/2016
33221 Y $334.21 General Fee Schedule - 8/1/2016
33222 Y $338.68 General Fee Schedule - 8/1/2016
33223 Y $405.12 General Fee Schedule - 8/1/2016
33224 Y $484.69 General Fee Schedule - 8/1/2016
33225 Y $430.73 General Fee Schedule - 8/1/2016
33226 Y $467.09 General Fee Schedule - 8/1/2016
33227 Y $318.86 General Fee Schedule - 8/1/2016
33228 Y $332.63 General Fee Schedule - 8/1/2016
33229 Y $346.41 General Fee Schedule - 8/1/2016
33230 Y $359.90 General Fee Schedule - 8/1/2016
33231 Y $373.67 General Fee Schedule - 8/1/2016
33233 Y $237.00 General Fee Schedule - 8/1/2016
33234 Y $469.68 General Fee Schedule - 8/1/2016
33235 Y $596.64 General Fee Schedule - 8/1/2016
33236 Y $766.73 General Fee Schedule - 8/1/2016
33237 Y $816.37 General Fee Schedule - 8/1/2016
33238 Y $900.38 General Fee Schedule - 8/1/2016
33240 Y $367.30 General Fee Schedule - 1/1/2017
33241 Y $223.64 General Fee Schedule - 8/1/2016
33243 Y $1,284.77 General Fee Schedule - 8/1/2016
33244 Y $835.14 General Fee Schedule - 8/1/2016
33249 Y $861.99 General Fee Schedule - 12/1/2009
33250 Y $1,330.39 General Fee Schedule - 12/1/2009
33251 Y $1,483.04 General Fee Schedule - 12/1/2009
33254 Y $1,151.91 General Fee Schedule - 12/1/2009
33255 Y $1,387.88 General Fee Schedule - 12/1/2009
33256 Y $1,658.78 General Fee Schedule - 12/1/2009
33257 Y $462.13 General Fee Schedule - 12/1/2009
33258 Y $522.79 General Fee Schedule - 12/1/2009
33259 Y $687.09 General Fee Schedule - 12/1/2009
33261 Y $1,481.97 General Fee Schedule - 12/1/2009
33262 Y $346.76 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 73 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33264 Y $374.29 General Fee Schedule - 8/1/2016
33265 Y $1,151.91 General Fee Schedule - 12/1/2009
33266 Y $1,578.16 General Fee Schedule - 12/1/2009
33270 Y $580.72 General Fee Schedule - 8/1/2016
33271 Y $487.72 General Fee Schedule - 8/1/2016
33272 Y $340.84 General Fee Schedule - 1/1/2017
33273 Y $387.38 General Fee Schedule - 1/1/2017
33282 Y $229.79 General Fee Schedule - 1/1/2017
33284 Y $203.08 General Fee Schedule - 1/1/2017
33300 Y $1,099.12 General Fee Schedule - 12/1/2009
33305 Y $1,298.45 General Fee Schedule - 12/1/2009
33310 Y $1,086.20 General Fee Schedule - 8/1/2016
33315 Y $1,348.78 General Fee Schedule - 12/1/2009
33320 Y $960.52 General Fee Schedule - 8/1/2016
33321 Y $1,166.01 General Fee Schedule - 8/1/2016
33322 Y $1,248.92 General Fee Schedule - 12/1/2009
33330 Y $1,275.39 General Fee Schedule - 12/1/2009
33335 Y $1,691.20 General Fee Schedule - 8/1/2016
33340 Y $787.96 General Fee Schedule - 1/1/2017
33361 Y $1,273.05 General Fee Schedule - 8/1/2016
33362 Y $1,392.90 General Fee Schedule - 8/1/2016
33363 Y $1,442.25 General Fee Schedule - 8/1/2016
33364 Y $1,533.43 General Fee Schedule - 8/1/2016
33365 Y $1,683.76 General Fee Schedule - 8/1/2016
33366 Y $1,904.76 General Fee Schedule - 8/1/2016
33367 Y $592.10 General Fee Schedule - 8/1/2016
33368 Y $717.58 General Fee Schedule - 8/1/2016
33369 Y $947.36 General Fee Schedule - 8/1/2016
33390 Y $1,882.99 General Fee Schedule - 1/1/2017
33391 Y $2,331.28 General Fee Schedule - 1/1/2017
33404 Y $1,678.53 General Fee Schedule - 8/1/2016
33405 Y $2,073.95 General Fee Schedule - 8/1/2016
33406 Y $2,289.38 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 74 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33410 Y $1,982.01 General Fee Schedule - 12/1/2009
33411 Y $2,229.21 General Fee Schedule - 12/1/2009
33412 Y $2,539.37 General Fee Schedule - 12/1/2009
33413 Y $2,615.75 General Fee Schedule - 12/1/2009
33414 Y $1,812.20 General Fee Schedule - 12/1/2009
33415 Y $1,601.64 General Fee Schedule - 12/1/2009
33416 Y $1,790.64 General Fee Schedule - 12/1/2009
33417 Y $1,639.97 General Fee Schedule - 8/1/2016
33418 Y $1,763.81 General Fee Schedule - 1/1/2017
33419 Y $415.91 General Fee Schedule - 1/1/2017
33420 Y $1,265.90 General Fee Schedule - 12/1/2009
33422 Y $1,540.00 General Fee Schedule - 8/1/2016
33425 Y $1,629.04 General Fee Schedule - 12/1/2009
33426 Y $2,033.09 General Fee Schedule - 12/1/2009
33427 Y $2,319.55 General Fee Schedule - 8/1/2016
33430 Y $2,060.28 General Fee Schedule - 12/1/2009
33460 Y $1,416.12 General Fee Schedule - 12/1/2009
33463 Y $1,564.07 General Fee Schedule - 12/1/2009
33464 Y $1,660.62 General Fee Schedule - 12/1/2009
33465 Y $1,706.10 General Fee Schedule - 12/1/2009
33468 Y $1,769.62 General Fee Schedule - 12/1/2009
33470 Y $1,204.68 General Fee Schedule - 12/1/2009
33471 Y $1,256.89 General Fee Schedule - 8/1/2016
33474 Y $1,372.57 General Fee Schedule - 12/1/2009
33475 Y $1,969.38 General Fee Schedule - 12/1/2009
33476 Y $1,427.41 General Fee Schedule - 8/1/2016
33477 Y $1,262.75 General Fee Schedule - 8/1/2016
33478 Y $1,548.27 General Fee Schedule - 8/1/2016
33496 Y $1,564.93 General Fee Schedule - 8/1/2016
33500 Y $1,450.93 General Fee Schedule - 8/1/2016
33501 Y $1,034.93 General Fee Schedule - 12/1/2009
33502 Y $1,242.51 General Fee Schedule - 8/1/2016
33503 Y $1,234.82 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 75 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33504 Y $1,412.53 General Fee Schedule - 8/1/2016
33505 Y $1,552.78 General Fee Schedule - 12/1/2009
33506 Y $1,947.67 General Fee Schedule - 8/1/2016
33507 Y $1,695.58 General Fee Schedule - 8/1/2016
33508 Y $15.58 General Fee Schedule - 1/1/2017
33510 Y $1,757.40 General Fee Schedule - 8/1/2016
33511 Y $1,899.74 General Fee Schedule - 12/1/2009
33512 Y $1,990.77 General Fee Schedule - 12/1/2009
33513 Y $2,011.91 General Fee Schedule - 12/1/2009
33514 Y $2,046.30 General Fee Schedule - 12/1/2009
33516 Y $2,170.91 General Fee Schedule - 12/1/2009
33517 Y $141.43 General Fee Schedule - 12/1/2009
33518 Y $266.14 General Fee Schedule - 12/1/2009
33519 Y $390.13 General Fee Schedule - 12/1/2009
33521 Y $515.22 General Fee Schedule - 12/1/2009
33522 Y $641.61 General Fee Schedule - 12/1/2009
33523 Y $766.35 General Fee Schedule - 12/1/2009
33530 Y $321.93 General Fee Schedule - 12/1/2009
33533 Y $1,803.70 General Fee Schedule - 8/1/2016
33534 Y $2,011.01 General Fee Schedule - 12/1/2009
33535 Y $2,125.22 General Fee Schedule - 12/1/2009
33536 Y $2,260.27 General Fee Schedule - 12/1/2009
33542 Y $1,709.09 General Fee Schedule - 12/1/2009
33545 Y $2,133.13 General Fee Schedule - 12/1/2009
33548 Y $2,318.43 General Fee Schedule - 12/1/2009
33572 Y $223.86 General Fee Schedule - 1/1/2017
33600 Y $1,650.74 General Fee Schedule - 8/1/2016
33602 Y $1,592.59 General Fee Schedule - 8/1/2016
33606 Y $1,733.74 General Fee Schedule - 8/1/2016
33608 Y $1,771.79 General Fee Schedule - 8/1/2016
33610 Y $1,731.60 General Fee Schedule - 8/1/2016
33611 Y $1,868.33 General Fee Schedule - 8/1/2016
33612 Y $1,969.42 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 76 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33615 Y $1,910.55 General Fee Schedule - 12/1/2009
33617 Y $2,083.04 General Fee Schedule - 8/1/2016
33619 Y $2,564.06 General Fee Schedule - 8/1/2016
33620 Y $1,537.72 General Fee Schedule - 1/1/2017
33621 Y $885.28 General Fee Schedule - 8/1/2016
33622 Y $3,473.56 General Fee Schedule - 8/1/2016
33641 Y $1,264.38 General Fee Schedule - 12/1/2009
33645 Y $1,491.05 General Fee Schedule - 12/1/2009
33647 Y $1,694.55 General Fee Schedule - 12/1/2009
33660 Y $1,703.10 General Fee Schedule - 8/1/2016
33665 Y $1,715.09 General Fee Schedule - 12/1/2009
33670 Y $1,883.12 General Fee Schedule - 8/1/2016
33675 Y $1,831.34 General Fee Schedule - 12/1/2009
33676 Y $1,888.69 General Fee Schedule - 12/1/2009
33677 Y $1,963.37 General Fee Schedule - 12/1/2009
33681 Y $1,763.45 General Fee Schedule - 8/1/2016
33684 Y $1,727.35 General Fee Schedule - 12/1/2009
33688 Y $1,702.51 General Fee Schedule - 12/1/2009
33690 Y $1,123.23 General Fee Schedule - 8/1/2016
33692 Y $1,820.81 General Fee Schedule - 12/1/2009
33694 Y $1,901.14 General Fee Schedule - 8/1/2016
33697 Y $1,957.48 General Fee Schedule - 8/1/2016
33702 Y $1,517.79 General Fee Schedule - 8/1/2016
33710 Y $1,777.23 General Fee Schedule - 12/1/2009
33720 Y $1,514.63 General Fee Schedule - 8/1/2016
33722 Y $1,550.89 General Fee Schedule - 8/1/2016
33724 Y $1,315.79 General Fee Schedule - 12/1/2009
33726 Y $1,735.26 General Fee Schedule - 12/1/2009
33730 Y $1,898.82 General Fee Schedule - 8/1/2016
33732 Y $1,604.76 General Fee Schedule - 8/1/2016
33735 Y $1,197.90 General Fee Schedule - 12/1/2009
33736 Y $1,362.65 General Fee Schedule - 8/1/2016
33737 Y $1,272.87 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 77 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33750 Y $1,167.26 General Fee Schedule - 8/1/2016
33755 Y $1,204.32 General Fee Schedule - 8/1/2016
33762 Y $1,244.71 General Fee Schedule - 8/1/2016
33764 Y $1,242.69 General Fee Schedule - 8/1/2016
33766 Y $1,312.48 General Fee Schedule - 1/1/2017
33767 Y $1,418.91 General Fee Schedule - 8/1/2016
33768 Y $423.67 General Fee Schedule - 8/1/2016
33770 Y $2,042.30 General Fee Schedule - 8/1/2016
33771 Y $1,956.27 General Fee Schedule - 12/1/2009
33774 Y $1,788.44 General Fee Schedule - 8/1/2016
33775 Y $1,850.46 General Fee Schedule - 8/1/2016
33776 Y $1,948.58 General Fee Schedule - 8/1/2016
33777 Y $1,934.11 General Fee Schedule - 8/1/2016
33778 Y $2,335.09 General Fee Schedule - 12/1/2009
33779 Y $2,023.84 General Fee Schedule - 12/1/2009
33780 Y $2,295.60 General Fee Schedule - 8/1/2016
33781 Y $2,068.29 General Fee Schedule - 12/1/2009
33782 Y $2,774.98 General Fee Schedule - 1/1/2010
33783 Y $3,032.25 General Fee Schedule - 1/1/2010
33786 Y $2,182.47 General Fee Schedule - 8/1/2016
33788 Y $1,511.99 General Fee Schedule - 8/1/2016
33800 Y $949.49 General Fee Schedule - 8/1/2016
33802 Y $1,032.25 General Fee Schedule - 8/1/2016
33803 Y $1,152.72 General Fee Schedule - 8/1/2016
33813 Y $1,227.11 General Fee Schedule - 8/1/2016
33814 Y $1,497.52 General Fee Schedule - 8/1/2016
33820 Y $955.91 General Fee Schedule - 8/1/2016
33822 Y $1,024.37 General Fee Schedule - 8/1/2016
33824 Y $1,146.71 General Fee Schedule - 8/1/2016
33840 Y $1,173.82 General Fee Schedule - 8/1/2016
33845 Y $1,299.02 General Fee Schedule - 8/1/2016
33851 Y $1,150.91 General Fee Schedule - 1/1/2017
33852 Y $1,322.75 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 78 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33853 Y $1,810.18 General Fee Schedule - 8/1/2016
33860 Y $2,227.63 General Fee Schedule - 12/1/2009
33863 Y $2,602.80 General Fee Schedule - 12/1/2009
33864 Y $2,507.98 General Fee Schedule - 12/1/2009
33870 Y $2,452.44 General Fee Schedule - 8/1/2016
33875 Y $1,926.50 General Fee Schedule - 12/1/2009
33877 Y $2,406.62 General Fee Schedule - 12/1/2009
33880 Y $1,757.70 General Fee Schedule - 8/1/2016
33881 Y $1,508.55 General Fee Schedule - 8/1/2016
33883 Y $1,113.45 General Fee Schedule - 8/1/2016
33884 Y $417.17 General Fee Schedule - 8/1/2016
33886 Y $960.46 General Fee Schedule - 8/1/2016
33889 Y $792.79 General Fee Schedule - 1/1/2017
33891 Y $977.11 General Fee Schedule - 1/1/2017
33910 Y $1,467.43 General Fee Schedule - 12/1/2009
33915 Y $1,190.66 General Fee Schedule - 12/1/2009
33916 Y $1,511.17 General Fee Schedule - 12/1/2009
33917 Y $1,430.38 General Fee Schedule - 8/1/2016
33920 Y $1,782.51 General Fee Schedule - 8/1/2016
33922 Y $1,331.76 General Fee Schedule - 8/1/2016
33924 Y $291.43 General Fee Schedule - 8/1/2016
33925 Y $1,728.82 General Fee Schedule - 8/1/2016
33926 Y $2,344.65 General Fee Schedule - 8/1/2016
33927 Y $2,527.70 General Fee Schedule - 1/1/2018
33928 Y $0.00 General by Report - 1/1/2018
33929 Y $0.00 General by Report - 1/1/2018
33930 Y $582.55 General Fee Schedule - 12/1/2009
33933 Y $0.00 General by Report - 1/1/2005
33935 Y $3,649.19 General Fee Schedule - 12/1/2009
33940 Y $448.30 General Fee Schedule - 12/1/2009
33944 Y $0.00 General by Report - 1/1/2005
33945 Y $2,572.63 General Fee Schedule - 12/1/2009
33946 Y $302.97 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 79 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33947 Y $342.05 General Fee Schedule - 8/1/2016
33948 Y $238.26 General Fee Schedule - 1/1/2017
33949 Y $231.86 General Fee Schedule - 1/1/2017
33951 Y $408.78 General Fee Schedule - 1/1/2017
33952 Y $433.92 General Fee Schedule - 8/1/2016
33953 Y $456.48 General Fee Schedule - 1/1/2017
33954 Y $484.88 General Fee Schedule - 8/1/2016
33955 Y $817.86 General Fee Schedule - 1/1/2017
33956 Y $851.40 General Fee Schedule - 8/1/2016
33957 Y $181.24 General Fee Schedule - 1/1/2017
33958 Y $179.40 General Fee Schedule - 1/1/2017
33959 Y $230.10 General Fee Schedule - 1/1/2017
33962 Y $238.25 General Fee Schedule - 8/1/2016
33963 Y $461.23 General Fee Schedule - 1/1/2017
33964 Y $481.32 General Fee Schedule - 1/1/2017
33965 Y $181.24 General Fee Schedule - 1/1/2017
33966 Y $234.45 General Fee Schedule - 1/1/2017
33967 Y $251.75 General Fee Schedule - 8/1/2016
33968 Y $33.60 General Fee Schedule - 8/1/2016
33969 Y $268.64 General Fee Schedule - 1/1/2017
33970 Y $352.20 General Fee Schedule - 8/1/2016
33971 Y $622.92 General Fee Schedule - 12/1/2009
33973 Y $512.19 General Fee Schedule - 8/1/2016
33974 Y $850.24 General Fee Schedule - 8/1/2016
33975 Y $1,130.82 General Fee Schedule - 12/1/2009
33976 Y $1,258.06 General Fee Schedule - 12/1/2009
33977 Y $1,116.46 General Fee Schedule - 1/1/2017
33978 Y $1,300.70 General Fee Schedule - 8/1/2016
33979 Y $1,935.27 General Fee Schedule - 1/1/2017
33980 Y $1,769.28 General Fee Schedule - 1/1/2017
33981 Y $814.81 General Fee Schedule - 8/1/2016
33982 Y $1,906.15 General Fee Schedule - 8/1/2016
33983 Y $2,238.20 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 80 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
33984 Y $288.64 General Fee Schedule - 8/1/2016
33985 Y $506.43 General Fee Schedule - 1/1/2017
33986 Y $526.78 General Fee Schedule - 8/1/2016
33987 Y $211.37 General Fee Schedule - 8/1/2016
33988 Y $785.45 General Fee Schedule - 8/1/2016
33989 Y $499.22 General Fee Schedule - 8/1/2016
33990 Y $414.02 General Fee Schedule - 8/1/2016
33991 Y $603.27 General Fee Schedule - 8/1/2016
33992 Y $197.33 General Fee Schedule - 8/1/2016
33993 Y $173.25 General Fee Schedule - 8/1/2016
33999 Y $0.00 General by Report - 7/1/1975
34001 Y $791.52 General Fee Schedule - 12/1/2009
34051 Y $929.36 General Fee Schedule - 12/1/2009
34101 Y $593.43 General Fee Schedule - 8/1/2016
34111 Y $593.10 General Fee Schedule - 8/1/2016
34151 Y $1,385.43 General Fee Schedule - 8/1/2016
34201 Y $622.37 General Fee Schedule - 12/1/2009
34203 Y $954.16 General Fee Schedule - 8/1/2016
34401 Y $1,378.70 General Fee Schedule - 8/1/2016
34421 Y $702.72 General Fee Schedule - 8/1/2016
34451 Y $1,450.16 General Fee Schedule - 1/1/2017
34471 Y $615.06 General Fee Schedule - 12/1/2009
34490 Y $590.54 General Fee Schedule - 8/1/2016
34501 Y $949.44 General Fee Schedule - 8/1/2016
34502 Y $1,522.44 General Fee Schedule - 8/1/2016
34510 Y $1,088.28 General Fee Schedule - 8/1/2016
34520 Y $1,018.02 General Fee Schedule - 8/1/2016
34530 Y $996.73 General Fee Schedule - 12/1/2009
34701 Y $1,216.37 General Fee Schedule - 1/1/2018
34702 Y $1,817.32 General Fee Schedule - 1/1/2018
34703 Y $1,374.83 General Fee Schedule - 1/1/2018
34704 Y $2,286.70 General Fee Schedule - 1/1/2018
34705 Y $1,511.37 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 81 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
34706 Y $2,276.62 General Fee Schedule - 1/1/2018
34707 Y $1,134.99 General Fee Schedule - 1/1/2018
34708 Y $1,828.03 General Fee Schedule - 1/1/2018
34709 Y $321.09 General Fee Schedule - 1/1/2018
34710 Y $790.55 General Fee Schedule - 1/1/2018
34711 Y $296.51 General Fee Schedule - 1/1/2018
34712 Y $670.30 General Fee Schedule - 1/1/2018
34713 Y $127.35 General Fee Schedule - 1/1/2018
34714 Y $266.86 General Fee Schedule - 1/1/2018
34715 Y $298.06 General Fee Schedule - 1/1/2018
34716 Y $369.68 General Fee Schedule - 1/1/2018
34808 Y $208.33 General Fee Schedule - 1/1/2017
34812 Y $339.75 General Fee Schedule - 1/1/2017
34813 Y $237.98 General Fee Schedule - 1/1/2017
34820 Y $495.09 General Fee Schedule - 1/1/2017
34830 Y $1,807.60 General Fee Schedule - 8/1/2016
34831 Y $1,856.03 General Fee Schedule - 8/1/2016
34832 Y $1,898.64 General Fee Schedule - 1/1/2017
34833 Y $612.14 General Fee Schedule - 1/1/2017
34834 Y $274.36 General Fee Schedule - 1/1/2017
34839 Y $0.00 General by Report - 1/1/2015
34841 Y $0.00 General by Report - 1/1/2014
34842 Y $0.00 General by Report - 1/1/2014
34843 Y $0.00 General by Report - 1/1/2014
34844 Y $0.00 General by Report - 1/1/2014
34845 Y $0.00 General by Report - 1/1/2014
34846 Y $0.00 General by Report - 1/1/2014
34847 Y $0.00 General by Report - 1/1/2014
34848 Y $0.00 General by Report - 1/1/2014
35001 Y $1,134.36 General Fee Schedule - 8/1/2016
35002 Y $1,142.58 General Fee Schedule - 1/1/2017
35005 Y $1,020.22 General Fee Schedule - 8/1/2016
35011 Y $1,013.04 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 82 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
35013 Y $1,235.38 General Fee Schedule - 8/1/2016
35021 Y $1,179.30 General Fee Schedule - 12/1/2009
35022 Y $1,287.35 General Fee Schedule - 8/1/2016
35045 Y $978.02 General Fee Schedule - 8/1/2016
35081 Y $1,611.17 General Fee Schedule - 12/1/2009
35082 Y $2,108.00 General Fee Schedule - 8/1/2016
35091 Y $1,806.27 General Fee Schedule - 1/1/2017
35092 Y $2,457.55 General Fee Schedule - 8/1/2016
35102 Y $1,763.98 General Fee Schedule - 12/1/2009
35103 Y $2,211.12 General Fee Schedule - 8/1/2016
35111 Y $1,442.10 General Fee Schedule - 12/1/2009
35112 Y $1,707.52 General Fee Schedule - 12/1/2009
35121 Y $1,659.99 General Fee Schedule - 8/1/2016
35122 Y $1,986.61 General Fee Schedule - 12/1/2009
35131 Y $1,404.57 General Fee Schedule - 8/1/2016
35132 Y $1,660.31 General Fee Schedule - 8/1/2016
35141 Y $1,129.67 General Fee Schedule - 8/1/2016
35142 Y $1,314.85 General Fee Schedule - 8/1/2016
35151 Y $1,246.54 General Fee Schedule - 1/1/2017
35152 Y $1,410.60 General Fee Schedule - 1/1/2017
35180 Y $797.78 General Fee Schedule - 12/1/2009
35182 Y $1,676.11 General Fee Schedule - 8/1/2016
35184 Y $1,022.57 General Fee Schedule - 8/1/2016
35188 Y $886.61 General Fee Schedule - 12/1/2009
35189 Y $1,562.46 General Fee Schedule - 8/1/2016
35190 Y $744.38 General Fee Schedule - 8/1/2016
35201 Y $937.86 General Fee Schedule - 8/1/2016
35206 Y $767.86 General Fee Schedule - 8/1/2016
35207 Y $694.45 General Fee Schedule - 12/1/2009
35211 Y $1,274.04 General Fee Schedule - 8/1/2016
35216 Y $1,121.90 General Fee Schedule - 12/1/2009
35221 Y $1,341.08 General Fee Schedule - 8/1/2016
35226 Y $848.07 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 83 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
35231 Y $1,157.27 General Fee Schedule - 8/1/2016
35236 Y $972.81 General Fee Schedule - 8/1/2016
35241 Y $1,338.80 General Fee Schedule - 8/1/2016
35246 Y $1,482.62 General Fee Schedule - 8/1/2016
35251 Y $1,642.32 General Fee Schedule - 8/1/2016
35256 Y $1,041.21 General Fee Schedule - 8/1/2016
35261 Y $1,008.62 General Fee Schedule - 8/1/2016
35266 Y $851.79 General Fee Schedule - 8/1/2016
35271 Y $1,269.43 General Fee Schedule - 8/1/2016
35276 Y $1,381.60 General Fee Schedule - 8/1/2016
35281 Y $1,552.92 General Fee Schedule - 8/1/2016
35286 Y $940.92 General Fee Schedule - 8/1/2016
35301 Y $1,058.09 General Fee Schedule - 8/1/2016
35302 Y $981.07 General Fee Schedule - 12/1/2009
35303 Y $1,078.20 General Fee Schedule - 12/1/2009
35304 Y $1,122.00 General Fee Schedule - 12/1/2009
35305 Y $1,078.20 General Fee Schedule - 12/1/2009
35306 Y $405.55 General Fee Schedule - 12/1/2009
35311 Y $1,467.55 General Fee Schedule - 8/1/2016
35321 Y $909.64 General Fee Schedule - 8/1/2016
35331 Y $1,466.12 General Fee Schedule - 8/1/2016
35341 Y $1,371.35 General Fee Schedule - 1/1/2017
35351 Y $1,278.10 General Fee Schedule - 8/1/2016
35355 Y $1,038.84 General Fee Schedule - 8/1/2016
35361 Y $1,566.30 General Fee Schedule - 8/1/2016
35363 Y $1,675.26 General Fee Schedule - 8/1/2016
35371 Y $820.07 General Fee Schedule - 1/1/2017
35372 Y $983.50 General Fee Schedule - 1/1/2017
35390 Y $158.39 General Fee Schedule - 1/1/2017
35400 Y $150.47 General Fee Schedule - 1/1/2017
35500 Y $319.06 General Fee Schedule - 1/1/2017
35501 Y $1,126.61 General Fee Schedule - 12/1/2009
35506 Y $1,181.79 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 84 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
35508 Y $1,138.62 General Fee Schedule - 12/1/2009
35509 Y $1,087.42 General Fee Schedule - 12/1/2009
35510 Y $1,256.37 General Fee Schedule - 8/1/2016
35511 Y $1,130.43 General Fee Schedule - 1/1/2017
35512 Y $1,232.25 General Fee Schedule - 8/1/2016
35515 Y $1,133.14 General Fee Schedule - 12/1/2009
35516 Y $943.14 General Fee Schedule - 12/1/2009
35518 Y $1,180.41 General Fee Schedule - 8/1/2016
35521 Y $1,249.05 General Fee Schedule - 8/1/2016
35522 Y $1,196.62 General Fee Schedule - 8/1/2016
35523 Y $1,019.56 General Fee Schedule - 12/1/2009
35525 Y $1,142.26 General Fee Schedule - 8/1/2016
35526 Y $1,640.52 General Fee Schedule - 8/1/2016
35531 Y $1,987.56 General Fee Schedule - 8/1/2016
35533 Y $1,508.98 General Fee Schedule - 1/1/2017
35535 Y $1,874.67 General Fee Schedule - 8/1/2016
35536 Y $1,705.17 General Fee Schedule - 1/1/2017
35537 Y $1,897.10 General Fee Schedule - 12/1/2009
35538 Y $2,119.73 General Fee Schedule - 12/1/2009
35539 Y $1,992.33 General Fee Schedule - 12/1/2009
35540 Y $2,221.34 General Fee Schedule - 12/1/2009
35556 Y $1,279.30 General Fee Schedule - 12/1/2009
35558 Y $1,198.15 General Fee Schedule - 8/1/2016
35560 Y $1,728.92 General Fee Schedule - 1/1/2017
35563 Y $1,358.41 General Fee Schedule - 8/1/2016
35565 Y $1,301.61 General Fee Schedule - 8/1/2016
35566 Y $1,560.14 General Fee Schedule - 12/1/2009
35570 Y $1,445.20 General Fee Schedule - 8/1/2016
35571 Y $1,360.73 General Fee Schedule - 8/1/2016
35572 Y $346.43 General Fee Schedule - 1/1/2017
35583 Y $1,319.99 General Fee Schedule - 12/1/2009
35585 Y $1,586.11 General Fee Schedule - 8/1/2016
35587 Y $1,371.48 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 85 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
35600 Y $249.18 General Fee Schedule - 1/1/2017
35601 Y $1,056.15 General Fee Schedule - 12/1/2009
35606 Y $1,123.45 General Fee Schedule - 12/1/2009
35612 Y $949.87 General Fee Schedule - 12/1/2009
35616 Y $958.88 General Fee Schedule - 12/1/2009
35621 Y $1,122.44 General Fee Schedule - 8/1/2016
35623 Y $1,348.00 General Fee Schedule - 8/1/2016
35626 Y $1,556.18 General Fee Schedule - 8/1/2016
35631 Y $1,878.05 General Fee Schedule - 8/1/2016
35632 Y $1,779.69 General Fee Schedule - 8/1/2016
35633 Y $1,922.45 General Fee Schedule - 8/1/2016
35634 Y $1,741.60 General Fee Schedule - 8/1/2016
35636 Y $1,632.53 General Fee Schedule - 8/1/2016
35637 Y $1,509.15 General Fee Schedule - 12/1/2009
35638 Y $1,533.07 General Fee Schedule - 12/1/2009
35642 Y $991.06 General Fee Schedule - 1/1/2017
35645 Y $1,001.28 General Fee Schedule - 8/1/2016
35646 Y $1,725.64 General Fee Schedule - 8/1/2016
35647 Y $1,555.88 General Fee Schedule - 8/1/2016
35650 Y $1,068.24 General Fee Schedule - 8/1/2016
35654 Y $1,392.64 General Fee Schedule - 8/1/2016
35656 Y $1,098.41 General Fee Schedule - 8/1/2016
35661 Y $1,086.96 General Fee Schedule - 8/1/2016
35663 Y $1,245.58 General Fee Schedule - 8/1/2016
35665 Y $1,187.78 General Fee Schedule - 8/1/2016
35666 Y $1,276.29 General Fee Schedule - 8/1/2016
35671 Y $1,115.64 General Fee Schedule - 8/1/2016
35681 Y $79.09 General Fee Schedule - 1/1/2017
35682 Y $357.19 General Fee Schedule - 1/1/2017
35683 Y $416.89 General Fee Schedule - 1/1/2017
35685 Y $199.72 General Fee Schedule - 1/1/2017
35686 Y $163.49 General Fee Schedule - 1/1/2017
35691 Y $965.45 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 86 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
35693 Y $813.85 General Fee Schedule - 1/1/2017
35694 Y $996.81 General Fee Schedule - 1/1/2017
35695 Y $1,055.32 General Fee Schedule - 1/1/2017
35697 Y $147.89 General Fee Schedule - 1/1/2017
35700 Y $152.83 General Fee Schedule - 1/1/2017
35701 Y $521.33 General Fee Schedule - 8/1/2016
35721 Y $445.78 General Fee Schedule - 8/1/2016
35741 Y $486.70 General Fee Schedule - 8/1/2016
35761 Y $355.61 General Fee Schedule - 8/1/2016
35800 Y $462.94 General Fee Schedule - 12/1/2009
35820 Y $810.58 General Fee Schedule - 12/1/2009
35840 Y $604.47 General Fee Schedule - 12/1/2009
35860 Y $379.10 General Fee Schedule - 12/1/2009
35870 Y $1,241.66 General Fee Schedule - 8/1/2016
35875 Y $592.30 General Fee Schedule - 8/1/2016
35876 Y $955.57 General Fee Schedule - 8/1/2016
35879 Y $920.82 General Fee Schedule - 8/1/2016
35881 Y $1,036.05 General Fee Schedule - 8/1/2016
35883 Y $1,100.54 General Fee Schedule - 12/1/2009
35884 Y $1,169.02 General Fee Schedule - 12/1/2009
35901 Y $470.97 General Fee Schedule - 1/1/2017
35903 Y $560.96 General Fee Schedule - 1/1/2017
35905 Y $1,697.64 General Fee Schedule - 1/1/2017
35907 Y $1,924.62 General Fee Schedule - 8/1/2016
36000 Y $26.81 General Fee Schedule - 12/1/2009
36002 Y $150.93 General Fee Schedule - 1/1/2017
36005 Y $288.96 General Fee Schedule - 8/1/2016
36010 Y $447.61 General Fee Schedule - 1/1/2017
36011 Y $741.27 General Fee Schedule - 1/1/2017
36012 Y $762.18 General Fee Schedule - 8/1/2016
36013 Y $707.35 General Fee Schedule - 1/1/2017
36014 Y $725.59 General Fee Schedule - 1/1/2017
36015 Y $776.68 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 87 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
36100 Y $442.73 General Fee Schedule - 1/1/2017
36140 Y $390.44 General Fee Schedule - 1/1/2017
36160 Y $442.85 General Fee Schedule - 1/1/2017
36200 Y $562.20 General Fee Schedule - 1/1/2017
36215 Y $1,008.32 General Fee Schedule - 1/1/2017
36216 Y $1,081.99 General Fee Schedule - 1/1/2017
36217 Y $1,795.93 General Fee Schedule - 1/1/2017
36218 Y $173.91 General Fee Schedule - 1/1/2017
36221 Y $983.80 General Fee Schedule - 1/1/2017
36222 Y $1,183.34 General Fee Schedule - 1/1/2017
36223 Y $1,408.38 General Fee Schedule - 8/1/2016
36224 Y $1,529.53 General Fee Schedule - 8/1/2016
36225 Y $1,350.22 General Fee Schedule - 1/1/2017
36226 Y $1,558.85 General Fee Schedule - 8/1/2016
36227 Y $228.00 General Fee Schedule - 8/1/2016
36228 Y $1,069.26 General Fee Schedule - 8/1/2016
36245 Y $1,241.00 General Fee Schedule - 8/1/2016
36246 Y $807.44 General Fee Schedule - 1/1/2017
36247 Y $1,414.26 General Fee Schedule - 1/1/2017
36248 Y $138.37 General Fee Schedule - 1/1/2017
36251 Y $1,278.43 General Fee Schedule - 1/1/2017
36252 Y $1,393.06 General Fee Schedule - 1/1/2017
36253 Y $2,002.62 General Fee Schedule - 8/1/2016
36254 Y $1,976.02 General Fee Schedule - 1/1/2017
36260 Y $586.39 General Fee Schedule - 12/1/2009
36261 Y $345.41 General Fee Schedule - 8/1/2016
36262 Y $267.92 General Fee Schedule - 12/1/2009
36299 Y $0.00 General by Report - 1/1/1996
36400 Y $25.29 General Fee Schedule - 12/1/2009
36405 Y $21.91 General Fee Schedule - 12/1/2009
36406 Y $15.51 General Fee Schedule - 1/1/2017
36410 Y $15.51 General Fee Schedule - 1/1/2017
36415 Y $2.82 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 88 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
36420 Y $50.92 General Fee Schedule - 8/1/2016
36425 Y $37.38 General Fee Schedule - 8/1/2016
36430 Y $30.49 General Fee Schedule - 1/1/2017
36440 Y $51.01 General Fee Schedule - 8/1/2016
36450 Y $112.93 General Fee Schedule - 8/1/2016
36455 Y $123.82 General Fee Schedule - 1/1/2017
36456 Y $103.79 General Fee Schedule - 1/1/2017
36460 Y $358.30 General Fee Schedule - 12/1/2009
36465 Y $1,416.37 General Fee Schedule - 1/1/2018
36466 Y $1,481.99 General Fee Schedule - 1/1/2018
36470 Y $132.78 General Fee Schedule - 8/1/2016
36471 Y $161.08 General Fee Schedule - 1/1/2017
36473 Y $1,331.38 General Fee Schedule - 1/1/2017
36474 Y $248.56 General Fee Schedule - 1/1/2017
36475 Y $1,377.35 General Fee Schedule - 1/1/2017
36476 Y $274.56 General Fee Schedule - 1/1/2017
36478 Y $1,086.63 General Fee Schedule - 1/1/2017
36479 Y $284.75 General Fee Schedule - 1/1/2017
36481 Y $485.28 General Fee Schedule - 12/1/2009
36482 Y $1,886.80 General Fee Schedule - 1/1/2018
36483 Y $134.52 General Fee Schedule - 1/1/2018
36500 Y $181.73 General Fee Schedule - 8/1/2016
36510 Y $83.64 General Fee Schedule - 1/1/2017
36511 Y $88.98 General Fee Schedule - 1/1/2017
36512 Y $91.45 General Fee Schedule - 8/1/2016
36513 Y $94.11 General Fee Schedule - 8/1/2016
36514 Y $478.43 General Fee Schedule - 1/1/2017
36516 Y $1,831.53 General Fee Schedule - 1/1/2017
36522 Y $1,180.28 General Fee Schedule - 12/1/2009
36555 Y $244.95 General Fee Schedule - 1/1/2017
36556 Y $217.17 General Fee Schedule - 1/1/2017
36557 Y $904.30 General Fee Schedule - 8/1/2016
36558 Y $707.14 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 89 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
36560 Y $1,228.26 General Fee Schedule - 8/1/2016
36561 Y $1,062.43 General Fee Schedule - 1/1/2017
36563 Y $1,138.72 General Fee Schedule - 8/1/2016
36565 Y $887.90 General Fee Schedule - 1/1/2017
36566 Y $1,145.64 General Fee Schedule - 12/1/2009
36568 Y $272.49 General Fee Schedule - 1/1/2017
36569 Y $226.32 General Fee Schedule - 1/1/2017
36570 Y $1,040.25 General Fee Schedule - 1/1/2017
36571 Y $1,175.80 General Fee Schedule - 1/1/2017
36575 Y $148.95 General Fee Schedule - 1/1/2017
36576 Y $353.27 General Fee Schedule - 8/1/2016
36578 Y $473.44 General Fee Schedule - 1/1/2017
36580 Y $193.90 General Fee Schedule - 1/1/2017
36581 Y $688.25 General Fee Schedule - 1/1/2017
36582 Y $993.63 General Fee Schedule - 1/1/2017
36583 Y $1,102.75 General Fee Schedule - 12/1/2009
36584 Y $184.30 General Fee Schedule - 1/1/2017
36585 Y $1,034.42 General Fee Schedule - 1/1/2017
36589 Y $155.31 General Fee Schedule - 1/1/2017
36590 Y $258.29 General Fee Schedule - 12/1/2009
36591 Y $16.17 General Fee Schedule - 12/1/2009
36592 Y $19.98 General Fee Schedule - 12/1/2009
36593 Y $27.40 General Fee Schedule - 1/1/2017
36595 Y $527.99 General Fee Schedule - 1/1/2017
36596 Y $120.47 General Fee Schedule - 1/1/2017
36597 Y $116.63 General Fee Schedule - 1/1/2017
36598 Y $99.77 General Fee Schedule - 1/1/2017
36600 Y $28.63 General Fee Schedule - 8/1/2016
36620 Y $50.06 General Fee Schedule - 1/1/2017
36625 Y $104.23 General Fee Schedule - 8/1/2016
36640 Y $112.88 General Fee Schedule - 1/1/2017
36660 Y $62.28 General Fee Schedule - 1/1/2017
36680 Y $57.05 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 90 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
36800 Y $120.37 General Fee Schedule - 1/1/2017
36810 Y $216.87 General Fee Schedule - 8/1/2016
36815 Y $147.14 General Fee Schedule - 8/1/2016
36818 Y $688.40 General Fee Schedule - 8/1/2016
36819 Y $730.73 General Fee Schedule - 1/1/2017
36820 Y $728.57 General Fee Schedule - 1/1/2017
36821 Y $546.33 General Fee Schedule - 12/1/2009
36823 Y $1,230.74 General Fee Schedule - 12/1/2009
36825 Y $599.30 General Fee Schedule - 12/1/2009
36830 Y $671.53 General Fee Schedule - 8/1/2016
36831 Y $481.29 General Fee Schedule - 12/1/2009
36832 Y $616.20 General Fee Schedule - 12/1/2009
36833 Y $696.20 General Fee Schedule - 12/1/2009
36835 Y $457.69 General Fee Schedule - 12/1/2009
36838 Y $1,145.50 General Fee Schedule - 1/1/2017
36860 Y $142.33 General Fee Schedule - 12/1/2009
36861 Y $130.43 General Fee Schedule - 1/1/2017
36901 Y $514.28 General Fee Schedule - 1/1/2017
36902 Y $1,086.11 General Fee Schedule - 1/1/2017
36903 Y $4,922.54 General Fee Schedule - 1/1/2017
36904 Y $1,585.90 General Fee Schedule - 1/1/2017
36905 Y $2,028.79 General Fee Schedule - 1/1/2017
36906 Y $5,981.22 General Fee Schedule - 1/1/2017
36907 Y $649.66 General Fee Schedule - 1/1/2017
36908 Y $2,369.82 General Fee Schedule - 1/1/2017
36909 Y $1,731.89 General Fee Schedule - 1/1/2017
37140 Y $1,338.66 General Fee Schedule - 12/1/2009
37145 Y $1,433.48 General Fee Schedule - 12/1/2009
37160 Y $1,247.37 General Fee Schedule - 12/1/2009
37180 Y $1,417.08 General Fee Schedule - 12/1/2009
37181 Y $1,523.36 General Fee Schedule - 12/1/2009
37182 Y $808.52 General Fee Schedule - 1/1/2017
37183 Y $428.03 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 91 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
37184 Y $2,038.22 General Fee Schedule - 1/1/2017
37185 Y $651.07 General Fee Schedule - 1/1/2017
37186 Y $1,235.84 General Fee Schedule - 1/1/2017
37187 Y $1,844.97 General Fee Schedule - 1/1/2017
37188 Y $1,587.19 General Fee Schedule - 1/1/2017
37191 Y $2,365.26 General Fee Schedule - 8/1/2016
37192 Y $1,394.86 General Fee Schedule - 1/1/2017
37193 Y $1,437.85 General Fee Schedule - 1/1/2017
37195 Y $257.57 General Fee Schedule - 12/1/2009
37197 Y $1,364.69 General Fee Schedule - 1/1/2017
37200 Y $213.45 General Fee Schedule - 1/1/2017
37211 Y $383.16 General Fee Schedule - 8/1/2016
37212 Y $338.27 General Fee Schedule - 8/1/2016
37213 Y $236.52 General Fee Schedule - 8/1/2016
37214 Y $132.99 General Fee Schedule - 1/1/2017
37215 Y $993.58 General Fee Schedule - 1/1/2017
37216 Y $1,022.06 General Fee Schedule - 12/1/2009
37217 Y $1,106.47 General Fee Schedule - 8/1/2016
37218 Y $826.58 General Fee Schedule - 8/1/2016
37220 Y $2,817.77 General Fee Schedule - 1/1/2017
37221 Y $4,143.15 General Fee Schedule - 1/1/2017
37222 Y $798.04 General Fee Schedule - 1/1/2017
37223 Y $2,298.27 General Fee Schedule - 1/1/2017
37224 Y $3,413.29 General Fee Schedule - 8/1/2016
37225 Y $9,809.18 General Fee Schedule - 8/1/2016
37226 Y $8,015.35 General Fee Schedule - 1/1/2017
37227 Y $13,256.97 General Fee Schedule - 8/1/2016
37228 Y $4,842.04 General Fee Schedule - 1/1/2017
37229 Y $9,730.93 General Fee Schedule - 8/1/2016
37230 Y $7,367.31 General Fee Schedule - 1/1/2017
37231 Y $11,819.48 General Fee Schedule - 1/1/2017
37232 Y $1,085.94 General Fee Schedule - 1/1/2017
37233 Y $1,319.54 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 92 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
37234 Y $3,437.61 General Fee Schedule - 1/1/2017
37235 Y $3,627.67 General Fee Schedule - 1/1/2017
37236 Y $2,663.65 General Fee Schedule - 1/1/2014
37237 Y $1,158.55 General Fee Schedule - 1/1/2014
37238 Y $3,712.93 General Fee Schedule - 8/1/2016
37239 Y $1,798.66 General Fee Schedule - 1/1/2017
37241 Y $4,115.08 General Fee Schedule - 8/1/2016
37242 Y $6,913.64 General Fee Schedule - 8/1/2016
37243 Y $8,725.24 General Fee Schedule - 8/1/2016
37244 Y $6,128.61 General Fee Schedule - 8/1/2016
37246 Y $1,911.21 General Fee Schedule - 1/1/2017
37247 Y $776.21 General Fee Schedule - 1/1/2017
37248 Y $1,328.97 General Fee Schedule - 1/1/2017
37249 Y $571.25 General Fee Schedule - 1/1/2017
37252 Y $1,236.90 General Fee Schedule - 8/1/2016
37253 Y $197.58 General Fee Schedule - 8/1/2016
37500 Y $712.21 General Fee Schedule - 12/1/2009
37501 Y $0.00 General by Report - 1/1/2003
37565 Y $658.22 General Fee Schedule - 12/1/2009
37600 Y $681.46 General Fee Schedule - 8/1/2016
37605 Y $778.15 General Fee Schedule - 8/1/2016
37606 Y $440.97 General Fee Schedule - 12/1/2009
37607 Y $373.42 General Fee Schedule - 8/1/2016
37609 Y $271.34 General Fee Schedule - 8/1/2016
37615 Y $385.33 General Fee Schedule - 12/1/2009
37616 Y $993.18 General Fee Schedule - 12/1/2009
37617 Y $1,217.19 General Fee Schedule - 8/1/2016
37618 Y $333.52 General Fee Schedule - 12/1/2009
37619 Y $1,560.93 General Fee Schedule - 8/1/2016
37650 Y $476.30 General Fee Schedule - 8/1/2016
37660 Y $1,157.71 General Fee Schedule - 8/1/2016
37700 Y $247.45 General Fee Schedule - 8/1/2016
37718 Y $405.11 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 93 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
37722 Y $462.45 General Fee Schedule - 8/1/2016
37735 Y $645.79 General Fee Schedule - 12/1/2009
37760 Y $611.15 General Fee Schedule - 8/1/2016
37761 Y $526.44 General Fee Schedule - 8/1/2016
37765 Y $458.41 General Fee Schedule - 12/1/2009
37766 Y $557.98 General Fee Schedule - 12/1/2009
37780 Y $253.49 General Fee Schedule - 8/1/2016
37785 Y $331.07 General Fee Schedule - 8/1/2016
37788 Y $1,188.51 General Fee Schedule - 8/1/2016
37790 Y $472.20 General Fee Schedule - 8/1/2016
37799 Y $0.00 General by Report - 7/1/1975
38100 Y $836.82 General Fee Schedule - 12/1/2009
38101 Y $884.55 General Fee Schedule - 12/1/2009
38102 Y $252.29 General Fee Schedule - 8/1/2016
38115 Y $909.73 General Fee Schedule - 12/1/2009
38120 Y $946.32 General Fee Schedule - 8/1/2016
38129 Y $0.00 General by Report - 1/1/2000
38200 Y $113.07 General Fee Schedule - 1/1/2017
38204 Y $0.00 General by Report - 1/1/2003
38205 Y $78.26 General Fee Schedule - 8/1/2016
38206 Y $79.93 General Fee Schedule - 8/1/2016
38207 Y $0.00 General by Report - 1/1/2003
38208 Y $0.00 General by Report - 1/1/2003
38209 Y $0.00 General by Report - 1/1/2003
38210 Y $0.00 General by Report - 1/1/2003
38211 Y $0.00 General by Report - 1/1/2003
38212 Y $0.00 General by Report - 1/1/2003
38213 Y $0.00 General by Report - 1/1/2003
38214 Y $0.00 General by Report - 1/1/2003
38215 Y $0.00 General by Report - 1/1/2003
38220 Y $148.93 General Fee Schedule - 1/1/2017
38221 Y $151.48 General Fee Schedule - 1/1/2017
38222 Y $154.92 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 94 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
38230 Y $190.48 General Fee Schedule - 1/1/2017
38232 Y $180.69 General Fee Schedule - 2/6/2012
38240 Y $125.52 General Fee Schedule - 12/1/2009
38241 Y $125.87 General Fee Schedule - 12/1/2009
38242 Y $95.48 General Fee Schedule - 12/1/2009
38243 Y $108.48 General Fee Schedule - 8/1/2016
38300 Y $233.01 General Fee Schedule - 12/1/2009
38305 Y $413.96 General Fee Schedule - 12/1/2009
38308 Y $406.33 General Fee Schedule - 12/1/2009
38380 Y $508.27 General Fee Schedule - 12/1/2009
38381 Y $764.34 General Fee Schedule - 8/1/2016
38382 Y $607.85 General Fee Schedule - 8/1/2016
38500 Y $287.96 General Fee Schedule - 12/1/2009
38505 Y $112.93 General Fee Schedule - 8/1/2016
38510 Y $463.03 General Fee Schedule - 12/1/2009
38520 Y $425.09 General Fee Schedule - 12/1/2009
38525 Y $374.53 General Fee Schedule - 12/1/2009
38530 Y $496.97 General Fee Schedule - 12/1/2009
38542 Y $402.18 General Fee Schedule - 12/1/2009
38550 Y $431.32 General Fee Schedule - 12/1/2009
38555 Y $898.19 General Fee Schedule - 12/1/2009
38562 Y $643.82 General Fee Schedule - 12/1/2009
38564 Y $642.94 General Fee Schedule - 12/1/2009
38570 Y $485.70 General Fee Schedule - 1/1/2017
38571 Y $639.61 General Fee Schedule - 1/1/2017
38572 Y $910.04 General Fee Schedule - 8/1/2016
38573 Y $1,126.44 General Fee Schedule - 1/1/2018
38589 Y $0.00 General by Report - 1/1/2000
38700 Y $556.52 General Fee Schedule - 12/1/2009
38720 Y $887.15 General Fee Schedule - 12/1/2009
38724 Y $942.25 General Fee Schedule - 12/1/2009
38740 Y $601.45 General Fee Schedule - 12/1/2009
38745 Y $773.13 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 95 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
38746 Y $210.14 General Fee Schedule - 1/1/2017
38747 Y $256.93 General Fee Schedule - 8/1/2016
38760 Y $768.37 General Fee Schedule - 12/1/2009
38765 Y $1,157.68 General Fee Schedule - 12/1/2009
38770 Y $725.24 General Fee Schedule - 8/1/2016
38780 Y $946.51 General Fee Schedule - 8/1/2016
38790 Y $79.90 General Fee Schedule - 1/1/2017
38792 Y $35.72 General Fee Schedule - 8/1/2016
38794 Y $281.97 General Fee Schedule - 1/1/2017
38900 Y $130.96 General Fee Schedule - 8/1/2016
38999 Y $0.00 General by Report - 7/1/1975
39000 Y $425.35 General Fee Schedule - 12/1/2009
39010 Y $742.65 General Fee Schedule - 8/1/2016
39200 Y $819.08 General Fee Schedule - 8/1/2016
39220 Y $1,034.26 General Fee Schedule - 8/1/2016
39401 Y $307.16 General Fee Schedule - 8/1/2016
39402 Y $401.34 General Fee Schedule - 8/1/2016
39499 Y $0.00 General by Report - 7/1/1975
39501 Y $759.36 General Fee Schedule - 8/1/2016
39503 Y $5,185.65 General Fee Schedule - 12/1/2009
39540 Y $788.84 General Fee Schedule - 12/1/2009
39541 Y $847.73 General Fee Schedule - 12/1/2009
39545 Y $803.85 General Fee Schedule - 8/1/2016
39560 Y $733.04 General Fee Schedule - 12/1/2009
39561 Y $1,079.07 General Fee Schedule - 12/1/2009
39599 Y $0.00 General by Report - 7/1/1975
40490 Y $104.62 General Fee Schedule - 12/1/2009
40500 Y $414.52 General Fee Schedule - 12/1/2009
40510 Y $424.95 General Fee Schedule - 12/1/2009
40520 Y $438.40 General Fee Schedule - 8/1/2016
40525 Y $515.30 General Fee Schedule - 8/1/2016
40527 Y $592.76 General Fee Schedule - 1/1/2017
40530 Y $475.32 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 96 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
40650 Y $386.40 General Fee Schedule - 12/1/2009
40652 Y $429.77 General Fee Schedule - 8/1/2016
40654 Y $499.60 General Fee Schedule - 8/1/2016
40700 Y $803.78 General Fee Schedule - 8/1/2016
40701 Y $978.28 General Fee Schedule - 1/1/2017
40702 Y $795.06 General Fee Schedule - 8/1/2016
40720 Y $923.71 General Fee Schedule - 12/1/2009
40761 Y $986.71 General Fee Schedule - 12/1/2009
40799 Y $0.00 General by Report - 7/1/1975
40800 Y $151.34 General Fee Schedule - 12/1/2009
40801 Y $246.33 General Fee Schedule - 12/1/2009
40804 Y $168.07 General Fee Schedule - 12/1/2009
40805 Y $268.61 General Fee Schedule - 12/1/2009
40806 Y $76.35 General Fee Schedule - 12/1/2009
40808 Y $131.58 General Fee Schedule - 12/1/2009
40810 Y $154.00 General Fee Schedule - 12/1/2009
40812 Y $226.53 General Fee Schedule - 12/1/2009
40814 Y $315.26 General Fee Schedule - 12/1/2009
40816 Y $332.44 General Fee Schedule - 12/1/2009
40818 Y $277.62 General Fee Schedule - 12/1/2009
40819 Y $243.06 General Fee Schedule - 12/1/2009
40820 Y $188.09 General Fee Schedule - 12/1/2009
40830 Y $202.21 General Fee Schedule - 12/1/2009
40831 Y $265.21 General Fee Schedule - 12/1/2009
40840 Y $709.75 General Fee Schedule - 12/1/2009
40842 Y $690.56 General Fee Schedule - 8/1/2016
40843 Y $924.45 General Fee Schedule - 12/1/2009
40844 Y $1,178.13 General Fee Schedule - 8/1/2016
40845 Y $1,316.05 General Fee Schedule - 8/1/2016
40899 Y $0.00 General by Report - 7/1/1975
41000 Y $133.75 General Fee Schedule - 12/1/2009
41005 Y $167.14 General Fee Schedule - 12/1/2009
41006 Y $301.49 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 97 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
41007 Y $306.68 General Fee Schedule - 12/1/2009
41008 Y $304.77 General Fee Schedule - 12/1/2009
41009 Y $324.92 General Fee Schedule - 12/1/2009
41010 Y $160.77 General Fee Schedule - 12/1/2009
41015 Y $353.91 General Fee Schedule - 12/1/2009
41016 Y $367.77 General Fee Schedule - 12/1/2009
41017 Y $368.46 General Fee Schedule - 12/1/2009
41018 Y $430.52 General Fee Schedule - 12/1/2009
41019 Y $365.59 General Fee Schedule - 12/1/2009
41100 Y $145.25 General Fee Schedule - 8/1/2016
41105 Y $138.38 General Fee Schedule - 12/1/2009
41108 Y $115.20 General Fee Schedule - 12/1/2009
41110 Y $165.14 General Fee Schedule - 12/1/2009
41112 Y $268.43 General Fee Schedule - 12/1/2009
41113 Y $297.51 General Fee Schedule - 12/1/2009
41114 Y $577.99 General Fee Schedule - 8/1/2016
41115 Y $186.37 General Fee Schedule - 12/1/2009
41116 Y $251.39 General Fee Schedule - 12/1/2009
41120 Y $929.55 General Fee Schedule - 12/1/2009
41130 Y $1,017.73 General Fee Schedule - 12/1/2009
41135 Y $1,752.41 General Fee Schedule - 12/1/2009
41140 Y $1,976.64 General Fee Schedule - 12/1/2009
41145 Y $2,294.77 General Fee Schedule - 12/1/2009
41150 Y $1,803.56 General Fee Schedule - 12/1/2009
41153 Y $1,844.05 General Fee Schedule - 12/1/2009
41155 Y $2,069.19 General Fee Schedule - 12/1/2009
41250 Y $174.10 General Fee Schedule - 12/1/2009
41251 Y $207.52 General Fee Schedule - 12/1/2009
41252 Y $258.18 General Fee Schedule - 12/1/2009
41500 Y $392.57 General Fee Schedule - 8/1/2016
41510 Y $394.28 General Fee Schedule - 8/1/2016
41512 Y $516.82 General Fee Schedule - 12/1/2009
41520 Y $273.22 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 98 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
41530 Y $900.43 General Fee Schedule - 1/1/2017
41599 Y $0.00 General by Report - 7/1/1975
41800 Y $138.32 General Fee Schedule - 12/1/2009
41805 Y $144.10 General Fee Schedule - 12/1/2009
41806 Y $239.52 General Fee Schedule - 12/1/2009
41820 Y $158.75 General Fee Schedule - 12/1/2009
41821 Y $31.60 General Fee Schedule - 12/1/2009
41822 Y $233.40 General Fee Schedule - 12/1/2009
41823 Y $334.66 General Fee Schedule - 12/1/2009
41825 Y $160.86 General Fee Schedule - 12/1/2009
41826 Y $183.07 General Fee Schedule - 12/1/2009
41827 Y $333.04 General Fee Schedule - 12/1/2009
41828 Y $264.92 General Fee Schedule - 12/1/2009
41830 Y $314.28 General Fee Schedule - 12/1/2009
41850 Y $23.77 General Fee Schedule - 12/1/2009
41870 Y $190.34 General Fee Schedule - 12/1/2009
41872 Y $282.54 General Fee Schedule - 12/1/2009
41874 Y $300.86 General Fee Schedule - 12/1/2009
41899 Y $0.00 Manual Review Fee Schedule - 7/1/1975
42000 Y $139.60 General Fee Schedule - 12/1/2009
42100 Y $126.61 General Fee Schedule - 12/1/2009
42104 Y $156.14 General Fee Schedule - 12/1/2009
42106 Y $200.28 General Fee Schedule - 12/1/2009
42107 Y $382.36 General Fee Schedule - 12/1/2009
42120 Y $659.73 General Fee Schedule - 12/1/2009
42140 Y $194.73 General Fee Schedule - 12/1/2009
42145 Y $589.91 General Fee Schedule - 12/1/2009
42160 Y $212.35 General Fee Schedule - 8/1/2016
42180 Y $209.20 General Fee Schedule - 12/1/2009
42182 Y $282.34 General Fee Schedule - 8/1/2016
42200 Y $822.60 General Fee Schedule - 8/1/2016
42205 Y $853.24 General Fee Schedule - 1/1/2017
42210 Y $955.20 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 99 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
42215 Y $630.79 General Fee Schedule - 1/1/2017
42220 Y $476.77 General Fee Schedule - 1/1/2017
42225 Y $831.87 General Fee Schedule - 1/1/2017
42226 Y $852.84 General Fee Schedule - 1/1/2017
42227 Y $809.89 General Fee Schedule - 1/1/2017
42235 Y $705.93 General Fee Schedule - 8/1/2016
42260 Y $740.46 General Fee Schedule - 8/1/2016
42280 Y $133.45 General Fee Schedule - 12/1/2009
42281 Y $170.75 General Fee Schedule - 12/1/2009
42299 Y $0.00 General by Report - 7/1/1975
42300 Y $176.92 General Fee Schedule - 12/1/2009
42305 Y $396.93 General Fee Schedule - 8/1/2016
42310 Y $142.43 General Fee Schedule - 12/1/2009
42320 Y $210.26 General Fee Schedule - 12/1/2009
42330 Y $199.71 General Fee Schedule - 12/1/2009
42335 Y $305.89 General Fee Schedule - 12/1/2009
42340 Y $399.16 General Fee Schedule - 12/1/2009
42400 Y $88.67 General Fee Schedule - 12/1/2009
42405 Y $263.00 General Fee Schedule - 8/1/2016
42408 Y $393.42 General Fee Schedule - 12/1/2009
42409 Y $272.89 General Fee Schedule - 12/1/2009
42410 Y $580.99 General Fee Schedule - 8/1/2016
42415 Y $1,030.09 General Fee Schedule - 8/1/2016
42420 Y $1,145.95 General Fee Schedule - 1/1/2017
42425 Y $800.18 General Fee Schedule - 8/1/2016
42426 Y $1,275.28 General Fee Schedule - 8/1/2016
42440 Y $396.04 General Fee Schedule - 1/1/2017
42450 Y $395.13 General Fee Schedule - 12/1/2009
42500 Y $374.90 General Fee Schedule - 12/1/2009
42505 Y $501.60 General Fee Schedule - 12/1/2009
42507 Y $457.56 General Fee Schedule - 8/1/2016
42509 Y $793.61 General Fee Schedule - 8/1/2016
42510 Y $580.21 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 100 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
42550 Y $123.47 General Fee Schedule - 1/1/2017
42600 Y $426.48 General Fee Schedule - 12/1/2009
42650 Y $69.80 General Fee Schedule - 12/1/2009
42660 Y $92.95 General Fee Schedule - 12/1/2009
42665 Y $248.71 General Fee Schedule - 12/1/2009
42699 Y $0.00 General by Report - 7/1/1975
42700 Y $158.09 General Fee Schedule - 12/1/2009
42720 Y $389.73 General Fee Schedule - 12/1/2009
42725 Y $726.56 General Fee Schedule - 12/1/2009
42800 Y $132.43 General Fee Schedule - 12/1/2009
42804 Y $172.51 General Fee Schedule - 8/1/2016
42806 Y $196.95 General Fee Schedule - 8/1/2016
42808 Y $201.48 General Fee Schedule - 12/1/2009
42809 Y $155.50 General Fee Schedule - 12/1/2009
42810 Y $331.64 General Fee Schedule - 12/1/2009
42815 Y $493.17 General Fee Schedule - 8/1/2016
42820 Y $263.25 General Fee Schedule - 8/1/2016
42821 Y $285.56 General Fee Schedule - 8/1/2016
42825 Y $239.16 General Fee Schedule - 8/1/2016
42826 Y $233.74 General Fee Schedule - 8/1/2016
42830 Y $186.34 General Fee Schedule - 8/1/2016
42831 Y $201.39 General Fee Schedule - 8/1/2016
42835 Y $173.38 General Fee Schedule - 8/1/2016
42836 Y $224.07 General Fee Schedule - 8/1/2016
42842 Y $739.56 General Fee Schedule - 12/1/2009
42844 Y $1,149.02 General Fee Schedule - 12/1/2009
42845 Y $1,800.43 General Fee Schedule - 12/1/2009
42860 Y $167.44 General Fee Schedule - 8/1/2016
42870 Y $517.35 General Fee Schedule - 12/1/2009
42890 Y $1,020.79 General Fee Schedule - 12/1/2009
42892 Y $1,244.03 General Fee Schedule - 12/1/2009
42894 Y $1,702.19 General Fee Schedule - 12/1/2009
42900 Y $331.37 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 101 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
42950 Y $744.55 General Fee Schedule - 12/1/2009
42953 Y $932.05 General Fee Schedule - 8/1/2016
42955 Y $678.84 General Fee Schedule - 12/1/2009
42960 Y $157.39 General Fee Schedule - 8/1/2016
42961 Y $385.05 General Fee Schedule - 8/1/2016
42962 Y $478.34 General Fee Schedule - 8/1/2016
42970 Y $366.13 General Fee Schedule - 12/1/2009
42971 Y $415.27 General Fee Schedule - 8/1/2016
42972 Y $474.99 General Fee Schedule - 8/1/2016
42999 Y $0.00 General by Report - 7/1/1975
43020 Y $506.73 General Fee Schedule - 8/1/2016
43030 Y $488.89 General Fee Schedule - 8/1/2016
43045 Y $1,182.66 General Fee Schedule - 8/1/2016
43100 Y $576.10 General Fee Schedule - 8/1/2016
43101 Y $937.29 General Fee Schedule - 8/1/2016
43107 Y $2,348.84 General Fee Schedule - 12/1/2009
43108 Y $1,946.23 General Fee Schedule - 12/1/2009
43112 Y $2,541.24 General Fee Schedule - 12/1/2009
43113 Y $2,030.83 General Fee Schedule - 12/1/2009
43116 Y $1,881.61 General Fee Schedule - 12/1/2009
43117 Y $2,313.22 General Fee Schedule - 12/1/2009
43118 Y $1,894.34 General Fee Schedule - 12/1/2009
43121 Y $1,729.27 General Fee Schedule - 12/1/2009
43122 Y $2,325.26 General Fee Schedule - 12/1/2009
43123 Y $1,907.02 General Fee Schedule - 12/1/2009
43124 Y $1,631.02 General Fee Schedule - 12/1/2009
43130 Y $722.26 General Fee Schedule - 8/1/2016
43135 Y $978.82 General Fee Schedule - 12/1/2009
43180 Y $530.90 General Fee Schedule - 1/1/2017
43191 Y $126.79 General Fee Schedule - 1/1/2014
43192 Y $151.42 General Fee Schedule - 1/1/2014
43193 Y $163.93 General Fee Schedule - 1/1/2017
43194 Y $164.89 General Fee Schedule - 1/1/2014
CPT FEES01/03/2018 at 6:55:00 AM - 102 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
43195 Y $173.76 General Fee Schedule - 8/1/2016
43196 Y $190.94 General Fee Schedule - 8/1/2016
43197 Y $170.43 General Fee Schedule - 8/1/2016
43198 Y $190.70 General Fee Schedule - 8/1/2016
43200 Y $207.60 General Fee Schedule - 12/1/2009
43201 Y $234.92 General Fee Schedule - 8/1/2016
43202 Y $268.49 General Fee Schedule - 12/1/2009
43204 Y $136.67 General Fee Schedule - 1/1/2017
43205 Y $142.70 General Fee Schedule - 1/1/2017
43206 Y $0.00 General by Report - 1/1/2013
43210 Y $414.09 General Fee Schedule - 8/1/2016
43211 Y $237.91 General Fee Schedule - 8/1/2016
43212 Y $188.42 General Fee Schedule - 8/1/2016
43213 Y $1,095.49 General Fee Schedule - 1/1/2017
43214 Y $191.51 General Fee Schedule - 8/1/2016
43215 Y $149.04 General Fee Schedule - 12/1/2009
43216 Y $135.84 General Fee Schedule - 12/1/2009
43217 Y $359.55 General Fee Schedule - 12/1/2009
43220 Y $120.14 General Fee Schedule - 12/1/2009
43226 Y $132.15 General Fee Schedule - 12/1/2009
43227 Y $197.88 General Fee Schedule - 12/1/2009
43229 Y $649.50 General Fee Schedule - 1/1/2017
43231 Y $175.93 General Fee Schedule - 12/1/2009
43232 Y $246.59 General Fee Schedule - 12/1/2009
43233 Y $227.36 General Fee Schedule - 8/1/2016
43235 Y $265.12 General Fee Schedule - 8/1/2016
43236 Y $326.17 General Fee Schedule - 8/1/2016
43237 Y $196.40 General Fee Schedule - 1/1/2017
43238 Y $232.75 General Fee Schedule - 1/1/2017
43239 Y $314.55 General Fee Schedule - 12/1/2009
43240 Y $373.11 General Fee Schedule - 12/1/2009
43241 Y $139.08 General Fee Schedule - 8/1/2016
43242 Y $262.34 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 103 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
43243 Y $239.08 General Fee Schedule - 8/1/2016
43244 Y $245.33 General Fee Schedule - 1/1/2017
43245 Y $176.23 General Fee Schedule - 12/1/2009
43246 Y $201.49 General Fee Schedule - 1/1/2017
43247 Y $186.70 General Fee Schedule - 12/1/2009
43248 Y $174.38 General Fee Schedule - 12/1/2009
43249 Y $160.96 General Fee Schedule - 12/1/2009
43250 Y $177.35 General Fee Schedule - 12/1/2009
43251 Y $203.12 General Fee Schedule - 12/1/2009
43252 Y $0.00 General by Report - 1/1/2013
43253 Y $263.73 General Fee Schedule - 8/1/2016
43254 Y $274.04 General Fee Schedule - 8/1/2016
43255 Y $262.45 General Fee Schedule - 12/1/2009
43257 Y $233.20 General Fee Schedule - 1/1/2017
43259 Y $226.31 General Fee Schedule - 1/1/2017
43260 Y $309.99 General Fee Schedule - 8/1/2016
43261 Y $326.10 General Fee Schedule - 8/1/2016
43262 Y $355.17 General Fee Schedule - 1/1/2017
43263 Y $355.87 General Fee Schedule - 1/1/2017
43264 Y $361.80 General Fee Schedule - 1/1/2017
43265 Y $430.26 General Fee Schedule - 1/1/2017
43266 Y $226.90 General Fee Schedule - 8/1/2016
43270 Y $664.27 General Fee Schedule - 8/1/2016
43273 Y $113.40 General Fee Schedule - 8/1/2016
43274 Y $459.26 General Fee Schedule - 1/1/2017
43275 Y $374.20 General Fee Schedule - 1/1/2017
43276 Y $477.98 General Fee Schedule - 1/1/2017
43277 Y $376.17 General Fee Schedule - 1/1/2017
43278 Y $429.92 General Fee Schedule - 1/1/2017
43279 Y $1,121.39 General Fee Schedule - 12/1/2009
43280 Y $992.67 General Fee Schedule - 12/1/2009
43281 Y $1,420.86 General Fee Schedule - 8/1/2016
43282 Y $1,598.72 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 104 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
43283 Y $156.38 General Fee Schedule - 8/1/2016
43284 Y $633.51 General Fee Schedule - 1/1/2017
43285 Y $642.02 General Fee Schedule - 1/1/2017
43286 Y $3,070.01 General Fee Schedule - 1/1/2018
43287 Y $3,513.10 General Fee Schedule - 1/1/2018
43288 Y $3,659.39 General Fee Schedule - 1/1/2018
43289 Y $0.00 General by Report - 1/1/2000
43300 Y $585.48 General Fee Schedule - 8/1/2016
43305 Y $1,046.68 General Fee Schedule - 8/1/2016
43310 Y $1,423.23 General Fee Schedule - 8/1/2016
43312 Y $1,576.06 General Fee Schedule - 8/1/2016
43313 Y $2,475.87 General Fee Schedule - 8/1/2016
43314 Y $2,825.03 General Fee Schedule - 12/1/2009
43320 Y $1,178.42 General Fee Schedule - 12/1/2009
43325 Y $1,164.22 General Fee Schedule - 12/1/2009
43327 Y $783.89 General Fee Schedule - 8/1/2016
43328 Y $1,116.11 General Fee Schedule - 1/1/2017
43330 Y $1,145.17 General Fee Schedule - 12/1/2009
43331 Y $1,212.91 General Fee Schedule - 12/1/2009
43332 Y $1,124.04 General Fee Schedule - 8/1/2016
43333 Y $1,220.88 General Fee Schedule - 8/1/2016
43334 Y $1,235.24 General Fee Schedule - 8/1/2016
43335 Y $1,331.16 General Fee Schedule - 8/1/2016
43336 Y $1,458.73 General Fee Schedule - 8/1/2016
43337 Y $1,590.95 General Fee Schedule - 8/1/2016
43338 Y $115.10 General Fee Schedule - 1/1/2017
43340 Y $1,148.19 General Fee Schedule - 12/1/2009
43341 Y $1,247.89 General Fee Schedule - 12/1/2009
43351 Y $1,128.31 General Fee Schedule - 12/1/2009
43352 Y $946.65 General Fee Schedule - 12/1/2009
43360 Y $2,064.70 General Fee Schedule - 12/1/2009
43361 Y $2,295.67 General Fee Schedule - 12/1/2009
43400 Y $1,208.38 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 105 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
43401 Y $1,282.10 General Fee Schedule - 12/1/2009
43405 Y $1,197.98 General Fee Schedule - 12/1/2009
43410 Y $840.14 General Fee Schedule - 12/1/2009
43415 Y $1,487.99 General Fee Schedule - 12/1/2009
43420 Y $856.56 General Fee Schedule - 12/1/2009
43425 Y $1,257.27 General Fee Schedule - 12/1/2009
43450 Y $147.45 General Fee Schedule - 12/1/2009
43453 Y $270.25 General Fee Schedule - 12/1/2009
43460 Y $199.69 General Fee Schedule - 8/1/2016
43496 Y $726.11 General Fee Schedule - 12/1/2009
43499 Y $0.00 General by Report - 7/1/1975
43500 Y $646.33 General Fee Schedule - 12/1/2009
43501 Y $1,148.41 General Fee Schedule - 12/1/2009
43502 Y $1,322.94 General Fee Schedule - 12/1/2009
43510 Y $781.19 General Fee Schedule - 12/1/2009
43520 Y $612.63 General Fee Schedule - 12/1/2009
43605 Y $697.67 General Fee Schedule - 12/1/2009
43610 Y $840.34 General Fee Schedule - 12/1/2009
43611 Y $1,028.13 General Fee Schedule - 12/1/2009
43620 Y $1,698.70 General Fee Schedule - 12/1/2009
43621 Y $1,734.27 General Fee Schedule - 12/1/2009
43622 Y $1,833.95 General Fee Schedule - 12/1/2009
43631 Y $1,288.02 General Fee Schedule - 12/1/2009
43632 Y $1,288.02 General Fee Schedule - 12/1/2009
43633 Y $1,315.95 General Fee Schedule - 12/1/2009
43634 Y $1,428.89 General Fee Schedule - 12/1/2009
43635 Y $108.30 General Fee Schedule - 8/1/2016
43640 Y $982.43 General Fee Schedule - 12/1/2009
43641 Y $995.49 General Fee Schedule - 12/1/2009
43644 Y $1,662.29 General Fee Schedule - 8/1/2016
43645 Y $1,776.38 General Fee Schedule - 8/1/2016
43647 Y $415.36 General Fee Schedule - 1/1/2011
43648 Y $0.00 General by Report - 1/1/2007
CPT FEES01/03/2018 at 6:55:00 AM - 106 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
43651 Y $600.27 General Fee Schedule - 12/1/2009
43652 Y $690.52 General Fee Schedule - 8/1/2016
43653 Y $476.32 General Fee Schedule - 12/1/2009
43659 Y $0.00 General by Report - 1/1/2014
43752 Y $39.89 General Fee Schedule - 8/1/2016
43753 Y $19.73 General Fee Schedule - 8/1/2016
43754 Y $75.60 General Fee Schedule - 1/1/2011
43755 Y $115.89 General Fee Schedule - 1/1/2011
43756 Y $183.98 General Fee Schedule - 1/1/2017
43757 Y $257.60 General Fee Schedule - 8/1/2016
43760 Y $117.13 General Fee Schedule - 12/1/2009
43761 Y $110.57 General Fee Schedule - 1/1/2017
43770 Y $1,068.35 General Fee Schedule - 8/1/2016
43771 Y $1,214.52 General Fee Schedule - 8/1/2016
43772 Y $910.02 General Fee Schedule - 8/1/2016
43773 Y $1,224.93 General Fee Schedule - 8/1/2016
43774 Y $889.37 General Fee Schedule - 8/1/2016
43775 Y $1,162.30 General Fee Schedule - 8/1/2016
43800 Y $792.52 General Fee Schedule - 12/1/2009
43810 Y $843.30 General Fee Schedule - 12/1/2009
43820 Y $882.42 General Fee Schedule - 12/1/2009
43825 Y $1,103.04 General Fee Schedule - 12/1/2009
43830 Y $576.69 General Fee Schedule - 12/1/2009
43831 Y $492.56 General Fee Schedule - 12/1/2009
43832 Y $904.28 General Fee Schedule - 12/1/2009
43840 Y $902.77 General Fee Schedule - 12/1/2009
43842 Y $1,612.24 General Fee Schedule - 1/1/2014
43843 Y $1,227.51 General Fee Schedule - 8/1/2016
43845 Y $1,885.31 General Fee Schedule - 8/1/2016
43846 Y $1,547.75 General Fee Schedule - 8/1/2016
43847 Y $1,731.17 General Fee Schedule - 8/1/2016
43848 Y $1,846.59 General Fee Schedule - 8/1/2016
43850 Y $1,402.47 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 107 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
43855 Y $1,482.08 General Fee Schedule - 12/1/2009
43860 Y $1,571.36 General Fee Schedule - 8/1/2016
43865 Y $1,644.47 General Fee Schedule - 8/1/2016
43870 Y $572.25 General Fee Schedule - 12/1/2009
43880 Y $1,402.15 General Fee Schedule - 12/1/2009
43881 Y $0.00 General by Report - 1/1/2007
43882 Y $0.00 General by Report - 1/1/2007
43886 Y $340.68 General Fee Schedule - 8/1/2016
44005 Y $930.03 General Fee Schedule - 12/1/2009
44010 Y $726.06 General Fee Schedule - 12/1/2009
44015 Y $137.62 General Fee Schedule - 8/1/2016
44020 Y $806.85 General Fee Schedule - 12/1/2009
44021 Y $811.70 General Fee Schedule - 12/1/2009
44025 Y $822.50 General Fee Schedule - 12/1/2009
44050 Y $809.07 General Fee Schedule - 12/1/2009
44055 Y $1,247.77 General Fee Schedule - 12/1/2009
44100 Y $103.46 General Fee Schedule - 8/1/2016
44110 Y $688.03 General Fee Schedule - 12/1/2009
44111 Y $824.59 General Fee Schedule - 12/1/2009
44120 Y $975.14 General Fee Schedule - 12/1/2009
44121 Y $233.71 General Fee Schedule - 8/1/2016
44125 Y $1,002.83 General Fee Schedule - 12/1/2009
44126 Y $2,014.45 General Fee Schedule - 12/1/2009
44127 Y $2,318.45 General Fee Schedule - 12/1/2009
44128 Y $235.05 General Fee Schedule - 8/1/2016
44130 Y $836.42 General Fee Schedule - 12/1/2009
44132 Y $775.14 General Fee Schedule - 12/1/2009
44133 Y $775.14 General Fee Schedule - 12/1/2009
44135 Y $670.60 General Fee Schedule - 12/1/2009
44136 Y $670.60 General Fee Schedule - 12/1/2009
44137 Y $761.78 General Fee Schedule - 12/1/2009
44139 Y $116.90 General Fee Schedule - 8/1/2016
44140 Y $1,199.52 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 108 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
44141 Y $1,183.72 General Fee Schedule - 12/1/2009
44143 Y $1,357.92 General Fee Schedule - 12/1/2009
44144 Y $1,258.37 General Fee Schedule - 12/1/2009
44145 Y $1,502.33 General Fee Schedule - 12/1/2009
44146 Y $1,620.23 General Fee Schedule - 12/1/2009
44147 Y $1,184.52 General Fee Schedule - 12/1/2009
44150 Y $1,440.12 General Fee Schedule - 12/1/2009
44151 Y $1,616.01 General Fee Schedule - 12/1/2009
44155 Y $1,643.50 General Fee Schedule - 12/1/2009
44156 Y $1,838.59 General Fee Schedule - 12/1/2009
44157 Y $1,721.46 General Fee Schedule - 12/1/2009
44158 Y $1,766.18 General Fee Schedule - 12/1/2009
44160 Y $1,064.75 General Fee Schedule - 12/1/2009
44180 Y $834.49 General Fee Schedule - 12/1/2009
44186 Y $585.32 General Fee Schedule - 12/1/2009
44187 Y $966.07 General Fee Schedule - 12/1/2009
44188 Y $1,060.44 General Fee Schedule - 12/1/2009
44202 Y $1,254.09 General Fee Schedule - 12/1/2009
44203 Y $232.72 General Fee Schedule - 8/1/2016
44204 Y $1,415.29 General Fee Schedule - 12/1/2009
44205 Y $1,205.02 General Fee Schedule - 8/1/2016
44206 Y $1,546.00 General Fee Schedule - 12/1/2009
44207 Y $1,676.92 General Fee Schedule - 12/1/2009
44208 Y $1,817.82 General Fee Schedule - 12/1/2009
44210 Y $1,604.43 General Fee Schedule - 12/1/2009
44211 Y $1,996.37 General Fee Schedule - 12/1/2009
44212 Y $1,852.49 General Fee Schedule - 12/1/2009
44213 Y $184.39 General Fee Schedule - 8/1/2016
44227 Y $1,503.91 General Fee Schedule - 12/1/2009
44238 Y $0.00 General by Report - 1/1/2003
44300 Y $710.23 General Fee Schedule - 12/1/2009
44310 Y $913.00 General Fee Schedule - 12/1/2009
44312 Y $477.90 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 109 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
44314 Y $865.18 General Fee Schedule - 12/1/2009
44316 Y $1,187.82 General Fee Schedule - 12/1/2009
44320 Y $1,020.05 General Fee Schedule - 12/1/2009
44322 Y $808.93 General Fee Schedule - 12/1/2009
44340 Y $478.00 General Fee Schedule - 12/1/2009
44345 Y $898.74 General Fee Schedule - 12/1/2009
44346 Y $981.22 General Fee Schedule - 12/1/2009
44360 Y $138.43 General Fee Schedule - 8/1/2016
44361 Y $152.76 General Fee Schedule - 8/1/2016
44363 Y $183.63 General Fee Schedule - 8/1/2016
44364 Y $196.14 General Fee Schedule - 8/1/2016
44365 Y $175.32 General Fee Schedule - 8/1/2016
44366 Y $230.83 General Fee Schedule - 8/1/2016
44370 Y $254.84 General Fee Schedule - 8/1/2016
44372 Y $231.84 General Fee Schedule - 8/1/2016
44373 Y $184.94 General Fee Schedule - 8/1/2016
44376 Y $275.18 General Fee Schedule - 8/1/2016
44377 Y $288.15 General Fee Schedule - 8/1/2016
44378 Y $369.82 General Fee Schedule - 8/1/2016
44379 Y $392.97 General Fee Schedule - 8/1/2016
44380 Y $62.12 General Fee Schedule - 12/1/2009
44381 Y $0.00 General by Report - 1/1/2015
44382 Y $74.74 General Fee Schedule - 12/1/2009
44384 Y $0.00 General by Report - 1/1/2015
44385 Y $190.47 General Fee Schedule - 12/1/2009
44386 Y $304.08 General Fee Schedule - 8/1/2016
44388 Y $292.10 General Fee Schedule - 12/1/2009
44389 Y $357.47 General Fee Schedule - 12/1/2009
44390 Y $386.52 General Fee Schedule - 8/1/2016
44391 Y $477.68 General Fee Schedule - 12/1/2009
44392 Y $369.38 General Fee Schedule - 8/1/2016
44394 Y $433.74 General Fee Schedule - 8/1/2016
44401 Y $0.00 General by Report - 1/1/2015
CPT FEES01/03/2018 at 6:55:00 AM - 110 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
44402 Y $0.00 General by Report - 1/1/2015
44403 Y $0.00 General by Report - 1/1/2015
44404 Y $0.00 General by Report - 1/1/2015
44405 Y $0.00 26 by Report - 1/1/2015
44405 Y $0.00 General by Report - 1/1/2015
44405 Y $0.00 TC by Report - 1/1/2015
44406 Y $0.00 General by Report - 1/1/2015
44407 Y $0.00 General by Report - 1/1/2015
44408 Y $0.00 General by Report - 1/1/2015
44500 Y $23.64 General Fee Schedule - 1/1/2017
44602 Y $910.32 General Fee Schedule - 12/1/2009
44603 Y $1,051.94 General Fee Schedule - 12/1/2009
44604 Y $912.37 General Fee Schedule - 12/1/2009
44605 Y $1,127.31 General Fee Schedule - 12/1/2009
44615 Y $914.32 General Fee Schedule - 12/1/2009
44620 Y $705.12 General Fee Schedule - 12/1/2009
44625 Y $860.43 General Fee Schedule - 12/1/2009
44626 Y $1,426.83 General Fee Schedule - 12/1/2009
44640 Y $1,224.29 General Fee Schedule - 12/1/2009
44650 Y $1,275.94 General Fee Schedule - 12/1/2009
44660 Y $1,183.11 General Fee Schedule - 12/1/2009
44661 Y $1,380.80 General Fee Schedule - 12/1/2009
44680 Y $883.56 General Fee Schedule - 12/1/2009
44700 Y $912.97 General Fee Schedule - 12/1/2009
44701 Y $161.97 General Fee Schedule - 8/1/2016
44705 Y $0.00 General by Report - 1/1/2013
44715 Y $0.00 General by Report - 1/1/2005
44720 Y $253.76 General Fee Schedule - 8/1/2016
44721 Y $370.44 General Fee Schedule - 8/1/2016
44799 Y $0.00 General by Report - 7/1/1975
44800 Y $668.35 General Fee Schedule - 12/1/2009
44820 Y $709.12 General Fee Schedule - 12/1/2009
44850 Y $633.32 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 111 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
44899 Y $0.00 General by Report - 7/1/1975
44900 Y $597.47 General Fee Schedule - 12/1/2009
44950 Y $578.76 General Fee Schedule - 12/1/2009
44960 Y $715.01 General Fee Schedule - 12/1/2009
44970 Y $514.83 General Fee Schedule - 12/1/2009
44979 Y $0.00 General by Report - 1/1/2000
45000 Y $293.73 General Fee Schedule - 12/1/2009
45005 Y $224.45 General Fee Schedule - 12/1/2009
45020 Y $313.10 General Fee Schedule - 12/1/2009
45100 Y $238.00 General Fee Schedule - 12/1/2009
45108 Y $298.90 General Fee Schedule - 12/1/2009
45110 Y $1,620.51 General Fee Schedule - 12/1/2009
45111 Y $952.32 General Fee Schedule - 12/1/2009
45112 Y $1,698.67 General Fee Schedule - 12/1/2009
45113 Y $1,731.04 General Fee Schedule - 12/1/2009
45114 Y $1,541.87 General Fee Schedule - 12/1/2009
45116 Y $1,390.44 General Fee Schedule - 12/1/2009
45119 Y $1,731.80 General Fee Schedule - 12/1/2009
45120 Y $1,339.52 General Fee Schedule - 8/1/2016
45121 Y $1,535.14 General Fee Schedule - 12/1/2009
45123 Y $942.94 General Fee Schedule - 12/1/2009
45126 Y $2,549.05 General Fee Schedule - 12/1/2009
45130 Y $927.76 General Fee Schedule - 12/1/2009
45135 Y $1,112.82 General Fee Schedule - 12/1/2009
45136 Y $1,578.95 General Fee Schedule - 12/1/2009
45150 Y $341.23 General Fee Schedule - 12/1/2009
45160 Y $876.27 General Fee Schedule - 12/1/2009
45171 Y $548.96 General Fee Schedule - 1/1/2010
45172 Y $727.28 General Fee Schedule - 8/1/2016
45190 Y $573.12 General Fee Schedule - 12/1/2009
45300 Y $68.43 General Fee Schedule - 12/1/2009
45303 Y $659.97 General Fee Schedule - 12/1/2009
45305 Y $133.17 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 112 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
45307 Y $144.16 General Fee Schedule - 12/1/2009
45308 Y $103.63 General Fee Schedule - 12/1/2009
45309 Y $181.73 General Fee Schedule - 12/1/2009
45315 Y $157.48 General Fee Schedule - 12/1/2009
45317 Y $146.62 General Fee Schedule - 12/1/2009
45320 Y $166.48 General Fee Schedule - 12/1/2009
45321 Y $68.82 General Fee Schedule - 12/1/2009
45327 Y $92.84 General Fee Schedule - 12/1/2009
45330 Y $117.88 General Fee Schedule - 12/1/2009
45331 Y $152.95 General Fee Schedule - 12/1/2009
45332 Y $246.15 General Fee Schedule - 12/1/2009
45333 Y $241.36 General Fee Schedule - 12/1/2009
45334 Y $151.32 General Fee Schedule - 12/1/2009
45335 Y $170.40 General Fee Schedule - 12/1/2009
45337 Y $118.18 General Fee Schedule - 1/1/2017
45338 Y $275.95 General Fee Schedule - 12/1/2009
45340 Y $290.06 General Fee Schedule - 12/1/2009
45341 Y $126.04 General Fee Schedule - 1/1/2017
45342 Y $170.98 General Fee Schedule - 1/1/2017
45346 Y $0.00 General by Report - 1/1/2015
45347 Y $0.00 General by Report - 1/1/2015
45349 Y $0.00 General by Report - 1/1/2015
45350 Y $0.00 General by Report - 1/1/2015
45378 Y $349.14 General Fee Schedule - 8/1/2016
45379 Y $438.77 General Fee Schedule - 8/1/2016
45380 Y $412.73 General Fee Schedule - 8/1/2016
45381 Y $399.55 General Fee Schedule - 8/1/2016
45382 Y $574.75 General Fee Schedule - 12/1/2009
45384 Y $427.64 General Fee Schedule - 12/1/2009
45385 Y $450.56 General Fee Schedule - 1/1/2017
45386 Y $591.15 General Fee Schedule - 8/1/2016
45388 Y $0.00 General by Report - 1/1/2015
45389 Y $0.00 General by Report - 1/1/2015
CPT FEES01/03/2018 at 6:55:00 AM - 113 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
45390 Y $0.00 General by Report - 1/1/2015
45391 Y $257.15 General Fee Schedule - 1/1/2017
45392 Y $303.35 General Fee Schedule - 1/1/2017
45393 Y $0.00 General by Report - 1/1/2015
45395 Y $1,771.71 General Fee Schedule - 12/1/2009
45397 Y $1,928.38 General Fee Schedule - 12/1/2009
45398 Y $0.00 General by Report - 1/1/2015
45399 Y $0.00 General by Report - 1/1/2015
45400 Y $1,035.63 General Fee Schedule - 12/1/2009
45402 Y $1,406.30 General Fee Schedule - 12/1/2009
45499 Y $0.00 General by Report - 1/1/2006
45500 Y $428.11 General Fee Schedule - 12/1/2009
45505 Y $454.06 General Fee Schedule - 12/1/2009
45520 Y $79.10 General Fee Schedule - 12/1/2009
45540 Y $923.94 General Fee Schedule - 12/1/2009
45541 Y $774.05 General Fee Schedule - 12/1/2009
45550 Y $1,293.13 General Fee Schedule - 12/1/2009
45560 Y $619.88 General Fee Schedule - 12/1/2009
45562 Y $895.75 General Fee Schedule - 12/1/2009
45563 Y $1,372.32 General Fee Schedule - 12/1/2009
45800 Y $1,003.38 General Fee Schedule - 12/1/2009
45805 Y $1,196.98 General Fee Schedule - 12/1/2009
45820 Y $1,028.30 General Fee Schedule - 12/1/2009
45825 Y $1,235.76 General Fee Schedule - 12/1/2009
45900 Y $162.47 General Fee Schedule - 12/1/2009
45905 Y $147.06 General Fee Schedule - 12/1/2009
45910 Y $175.27 General Fee Schedule - 12/1/2009
45915 Y $279.82 General Fee Schedule - 12/1/2009
45990 Y $98.30 General Fee Schedule - 8/1/2016
45999 Y $0.00 General by Report - 7/1/1975
46020 Y $202.76 General Fee Schedule - 12/1/2009
46030 Y $98.53 General Fee Schedule - 12/1/2009
46040 Y $401.12 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 114 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
46045 Y $284.31 General Fee Schedule - 12/1/2009
46050 Y $138.08 General Fee Schedule - 12/1/2009
46060 Y $353.65 General Fee Schedule - 12/1/2009
46070 Y $180.03 General Fee Schedule - 12/1/2009
46080 Y $187.62 General Fee Schedule - 12/1/2009
46083 Y $145.84 General Fee Schedule - 12/1/2009
46200 Y $277.25 General Fee Schedule - 12/1/2009
46220 Y $144.83 General Fee Schedule - 12/1/2009
46221 Y $177.41 General Fee Schedule - 12/1/2009
46230 Y $215.02 General Fee Schedule - 12/1/2009
46250 Y $348.49 General Fee Schedule - 12/1/2009
46255 Y $397.49 General Fee Schedule - 12/1/2009
46257 Y $328.76 General Fee Schedule - 12/1/2009
46258 Y $356.58 General Fee Schedule - 12/1/2009
46260 Y $380.96 General Fee Schedule - 12/1/2009
46261 Y $423.77 General Fee Schedule - 12/1/2009
46262 Y $445.82 General Fee Schedule - 12/1/2009
46270 Y $330.28 General Fee Schedule - 12/1/2009
46275 Y $352.45 General Fee Schedule - 12/1/2009
46280 Y $364.85 General Fee Schedule - 12/1/2009
46285 Y $301.75 General Fee Schedule - 12/1/2009
46288 Y $428.11 General Fee Schedule - 12/1/2009
46320 Y $141.29 General Fee Schedule - 12/1/2009
46500 Y $140.26 General Fee Schedule - 12/1/2009
46505 Y $219.65 General Fee Schedule - 12/1/2009
46600 Y $74.43 General Fee Schedule - 12/1/2009
46601 Y $0.00 General by Report - 1/1/2015
46604 Y $367.97 General Fee Schedule - 12/1/2009
46606 Y $164.13 General Fee Schedule - 12/1/2009
46607 Y $0.00 General by Report - 1/1/2015
46608 Y $206.20 General Fee Schedule - 8/1/2016
46610 Y $194.46 General Fee Schedule - 12/1/2009
46611 Y $160.09 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 115 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
46612 Y $233.56 General Fee Schedule - 1/1/2017
46614 Y $117.00 General Fee Schedule - 1/1/2017
46615 Y $133.58 General Fee Schedule - 1/1/2017
46700 Y $528.63 General Fee Schedule - 12/1/2009
46705 Y $423.72 General Fee Schedule - 12/1/2009
46706 Y $144.71 General Fee Schedule - 12/1/2009
46707 Y $418.91 General Fee Schedule - 1/1/2010
46710 Y $931.28 General Fee Schedule - 12/1/2009
46712 Y $1,955.08 General Fee Schedule - 12/1/2009
46715 Y $431.87 General Fee Schedule - 12/1/2009
46716 Y $909.05 General Fee Schedule - 12/1/2009
46730 Y $1,528.51 General Fee Schedule - 12/1/2009
46735 Y $1,815.28 General Fee Schedule - 12/1/2009
46740 Y $1,693.65 General Fee Schedule - 12/1/2009
46742 Y $2,086.86 General Fee Schedule - 12/1/2009
46744 Y $2,973.55 General Fee Schedule - 12/1/2009
46746 Y $3,372.17 General Fee Schedule - 12/1/2009
46748 Y $3,402.04 General Fee Schedule - 12/1/2009
46750 Y $606.09 General Fee Schedule - 12/1/2009
46751 Y $534.25 General Fee Schedule - 8/1/2016
46753 Y $483.87 General Fee Schedule - 12/1/2009
46754 Y $214.73 General Fee Schedule - 12/1/2009
46760 Y $854.22 General Fee Schedule - 12/1/2009
46761 Y $788.94 General Fee Schedule - 12/1/2009
46762 Y $721.98 General Fee Schedule - 12/1/2009
46900 Y $168.27 General Fee Schedule - 12/1/2009
46910 Y $177.99 General Fee Schedule - 12/1/2009
46916 Y $183.78 General Fee Schedule - 12/1/2009
46917 Y $376.63 General Fee Schedule - 8/1/2016
46922 Y $191.69 General Fee Schedule - 12/1/2009
46924 Y $413.71 General Fee Schedule - 12/1/2009
46930 Y $170.93 General Fee Schedule - 12/1/2009
46940 Y $165.97 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 116 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
46942 Y $148.30 General Fee Schedule - 12/1/2009
46945 Y $189.55 General Fee Schedule - 12/1/2009
46946 Y $236.62 General Fee Schedule - 12/1/2009
46947 Y $319.75 General Fee Schedule - 12/1/2009
46999 Y $0.00 General by Report - 7/1/1975
47000 Y $182.93 General Fee Schedule - 12/1/2009
47001 Y $100.06 General Fee Schedule - 8/1/2016
47010 Y $967.31 General Fee Schedule - 12/1/2009
47015 Y $902.45 General Fee Schedule - 12/1/2009
47100 Y $709.66 General Fee Schedule - 12/1/2009
47120 Y $2,048.67 General Fee Schedule - 12/1/2009
47122 Y $3,109.33 General Fee Schedule - 12/1/2009
47125 Y $2,788.46 General Fee Schedule - 12/1/2009
47130 Y $3,015.56 General Fee Schedule - 12/1/2009
47133 Y $805.48 General Fee Schedule - 12/1/2009
47135 Y $4,566.52 General Fee Schedule - 12/1/2009
47140 Y $3,062.95 General Fee Schedule - 12/1/2009
47141 Y $3,703.86 General Fee Schedule - 12/1/2009
47142 Y $4,080.95 General Fee Schedule - 12/1/2009
47143 Y $203.55 General Fee Schedule - 1/1/2011
47144 Y $0.00 General by Report - 1/1/2005
47145 Y $0.00 General by Report - 1/1/2005
47146 Y $317.56 General Fee Schedule - 8/1/2016
47147 Y $370.44 General Fee Schedule - 8/1/2016
47300 Y $897.57 General Fee Schedule - 12/1/2009
47350 Y $1,147.33 General Fee Schedule - 12/1/2009
47360 Y $1,551.10 General Fee Schedule - 12/1/2009
47361 Y $2,653.60 General Fee Schedule - 12/1/2009
47362 Y $1,098.90 General Fee Schedule - 12/1/2009
47370 Y $1,125.98 General Fee Schedule - 12/1/2009
47371 Y $1,082.92 General Fee Schedule - 8/1/2016
47379 Y $591.41 General Fee Schedule - 12/1/2009
47380 Y $1,306.55 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 117 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
47381 Y $1,271.20 General Fee Schedule - 8/1/2016
47382 Y $827.21 General Fee Schedule - 12/1/2009
47383 Y $6,660.58 General Fee Schedule - 1/1/2017
47399 Y $0.00 General by Report - 7/1/1975
47400 Y $1,819.37 General Fee Schedule - 12/1/2009
47420 Y $1,157.29 General Fee Schedule - 12/1/2009
47425 Y $1,156.73 General Fee Schedule - 12/1/2009
47460 Y $1,058.07 General Fee Schedule - 12/1/2009
47480 Y $668.60 General Fee Schedule - 12/1/2009
47490 Y $312.91 General Fee Schedule - 1/1/2017
47531 Y $333.13 General Fee Schedule - 8/1/2016
47532 Y $734.16 General Fee Schedule - 8/1/2016
47533 Y $1,195.87 General Fee Schedule - 8/1/2016
47534 Y $1,476.04 General Fee Schedule - 8/1/2016
47535 Y $986.98 General Fee Schedule - 8/1/2016
47536 Y $725.55 General Fee Schedule - 8/1/2016
47537 Y $361.02 General Fee Schedule - 8/1/2016
47538 Y $3,970.75 General Fee Schedule - 8/1/2016
47539 Y $4,346.47 General Fee Schedule - 8/1/2016
47540 Y $4,524.63 General Fee Schedule - 8/1/2016
47541 Y $1,056.25 General Fee Schedule - 8/1/2016
47542 Y $465.05 General Fee Schedule - 8/1/2016
47543 Y $1,180.92 General Fee Schedule - 8/1/2016
47544 Y $727.68 General Fee Schedule - 8/1/2016
47550 Y $158.71 General Fee Schedule - 8/1/2016
47552 Y $299.88 General Fee Schedule - 1/1/2017
47553 Y $297.31 General Fee Schedule - 1/1/2017
47554 Y $464.95 General Fee Schedule - 1/1/2017
47555 Y $355.59 General Fee Schedule - 1/1/2017
47556 Y $404.94 General Fee Schedule - 1/1/2017
47562 Y $622.63 General Fee Schedule - 8/1/2016
47563 Y $668.62 General Fee Schedule - 8/1/2016
47564 Y $817.49 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 118 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
47570 Y $696.96 General Fee Schedule - 8/1/2016
47579 Y $0.00 General by Report - 1/1/2000
47600 Y $795.45 General Fee Schedule - 12/1/2009
47605 Y $856.14 General Fee Schedule - 12/1/2009
47610 Y $1,082.79 General Fee Schedule - 12/1/2009
47612 Y $1,079.18 General Fee Schedule - 12/1/2009
47620 Y $1,181.87 General Fee Schedule - 12/1/2009
47700 Y $927.35 General Fee Schedule - 12/1/2009
47701 Y $1,528.69 General Fee Schedule - 8/1/2016
47711 Y $1,333.10 General Fee Schedule - 12/1/2009
47712 Y $1,726.62 General Fee Schedule - 12/1/2009
47715 Y $1,099.13 General Fee Schedule - 12/1/2009
47720 Y $941.97 General Fee Schedule - 12/1/2009
47721 Y $1,117.31 General Fee Schedule - 12/1/2009
47740 Y $1,082.31 General Fee Schedule - 12/1/2009
47741 Y $1,238.36 General Fee Schedule - 12/1/2009
47760 Y $1,485.85 General Fee Schedule - 12/1/2009
47765 Y $1,442.55 General Fee Schedule - 12/1/2009
47780 Y $1,526.02 General Fee Schedule - 12/1/2009
47785 Y $1,785.56 General Fee Schedule - 12/1/2009
47800 Y $1,349.02 General Fee Schedule - 12/1/2009
47801 Y $904.21 General Fee Schedule - 12/1/2009
47802 Y $1,260.52 General Fee Schedule - 12/1/2009
47900 Y $1,162.18 General Fee Schedule - 12/1/2009
47999 Y $0.00 General by Report - 7/1/1975
48000 Y $1,596.20 General Fee Schedule - 12/1/2009
48001 Y $2,003.96 General Fee Schedule - 12/1/2009
48020 Y $928.74 General Fee Schedule - 12/1/2009
48100 Y $718.98 General Fee Schedule - 12/1/2009
48102 Y $462.80 General Fee Schedule - 12/1/2009
48105 Y $2,220.54 General Fee Schedule - 12/1/2009
48120 Y $918.09 General Fee Schedule - 12/1/2009
48140 Y $1,315.58 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 119 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
48145 Y $1,372.00 General Fee Schedule - 12/1/2009
48146 Y $1,548.87 General Fee Schedule - 12/1/2009
48148 Y $1,007.79 General Fee Schedule - 12/1/2009
48150 Y $2,736.66 General Fee Schedule - 12/1/2009
48152 Y $2,509.80 General Fee Schedule - 12/1/2009
48153 Y $2,733.44 General Fee Schedule - 12/1/2009
48154 Y $2,525.72 General Fee Schedule - 12/1/2009
48155 Y $1,462.03 General Fee Schedule - 12/1/2009
48160 Y $1,349.34 General Fee Schedule - 12/1/2009
48400 Y $98.27 General Fee Schedule - 8/1/2016
48500 Y $910.10 General Fee Schedule - 12/1/2009
48510 Y $869.52 General Fee Schedule - 12/1/2009
48520 Y $901.53 General Fee Schedule - 12/1/2009
48540 Y $1,127.83 General Fee Schedule - 12/1/2009
48545 Y $1,055.99 General Fee Schedule - 12/1/2009
48547 Y $1,472.75 General Fee Schedule - 12/1/2009
48548 Y $1,292.01 General Fee Schedule - 12/1/2009
48550 Y $0.00 General by Report - 1/1/1994
48551 Y $0.00 General by Report - 1/1/2005
48552 Y $217.60 General Fee Schedule - 8/1/2016
48554 Y $2,087.93 General Fee Schedule - 12/1/2009
48556 Y $953.75 General Fee Schedule - 12/1/2009
48999 Y $0.00 General by Report - 7/1/1975
49000 Y $687.11 General Fee Schedule - 12/1/2009
49002 Y $623.32 General Fee Schedule - 12/1/2009
49010 Y $727.73 General Fee Schedule - 12/1/2009
49020 Y $1,328.10 General Fee Schedule - 12/1/2009
49040 Y $799.60 General Fee Schedule - 12/1/2009
49060 Y $926.23 General Fee Schedule - 12/1/2009
49062 Y $671.98 General Fee Schedule - 12/1/2009
49082 Y $154.13 General Fee Schedule - 2/6/2012
49083 Y $264.74 General Fee Schedule - 1/1/2017
49084 Y $96.32 General Fee Schedule - 2/6/2012
CPT FEES01/03/2018 at 6:55:00 AM - 120 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
49180 Y $149.86 General Fee Schedule - 1/1/2017
49185 Y $882.10 General Fee Schedule - 8/1/2016
49203 Y $864.82 General Fee Schedule - 12/1/2009
49204 Y $1,103.96 General Fee Schedule - 12/1/2009
49205 Y $1,263.78 General Fee Schedule - 12/1/2009
49215 Y $1,924.14 General Fee Schedule - 12/1/2009
49220 Y $831.23 General Fee Schedule - 8/1/2016
49250 Y $505.41 General Fee Schedule - 12/1/2009
49255 Y $671.03 General Fee Schedule - 12/1/2009
49320 Y $296.93 General Fee Schedule - 8/1/2016
49321 Y $310.03 General Fee Schedule - 8/1/2016
49322 Y $332.99 General Fee Schedule - 8/1/2016
49323 Y $561.05 General Fee Schedule - 12/1/2009
49324 Y $306.23 General Fee Schedule - 12/1/2009
49325 Y $329.97 General Fee Schedule - 12/1/2009
49326 Y $152.06 General Fee Schedule - 12/1/2009
49327 Y $125.94 General Fee Schedule - 8/1/2016
49329 Y $0.00 General by Report - 1/1/2000
49400 Y $127.01 General Fee Schedule - 1/1/2017
49402 Y $660.68 General Fee Schedule - 12/1/2009
49405 Y $795.07 General Fee Schedule - 8/1/2016
49406 Y $794.76 General Fee Schedule - 8/1/2016
49407 Y $658.63 General Fee Schedule - 1/1/2017
49411 Y $462.27 General Fee Schedule - 1/1/2010
49412 Y $78.70 General Fee Schedule - 8/1/2016
49418 Y $1,275.29 General Fee Schedule - 1/1/2017
49419 Y $406.51 General Fee Schedule - 12/1/2009
49421 Y $227.07 General Fee Schedule - 1/1/2017
49422 Y $354.07 General Fee Schedule - 8/1/2016
49423 Y $487.56 General Fee Schedule - 1/1/2017
49424 Y $131.39 General Fee Schedule - 1/1/2017
49425 Y $656.04 General Fee Schedule - 8/1/2016
49426 Y $555.70 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 121 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
49427 Y $45.17 General Fee Schedule - 8/1/2016
49428 Y $395.71 General Fee Schedule - 12/1/2009
49429 Y $420.40 General Fee Schedule - 8/1/2016
49435 Y $97.76 General Fee Schedule - 12/1/2009
49436 Y $143.67 General Fee Schedule - 12/1/2009
49440 Y $869.64 General Fee Schedule - 12/1/2009
49441 Y $987.49 General Fee Schedule - 8/1/2016
49442 Y $805.22 General Fee Schedule - 8/1/2016
49446 Y $821.70 General Fee Schedule - 8/1/2016
49450 Y $573.95 General Fee Schedule - 8/1/2016
49451 Y $608.70 General Fee Schedule - 8/1/2016
49452 Y $745.72 General Fee Schedule - 8/1/2016
49460 Y $607.84 General Fee Schedule - 8/1/2016
49465 Y $132.81 General Fee Schedule - 12/1/2009
49491 Y $650.43 General Fee Schedule - 12/1/2009
49492 Y $812.48 General Fee Schedule - 12/1/2009
49495 Y $339.72 General Fee Schedule - 8/1/2016
49496 Y $522.40 General Fee Schedule - 12/1/2009
49500 Y $328.78 General Fee Schedule - 8/1/2016
49501 Y $525.20 General Fee Schedule - 12/1/2009
49505 Y $456.93 General Fee Schedule - 12/1/2009
49507 Y $542.96 General Fee Schedule - 8/1/2016
49520 Y $567.55 General Fee Schedule - 12/1/2009
49521 Y $668.08 General Fee Schedule - 8/1/2016
49525 Y $509.12 General Fee Schedule - 12/1/2009
49540 Y $610.23 General Fee Schedule - 12/1/2009
49550 Y $513.50 General Fee Schedule - 12/1/2009
49553 Y $558.15 General Fee Schedule - 12/1/2009
49555 Y $535.80 General Fee Schedule - 12/1/2009
49557 Y $651.23 General Fee Schedule - 12/1/2009
49560 Y $674.64 General Fee Schedule - 12/1/2009
49561 Y $822.02 General Fee Schedule - 12/1/2009
49565 Y $677.38 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 122 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
49566 Y $830.90 General Fee Schedule - 12/1/2009
49568 Y $256.93 General Fee Schedule - 8/1/2016
49570 Y $353.68 General Fee Schedule - 12/1/2009
49572 Y $408.58 General Fee Schedule - 12/1/2009
49580 Y $265.92 General Fee Schedule - 12/1/2009
49582 Y $405.50 General Fee Schedule - 12/1/2009
49585 Y $381.39 General Fee Schedule - 12/1/2009
49587 Y $435.52 General Fee Schedule - 8/1/2016
49590 Y $508.31 General Fee Schedule - 12/1/2009
49600 Y $624.67 General Fee Schedule - 8/1/2016
49605 Y $4,231.09 General Fee Schedule - 12/1/2009
49606 Y $1,022.43 General Fee Schedule - 8/1/2016
49610 Y $619.85 General Fee Schedule - 12/1/2009
49611 Y $585.76 General Fee Schedule - 8/1/2016
49650 Y $383.31 General Fee Schedule - 12/1/2009
49651 Y $495.71 General Fee Schedule - 12/1/2009
49652 Y $679.76 General Fee Schedule - 12/1/2009
49653 Y $848.48 General Fee Schedule - 12/1/2009
49654 Y $780.63 General Fee Schedule - 12/1/2009
49655 Y $939.96 General Fee Schedule - 12/1/2009
49656 Y $783.84 General Fee Schedule - 12/1/2009
49657 Y $1,133.40 General Fee Schedule - 12/1/2009
49659 Y $0.00 General by Report - 1/1/2000
49900 Y $742.83 General Fee Schedule - 12/1/2009
49904 Y $1,330.42 General Fee Schedule - 8/1/2016
49905 Y $342.81 General Fee Schedule - 8/1/2016
49906 Y $243.51 General Fee Schedule - 12/1/2009
49999 Y $0.00 General by Report - 7/1/1975
50010 Y $634.23 General Fee Schedule - 12/1/2009
50020 Y $877.05 General Fee Schedule - 12/1/2009
50040 Y $844.97 General Fee Schedule - 12/1/2009
50045 Y $865.10 General Fee Schedule - 12/1/2009
50060 Y $1,016.83 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 123 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
50065 Y $1,064.74 General Fee Schedule - 12/1/2009
50070 Y $1,070.09 General Fee Schedule - 8/1/2016
50075 Y $1,323.23 General Fee Schedule - 8/1/2016
50080 Y $785.56 General Fee Schedule - 8/1/2016
50081 Y $1,146.33 General Fee Schedule - 8/1/2016
50100 Y $958.49 General Fee Schedule - 12/1/2009
50120 Y $851.77 General Fee Schedule - 8/1/2016
50125 Y $925.25 General Fee Schedule - 12/1/2009
50130 Y $916.01 General Fee Schedule - 8/1/2016
50135 Y $1,009.75 General Fee Schedule - 8/1/2016
50200 Y $151.20 General Fee Schedule - 12/1/2009
50205 Y $652.56 General Fee Schedule - 12/1/2009
50220 Y $955.66 General Fee Schedule - 12/1/2009
50225 Y $1,066.45 General Fee Schedule - 8/1/2016
50230 Y $1,150.43 General Fee Schedule - 8/1/2016
50234 Y $1,172.52 General Fee Schedule - 8/1/2016
50236 Y $1,315.62 General Fee Schedule - 8/1/2016
50240 Y $1,210.72 General Fee Schedule - 12/1/2009
50250 Y $1,087.80 General Fee Schedule - 8/1/2016
50280 Y $839.58 General Fee Schedule - 8/1/2016
50290 Y $804.49 General Fee Schedule - 8/1/2016
50300 Y $1,161.68 General Fee Schedule - 12/1/2009
50320 Y $1,302.94 General Fee Schedule - 12/1/2009
50323 Y $126.05 General Fee Schedule - 1/1/2011
50325 Y $129.80 General Fee Schedule - 1/1/2011
50327 Y $202.21 General Fee Schedule - 8/1/2016
50328 Y $177.10 General Fee Schedule - 8/1/2016
50329 Y $169.19 General Fee Schedule - 8/1/2016
50340 Y $748.09 General Fee Schedule - 12/1/2009
50360 Y $1,877.72 General Fee Schedule - 12/1/2009
50365 Y $2,195.67 General Fee Schedule - 12/1/2009
50370 Y $831.63 General Fee Schedule - 12/1/2009
50380 Y $1,299.06 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 124 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
50382 Y $1,062.42 General Fee Schedule - 1/1/2017
50384 Y $849.34 General Fee Schedule - 1/1/2017
50385 Y $992.28 General Fee Schedule - 8/1/2016
50386 Y $642.03 General Fee Schedule - 8/1/2016
50387 Y $485.33 General Fee Schedule - 1/1/2017
50389 Y $264.41 General Fee Schedule - 1/1/2017
50390 Y $93.09 General Fee Schedule - 1/1/2017
50391 Y $114.68 General Fee Schedule - 1/1/2017
50395 Y $171.50 General Fee Schedule - 1/1/2017
50396 Y $112.40 General Fee Schedule - 1/1/2017
50400 Y $1,026.54 General Fee Schedule - 8/1/2016
50405 Y $1,241.72 General Fee Schedule - 8/1/2016
50430 Y $468.32 General Fee Schedule - 8/1/2016
50431 Y $145.88 General Fee Schedule - 8/1/2016
50432 Y $755.87 General Fee Schedule - 8/1/2016
50433 Y $1,016.13 General Fee Schedule - 8/1/2016
50434 Y $803.70 General Fee Schedule - 8/1/2016
50435 Y $420.70 General Fee Schedule - 8/1/2016
50500 Y $1,111.24 General Fee Schedule - 12/1/2009
50520 Y $970.09 General Fee Schedule - 12/1/2009
50525 Y $1,230.47 General Fee Schedule - 12/1/2009
50526 Y $1,331.57 General Fee Schedule - 12/1/2009
50540 Y $1,056.60 General Fee Schedule - 8/1/2016
50541 Y $843.24 General Fee Schedule - 8/1/2016
50542 Y $1,053.96 General Fee Schedule - 8/1/2016
50543 Y $1,339.01 General Fee Schedule - 8/1/2016
50544 Y $1,161.99 General Fee Schedule - 8/1/2016
50545 Y $1,246.92 General Fee Schedule - 8/1/2016
50546 Y $1,085.27 General Fee Schedule - 8/1/2016
50547 Y $1,459.12 General Fee Schedule - 12/1/2009
50548 Y $1,262.07 General Fee Schedule - 8/1/2016
50549 Y $0.00 General by Report - 1/1/2000
50551 Y $338.79 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 125 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
50553 Y $359.81 General Fee Schedule - 1/1/2017
50555 Y $387.40 General Fee Schedule - 1/1/2017
50557 Y $395.85 General Fee Schedule - 1/1/2017
50561 Y $449.23 General Fee Schedule - 1/1/2017
50562 Y $557.56 General Fee Schedule - 1/1/2017
50570 Y $481.52 General Fee Schedule - 8/1/2016
50572 Y $512.19 General Fee Schedule - 1/1/2017
50574 Y $544.61 General Fee Schedule - 8/1/2016
50575 Y $702.61 General Fee Schedule - 8/1/2016
50576 Y $552.98 General Fee Schedule - 8/1/2016
50580 Y $596.75 General Fee Schedule - 8/1/2016
50590 Y $671.10 General Fee Schedule - 1/1/2017
50592 Y $2,259.37 General Fee Schedule - 1/1/2017
50593 Y $3,639.61 General Fee Schedule - 12/1/2009
50600 Y $843.23 General Fee Schedule - 8/1/2016
50605 Y $877.15 General Fee Schedule - 12/1/2009
50606 Y $475.41 General Fee Schedule - 8/1/2016
50610 Y $866.02 General Fee Schedule - 8/1/2016
50620 Y $805.21 General Fee Schedule - 8/1/2016
50630 Y $795.73 General Fee Schedule - 8/1/2016
50650 Y $922.76 General Fee Schedule - 8/1/2016
50660 Y $1,031.02 General Fee Schedule - 8/1/2016
50684 Y $96.20 General Fee Schedule - 1/1/2017
50686 Y $132.71 General Fee Schedule - 1/1/2017
50688 Y $75.05 General Fee Schedule - 1/1/2017
50690 Y $91.03 General Fee Schedule - 1/1/2017
50693 Y $943.32 General Fee Schedule - 8/1/2016
50694 Y $1,041.91 General Fee Schedule - 8/1/2016
50695 Y $1,271.59 General Fee Schedule - 8/1/2016
50700 Y $839.32 General Fee Schedule - 8/1/2016
50705 Y $1,511.58 General Fee Schedule - 8/1/2016
50706 Y $684.61 General Fee Schedule - 8/1/2016
50715 Y $1,101.85 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 126 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
50722 Y $925.14 General Fee Schedule - 8/1/2016
50725 Y $999.34 General Fee Schedule - 8/1/2016
50727 Y $463.64 General Fee Schedule - 8/1/2016
50728 Y $660.89 General Fee Schedule - 8/1/2016
50740 Y $1,042.88 General Fee Schedule - 12/1/2009
50750 Y $1,030.53 General Fee Schedule - 8/1/2016
50760 Y $1,026.66 General Fee Schedule - 12/1/2009
50770 Y $1,032.53 General Fee Schedule - 8/1/2016
50780 Y $979.08 General Fee Schedule - 8/1/2016
50782 Y $1,027.12 General Fee Schedule - 1/1/2017
50783 Y $1,096.52 General Fee Schedule - 8/1/2016
50785 Y $1,080.46 General Fee Schedule - 8/1/2016
50800 Y $822.65 General Fee Schedule - 12/1/2009
50810 Y $1,117.86 General Fee Schedule - 8/1/2016
50815 Y $1,110.96 General Fee Schedule - 12/1/2009
50820 Y $1,205.55 General Fee Schedule - 12/1/2009
50825 Y $1,477.83 General Fee Schedule - 8/1/2016
50830 Y $1,636.80 General Fee Schedule - 8/1/2016
50840 Y $1,110.55 General Fee Schedule - 12/1/2009
50845 Y $1,118.21 General Fee Schedule - 8/1/2016
50860 Y $863.66 General Fee Schedule - 12/1/2009
50900 Y $774.88 General Fee Schedule - 12/1/2009
50920 Y $780.02 General Fee Schedule - 8/1/2016
50930 Y $1,038.84 General Fee Schedule - 12/1/2009
50940 Y $789.39 General Fee Schedule - 8/1/2016
50945 Y $905.64 General Fee Schedule - 8/1/2016
50947 Y $1,297.13 General Fee Schedule - 8/1/2016
50948 Y $1,175.28 General Fee Schedule - 8/1/2016
50949 Y $1,144.99 General Fee Schedule - 12/1/2009
50951 Y $353.61 General Fee Schedule - 1/1/2017
50953 Y $373.59 General Fee Schedule - 1/1/2017
50955 Y $400.94 General Fee Schedule - 1/1/2017
50957 Y $404.75 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 127 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
50961 Y $364.25 General Fee Schedule - 1/1/2017
50970 Y $362.63 General Fee Schedule - 8/1/2016
50972 Y $352.37 General Fee Schedule - 8/1/2016
50974 Y $462.86 General Fee Schedule - 8/1/2016
50976 Y $457.39 General Fee Schedule - 8/1/2016
50980 Y $347.60 General Fee Schedule - 8/1/2016
51020 Y $407.00 General Fee Schedule - 12/1/2009
51030 Y $417.23 General Fee Schedule - 12/1/2009
51040 Y $264.00 General Fee Schedule - 8/1/2016
51045 Y $413.44 General Fee Schedule - 12/1/2009
51050 Y $408.61 General Fee Schedule - 12/1/2009
51060 Y $517.04 General Fee Schedule - 12/1/2009
51065 Y $512.25 General Fee Schedule - 12/1/2009
51080 Y $366.06 General Fee Schedule - 12/1/2009
51100 Y $50.81 General Fee Schedule - 12/1/2009
51101 Y $102.91 General Fee Schedule - 12/1/2009
51102 Y $209.36 General Fee Schedule - 1/1/2017
51500 Y $573.81 General Fee Schedule - 8/1/2016
51520 Y $542.26 General Fee Schedule - 12/1/2009
51525 Y $782.87 General Fee Schedule - 12/1/2009
51530 Y $710.55 General Fee Schedule - 12/1/2009
51535 Y $706.97 General Fee Schedule - 8/1/2016
51550 Y $879.70 General Fee Schedule - 12/1/2009
51555 Y $1,126.91 General Fee Schedule - 8/1/2016
51565 Y $1,149.23 General Fee Schedule - 8/1/2016
51570 Y $1,327.31 General Fee Schedule - 12/1/2009
51575 Y $1,660.57 General Fee Schedule - 12/1/2009
51580 Y $1,703.75 General Fee Schedule - 12/1/2009
51585 Y $1,913.65 General Fee Schedule - 12/1/2009
51590 Y $1,769.88 General Fee Schedule - 12/1/2009
51595 Y $2,005.50 General Fee Schedule - 12/1/2009
51596 Y $2,141.26 General Fee Schedule - 12/1/2009
51597 Y $2,083.78 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 128 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
51600 Y $163.68 General Fee Schedule - 1/1/2017
51605 Y $36.36 General Fee Schedule - 1/1/2017
51610 Y $97.46 General Fee Schedule - 1/1/2017
51700 Y $76.26 General Fee Schedule - 1/1/2017
51701 Y $49.83 General Fee Schedule - 1/1/2017
51702 Y $63.75 General Fee Schedule - 1/1/2017
51703 Y $119.21 General Fee Schedule - 1/1/2017
51705 Y $83.12 General Fee Schedule - 1/1/2017
51710 Y $117.88 General Fee Schedule - 1/1/2017
51715 Y $269.24 General Fee Schedule - 1/1/2017
51720 Y $101.03 General Fee Schedule - 1/1/2017
51725 Y $72.96 26 Fee Schedule (FS) - 1/1/2017
51725 Y $168.98 General Fee Schedule - 1/1/2017
51725 Y $96.03 TC Fee Schedule - 1/1/2017
51726 Y $81.63 26 Fee Schedule (FS) - 1/1/2017
51726 Y $235.93 General Fee Schedule - 1/1/2017
51726 Y $154.29 TC Fee Schedule - 1/1/2017
51727 Y $99.94 26 Fee Schedule (FS) - 8/1/2016
51727 Y $267.00 General Fee Schedule - 1/1/2010
51727 Y $162.90 TC Fee Schedule - 1/1/2010
51728 Y $98.56 26 Fee Schedule (FS) - 8/1/2016
51728 Y $266.53 General Fee Schedule - 1/1/2010
51728 Y $163.86 TC Fee Schedule - 1/1/2010
51729 Y $116.67 26 Fee Schedule (FS) - 8/1/2016
51729 Y $287.32 General Fee Schedule - 1/1/2010
51729 Y $165.79 TC Fee Schedule - 1/1/2010
51736 Y $7.97 26 Fee Schedule (FS) - 1/1/2017
51736 Y $14.24 General Fee Schedule - 1/1/2017
51736 Y $6.27 TC Fee Schedule - 1/1/2017
51741 Y $7.97 26 Fee Schedule (FS) - 1/1/2017
51741 Y $14.55 General Fee Schedule - 1/1/2017
51741 Y $6.58 TC Fee Schedule - 1/1/2017
51784 Y $73.32 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 129 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
51784 Y $173.46 General Fee Schedule - 1/1/2017
51784 Y $100.13 TC Fee Schedule - 1/1/2017
51785 Y $79.98 26 Fee Schedule (FS) - 12/1/2009
51785 Y $216.59 General Fee Schedule - 12/1/2009
51785 Y $136.62 TC Fee Schedule - 12/1/2009
51792 Y $53.03 26 Fee Schedule (FS) - 1/1/2017
51792 Y $188.75 General Fee Schedule - 1/1/2017
51792 Y $135.73 TC Fee Schedule - 1/1/2017
51797 Y $38.34 26 Fee Schedule (FS) - 1/1/2017
51797 Y $100.55 General Fee Schedule - 1/1/2017
51797 Y $62.21 TC Fee Schedule - 1/1/2017
51798 Y $14.40 General Fee Schedule - 12/1/2009
51800 Y $937.29 General Fee Schedule - 8/1/2016
51820 Y $992.29 General Fee Schedule - 8/1/2016
51840 Y $614.67 General Fee Schedule - 8/1/2016
51841 Y $733.24 General Fee Schedule - 8/1/2016
51845 Y $542.49 General Fee Schedule - 8/1/2016
51860 Y $672.77 General Fee Schedule - 8/1/2016
51865 Y $817.23 General Fee Schedule - 8/1/2016
51880 Y $437.50 General Fee Schedule - 8/1/2016
51900 Y $749.81 General Fee Schedule - 12/1/2009
51920 Y $689.28 General Fee Schedule - 12/1/2009
51925 Y $966.19 General Fee Schedule - 12/1/2009
51940 Y $1,520.98 General Fee Schedule - 8/1/2016
51960 Y $1,274.03 General Fee Schedule - 12/1/2009
51980 Y $625.88 General Fee Schedule - 8/1/2016
51990 Y $711.00 General Fee Schedule - 8/1/2016
51992 Y $769.60 General Fee Schedule - 8/1/2016
51999 Y $0.00 General by Report - 1/1/2006
52000 Y $187.92 General Fee Schedule - 8/1/2016
52001 Y $347.26 General Fee Schedule - 1/1/2017
52005 Y $241.41 General Fee Schedule - 1/1/2017
52007 Y $398.81 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 130 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
52010 Y $337.16 General Fee Schedule - 1/1/2017
52204 Y $331.62 General Fee Schedule - 1/1/2017
52214 Y $589.02 General Fee Schedule - 1/1/2017
52224 Y $617.94 General Fee Schedule - 1/1/2017
52234 Y $236.69 General Fee Schedule - 8/1/2016
52235 Y $278.28 General Fee Schedule - 8/1/2016
52240 Y $377.13 General Fee Schedule - 1/1/2017
52250 Y $231.22 General Fee Schedule - 8/1/2016
52260 Y $200.84 General Fee Schedule - 8/1/2016
52265 Y $331.12 General Fee Schedule - 1/1/2017
52270 Y $323.54 General Fee Schedule - 1/1/2017
52275 Y $437.02 General Fee Schedule - 1/1/2017
52276 Y $255.34 General Fee Schedule - 8/1/2016
52277 Y $316.15 General Fee Schedule - 8/1/2016
52281 Y $248.66 General Fee Schedule - 1/1/2017
52282 Y $325.33 General Fee Schedule - 8/1/2016
52283 Y $256.86 General Fee Schedule - 1/1/2017
52285 Y $258.59 General Fee Schedule - 1/1/2017
52287 Y $281.62 General Fee Schedule - 8/1/2016
52290 Y $234.55 General Fee Schedule - 8/1/2016
52300 Y $271.77 General Fee Schedule - 8/1/2016
52301 Y $284.47 General Fee Schedule - 8/1/2016
52305 Y $270.12 General Fee Schedule - 8/1/2016
52310 Y $223.83 General Fee Schedule - 1/1/2017
52315 Y $381.65 General Fee Schedule - 1/1/2017
52317 Y $728.00 General Fee Schedule - 1/1/2017
52318 Y $463.60 General Fee Schedule - 8/1/2016
52320 Y $238.30 General Fee Schedule - 8/1/2016
52325 Y $312.15 General Fee Schedule - 8/1/2016
52327 Y $252.53 General Fee Schedule - 1/1/2017
52330 Y $450.66 General Fee Schedule - 1/1/2017
52332 Y $313.70 General Fee Schedule - 12/1/2009
52334 Y $247.40 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 131 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
52341 Y $272.66 General Fee Schedule - 1/1/2017
52342 Y $296.40 General Fee Schedule - 1/1/2017
52343 Y $330.93 General Fee Schedule - 1/1/2017
52344 Y $355.45 General Fee Schedule - 1/1/2017
52345 Y $379.82 General Fee Schedule - 1/1/2017
52351 Y $290.79 General Fee Schedule - 1/1/2017
52352 Y $340.30 General Fee Schedule - 1/1/2017
52353 Y $377.13 General Fee Schedule - 1/1/2017
52354 Y $376.94 General Fee Schedule - 8/1/2016
52355 Y $450.87 General Fee Schedule - 8/1/2016
52356 Y $400.13 General Fee Schedule - 8/1/2016
52400 Y $457.65 General Fee Schedule - 1/1/2017
52402 Y $257.19 General Fee Schedule - 1/1/2017
52441 Y $1,117.73 General Fee Schedule - 8/1/2016
52442 Y $846.41 General Fee Schedule - 8/1/2016
52450 Y $421.59 General Fee Schedule - 8/1/2016
52500 Y $462.55 General Fee Schedule - 8/1/2016
52601 Y $681.71 General Fee Schedule - 12/1/2009
52630 Y $379.21 General Fee Schedule - 1/1/2017
52640 Y $296.87 General Fee Schedule - 1/1/2017
52647 Y $1,597.75 General Fee Schedule - 1/1/2017
52648 Y $1,646.69 General Fee Schedule - 1/1/2017
52649 Y $763.62 General Fee Schedule - 8/1/2016
52700 Y $387.88 General Fee Schedule - 12/1/2009
53000 Y $140.41 General Fee Schedule - 8/1/2016
53010 Y $248.37 General Fee Schedule - 12/1/2009
53020 Y $92.81 General Fee Schedule - 1/1/2017
53025 Y $68.38 General Fee Schedule - 1/1/2017
53040 Y $364.76 General Fee Schedule - 8/1/2016
53060 Y $175.43 General Fee Schedule - 8/1/2016
53080 Y $398.49 General Fee Schedule - 1/1/2017
53085 Y $632.47 General Fee Schedule - 1/1/2017
53200 Y $146.00 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 132 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
53210 Y $686.82 General Fee Schedule - 8/1/2016
53215 Y $831.29 General Fee Schedule - 8/1/2016
53220 Y $397.53 General Fee Schedule - 8/1/2016
53230 Y $533.96 General Fee Schedule - 8/1/2016
53235 Y $560.25 General Fee Schedule - 8/1/2016
53240 Y $387.40 General Fee Schedule - 12/1/2009
53250 Y $356.87 General Fee Schedule - 12/1/2009
53260 Y $192.66 General Fee Schedule - 8/1/2016
53265 Y $203.78 General Fee Schedule - 1/1/2017
53270 Y $197.09 General Fee Schedule - 8/1/2016
53275 Y $252.38 General Fee Schedule - 8/1/2016
53400 Y $703.47 General Fee Schedule - 8/1/2016
53405 Y $780.34 General Fee Schedule - 8/1/2016
53410 Y $879.27 General Fee Schedule - 8/1/2016
53415 Y $1,005.13 General Fee Schedule - 8/1/2016
53420 Y $759.90 General Fee Schedule - 8/1/2016
53425 Y $855.66 General Fee Schedule - 8/1/2016
53430 Y $873.27 General Fee Schedule - 8/1/2016
53431 Y $1,047.91 General Fee Schedule - 8/1/2016
53440 Y $732.66 General Fee Schedule - 8/1/2016
53442 Y $660.73 General Fee Schedule - 12/1/2009
53444 Y $720.56 General Fee Schedule - 8/1/2016
53445 Y $716.28 General Fee Schedule - 1/1/2017
53446 Y $574.10 General Fee Schedule - 8/1/2016
53447 Y $742.30 General Fee Schedule - 8/1/2016
53448 Y $1,177.55 General Fee Schedule - 12/1/2009
53449 Y $537.07 General Fee Schedule - 8/1/2016
53450 Y $364.45 General Fee Schedule - 12/1/2009
53460 Y $401.65 General Fee Schedule - 8/1/2016
53500 Y $685.98 General Fee Schedule - 8/1/2016
53502 Y $434.06 General Fee Schedule - 8/1/2016
53505 Y $427.47 General Fee Schedule - 8/1/2016
53510 Y $568.35 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 133 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
53515 Y $722.52 General Fee Schedule - 8/1/2016
53520 Y $488.74 General Fee Schedule - 8/1/2016
53600 Y $77.40 General Fee Schedule - 1/1/2017
53601 Y $74.76 General Fee Schedule - 1/1/2017
53605 Y $62.28 General Fee Schedule - 1/1/2017
53620 Y $108.02 General Fee Schedule - 1/1/2017
53621 Y $101.16 General Fee Schedule - 1/1/2017
53660 Y $64.49 General Fee Schedule - 1/1/2017
53661 Y $63.28 General Fee Schedule - 1/1/2017
53665 Y $37.16 General Fee Schedule - 1/1/2017
53850 Y $1,847.47 General Fee Schedule - 1/1/2017
53852 Y $1,708.71 General Fee Schedule - 1/1/2017
53855 Y $585.73 General Fee Schedule - 1/1/2010
53860 Y $1,336.52 General Fee Schedule - 8/1/2016
53899 Y $0.00 General by Report - 7/1/1975
54000 Y $135.79 General Fee Schedule - 1/1/2017
54001 Y $170.02 General Fee Schedule - 1/1/2017
54015 Y $293.50 General Fee Schedule - 8/1/2016
54050 Y $107.47 General Fee Schedule - 12/1/2009
54055 Y $103.61 General Fee Schedule - 12/1/2009
54056 Y $107.80 General Fee Schedule - 12/1/2009
54057 Y $121.89 General Fee Schedule - 8/1/2016
54060 Y $164.81 General Fee Schedule - 1/1/2017
54065 Y $188.29 General Fee Schedule - 12/1/2009
54100 Y $173.00 General Fee Schedule - 12/1/2009
54105 Y $245.66 General Fee Schedule - 1/1/2017
54110 Y $554.95 General Fee Schedule - 8/1/2016
54111 Y $723.91 General Fee Schedule - 8/1/2016
54112 Y $847.57 General Fee Schedule - 8/1/2016
54115 Y $401.81 General Fee Schedule - 12/1/2009
54120 Y $568.16 General Fee Schedule - 12/1/2009
54125 Y $724.06 General Fee Schedule - 8/1/2016
54130 Y $1,064.76 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 134 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
54135 Y $1,372.21 General Fee Schedule - 8/1/2016
54150 Y $142.62 General Fee Schedule - 1/1/2017
54160 Y $205.26 General Fee Schedule - 1/1/2017
54161 Y $180.08 General Fee Schedule - 8/1/2016
54162 Y $238.40 General Fee Schedule - 1/1/2017
54163 Y $191.87 General Fee Schedule - 12/1/2009
54164 Y $165.71 General Fee Schedule - 12/1/2009
54200 Y $98.10 General Fee Schedule - 1/1/2017
54205 Y $466.20 General Fee Schedule - 8/1/2016
54220 Y $188.55 General Fee Schedule - 1/1/2017
54231 Y $125.92 General Fee Schedule - 8/1/2016
54235 Y $78.30 General Fee Schedule - 8/1/2016
54240 Y $64.38 26 Fee Schedule (FS) - 1/1/2017
54240 Y $88.03 General Fee Schedule - 8/1/2016
54240 Y $22.61 TC Fee Schedule - 12/1/2009
54250 Y $105.87 26 Fee Schedule (FS) - 8/1/2016
54250 Y $112.77 General Fee Schedule - 8/1/2016
54250 Y $7.20 TC Fee Schedule - 1/1/2006
54300 Y $593.62 General Fee Schedule - 8/1/2016
54304 Y $699.64 General Fee Schedule - 8/1/2016
54308 Y $661.69 General Fee Schedule - 8/1/2016
54312 Y $773.29 General Fee Schedule - 8/1/2016
54316 Y $923.90 General Fee Schedule - 8/1/2016
54318 Y $680.06 General Fee Schedule - 12/1/2009
54322 Y $724.50 General Fee Schedule - 8/1/2016
54324 Y $903.39 General Fee Schedule - 8/1/2016
54326 Y $874.61 General Fee Schedule - 8/1/2016
54328 Y $850.28 General Fee Schedule - 8/1/2016
54332 Y $964.90 General Fee Schedule - 12/1/2009
54336 Y $1,153.30 General Fee Schedule - 8/1/2016
54340 Y $516.34 General Fee Schedule - 8/1/2016
54344 Y $933.37 General Fee Schedule - 12/1/2009
54348 Y $949.95 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 135 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
54352 Y $1,357.65 General Fee Schedule - 8/1/2016
54360 Y $667.70 General Fee Schedule - 8/1/2016
54380 Y $736.07 General Fee Schedule - 8/1/2016
54385 Y $869.87 General Fee Schedule - 8/1/2016
54390 Y $1,160.65 General Fee Schedule - 8/1/2016
54406 Y $654.61 General Fee Schedule - 8/1/2016
54408 Y $718.97 General Fee Schedule - 12/1/2009
54410 Y $827.99 General Fee Schedule - 8/1/2016
54411 Y $897.22 General Fee Schedule - 12/1/2009
54415 Y $479.96 General Fee Schedule - 12/1/2009
54416 Y $629.59 General Fee Schedule - 12/1/2009
54417 Y $793.07 General Fee Schedule - 12/1/2009
54420 Y $632.69 General Fee Schedule - 8/1/2016
54430 Y $567.21 General Fee Schedule - 8/1/2016
54435 Y $374.63 General Fee Schedule - 12/1/2009
54437 Y $649.50 General Fee Schedule - 8/1/2016
54438 Y $1,317.62 General Fee Schedule - 8/1/2016
54440 Y $238.85 General Fee Schedule - 12/1/2009
54450 Y $66.02 General Fee Schedule - 1/1/2017
54500 Y $71.90 General Fee Schedule - 8/1/2016
54505 Y $199.90 General Fee Schedule - 8/1/2016
54512 Y $475.53 General Fee Schedule - 8/1/2016
54520 Y $301.71 General Fee Schedule - 8/1/2016
54522 Y $563.78 General Fee Schedule - 12/1/2009
54530 Y $478.81 General Fee Schedule - 8/1/2016
54535 Y $663.76 General Fee Schedule - 8/1/2016
54550 Y $432.71 General Fee Schedule - 8/1/2016
54560 Y $611.12 General Fee Schedule - 8/1/2016
54600 Y $409.35 General Fee Schedule - 12/1/2009
54620 Y $273.66 General Fee Schedule - 8/1/2016
54640 Y $415.40 General Fee Schedule - 12/1/2009
54650 Y $639.82 General Fee Schedule - 8/1/2016
54660 Y $314.77 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 136 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
54670 Y $369.08 General Fee Schedule - 8/1/2016
54680 Y $708.93 General Fee Schedule - 8/1/2016
54690 Y $626.63 General Fee Schedule - 12/1/2009
54692 Y $727.54 General Fee Schedule - 12/1/2009
54699 Y $0.00 General by Report - 1/1/2000
54700 Y $199.78 General Fee Schedule - 8/1/2016
54800 Y $122.14 General Fee Schedule - 1/1/2017
54830 Y $324.83 General Fee Schedule - 12/1/2009
54840 Y $295.96 General Fee Schedule - 8/1/2016
54860 Y $372.42 General Fee Schedule - 12/1/2009
54861 Y $512.47 General Fee Schedule - 12/1/2009
54865 Y $292.43 General Fee Schedule - 12/1/2009
54900 Y $739.43 General Fee Schedule - 12/1/2009
54901 Y $1,011.98 General Fee Schedule - 12/1/2009
55000 Y $108.66 General Fee Schedule - 1/1/2017
55040 Y $307.81 General Fee Schedule - 8/1/2016
55041 Y $455.02 General Fee Schedule - 12/1/2009
55060 Y $334.02 General Fee Schedule - 12/1/2009
55100 Y $199.64 General Fee Schedule - 1/1/2017
55110 Y $341.64 General Fee Schedule - 12/1/2009
55120 Y $310.56 General Fee Schedule - 12/1/2009
55150 Y $429.12 General Fee Schedule - 12/1/2009
55175 Y $317.71 General Fee Schedule - 12/1/2009
55180 Y $627.95 General Fee Schedule - 12/1/2009
55200 Y $399.42 General Fee Schedule - 1/1/2017
55250 Y $529.36 General Fee Schedule - 12/1/2009
55300 Y $188.59 General Fee Schedule - 12/1/2009
55500 Y $340.17 General Fee Schedule - 12/1/2009
55520 Y $369.54 General Fee Schedule - 12/1/2009
55530 Y $323.22 General Fee Schedule - 8/1/2016
55535 Y $385.46 General Fee Schedule - 12/1/2009
55540 Y $458.25 General Fee Schedule - 12/1/2009
55550 Y $385.88 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 137 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
55559 Y $0.00 General by Report - 1/1/2000
55600 Y $381.30 General Fee Schedule - 12/1/2009
55605 Y $475.84 General Fee Schedule - 12/1/2009
55650 Y $640.55 General Fee Schedule - 8/1/2016
55680 Y $317.86 General Fee Schedule - 12/1/2009
55700 Y $199.86 General Fee Schedule - 8/1/2016
55705 Y $255.18 General Fee Schedule - 8/1/2016
55706 Y $352.13 General Fee Schedule - 8/1/2016
55720 Y $439.79 General Fee Schedule - 8/1/2016
55725 Y $512.56 General Fee Schedule - 12/1/2009
55801 Y $993.08 General Fee Schedule - 12/1/2009
55810 Y $1,182.81 General Fee Schedule - 8/1/2016
55812 Y $1,446.76 General Fee Schedule - 8/1/2016
55815 Y $1,589.60 General Fee Schedule - 8/1/2016
55821 Y $796.76 General Fee Schedule - 12/1/2009
55831 Y $833.43 General Fee Schedule - 8/1/2016
55840 Y $1,121.88 General Fee Schedule - 1/1/2017
55842 Y $1,120.71 General Fee Schedule - 1/1/2017
55845 Y $1,307.58 General Fee Schedule - 1/1/2017
55860 Y $779.21 General Fee Schedule - 8/1/2016
55862 Y $1,028.90 General Fee Schedule - 12/1/2009
55865 Y $1,205.07 General Fee Schedule - 8/1/2016
55866 Y $1,324.35 General Fee Schedule - 1/1/2017
55873 Y $1,104.80 General Fee Schedule - 12/1/2009
55874 Y $3,297.98 General Fee Schedule - 1/1/2018
55875 Y $643.23 General Fee Schedule - 12/1/2009
55876 Y $121.29 General Fee Schedule - 8/1/2016
55899 Y $0.00 General by Report - 7/1/1975
55920 Y $346.37 General Fee Schedule - 12/1/2009
56405 Y $102.71 General Fee Schedule - 8/1/2016
56420 Y $112.17 General Fee Schedule - 1/1/2017
56440 Y $172.71 General Fee Schedule - 8/1/2016
56441 Y $134.05 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 138 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
56442 Y $39.58 General Fee Schedule - 12/1/2009
56501 Y $121.50 General Fee Schedule - 8/1/2016
56515 Y $197.03 General Fee Schedule - 8/1/2016
56605 Y $76.25 General Fee Schedule - 1/1/2017
56606 Y $35.58 General Fee Schedule - 1/1/2017
56620 Y $464.04 General Fee Schedule - 8/1/2016
56625 Y $541.57 General Fee Schedule - 12/1/2009
56630 Y $762.30 General Fee Schedule - 12/1/2009
56631 Y $994.20 General Fee Schedule - 12/1/2009
56632 Y $1,190.85 General Fee Schedule - 12/1/2009
56633 Y $997.78 General Fee Schedule - 12/1/2009
56634 Y $1,087.15 General Fee Schedule - 12/1/2009
56637 Y $1,316.36 General Fee Schedule - 12/1/2009
56640 Y $1,318.35 General Fee Schedule - 12/1/2009
56700 Y $163.80 General Fee Schedule - 8/1/2016
56740 Y $272.02 General Fee Schedule - 8/1/2016
56800 Y $230.68 General Fee Schedule - 8/1/2016
56805 Y $1,078.98 General Fee Schedule - 8/1/2016
56810 Y $244.50 General Fee Schedule - 8/1/2016
56820 Y $104.61 General Fee Schedule - 8/1/2016
56821 Y $138.34 General Fee Schedule - 1/1/2017
57000 Y $176.86 General Fee Schedule - 8/1/2016
57010 Y $387.34 General Fee Schedule - 12/1/2009
57020 Y $87.27 General Fee Schedule - 1/1/2017
57022 Y $152.46 General Fee Schedule - 8/1/2016
57023 Y $279.67 General Fee Schedule - 8/1/2016
57061 Y $105.52 General Fee Schedule - 8/1/2016
57065 Y $182.59 General Fee Schedule - 8/1/2016
57100 Y $84.60 General Fee Schedule - 8/1/2016
57105 Y $128.42 General Fee Schedule - 8/1/2016
57106 Y $413.77 General Fee Schedule - 12/1/2009
57107 Y $1,285.80 General Fee Schedule - 8/1/2016
57109 Y $1,537.36 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 139 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
57110 Y $825.75 General Fee Schedule - 8/1/2016
57111 Y $1,519.89 General Fee Schedule - 8/1/2016
57112 Y $1,639.16 General Fee Schedule - 12/1/2009
57120 Y $455.23 General Fee Schedule - 8/1/2016
57130 Y $164.13 General Fee Schedule - 1/1/2017
57135 Y $178.67 General Fee Schedule - 1/1/2017
57150 Y $41.60 General Fee Schedule - 1/1/2017
57155 Y $396.42 General Fee Schedule - 8/1/2016
57156 Y $145.84 General Fee Schedule - 1/1/2011
57160 Y $69.48 General Fee Schedule - 8/1/2016
57170 Y $89.60 General Fee Schedule - 12/1/2009
57180 Y $129.26 General Fee Schedule - 1/1/2017
57200 Y $266.87 General Fee Schedule - 12/1/2009
57210 Y $324.84 General Fee Schedule - 8/1/2016
57220 Y $278.47 General Fee Schedule - 8/1/2016
57230 Y $352.72 General Fee Schedule - 12/1/2009
57240 Y $386.12 General Fee Schedule - 12/1/2009
57250 Y $358.09 General Fee Schedule - 12/1/2009
57260 Y $518.04 General Fee Schedule - 12/1/2009
57265 Y $689.67 General Fee Schedule - 12/1/2009
57267 Y $243.89 General Fee Schedule - 1/1/2017
57268 Y $431.63 General Fee Schedule - 12/1/2009
57270 Y $700.84 General Fee Schedule - 8/1/2016
57280 Y $854.51 General Fee Schedule - 8/1/2016
57282 Y $436.26 General Fee Schedule - 8/1/2016
57283 Y $630.40 General Fee Schedule - 8/1/2016
57284 Y $751.95 General Fee Schedule - 8/1/2016
57285 Y $497.95 General Fee Schedule - 12/1/2009
57287 Y $606.40 General Fee Schedule - 8/1/2016
57288 Y $673.80 General Fee Schedule - 1/1/2017
57289 Y $667.33 General Fee Schedule - 8/1/2016
57291 Y $507.39 General Fee Schedule - 12/1/2009
57292 Y $765.14 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 140 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
57295 Y $452.16 General Fee Schedule - 8/1/2016
57296 Y $777.81 General Fee Schedule - 12/1/2009
57300 Y $470.29 General Fee Schedule - 12/1/2009
57305 Y $805.16 General Fee Schedule - 12/1/2009
57307 Y $923.55 General Fee Schedule - 12/1/2009
57308 Y $597.28 General Fee Schedule - 12/1/2009
57310 Y $411.44 General Fee Schedule - 12/1/2009
57311 Y $471.14 General Fee Schedule - 12/1/2009
57320 Y $482.24 General Fee Schedule - 12/1/2009
57330 Y $680.04 General Fee Schedule - 8/1/2016
57335 Y $1,053.71 General Fee Schedule - 8/1/2016
57400 Y $129.23 General Fee Schedule - 8/1/2016
57410 Y $102.06 General Fee Schedule - 1/1/2017
57415 Y $140.67 General Fee Schedule - 12/1/2009
57420 Y $109.96 General Fee Schedule - 8/1/2016
57421 Y $147.74 General Fee Schedule - 1/1/2017
57423 Y $698.03 General Fee Schedule - 12/1/2009
57425 Y $859.47 General Fee Schedule - 8/1/2016
57426 Y $781.54 General Fee Schedule - 8/1/2016
57452 Y $103.62 General Fee Schedule - 8/1/2016
57454 Y $142.96 General Fee Schedule - 1/1/2017
57455 Y $132.81 General Fee Schedule - 1/1/2017
57456 Y $125.15 General Fee Schedule - 1/1/2017
57460 Y $258.17 General Fee Schedule - 1/1/2017
57461 Y $292.96 General Fee Schedule - 1/1/2017
57500 Y $116.53 General Fee Schedule - 1/1/2017
57505 Y $94.87 General Fee Schedule - 8/1/2016
57510 Y $122.19 General Fee Schedule - 1/1/2017
57511 Y $134.09 General Fee Schedule - 1/1/2017
57513 Y $134.56 General Fee Schedule - 8/1/2016
57520 Y $285.91 General Fee Schedule - 1/1/2017
57522 Y $241.59 General Fee Schedule - 8/1/2016
57530 Y $307.78 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 141 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
57531 Y $1,646.53 General Fee Schedule - 12/1/2009
57540 Y $706.91 General Fee Schedule - 8/1/2016
57545 Y $752.37 General Fee Schedule - 8/1/2016
57550 Y $352.65 General Fee Schedule - 8/1/2016
57555 Y $534.71 General Fee Schedule - 8/1/2016
57556 Y $500.03 General Fee Schedule - 8/1/2016
57558 Y $103.88 General Fee Schedule - 12/1/2009
57700 Y $257.28 General Fee Schedule - 12/1/2009
57720 Y $271.13 General Fee Schedule - 8/1/2016
57800 Y $56.50 General Fee Schedule - 8/1/2016
58100 Y $101.36 General Fee Schedule - 1/1/2017
58110 Y $44.92 General Fee Schedule - 1/1/2017
58120 Y $218.77 General Fee Schedule - 12/1/2009
58140 Y $834.30 General Fee Schedule - 8/1/2016
58145 Y $487.49 General Fee Schedule - 8/1/2016
58146 Y $1,076.66 General Fee Schedule - 8/1/2016
58150 Y $907.81 General Fee Schedule - 12/1/2009
58152 Y $1,168.86 General Fee Schedule - 8/1/2016
58180 Y $865.74 General Fee Schedule - 8/1/2016
58200 Y $1,212.47 General Fee Schedule - 8/1/2016
58210 Y $1,681.40 General Fee Schedule - 12/1/2009
58240 Y $2,229.89 General Fee Schedule - 12/1/2009
58260 Y $752.84 General Fee Schedule - 8/1/2016
58262 Y $849.13 General Fee Schedule - 8/1/2016
58263 Y $918.35 General Fee Schedule - 8/1/2016
58267 Y $974.38 General Fee Schedule - 8/1/2016
58270 Y $817.74 General Fee Schedule - 8/1/2016
58275 Y $902.62 General Fee Schedule - 8/1/2016
58280 Y $969.32 General Fee Schedule - 8/1/2016
58285 Y $1,240.95 General Fee Schedule - 8/1/2016
58290 Y $1,079.62 General Fee Schedule - 8/1/2016
58291 Y $1,178.22 General Fee Schedule - 8/1/2016
58292 Y $1,247.09 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 142 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
58293 Y $1,296.59 General Fee Schedule - 8/1/2016
58294 Y $1,144.49 General Fee Schedule - 8/1/2016
58300 Y $39.69 General Fee Schedule - 12/1/2009
58301 Y $99.40 General Fee Schedule - 12/1/2009
58340 Y $107.21 General Fee Schedule - 1/1/2017
58345 Y $255.76 General Fee Schedule - 1/1/2017
58346 Y $397.49 General Fee Schedule - 8/1/2016
58350 Y $94.14 General Fee Schedule - 12/1/2009
58353 Y $892.31 General Fee Schedule - 1/1/2017
58356 Y $1,668.31 General Fee Schedule - 1/1/2017
58400 Y $389.67 General Fee Schedule - 8/1/2016
58410 Y $731.05 General Fee Schedule - 8/1/2016
58520 Y $717.24 General Fee Schedule - 12/1/2009
58540 Y $829.85 General Fee Schedule - 8/1/2016
58541 Y $671.54 General Fee Schedule - 8/1/2016
58542 Y $743.64 General Fee Schedule - 8/1/2016
58543 Y $756.29 General Fee Schedule - 8/1/2016
58544 Y $819.07 General Fee Schedule - 8/1/2016
58545 Y $835.60 General Fee Schedule - 8/1/2016
58546 Y $1,073.04 General Fee Schedule - 8/1/2016
58548 Y $1,491.22 General Fee Schedule - 12/1/2009
58550 Y $822.36 General Fee Schedule - 8/1/2016
58552 Y $913.09 General Fee Schedule - 8/1/2016
58553 Y $1,073.04 General Fee Schedule - 8/1/2016
58554 Y $1,231.84 General Fee Schedule - 8/1/2016
58555 Y $217.68 General Fee Schedule - 12/1/2009
58558 Y $277.28 General Fee Schedule - 12/1/2009
58559 Y $323.22 General Fee Schedule - 1/1/2017
58560 Y $364.12 General Fee Schedule - 1/1/2017
58561 Y $517.55 General Fee Schedule - 1/1/2017
58562 Y $303.28 General Fee Schedule - 12/1/2009
58563 Y $1,480.90 General Fee Schedule - 1/1/2017
58565 Y $1,658.05 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 143 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
58570 Y $694.72 General Fee Schedule - 12/1/2009
58571 Y $759.91 General Fee Schedule - 12/1/2009
58572 Y $863.41 General Fee Schedule - 12/1/2009
58573 Y $972.02 General Fee Schedule - 12/1/2009
58575 Y $1,793.81 General Fee Schedule - 1/1/2018
58578 Y $0.00 General by Report - 1/1/2000
58579 Y $0.00 General by Report - 1/1/2000
58600 Y $352.92 General Fee Schedule - 12/1/2009
58605 Y $319.81 General Fee Schedule - 12/1/2009
58615 Y $259.16 General Fee Schedule - 12/1/2009
58660 Y $663.80 General Fee Schedule - 12/1/2009
58661 Y $621.77 General Fee Schedule - 8/1/2016
58662 Y $674.19 General Fee Schedule - 8/1/2016
58670 Y $337.16 General Fee Schedule - 8/1/2016
58671 Y $351.56 General Fee Schedule - 12/1/2009
58672 Y $691.84 General Fee Schedule - 1/1/2017
58673 Y $751.86 General Fee Schedule - 1/1/2017
58674 Y $774.69 General Fee Schedule - 1/1/2017
58679 Y $0.00 General by Report - 1/1/2000
58700 Y $693.04 General Fee Schedule - 8/1/2016
58720 Y $656.61 General Fee Schedule - 8/1/2016
58740 Y $809.74 General Fee Schedule - 8/1/2016
58760 Y $798.28 General Fee Schedule - 12/1/2009
58770 Y $835.14 General Fee Schedule - 12/1/2009
58800 Y $287.27 General Fee Schedule - 8/1/2016
58805 Y $355.76 General Fee Schedule - 8/1/2016
58820 Y $281.71 General Fee Schedule - 8/1/2016
58822 Y $609.37 General Fee Schedule - 12/1/2009
58825 Y $640.85 General Fee Schedule - 8/1/2016
58900 Y $377.22 General Fee Schedule - 12/1/2009
58920 Y $678.50 General Fee Schedule - 12/1/2009
58925 Y $654.31 General Fee Schedule - 8/1/2016
58940 Y $453.15 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 144 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
58943 Y $1,040.39 General Fee Schedule - 8/1/2016
58950 Y $1,011.07 General Fee Schedule - 12/1/2009
58951 Y $1,311.99 General Fee Schedule - 12/1/2009
58952 Y $1,471.45 General Fee Schedule - 12/1/2009
58953 Y $1,864.71 General Fee Schedule - 12/1/2009
58954 Y $2,032.31 General Fee Schedule - 12/1/2009
58956 Y $1,242.50 General Fee Schedule - 8/1/2016
58957 Y $1,207.88 General Fee Schedule - 12/1/2009
58958 Y $1,337.75 General Fee Schedule - 12/1/2009
58960 Y $878.87 General Fee Schedule - 12/1/2009
58999 Y $0.00 General by Report - 7/1/1975
59000 Y $132.10 General Fee Schedule - 12/1/2009
59001 Y $188.60 General Fee Schedule - 12/1/2009
59012 Y $213.84 General Fee Schedule - 12/1/2009
59015 Y $155.96 General Fee Schedule - 12/1/2009
59020 Y $39.91 26 Fee Schedule (FS) - 12/1/2009
59020 Y $61.16 General Fee Schedule - 12/1/2009
59020 Y $21.25 TC Fee Schedule - 12/1/2009
59025 Y $32.14 26 Fee Schedule (FS) - 12/1/2009
59025 Y $40.70 General Fee Schedule - 12/1/2009
59025 Y $8.57 TC Fee Schedule - 12/1/2009
59030 Y $119.41 General Fee Schedule - 12/1/2009
59050 Y $53.59 General Fee Schedule - 12/1/2009
59051 Y $44.37 General Fee Schedule - 12/1/2009
59070 Y $388.59 General Fee Schedule - 12/1/2009
59072 Y $459.69 General Fee Schedule - 12/1/2009
59074 Y $368.74 General Fee Schedule - 12/1/2009
59076 Y $459.69 General Fee Schedule - 12/1/2009
59100 Y $799.00 General Fee Schedule - 12/1/2009
59120 Y $751.01 General Fee Schedule - 12/1/2009
59121 Y $762.78 General Fee Schedule - 12/1/2009
59130 Y $829.20 General Fee Schedule - 12/1/2009
59135 Y $896.85 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 145 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
59136 Y $842.74 General Fee Schedule - 12/1/2009
59140 Y $330.93 General Fee Schedule - 12/1/2009
59150 Y $751.48 General Fee Schedule - 12/1/2009
59151 Y $744.85 General Fee Schedule - 12/1/2009
59160 Y $239.70 General Fee Schedule - 12/1/2009
59200 Y $77.80 General Fee Schedule - 12/1/2009
59300 Y $187.36 General Fee Schedule - 12/1/2009
59320 Y $158.56 General Fee Schedule - 12/1/2009
59325 Y $252.16 General Fee Schedule - 12/1/2009
59350 Y $295.45 General Fee Schedule - 12/1/2009
59400 Y $1,909.67 General Fee Schedule - 12/1/2009
59409 Y $968.26 General Fee Schedule - 12/1/2009
59410 Y $1,080.18 General Fee Schedule - 12/1/2009
59412 Y $128.04 General Fee Schedule - 12/1/2009
59414 Y $115.70 General Fee Schedule - 12/1/2009
59425 Y $368.78 General Fee Schedule - 12/1/2009
59426 Y $646.10 General Fee Schedule - 12/1/2009
59430 Y $141.60 General Fee Schedule - 12/1/2009
59510 Y $0.00 General Fee Schedule U1 $2,164.73 11/1/2013
59514 Y $0.00 General Fee Schedule U1 $1,142.71 11/1/2013
59515 Y $0.00 General Fee Schedule U1 $1,286.17 11/1/2013
59525 Y $509.59 General Fee Schedule - 12/1/2009
59610 Y $2,018.52 General Fee Schedule - 12/1/2009
59612 Y $1,085.73 General Fee Schedule - 12/1/2009
59614 Y $1,192.75 General Fee Schedule - 12/1/2009
59618 Y $2,290.75 General Fee Schedule - 12/1/2009
59620 Y $1,251.57 General Fee Schedule - 12/1/2009
59622 Y $1,406.09 General Fee Schedule - 12/1/2009
59812 Y $274.52 General Fee Schedule - 12/1/2009
59820 Y $338.89 General Fee Schedule - 12/1/2009
59821 Y $355.30 General Fee Schedule - 12/1/2009
59830 Y $421.80 General Fee Schedule - 12/1/2009
59840 Y $204.95 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 146 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
59841 Y $349.72 General Fee Schedule - 8/1/2016
59850 Y $329.41 General Fee Schedule - 1/1/2017
59851 Y $348.35 General Fee Schedule - 1/1/2017
59852 Y $475.50 General Fee Schedule - 1/1/2017
59855 Y $390.90 General Fee Schedule - 8/1/2016
59856 Y $469.59 General Fee Schedule - 8/1/2016
59857 Y $491.92 General Fee Schedule - 1/1/2017
59870 Y $434.37 General Fee Schedule - 12/1/2009
59871 Y $159.41 General Fee Schedule - 12/1/2009
59897 Y $0.00 Manual Review Fee Schedule - 7/1/2004
59898 Y $0.00 General by Report - 1/1/2000
59899 Y $0.00 General by Report - 1/1/1991
60000 Y $139.19 General Fee Schedule - 12/1/2009
60100 Y $107.14 General Fee Schedule - 8/1/2016
60200 Y $584.20 General Fee Schedule - 8/1/2016
60210 Y $628.91 General Fee Schedule - 8/1/2016
60212 Y $910.33 General Fee Schedule - 8/1/2016
60220 Y $686.45 General Fee Schedule - 8/1/2016
60225 Y $857.64 General Fee Schedule - 12/1/2009
60240 Y $905.51 General Fee Schedule - 8/1/2016
60252 Y $1,218.40 General Fee Schedule - 12/1/2009
60254 Y $1,550.92 General Fee Schedule - 8/1/2016
60260 Y $995.20 General Fee Schedule - 8/1/2016
60270 Y $1,220.18 General Fee Schedule - 12/1/2009
60271 Y $962.89 General Fee Schedule - 8/1/2016
60280 Y $388.54 General Fee Schedule - 8/1/2016
60281 Y $532.20 General Fee Schedule - 8/1/2016
60300 Y $78.61 General Fee Schedule - 12/1/2009
60500 Y $910.87 General Fee Schedule - 8/1/2016
60502 Y $1,192.87 General Fee Schedule - 12/1/2009
60505 Y $1,242.65 General Fee Schedule - 8/1/2016
60512 Y $235.35 General Fee Schedule - 8/1/2016
60520 Y $967.54 General Fee Schedule - 8/1/2016
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NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
60521 Y $1,105.84 General Fee Schedule - 8/1/2016
60522 Y $1,333.66 General Fee Schedule - 8/1/2016
60540 Y $976.49 General Fee Schedule - 12/1/2009
60545 Y $1,085.20 General Fee Schedule - 8/1/2016
60600 Y $1,142.83 General Fee Schedule - 12/1/2009
60605 Y $1,286.86 General Fee Schedule - 12/1/2009
60650 Y $1,078.53 General Fee Schedule - 8/1/2016
60659 Y $0.00 General by Report - 1/1/2000
60699 Y $0.00 General by Report - 7/1/1975
61000 Y $98.00 General Fee Schedule - 12/1/2009
61001 Y $81.53 General Fee Schedule - 1/1/2017
61020 Y $98.62 General Fee Schedule - 1/1/2017
61026 Y $98.96 General Fee Schedule - 1/1/2017
61050 Y $81.87 General Fee Schedule - 1/1/2017
61055 Y $116.60 General Fee Schedule - 1/1/2017
61070 Y $55.42 General Fee Schedule - 1/1/2017
61105 Y $378.50 General Fee Schedule - 12/1/2009
61107 Y $311.17 General Fee Schedule - 8/1/2016
61108 Y $728.55 General Fee Schedule - 12/1/2009
61120 Y $615.71 General Fee Schedule - 12/1/2009
61140 Y $1,094.22 General Fee Schedule - 12/1/2009
61150 Y $1,181.98 General Fee Schedule - 12/1/2009
61151 Y $850.33 General Fee Schedule - 12/1/2009
61154 Y $1,048.50 General Fee Schedule - 12/1/2009
61156 Y $1,112.52 General Fee Schedule - 12/1/2009
61210 Y $361.76 General Fee Schedule - 8/1/2016
61215 Y $369.17 General Fee Schedule - 12/1/2009
61250 Y $731.97 General Fee Schedule - 12/1/2009
61253 Y $798.20 General Fee Schedule - 8/1/2016
61304 Y $1,480.90 General Fee Schedule - 12/1/2009
61305 Y $1,760.79 General Fee Schedule - 12/1/2009
61312 Y $1,682.14 General Fee Schedule - 12/1/2009
61313 Y $1,690.92 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 148 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
61314 Y $1,597.43 General Fee Schedule - 12/1/2009
61315 Y $1,863.37 General Fee Schedule - 12/1/2009
61316 Y $82.84 General Fee Schedule - 8/1/2016
61320 Y $1,721.72 General Fee Schedule - 12/1/2009
61321 Y $1,898.10 General Fee Schedule - 12/1/2009
61322 Y $1,937.87 General Fee Schedule - 12/1/2009
61323 Y $2,023.58 General Fee Schedule - 12/1/2009
61330 Y $1,449.87 General Fee Schedule - 12/1/2009
61332 Y $1,683.26 General Fee Schedule - 8/1/2016
61333 Y $1,677.25 General Fee Schedule - 8/1/2016
61340 Y $1,267.68 General Fee Schedule - 12/1/2009
61343 Y $1,987.67 General Fee Schedule - 12/1/2009
61345 Y $1,819.12 General Fee Schedule - 12/1/2009
61450 Y $1,689.69 General Fee Schedule - 12/1/2009
61458 Y $1,826.36 General Fee Schedule - 12/1/2009
61460 Y $1,865.78 General Fee Schedule - 12/1/2009
61480 Y $1,554.84 General Fee Schedule - 1/1/2017
61500 Y $1,202.96 General Fee Schedule - 12/1/2009
61501 Y $998.94 General Fee Schedule - 12/1/2009
61510 Y $1,922.94 General Fee Schedule - 12/1/2009
61512 Y $2,340.63 General Fee Schedule - 12/1/2009
61514 Y $1,694.11 General Fee Schedule - 12/1/2009
61516 Y $1,656.63 General Fee Schedule - 12/1/2009
61517 Y $83.77 General Fee Schedule - 8/1/2016
61518 Y $2,494.63 General Fee Schedule - 12/1/2009
61519 Y $2,738.99 General Fee Schedule - 12/1/2009
61520 Y $3,541.03 General Fee Schedule - 12/1/2009
61521 Y $2,937.88 General Fee Schedule - 12/1/2009
61522 Y $1,961.27 General Fee Schedule - 12/1/2009
61524 Y $1,858.34 General Fee Schedule - 12/1/2009
61526 Y $3,266.53 General Fee Schedule - 12/1/2009
61530 Y $2,762.03 General Fee Schedule - 12/1/2009
61531 Y $1,007.77 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 149 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
61533 Y $1,331.59 General Fee Schedule - 12/1/2009
61534 Y $1,410.45 General Fee Schedule - 12/1/2009
61535 Y $806.84 General Fee Schedule - 12/1/2009
61536 Y $2,365.49 General Fee Schedule - 12/1/2009
61537 Y $1,708.50 General Fee Schedule - 12/1/2009
61538 Y $1,797.88 General Fee Schedule - 12/1/2009
61539 Y $2,132.80 General Fee Schedule - 12/1/2009
61540 Y $2,035.11 General Fee Schedule - 12/1/2009
61541 Y $1,895.68 General Fee Schedule - 12/1/2009
61543 Y $1,949.29 General Fee Schedule - 12/1/2009
61544 Y $1,662.79 General Fee Schedule - 12/1/2009
61545 Y $2,885.38 General Fee Schedule - 12/1/2009
61546 Y $2,071.00 General Fee Schedule - 12/1/2009
61548 Y $1,386.94 General Fee Schedule - 12/1/2009
61550 Y $836.51 General Fee Schedule - 12/1/2009
61552 Y $1,059.24 General Fee Schedule - 8/1/2016
61556 Y $1,408.30 General Fee Schedule - 12/1/2009
61557 Y $1,468.83 General Fee Schedule - 8/1/2016
61558 Y $1,519.98 General Fee Schedule - 12/1/2009
61559 Y $2,032.19 General Fee Schedule - 1/1/2017
61563 Y $1,735.11 General Fee Schedule - 12/1/2009
61564 Y $2,144.36 General Fee Schedule - 8/1/2016
61566 Y $2,043.78 General Fee Schedule - 12/1/2009
61567 Y $2,303.28 General Fee Schedule - 12/1/2009
61570 Y $1,628.02 General Fee Schedule - 12/1/2009
61571 Y $1,770.67 General Fee Schedule - 12/1/2009
61575 Y $2,094.94 General Fee Schedule - 8/1/2016
61576 Y $3,268.98 General Fee Schedule - 8/1/2016
61580 Y $2,163.79 General Fee Schedule - 12/1/2009
61581 Y $2,273.56 General Fee Schedule - 12/1/2009
61582 Y $2,405.89 General Fee Schedule - 12/1/2009
61583 Y $2,574.94 General Fee Schedule - 12/1/2009
61584 Y $2,459.29 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 150 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
61585 Y $2,639.82 General Fee Schedule - 12/1/2009
61586 Y $1,893.37 General Fee Schedule - 12/1/2009
61590 Y $2,775.67 General Fee Schedule - 12/1/2009
61591 Y $2,776.20 General Fee Schedule - 8/1/2016
61592 Y $2,784.59 General Fee Schedule - 12/1/2009
61595 Y $2,044.21 General Fee Schedule - 12/1/2009
61596 Y $2,236.41 General Fee Schedule - 8/1/2016
61597 Y $2,556.75 General Fee Schedule - 12/1/2009
61598 Y $2,281.60 General Fee Schedule - 12/1/2009
61600 Y $1,805.73 General Fee Schedule - 12/1/2009
61601 Y $2,006.89 General Fee Schedule - 12/1/2009
61605 Y $1,982.90 General Fee Schedule - 12/1/2009
61606 Y $2,668.76 General Fee Schedule - 12/1/2009
61607 Y $2,452.27 General Fee Schedule - 12/1/2009
61608 Y $2,905.77 General Fee Schedule - 12/1/2009
61610 Y $1,508.86 General Fee Schedule - 1/1/2017
61611 Y $377.42 General Fee Schedule - 1/1/2017
61612 Y $1,418.15 General Fee Schedule - 1/1/2017
61613 Y $2,767.50 General Fee Schedule - 12/1/2009
61615 Y $2,092.07 General Fee Schedule - 8/1/2016
61616 Y $2,938.44 General Fee Schedule - 12/1/2009
61618 Y $1,141.26 General Fee Schedule - 12/1/2009
61619 Y $1,300.57 General Fee Schedule - 8/1/2016
61623 Y $537.95 General Fee Schedule - 8/1/2016
61624 Y $1,080.55 General Fee Schedule - 12/1/2009
61626 Y $837.98 General Fee Schedule - 8/1/2016
61630 Y $1,221.57 General Fee Schedule - 8/1/2016
61635 Y $1,332.95 General Fee Schedule - 1/1/2011
61640 Y $0.00 General by Report - 1/1/2006
61641 Y $0.00 General by Report - 1/1/2006
61642 Y $0.00 General by Report - 1/1/2006
61645 Y $765.19 General Fee Schedule - 8/1/2016
61650 Y $524.26 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 151 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
61651 Y $223.38 General Fee Schedule - 8/1/2016
61680 Y $2,055.85 General Fee Schedule - 12/1/2009
61682 Y $3,865.39 General Fee Schedule - 8/1/2016
61684 Y $2,644.69 General Fee Schedule - 12/1/2009
61686 Y $4,253.03 General Fee Schedule - 12/1/2009
61690 Y $1,943.00 General Fee Schedule - 12/1/2009
61692 Y $3,404.82 General Fee Schedule - 12/1/2009
61697 Y $3,351.16 General Fee Schedule - 12/1/2009
61698 Y $3,214.20 General Fee Schedule - 12/1/2009
61700 Y $3,215.86 General Fee Schedule - 8/1/2016
61702 Y $3,131.50 General Fee Schedule - 12/1/2009
61703 Y $1,172.22 General Fee Schedule - 12/1/2009
61705 Y $2,361.84 General Fee Schedule - 12/1/2009
61708 Y $1,888.35 General Fee Schedule - 8/1/2016
61710 Y $1,767.84 General Fee Schedule - 12/1/2009
61711 Y $2,404.69 General Fee Schedule - 12/1/2009
61720 Y $1,084.55 General Fee Schedule - 12/1/2009
61735 Y $1,299.06 General Fee Schedule - 12/1/2009
61750 Y $1,228.33 General Fee Schedule - 12/1/2009
61751 Y $1,207.60 General Fee Schedule - 12/1/2009
61760 Y $1,344.21 General Fee Schedule - 12/1/2009
61770 Y $1,369.47 General Fee Schedule - 12/1/2009
61781 Y $231.08 General Fee Schedule - 8/1/2016
61782 Y $170.83 General Fee Schedule - 1/1/2017
61783 Y $231.08 General Fee Schedule - 8/1/2016
61790 Y $718.51 General Fee Schedule - 12/1/2009
61791 Y $986.34 General Fee Schedule - 12/1/2009
61796 Y $692.00 General Fee Schedule - 12/1/2009
61797 Y $191.08 General Fee Schedule - 12/1/2009
61798 Y $692.00 General Fee Schedule - 12/1/2009
61799 Y $264.22 General Fee Schedule - 12/1/2009
61800 Y $135.13 General Fee Schedule - 12/1/2009
61850 Y $851.64 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 152 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
61860 Y $1,388.98 General Fee Schedule - 12/1/2009
61863 Y $1,323.10 General Fee Schedule - 12/1/2009
61864 Y $287.21 General Fee Schedule - 1/1/2017
61867 Y $2,013.31 General Fee Schedule - 12/1/2009
61868 Y $499.30 General Fee Schedule - 1/1/2017
61870 Y $1,042.36 General Fee Schedule - 12/1/2009
61880 Y $456.55 General Fee Schedule - 12/1/2009
61885 Y $462.48 General Fee Schedule - 12/1/2009
61886 Y $594.20 General Fee Schedule - 12/1/2009
61888 Y $367.25 General Fee Schedule - 12/1/2009
62000 Y $708.82 General Fee Schedule - 12/1/2009
62005 Y $1,058.68 General Fee Schedule - 12/1/2009
62010 Y $1,342.31 General Fee Schedule - 12/1/2009
62100 Y $1,454.95 General Fee Schedule - 12/1/2009
62115 Y $1,261.04 General Fee Schedule - 1/1/2017
62117 Y $1,572.07 General Fee Schedule - 1/1/2017
62120 Y $1,571.93 General Fee Schedule - 8/1/2016
62121 Y $1,445.61 General Fee Schedule - 8/1/2016
62140 Y $925.76 General Fee Schedule - 12/1/2009
62141 Y $1,014.81 General Fee Schedule - 12/1/2009
62142 Y $749.67 General Fee Schedule - 12/1/2009
62143 Y $894.97 General Fee Schedule - 12/1/2009
62145 Y $1,254.24 General Fee Schedule - 12/1/2009
62146 Y $1,076.88 General Fee Schedule - 12/1/2009
62147 Y $1,282.14 General Fee Schedule - 12/1/2009
62148 Y $123.22 General Fee Schedule - 12/1/2009
62160 Y $186.99 General Fee Schedule - 8/1/2016
62161 Y $1,364.71 General Fee Schedule - 12/1/2009
62162 Y $1,686.34 General Fee Schedule - 12/1/2009
62163 Y $1,033.30 General Fee Schedule - 8/1/2016
62164 Y $1,758.30 General Fee Schedule - 12/1/2009
62165 Y $1,411.11 General Fee Schedule - 12/1/2009
62180 Y $1,405.23 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 153 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
62190 Y $765.98 General Fee Schedule - 12/1/2009
62192 Y $837.61 General Fee Schedule - 12/1/2009
62194 Y $309.08 General Fee Schedule - 12/1/2009
62200 Y $1,238.42 General Fee Schedule - 12/1/2009
62201 Y $1,023.81 General Fee Schedule - 12/1/2009
62220 Y $890.30 General Fee Schedule - 12/1/2009
62223 Y $886.92 General Fee Schedule - 12/1/2009
62225 Y $396.82 General Fee Schedule - 12/1/2009
62230 Y $721.87 General Fee Schedule - 12/1/2009
62252 Y $45.89 26 Fee Schedule (FS) - 8/1/2016
62252 Y $80.83 General Fee Schedule - 1/1/2017
62252 Y $34.13 TC Fee Schedule - 1/1/2017
62256 Y $474.36 General Fee Schedule - 12/1/2009
62258 Y $988.54 General Fee Schedule - 12/1/2009
62263 Y $595.67 General Fee Schedule - 1/1/2017
62264 Y $392.75 General Fee Schedule - 1/1/2017
62267 Y $219.02 General Fee Schedule - 12/1/2009
62268 Y $249.09 General Fee Schedule - 1/1/2017
62269 Y $260.43 General Fee Schedule - 1/1/2017
62270 Y $143.13 General Fee Schedule - 8/1/2016
62272 Y $174.97 General Fee Schedule - 8/1/2016
62273 Y $162.17 General Fee Schedule - 1/1/2017
62280 Y $282.31 General Fee Schedule - 1/1/2017
62281 Y $224.82 General Fee Schedule - 1/1/2017
62282 Y $268.39 General Fee Schedule - 1/1/2017
62284 Y $166.14 General Fee Schedule - 1/1/2017
62287 Y $501.34 General Fee Schedule - 8/1/2016
62290 Y $307.05 General Fee Schedule - 1/1/2017
62291 Y $303.39 General Fee Schedule - 1/1/2017
62292 Y $484.71 General Fee Schedule - 12/1/2009
62294 Y $690.41 General Fee Schedule - 12/1/2009
62302 Y $220.59 General Fee Schedule - 1/1/2017
62303 Y $228.95 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 154 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
62304 Y $218.32 General Fee Schedule - 1/1/2017
62305 Y $237.15 General Fee Schedule - 1/1/2017
62320 Y $266.04 General Fee Schedule - 1/1/2017
62321 Y $266.04 General Fee Schedule - 1/1/2017
62322 Y $266.04 General Fee Schedule - 1/1/2017
62323 Y $266.04 General Fee Schedule - 1/1/2017
62324 Y $335.14 General Fee Schedule - 1/1/2017
62325 Y $335.14 General Fee Schedule - 1/1/2017
62326 Y $335.14 General Fee Schedule - 1/1/2017
62327 Y $335.14 General Fee Schedule - 1/1/2017
62350 Y $388.08 General Fee Schedule - 1/1/2017
62351 Y $707.43 General Fee Schedule - 12/1/2009
62355 Y $253.31 General Fee Schedule - 1/1/2017
62360 Y $204.97 General Fee Schedule - 12/1/2009
62361 Y $356.17 General Fee Schedule - 8/1/2016
62362 Y $375.60 General Fee Schedule - 1/1/2017
62365 Y $286.49 General Fee Schedule - 1/1/2017
62367 Y $38.83 General Fee Schedule - 8/1/2016
62368 Y $52.45 General Fee Schedule - 8/1/2016
62369 Y $111.49 General Fee Schedule - 8/1/2016
62370 Y $117.26 General Fee Schedule - 8/1/2016
62380 Y $0.00 General by Report - 1/1/2017
63001 Y $1,066.37 General Fee Schedule - 12/1/2009
63003 Y $1,082.00 General Fee Schedule - 12/1/2009
63005 Y $1,032.88 General Fee Schedule - 12/1/2009
63011 Y $959.92 General Fee Schedule - 12/1/2009
63012 Y $1,061.36 General Fee Schedule - 12/1/2009
63015 Y $1,317.24 General Fee Schedule - 12/1/2009
63016 Y $1,302.49 General Fee Schedule - 12/1/2009
63017 Y $1,096.64 General Fee Schedule - 12/1/2009
63020 Y $1,031.14 General Fee Schedule - 12/1/2009
63030 Y $855.01 General Fee Schedule - 12/1/2009
63035 Y $184.72 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 155 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
63040 Y $1,280.97 General Fee Schedule - 12/1/2009
63042 Y $1,160.88 General Fee Schedule - 8/1/2016
63043 Y $202.53 General Fee Schedule - 12/1/2009
63044 Y $202.53 General Fee Schedule - 12/1/2009
63045 Y $1,128.97 General Fee Schedule - 12/1/2009
63046 Y $1,081.28 General Fee Schedule - 12/1/2009
63047 Y $1,014.37 General Fee Schedule - 12/1/2009
63048 Y $199.24 General Fee Schedule - 8/1/2016
63050 Y $1,368.29 General Fee Schedule - 12/1/2009
63051 Y $1,559.54 General Fee Schedule - 12/1/2009
63055 Y $1,480.58 General Fee Schedule - 12/1/2009
63056 Y $1,380.19 General Fee Schedule - 12/1/2009
63057 Y $305.87 General Fee Schedule - 1/1/2017
63064 Y $1,640.00 General Fee Schedule - 12/1/2009
63066 Y $198.24 General Fee Schedule - 8/1/2016
63075 Y $1,269.70 General Fee Schedule - 8/1/2016
63076 Y $239.19 General Fee Schedule - 1/1/2017
63077 Y $1,347.01 General Fee Schedule - 8/1/2016
63078 Y $184.88 General Fee Schedule - 1/1/2017
63081 Y $1,597.43 General Fee Schedule - 12/1/2009
63082 Y $255.54 General Fee Schedule - 1/1/2017
63085 Y $1,723.31 General Fee Schedule - 12/1/2009
63086 Y $190.03 General Fee Schedule - 8/1/2016
63087 Y $2,253.16 General Fee Schedule - 12/1/2009
63088 Y $253.04 General Fee Schedule - 1/1/2017
63090 Y $1,781.36 General Fee Schedule - 12/1/2009
63091 Y $168.61 General Fee Schedule - 1/1/2017
63101 Y $2,091.59 General Fee Schedule - 12/1/2009
63102 Y $2,091.59 General Fee Schedule - 12/1/2009
63103 Y $283.98 General Fee Schedule - 8/1/2016
63170 Y $1,339.23 General Fee Schedule - 12/1/2009
63172 Y $1,200.57 General Fee Schedule - 12/1/2009
63173 Y $1,483.45 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 156 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
63180 Y $1,217.45 General Fee Schedule - 12/1/2009
63182 Y $1,295.16 General Fee Schedule - 8/1/2016
63185 Y $953.79 General Fee Schedule - 12/1/2009
63190 Y $1,132.16 General Fee Schedule - 12/1/2009
63191 Y $1,254.37 General Fee Schedule - 12/1/2009
63194 Y $1,254.11 General Fee Schedule - 12/1/2009
63195 Y $1,273.28 General Fee Schedule - 12/1/2009
63196 Y $1,364.02 General Fee Schedule - 1/1/2017
63197 Y $1,417.89 General Fee Schedule - 12/1/2009
63198 Y $1,489.51 General Fee Schedule - 12/1/2009
63199 Y $1,600.68 General Fee Schedule - 12/1/2009
63200 Y $1,298.06 General Fee Schedule - 12/1/2009
63250 Y $2,566.27 General Fee Schedule - 12/1/2009
63251 Y $2,723.03 General Fee Schedule - 12/1/2009
63252 Y $2,718.26 General Fee Schedule - 12/1/2009
63265 Y $1,456.84 General Fee Schedule - 12/1/2009
63266 Y $1,503.25 General Fee Schedule - 12/1/2009
63267 Y $1,222.68 General Fee Schedule - 12/1/2009
63268 Y $1,196.88 General Fee Schedule - 12/1/2009
63270 Y $1,799.17 General Fee Schedule - 12/1/2009
63271 Y $1,810.33 General Fee Schedule - 12/1/2009
63272 Y $1,693.23 General Fee Schedule - 12/1/2009
63273 Y $1,626.29 General Fee Schedule - 12/1/2009
63275 Y $1,585.31 General Fee Schedule - 12/1/2009
63276 Y $1,574.39 General Fee Schedule - 12/1/2009
63277 Y $1,405.60 General Fee Schedule - 12/1/2009
63278 Y $1,374.83 General Fee Schedule - 12/1/2009
63280 Y $1,903.64 General Fee Schedule - 12/1/2009
63281 Y $1,883.82 General Fee Schedule - 12/1/2009
63282 Y $1,776.48 General Fee Schedule - 12/1/2009
63283 Y $1,682.62 General Fee Schedule - 12/1/2009
63285 Y $2,389.15 General Fee Schedule - 12/1/2009
63286 Y $2,374.53 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 157 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
63287 Y $2,439.47 General Fee Schedule - 12/1/2009
63290 Y $2,458.75 General Fee Schedule - 12/1/2009
63295 Y $311.84 General Fee Schedule - 12/1/2009
63300 Y $1,638.28 General Fee Schedule - 12/1/2009
63301 Y $1,783.73 General Fee Schedule - 12/1/2009
63302 Y $1,806.95 General Fee Schedule - 12/1/2009
63303 Y $1,917.31 General Fee Schedule - 12/1/2009
63304 Y $1,982.84 General Fee Schedule - 12/1/2009
63305 Y $2,050.99 General Fee Schedule - 12/1/2009
63306 Y $2,140.27 General Fee Schedule - 12/1/2009
63307 Y $1,949.90 General Fee Schedule - 12/1/2009
63308 Y $322.72 General Fee Schedule - 8/1/2016
63600 Y $778.11 General Fee Schedule - 12/1/2009
63610 Y $418.15 General Fee Schedule - 1/1/2017
63615 Y $941.47 General Fee Schedule - 1/1/2017
63620 Y $692.00 General Fee Schedule - 12/1/2009
63621 Y $219.71 General Fee Schedule - 12/1/2009
63650 Y $386.95 General Fee Schedule - 12/1/2009
63655 Y $716.94 General Fee Schedule - 12/1/2009
63661 Y $491.24 General Fee Schedule - 1/1/2010
63662 Y $652.20 General Fee Schedule - 1/1/2010
63663 Y $704.52 General Fee Schedule - 8/1/2016
63664 Y $679.58 General Fee Schedule - 1/1/2010
63685 Y $352.52 General Fee Schedule - 1/1/2017
63688 Y $345.89 General Fee Schedule - 8/1/2016
63700 Y $1,068.03 General Fee Schedule - 8/1/2016
63702 Y $1,183.80 General Fee Schedule - 8/1/2016
63704 Y $1,417.60 General Fee Schedule - 12/1/2009
63706 Y $1,545.84 General Fee Schedule - 8/1/2016
63707 Y $784.87 General Fee Schedule - 12/1/2009
63709 Y $981.22 General Fee Schedule - 12/1/2009
63710 Y $969.95 General Fee Schedule - 12/1/2009
63740 Y $790.92 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 158 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
63741 Y $538.37 General Fee Schedule - 12/1/2009
63744 Y $557.98 General Fee Schedule - 12/1/2009
63746 Y $430.07 General Fee Schedule - 12/1/2009
64400 Y $110.32 General Fee Schedule - 12/1/2009
64402 Y $106.48 General Fee Schedule - 12/1/2009
64405 Y $93.56 General Fee Schedule - 1/1/2017
64408 Y $97.68 General Fee Schedule - 1/1/2017
64410 Y $116.22 General Fee Schedule - 1/1/2017
64413 Y $115.33 General Fee Schedule - 8/1/2016
64415 Y $112.72 General Fee Schedule - 1/1/2017
64416 Y $77.58 General Fee Schedule - 1/1/2017
64417 Y $122.91 General Fee Schedule - 1/1/2017
64418 Y $133.50 General Fee Schedule - 1/1/2017
64420 Y $104.09 General Fee Schedule - 1/1/2017
64421 Y $139.74 General Fee Schedule - 1/1/2017
64425 Y $123.39 General Fee Schedule - 8/1/2016
64430 Y $127.76 General Fee Schedule - 1/1/2017
64435 Y $125.42 General Fee Schedule - 1/1/2017
64445 Y $126.98 General Fee Schedule - 1/1/2017
64446 Y $77.58 General Fee Schedule - 1/1/2017
64447 Y $75.73 General Fee Schedule - 12/1/2009
64448 Y $69.88 General Fee Schedule - 1/1/2017
64449 Y $82.15 General Fee Schedule - 1/1/2017
64450 Y $73.18 General Fee Schedule - 1/1/2017
64455 Y $44.04 General Fee Schedule - 8/1/2016
64461 Y $137.62 General Fee Schedule - 8/1/2016
64462 Y $78.10 General Fee Schedule - 8/1/2016
64463 Y $151.24 General Fee Schedule - 8/1/2016
64479 Y $217.10 General Fee Schedule - 1/1/2017
64480 Y $104.45 General Fee Schedule - 1/1/2017
64483 Y $201.16 General Fee Schedule - 1/1/2017
64484 Y $81.38 General Fee Schedule - 1/1/2017
64486 Y $115.71 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 159 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
64487 Y $140.99 General Fee Schedule - 8/1/2016
64488 Y $142.35 General Fee Schedule - 8/1/2016
64489 Y $196.46 General Fee Schedule - 8/1/2016
64490 Y $161.62 General Fee Schedule - 8/1/2016
64491 Y $82.29 General Fee Schedule - 8/1/2016
64492 Y $83.21 General Fee Schedule - 8/1/2016
64493 Y $150.21 General Fee Schedule - 1/1/2010
64494 Y $74.59 General Fee Schedule - 8/1/2016
64495 Y $75.52 General Fee Schedule - 8/1/2016
64505 Y $94.47 General Fee Schedule - 8/1/2016
64508 Y $59.29 General Fee Schedule - 1/1/2017
64510 Y $117.74 General Fee Schedule - 1/1/2017
64517 Y $169.88 General Fee Schedule - 1/1/2017
64520 Y $170.55 General Fee Schedule - 1/1/2017
64530 Y $175.29 General Fee Schedule - 1/1/2017
64550 Y $13.63 General Fee Schedule - 7/1/2009
64553 Y $176.53 General Fee Schedule - 7/1/2009
64555 Y $179.25 General Fee Schedule - 8/1/2016
64561 Y $738.25 General Fee Schedule - 1/1/2017
64566 Y $113.32 General Fee Schedule - 1/1/2017
64568 Y $603.41 General Fee Schedule - 8/1/2016
64569 Y $631.37 General Fee Schedule - 1/1/2011
64570 Y $556.60 General Fee Schedule - 1/1/2011
64575 Y $253.70 General Fee Schedule - 10/1/2009
64580 Y $260.81 General Fee Schedule - 7/1/2009
64581 Y $635.01 General Fee Schedule - 1/1/2017
64585 Y $223.29 General Fee Schedule - 1/1/2017
64590 Y $242.27 General Fee Schedule - 1/1/2017
64595 Y $222.76 General Fee Schedule - 1/1/2017
64600 Y $363.46 General Fee Schedule - 1/1/2017
64605 Y $571.43 General Fee Schedule - 12/1/2009
64610 Y $634.93 General Fee Schedule - 12/1/2009
64611 Y $97.83 General Fee Schedule - 1/1/2011
CPT FEES01/03/2018 at 6:55:00 AM - 160 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
64612 Y $123.06 General Fee Schedule - 1/1/2017
64615 Y $133.22 General Fee Schedule - 8/1/2016
64616 Y $116.56 General Fee Schedule - 8/1/2016
64617 Y $177.11 General Fee Schedule - 8/1/2016
64620 Y $192.14 General Fee Schedule - 1/1/2017
64630 Y $208.51 General Fee Schedule - 8/1/2016
64632 Y $73.48 General Fee Schedule - 12/1/2009
64633 Y $388.74 General Fee Schedule - 1/1/2017
64634 Y $173.49 General Fee Schedule - 1/1/2017
64635 Y $384.16 General Fee Schedule - 1/1/2017
64636 Y $157.41 General Fee Schedule - 1/1/2017
64640 Y $121.78 General Fee Schedule - 1/1/2017
64642 Y $131.07 General Fee Schedule - 8/1/2016
64643 Y $86.74 General Fee Schedule - 8/1/2016
64644 Y $149.34 General Fee Schedule - 8/1/2016
64645 Y $105.75 General Fee Schedule - 8/1/2016
64646 Y $141.07 General Fee Schedule - 8/1/2016
64647 Y $163.38 General Fee Schedule - 8/1/2016
64650 Y $58.88 General Fee Schedule - 12/1/2009
64653 Y $68.23 General Fee Schedule - 12/1/2009
64680 Y $283.93 General Fee Schedule - 1/1/2017
64681 Y $326.90 General Fee Schedule - 1/1/2017
64702 Y $316.46 General Fee Schedule - 12/1/2009
64704 Y $298.32 General Fee Schedule - 8/1/2016
64708 Y $435.73 General Fee Schedule - 12/1/2009
64712 Y $501.73 General Fee Schedule - 12/1/2009
64713 Y $660.81 General Fee Schedule - 8/1/2016
64714 Y $583.20 General Fee Schedule - 12/1/2009
64716 Y $470.01 General Fee Schedule - 12/1/2009
64718 Y $472.86 General Fee Schedule - 12/1/2009
64719 Y $353.77 General Fee Schedule - 8/1/2016
64721 Y $374.61 General Fee Schedule - 12/1/2009
64722 Y $302.04 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 161 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
64726 Y $257.01 General Fee Schedule - 1/1/2017
64727 Y $180.10 General Fee Schedule - 8/1/2016
64732 Y $323.86 General Fee Schedule - 12/1/2009
64734 Y $359.27 General Fee Schedule - 12/1/2009
64736 Y $333.11 General Fee Schedule - 12/1/2009
64738 Y $399.63 General Fee Schedule - 8/1/2016
64740 Y $398.27 General Fee Schedule - 8/1/2016
64742 Y $426.17 General Fee Schedule - 12/1/2009
64744 Y $371.35 General Fee Schedule - 12/1/2009
64746 Y $411.24 General Fee Schedule - 12/1/2009
64755 Y $777.74 General Fee Schedule - 12/1/2009
64760 Y $414.70 General Fee Schedule - 12/1/2009
64763 Y $458.83 General Fee Schedule - 8/1/2016
64766 Y $550.97 General Fee Schedule - 12/1/2009
64771 Y $516.51 General Fee Schedule - 12/1/2009
64772 Y $495.06 General Fee Schedule - 12/1/2009
64774 Y $356.20 General Fee Schedule - 12/1/2009
64776 Y $349.82 General Fee Schedule - 12/1/2009
64778 Y $138.26 General Fee Schedule - 1/1/2017
64782 Y $399.21 General Fee Schedule - 12/1/2009
64783 Y $214.87 General Fee Schedule - 8/1/2016
64784 Y $652.64 General Fee Schedule - 12/1/2009
64786 Y $982.43 General Fee Schedule - 8/1/2016
64787 Y $236.29 General Fee Schedule - 1/1/2017
64788 Y $321.57 General Fee Schedule - 12/1/2009
64790 Y $755.51 General Fee Schedule - 12/1/2009
64792 Y $963.78 General Fee Schedule - 12/1/2009
64795 Y $180.06 General Fee Schedule - 8/1/2016
64802 Y $573.34 General Fee Schedule - 12/1/2009
64804 Y $884.06 General Fee Schedule - 12/1/2009
64809 Y $776.57 General Fee Schedule - 12/1/2009
64818 Y $599.23 General Fee Schedule - 8/1/2016
64820 Y $667.60 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 162 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
64821 Y $632.17 General Fee Schedule - 12/1/2009
64822 Y $630.48 General Fee Schedule - 12/1/2009
64823 Y $703.45 General Fee Schedule - 8/1/2016
64831 Y $629.22 General Fee Schedule - 8/1/2016
64832 Y $334.18 General Fee Schedule - 8/1/2016
64834 Y $661.60 General Fee Schedule - 8/1/2016
64835 Y $715.41 General Fee Schedule - 8/1/2016
64836 Y $742.13 General Fee Schedule - 12/1/2009
64837 Y $370.24 General Fee Schedule - 8/1/2016
64840 Y $832.25 General Fee Schedule - 12/1/2009
64856 Y $920.45 General Fee Schedule - 12/1/2009
64857 Y $965.60 General Fee Schedule - 12/1/2009
64858 Y $1,075.69 General Fee Schedule - 8/1/2016
64859 Y $252.01 General Fee Schedule - 8/1/2016
64861 Y $1,234.96 General Fee Schedule - 8/1/2016
64862 Y $1,307.56 General Fee Schedule - 12/1/2009
64864 Y $794.99 General Fee Schedule - 8/1/2016
64865 Y $1,059.41 General Fee Schedule - 8/1/2016
64866 Y $1,084.00 General Fee Schedule - 8/1/2016
64868 Y $943.58 General Fee Schedule - 8/1/2016
64872 Y $118.86 General Fee Schedule - 8/1/2016
64874 Y $166.66 General Fee Schedule - 1/1/2017
64876 Y $171.41 General Fee Schedule - 1/1/2017
64885 Y $1,084.76 General Fee Schedule - 8/1/2016
64886 Y $1,253.88 General Fee Schedule - 1/1/2017
64890 Y $1,006.16 General Fee Schedule - 12/1/2009
64891 Y $938.72 General Fee Schedule - 12/1/2009
64892 Y $954.39 General Fee Schedule - 12/1/2009
64893 Y $1,030.13 General Fee Schedule - 12/1/2009
64895 Y $1,162.06 General Fee Schedule - 12/1/2009
64896 Y $1,275.84 General Fee Schedule - 12/1/2009
64897 Y $1,111.34 General Fee Schedule - 8/1/2016
64898 Y $1,251.89 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 163 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
64901 Y $541.82 General Fee Schedule - 1/1/2017
64902 Y $638.34 General Fee Schedule - 1/1/2017
64905 Y $900.83 General Fee Schedule - 12/1/2009
64907 Y $1,264.83 General Fee Schedule - 12/1/2009
64910 Y $567.06 General Fee Schedule - 12/1/2009
64911 Y $690.15 General Fee Schedule - 12/1/2009
64912 Y $742.00 General Fee Schedule - 1/1/2018
64913 Y $152.76 General Fee Schedule - 1/1/2018
64999 Y $0.00 General by Report - 7/1/1975
65091 Y $546.58 General Fee Schedule - 12/1/2009
65093 Y $552.73 General Fee Schedule - 8/1/2016
65101 Y $610.02 General Fee Schedule - 12/1/2009
65103 Y $638.75 General Fee Schedule - 12/1/2009
65105 Y $700.97 General Fee Schedule - 12/1/2009
65110 Y $1,035.05 General Fee Schedule - 12/1/2009
65112 Y $1,230.34 General Fee Schedule - 12/1/2009
65114 Y $1,271.85 General Fee Schedule - 12/1/2009
65125 Y $412.14 General Fee Schedule - 8/1/2016
65130 Y $602.32 General Fee Schedule - 12/1/2009
65135 Y $614.76 General Fee Schedule - 12/1/2009
65140 Y $661.95 General Fee Schedule - 12/1/2009
65150 Y $504.49 General Fee Schedule - 8/1/2016
65155 Y $710.98 General Fee Schedule - 12/1/2009
65175 Y $543.73 General Fee Schedule - 12/1/2009
65205 Y $48.34 General Fee Schedule - 8/1/2016
65210 Y $59.08 General Fee Schedule - 8/1/2016
65220 Y $49.01 General Fee Schedule - 8/1/2016
65222 Y $60.88 General Fee Schedule - 1/1/2017
65235 Y $536.02 General Fee Schedule - 12/1/2009
65260 Y $773.38 General Fee Schedule - 12/1/2009
65265 Y $871.22 General Fee Schedule - 12/1/2009
65270 Y $239.91 General Fee Schedule - 1/1/2017
65272 Y $418.27 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 164 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
65273 Y $298.41 General Fee Schedule - 12/1/2009
65275 Y $431.44 General Fee Schedule - 12/1/2009
65280 Y $522.39 General Fee Schedule - 12/1/2009
65285 Y $835.61 General Fee Schedule - 12/1/2009
65286 Y $604.04 General Fee Schedule - 12/1/2009
65290 Y $381.76 General Fee Schedule - 12/1/2009
65400 Y $529.77 General Fee Schedule - 12/1/2009
65410 Y $126.48 General Fee Schedule - 8/1/2016
65420 Y $452.98 General Fee Schedule - 8/1/2016
65426 Y $560.12 General Fee Schedule - 12/1/2009
65430 Y $99.19 General Fee Schedule - 8/1/2016
65435 Y $68.28 General Fee Schedule - 8/1/2016
65436 Y $308.97 General Fee Schedule - 12/1/2009
65450 Y $271.44 General Fee Schedule - 12/1/2009
65600 Y $308.60 General Fee Schedule - 12/1/2009
65710 Y $881.47 General Fee Schedule - 12/1/2009
65730 Y $986.00 General Fee Schedule - 12/1/2009
65750 Y $1,014.62 General Fee Schedule - 12/1/2009
65755 Y $1,007.29 General Fee Schedule - 12/1/2009
65756 Y $906.41 General Fee Schedule - 12/1/2009
65757 Y $0.00 General by Report - 1/1/2009
65760 Y $967.90 General Fee Schedule - 12/1/2009
65765 Y $967.90 General Fee Schedule - 12/1/2009
65767 Y $967.90 General Fee Schedule - 12/1/2009
65770 Y $1,159.99 General Fee Schedule - 12/1/2009
65772 Y $362.47 General Fee Schedule - 12/1/2009
65775 Y $437.17 General Fee Schedule - 12/1/2009
65778 Y $1,191.04 General Fee Schedule - 1/1/2011
65779 Y $1,040.72 General Fee Schedule - 8/1/2016
65780 Y $655.48 General Fee Schedule - 1/1/2017
65781 Y $1,165.47 General Fee Schedule - 12/1/2009
65782 Y $1,004.93 General Fee Schedule - 12/1/2009
65785 Y $1,875.98 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 165 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
65800 Y $109.68 General Fee Schedule - 1/1/2017
65810 Y $357.13 General Fee Schedule - 12/1/2009
65815 Y $546.57 General Fee Schedule - 12/1/2009
65820 Y $638.11 General Fee Schedule - 12/1/2009
65850 Y $712.89 General Fee Schedule - 12/1/2009
65855 Y $248.05 General Fee Schedule - 1/1/2017
65860 Y $270.25 General Fee Schedule - 8/1/2016
65865 Y $401.80 General Fee Schedule - 8/1/2016
65870 Y $472.49 General Fee Schedule - 12/1/2009
65875 Y $496.25 General Fee Schedule - 12/1/2009
65880 Y $526.74 General Fee Schedule - 12/1/2009
65900 Y $791.72 General Fee Schedule - 12/1/2009
65920 Y $618.40 General Fee Schedule - 12/1/2009
65930 Y $534.09 General Fee Schedule - 12/1/2009
66020 Y $164.45 General Fee Schedule - 8/1/2016
66030 Y $145.92 General Fee Schedule - 8/1/2016
66130 Y $614.36 General Fee Schedule - 8/1/2016
66150 Y $658.73 General Fee Schedule - 12/1/2009
66155 Y $654.91 General Fee Schedule - 12/1/2009
66160 Y $758.95 General Fee Schedule - 12/1/2009
66170 Y $872.70 General Fee Schedule - 8/1/2016
66172 Y $1,082.00 General Fee Schedule - 8/1/2016
66174 Y $875.75 General Fee Schedule - 1/1/2017
66175 Y $918.13 General Fee Schedule - 1/1/2017
66179 Y $1,008.86 General Fee Schedule - 8/1/2016
66180 Y $954.78 General Fee Schedule - 12/1/2009
66183 Y $949.60 General Fee Schedule - 1/1/2017
66184 Y $732.41 General Fee Schedule - 8/1/2016
66185 Y $580.98 General Fee Schedule - 12/1/2009
66220 Y $557.11 General Fee Schedule - 12/1/2009
66225 Y $744.66 General Fee Schedule - 12/1/2009
66250 Y $642.05 General Fee Schedule - 12/1/2009
66500 Y $308.24 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 166 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
66505 Y $335.19 General Fee Schedule - 12/1/2009
66600 Y $631.62 General Fee Schedule - 12/1/2009
66605 Y $863.59 General Fee Schedule - 12/1/2009
66625 Y $368.89 General Fee Schedule - 12/1/2009
66630 Y $444.27 General Fee Schedule - 12/1/2009
66635 Y $448.77 General Fee Schedule - 12/1/2009
66680 Y $400.04 General Fee Schedule - 12/1/2009
66682 Y $477.02 General Fee Schedule - 12/1/2009
66700 Y $372.50 General Fee Schedule - 12/1/2009
66710 Y $369.41 General Fee Schedule - 12/1/2009
66711 Y $487.31 General Fee Schedule - 12/1/2009
66720 Y $392.01 General Fee Schedule - 12/1/2009
66740 Y $366.67 General Fee Schedule - 12/1/2009
66761 Y $269.65 General Fee Schedule - 1/1/2017
66762 Y $378.46 General Fee Schedule - 12/1/2009
66770 Y $417.38 General Fee Schedule - 12/1/2009
66820 Y $341.68 General Fee Schedule - 8/1/2016
66821 Y $234.88 General Fee Schedule - 12/1/2009
66825 Y $642.31 General Fee Schedule - 12/1/2009
66830 Y $567.19 General Fee Schedule - 12/1/2009
66840 Y $553.95 General Fee Schedule - 12/1/2009
66850 Y $629.05 General Fee Schedule - 12/1/2009
66852 Y $679.37 General Fee Schedule - 12/1/2009
66920 Y $607.41 General Fee Schedule - 12/1/2009
66930 Y $688.47 General Fee Schedule - 12/1/2009
66940 Y $620.04 General Fee Schedule - 12/1/2009
66982 Y $732.50 General Fee Schedule - 1/1/2017
66983 Y $561.33 General Fee Schedule - 12/1/2009
66984 Y $582.37 General Fee Schedule - 1/1/2017
66985 Y $591.65 General Fee Schedule - 12/1/2009
66986 Y $776.56 General Fee Schedule - 8/1/2016
66990 Y $80.95 General Fee Schedule - 8/1/2016
66999 Y $0.00 General by Report - 7/1/1975
CPT FEES01/03/2018 at 6:55:00 AM - 167 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
67005 Y $396.03 General Fee Schedule - 12/1/2009
67010 Y $462.44 General Fee Schedule - 12/1/2009
67015 Y $499.97 General Fee Schedule - 12/1/2009
67025 Y $592.07 General Fee Schedule - 12/1/2009
67027 Y $711.26 General Fee Schedule - 12/1/2009
67028 Y $94.27 General Fee Schedule - 1/1/2017
67030 Y $395.70 General Fee Schedule - 12/1/2009
67031 Y $305.33 General Fee Schedule - 12/1/2009
67036 Y $791.46 General Fee Schedule - 12/1/2009
67039 Y $893.36 General Fee Schedule - 1/1/2017
67040 Y $966.04 General Fee Schedule - 1/1/2017
67041 Y $870.21 General Fee Schedule - 12/1/2009
67042 Y $996.37 General Fee Schedule - 12/1/2009
67043 Y $1,045.74 General Fee Schedule - 12/1/2009
67101 Y $616.32 General Fee Schedule - 12/1/2009
67105 Y $575.72 General Fee Schedule - 12/1/2009
67107 Y $945.74 General Fee Schedule - 8/1/2016
67108 Y $1,004.84 General Fee Schedule - 1/1/2017
67110 Y $677.89 General Fee Schedule - 8/1/2016
67113 Y $1,048.12 General Fee Schedule - 12/1/2009
67115 Y $375.13 General Fee Schedule - 12/1/2009
67120 Y $534.89 General Fee Schedule - 12/1/2009
67121 Y $722.11 General Fee Schedule - 12/1/2009
67141 Y $410.28 General Fee Schedule - 12/1/2009
67145 Y $412.74 General Fee Schedule - 12/1/2009
67208 Y $479.84 General Fee Schedule - 12/1/2009
67210 Y $475.76 General Fee Schedule - 1/1/2017
67218 Y $1,163.20 General Fee Schedule - 12/1/2009
67220 Y $489.99 General Fee Schedule - 1/1/2017
67221 Y $263.08 General Fee Schedule - 1/1/2017
67225 Y $26.28 General Fee Schedule - 8/1/2016
67227 Y $265.69 General Fee Schedule - 1/1/2017
67228 Y $313.88 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 168 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
67229 Y $755.50 General Fee Schedule - 12/1/2009
67250 Y $665.09 General Fee Schedule - 12/1/2009
67255 Y $628.27 General Fee Schedule - 1/1/2017
67299 Y $0.00 General by Report - 7/1/1975
67311 Y $475.86 General Fee Schedule - 12/1/2009
67312 Y $575.88 General Fee Schedule - 12/1/2009
67314 Y $528.28 General Fee Schedule - 12/1/2009
67316 Y $646.87 General Fee Schedule - 12/1/2009
67318 Y $554.72 General Fee Schedule - 12/1/2009
67320 Y $241.44 General Fee Schedule - 12/1/2009
67331 Y $226.57 General Fee Schedule - 12/1/2009
67332 Y $250.37 General Fee Schedule - 12/1/2009
67334 Y $221.77 General Fee Schedule - 12/1/2009
67335 Y $133.38 General Fee Schedule - 8/1/2016
67340 Y $274.20 General Fee Schedule - 12/1/2009
67343 Y $519.66 General Fee Schedule - 12/1/2009
67345 Y $208.80 General Fee Schedule - 12/1/2009
67346 Y $151.46 General Fee Schedule - 12/1/2009
67399 Y $0.00 General by Report - 7/1/1975
67400 Y $782.22 General Fee Schedule - 12/1/2009
67405 Y $656.43 General Fee Schedule - 12/1/2009
67412 Y $727.80 General Fee Schedule - 8/1/2016
67413 Y $741.72 General Fee Schedule - 8/1/2016
67414 Y $864.52 General Fee Schedule - 12/1/2009
67415 Y $93.19 General Fee Schedule - 8/1/2016
67420 Y $1,409.95 General Fee Schedule - 12/1/2009
67430 Y $1,056.93 General Fee Schedule - 12/1/2009
67440 Y $1,018.26 General Fee Schedule - 12/1/2009
67445 Y $1,064.52 General Fee Schedule - 12/1/2009
67450 Y $1,048.49 General Fee Schedule - 12/1/2009
67500 Y $55.16 General Fee Schedule - 12/1/2009
67505 Y $57.01 General Fee Schedule - 12/1/2009
67515 Y $44.78 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 169 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
67550 Y $805.33 General Fee Schedule - 12/1/2009
67560 Y $819.41 General Fee Schedule - 12/1/2009
67570 Y $1,013.19 General Fee Schedule - 12/1/2009
67599 Y $0.00 General by Report - 7/1/1975
67700 Y $239.31 General Fee Schedule - 1/1/2017
67710 Y $199.18 General Fee Schedule - 1/1/2017
67715 Y $213.97 General Fee Schedule - 1/1/2017
67800 Y $106.70 General Fee Schedule - 8/1/2016
67801 Y $137.40 General Fee Schedule - 8/1/2016
67805 Y $176.11 General Fee Schedule - 12/1/2009
67808 Y $282.27 General Fee Schedule - 12/1/2009
67810 Y $155.17 General Fee Schedule - 1/1/2017
67820 Y $45.90 General Fee Schedule - 1/1/2017
67825 Y $110.65 General Fee Schedule - 8/1/2016
67830 Y $239.28 General Fee Schedule - 1/1/2017
67835 Y $382.41 General Fee Schedule - 12/1/2009
67840 Y $247.80 General Fee Schedule - 1/1/2017
67850 Y $183.37 General Fee Schedule - 12/1/2009
67875 Y $154.69 General Fee Schedule - 1/1/2017
67880 Y $379.84 General Fee Schedule - 12/1/2009
67882 Y $465.86 General Fee Schedule - 12/1/2009
67900 Y $538.51 General Fee Schedule - 8/1/2016
67901 Y $489.46 General Fee Schedule - 12/1/2009
67902 Y $569.24 General Fee Schedule - 12/1/2009
67903 Y $542.27 General Fee Schedule - 1/1/2017
67904 Y $586.13 General Fee Schedule - 12/1/2009
67906 Y $443.64 General Fee Schedule - 8/1/2016
67908 Y $417.57 General Fee Schedule - 8/1/2016
67909 Y $474.59 General Fee Schedule - 8/1/2016
67911 Y $377.73 General Fee Schedule - 12/1/2009
67912 Y $796.78 General Fee Schedule - 1/1/2017
67914 Y $365.97 General Fee Schedule - 12/1/2009
67915 Y $263.03 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 170 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
67916 Y $490.54 General Fee Schedule - 12/1/2009
67917 Y $513.35 General Fee Schedule - 8/1/2016
67921 Y $349.34 General Fee Schedule - 12/1/2009
67922 Y $260.55 General Fee Schedule - 1/1/2017
67923 Y $495.00 General Fee Schedule - 8/1/2016
67924 Y $539.88 General Fee Schedule - 12/1/2009
67930 Y $328.02 General Fee Schedule - 8/1/2016
67935 Y $523.73 General Fee Schedule - 8/1/2016
67938 Y $214.65 General Fee Schedule - 1/1/2017
67950 Y $511.86 General Fee Schedule - 8/1/2016
67961 Y $507.69 General Fee Schedule - 8/1/2016
67966 Y $579.59 General Fee Schedule - 12/1/2009
67971 Y $619.90 General Fee Schedule - 8/1/2016
67973 Y $808.01 General Fee Schedule - 8/1/2016
67974 Y $804.27 General Fee Schedule - 8/1/2016
67975 Y $583.60 General Fee Schedule - 8/1/2016
67999 Y $0.00 General by Report - 7/1/1975
68020 Y $103.23 General Fee Schedule - 12/1/2009
68040 Y $56.16 General Fee Schedule - 8/1/2016
68100 Y $153.06 General Fee Schedule - 1/1/2017
68110 Y $203.65 General Fee Schedule - 8/1/2016
68115 Y $280.71 General Fee Schedule - 1/1/2017
68130 Y $477.53 General Fee Schedule - 8/1/2016
68135 Y $136.44 General Fee Schedule - 12/1/2009
68200 Y $36.57 General Fee Schedule - 8/1/2016
68320 Y $603.44 General Fee Schedule - 12/1/2009
68325 Y $523.50 General Fee Schedule - 12/1/2009
68326 Y $507.82 General Fee Schedule - 12/1/2009
68328 Y $584.27 General Fee Schedule - 12/1/2009
68330 Y $517.53 General Fee Schedule - 12/1/2009
68335 Y $508.69 General Fee Schedule - 12/1/2009
68340 Y $472.54 General Fee Schedule - 12/1/2009
68360 Y $451.84 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 171 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
68362 Y $515.17 General Fee Schedule - 12/1/2009
68371 Y $351.58 General Fee Schedule - 8/1/2016
68399 Y $0.00 General by Report - 7/1/1975
68400 Y $254.03 General Fee Schedule - 1/1/2017
68420 Y $292.97 General Fee Schedule - 8/1/2016
68440 Y $93.02 General Fee Schedule - 1/1/2017
68500 Y $777.74 General Fee Schedule - 12/1/2009
68505 Y $806.15 General Fee Schedule - 12/1/2009
68510 Y $350.97 General Fee Schedule - 7/1/2009
68520 Y $556.99 General Fee Schedule - 12/1/2009
68525 Y $237.80 General Fee Schedule - 8/1/2016
68530 Y $386.57 General Fee Schedule - 1/1/2017
68540 Y $748.85 General Fee Schedule - 12/1/2009
68550 Y $928.30 General Fee Schedule - 12/1/2009
68700 Y $470.84 General Fee Schedule - 12/1/2009
68705 Y $217.04 General Fee Schedule - 8/1/2016
68720 Y $630.44 General Fee Schedule - 12/1/2009
68745 Y $620.47 General Fee Schedule - 12/1/2009
68750 Y $632.56 General Fee Schedule - 12/1/2009
68760 Y $183.77 General Fee Schedule - 8/1/2016
68761 Y $127.32 General Fee Schedule - 8/1/2016
68770 Y $391.88 General Fee Schedule - 12/1/2009
68801 Y $90.54 General Fee Schedule - 1/1/2017
68810 Y $175.63 General Fee Schedule - 1/1/2017
68811 Y $151.89 General Fee Schedule - 1/1/2017
68815 Y $356.57 General Fee Schedule - 1/1/2017
68816 Y $464.24 General Fee Schedule - 12/1/2009
68840 Y $105.10 General Fee Schedule - 12/1/2009
68850 Y $56.30 General Fee Schedule - 1/1/2017
68899 Y $0.00 General by Report - 7/1/1975
69000 Y $159.06 General Fee Schedule - 12/1/2009
69005 Y $187.98 General Fee Schedule - 12/1/2009
69020 Y $198.22 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 172 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
69100 Y $87.22 General Fee Schedule - 8/1/2016
69105 Y $115.68 General Fee Schedule - 12/1/2009
69110 Y $374.20 General Fee Schedule - 12/1/2009
69120 Y $366.09 General Fee Schedule - 8/1/2016
69140 Y $754.30 General Fee Schedule - 8/1/2016
69145 Y $306.96 General Fee Schedule - 12/1/2009
69150 Y $979.10 General Fee Schedule - 8/1/2016
69155 Y $1,477.51 General Fee Schedule - 8/1/2016
69200 Y $90.50 General Fee Schedule - 1/1/2017
69205 Y $92.49 General Fee Schedule - 8/1/2016
69209 Y $11.22 General Fee Schedule - 8/1/2016
69210 Y $44.97 General Fee Schedule - 8/1/2016
69220 Y $101.04 General Fee Schedule - 1/1/2017
69222 Y $190.33 General Fee Schedule - 12/1/2009
69300 Y $414.79 General Fee Schedule - 12/1/2009
69310 Y $963.99 General Fee Schedule - 8/1/2016
69320 Y $1,392.57 General Fee Schedule - 8/1/2016
69399 Y $0.00 General by Report - 7/1/1975
69420 Y $163.33 General Fee Schedule - 12/1/2009
69421 Y $140.41 General Fee Schedule - 8/1/2016
69424 Y $110.20 General Fee Schedule - 12/1/2009
69433 Y $169.29 General Fee Schedule - 12/1/2009
69436 Y $154.52 General Fee Schedule - 8/1/2016
69440 Y $614.17 General Fee Schedule - 12/1/2009
69450 Y $471.53 General Fee Schedule - 12/1/2009
69501 Y $656.72 General Fee Schedule - 8/1/2016
69502 Y $873.08 General Fee Schedule - 8/1/2016
69505 Y $1,082.05 General Fee Schedule - 8/1/2016
69511 Y $1,112.23 General Fee Schedule - 8/1/2016
69530 Y $1,473.94 General Fee Schedule - 8/1/2016
69535 Y $2,487.55 General Fee Schedule - 8/1/2016
69540 Y $178.17 General Fee Schedule - 12/1/2009
69550 Y $925.74 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 173 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
69552 Y $1,454.05 General Fee Schedule - 8/1/2016
69554 Y $2,323.21 General Fee Schedule - 8/1/2016
69601 Y $943.10 General Fee Schedule - 8/1/2016
69602 Y $975.09 General Fee Schedule - 8/1/2016
69603 Y $1,161.67 General Fee Schedule - 8/1/2016
69604 Y $1,007.85 General Fee Schedule - 8/1/2016
69605 Y $1,424.32 General Fee Schedule - 8/1/2016
69610 Y $358.79 General Fee Schedule - 8/1/2016
69620 Y $600.28 General Fee Schedule - 8/1/2016
69631 Y $792.32 General Fee Schedule - 12/1/2009
69632 Y $949.91 General Fee Schedule - 8/1/2016
69633 Y $910.35 General Fee Schedule - 8/1/2016
69635 Y $1,080.85 General Fee Schedule - 8/1/2016
69636 Y $1,240.34 General Fee Schedule - 8/1/2016
69637 Y $1,233.30 General Fee Schedule - 8/1/2016
69641 Y $925.75 General Fee Schedule - 8/1/2016
69642 Y $1,204.72 General Fee Schedule - 8/1/2016
69643 Y $1,096.47 General Fee Schedule - 8/1/2016
69644 Y $1,345.61 General Fee Schedule - 8/1/2016
69645 Y $1,310.31 General Fee Schedule - 8/1/2016
69646 Y $1,398.22 General Fee Schedule - 8/1/2016
69650 Y $710.15 General Fee Schedule - 8/1/2016
69660 Y $840.49 General Fee Schedule - 8/1/2016
69661 Y $1,109.09 General Fee Schedule - 8/1/2016
69662 Y $1,066.08 General Fee Schedule - 8/1/2016
69666 Y $715.79 General Fee Schedule - 8/1/2016
69667 Y $716.49 General Fee Schedule - 8/1/2016
69670 Y $842.47 General Fee Schedule - 8/1/2016
69676 Y $733.56 General Fee Schedule - 8/1/2016
69700 Y $631.49 General Fee Schedule - 8/1/2016
69710 Y $1,404.45 General Fee Schedule - 12/1/2009
69711 Y $769.27 General Fee Schedule - 8/1/2016
69714 Y $972.92 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 174 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
69715 Y $1,219.53 General Fee Schedule - 8/1/2016
69717 Y $1,061.10 General Fee Schedule - 8/1/2016
69718 Y $1,295.05 General Fee Schedule - 8/1/2016
69720 Y $1,092.84 General Fee Schedule - 12/1/2009
69725 Y $1,683.48 General Fee Schedule - 8/1/2016
69740 Y $1,074.84 General Fee Schedule - 8/1/2016
69745 Y $1,196.33 General Fee Schedule - 12/1/2009
69799 Y $0.00 General by Report - 7/1/1975
69801 Y $182.31 General Fee Schedule - 1/1/2017
69805 Y $939.96 General Fee Schedule - 8/1/2016
69806 Y $853.89 General Fee Schedule - 8/1/2016
69905 Y $814.44 General Fee Schedule - 8/1/2016
69910 Y $932.57 General Fee Schedule - 8/1/2016
69915 Y $1,384.24 General Fee Schedule - 8/1/2016
69930 Y $1,152.99 General Fee Schedule - 8/1/2016
69949 Y $0.00 General by Report - 7/1/1975
69950 Y $1,647.06 General Fee Schedule - 8/1/2016
69955 Y $1,787.40 General Fee Schedule - 8/1/2016
69960 Y $1,733.40 General Fee Schedule - 8/1/2016
69970 Y $1,958.32 General Fee Schedule - 8/1/2016
69979 Y $0.00 General by Report - 6/1/1981
69990 Y $216.88 General Fee Schedule - 8/1/2016
70010 Y $61.01 26 Fee Schedule (FS) - 12/1/2009
70010 Y $58.22 General Fee Schedule - 1/1/2017
70010 Y $156.19 TC Fee Schedule - 12/1/2009
70015 Y $44.42 26 Fee Schedule (FS) - 12/1/2009
70015 Y $111.04 General Fee Schedule - 12/1/2009
70015 Y $48.98 TC Fee Schedule - 12/1/2009
70030 Y $7.97 26 Fee Schedule (FS) - 1/1/2017
70030 Y $23.08 General Fee Schedule - 8/1/2016
70030 Y $15.07 TC Fee Schedule - 12/1/2009
70100 Y $8.62 26 Fee Schedule (FS) - 1/1/2017
70100 Y $27.85 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 175 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
70100 Y $18.50 TC Fee Schedule - 12/1/2009
70110 Y $11.91 26 Fee Schedule (FS) - 1/1/2017
70110 Y $33.94 General Fee Schedule - 8/1/2016
70110 Y $21.71 TC Fee Schedule - 8/1/2016
70120 Y $8.62 26 Fee Schedule (FS) - 1/1/2017
70120 Y $30.68 General Fee Schedule - 8/1/2016
70120 Y $21.71 TC Fee Schedule - 8/1/2016
70130 Y $16.25 26 Fee Schedule (FS) - 1/1/2017
70130 Y $46.02 General Fee Schedule - 12/1/2009
70130 Y $28.44 TC Fee Schedule - 12/1/2009
70134 Y $16.49 26 Fee Schedule (FS) - 1/1/2017
70134 Y $42.54 General Fee Schedule - 8/1/2016
70134 Y $26.71 TC Fee Schedule - 12/1/2009
70140 Y $9.35 26 Fee Schedule (FS) - 8/1/2016
70140 Y $26.37 General Fee Schedule - 1/1/2017
70140 Y $16.49 TC Fee Schedule - 1/1/2017
70150 Y $12.59 26 Fee Schedule (FS) - 8/1/2016
70150 Y $36.77 General Fee Schedule - 1/1/2017
70150 Y $24.22 TC Fee Schedule - 1/1/2017
70160 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
70160 Y $27.46 General Fee Schedule - 12/1/2009
70160 Y $18.50 TC Fee Schedule - 12/1/2009
70170 Y $14.58 26 Fee Schedule (FS) - 8/1/2016
70190 Y $10.41 26 Fee Schedule (FS) - 8/1/2016
70190 Y $32.12 General Fee Schedule - 8/1/2016
70190 Y $21.13 TC Fee Schedule - 1/1/2017
70200 Y $13.23 26 Fee Schedule (FS) - 1/1/2017
70200 Y $37.45 General Fee Schedule - 1/1/2017
70200 Y $24.22 TC Fee Schedule - 1/1/2017
70210 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
70210 Y $26.32 General Fee Schedule - 1/1/2017
70210 Y $18.03 TC Fee Schedule - 1/1/2017
70220 Y $11.91 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 176 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
70220 Y $33.34 General Fee Schedule - 1/1/2017
70220 Y $21.44 TC Fee Schedule - 1/1/2017
70240 Y $9.35 26 Fee Schedule (FS) - 8/1/2016
70240 Y $24.80 General Fee Schedule - 12/1/2009
70240 Y $15.07 TC Fee Schedule - 12/1/2009
70250 Y $11.86 26 Fee Schedule (FS) - 8/1/2016
70250 Y $32.07 General Fee Schedule - 1/1/2017
70250 Y $20.20 TC Fee Schedule - 1/1/2017
70260 Y $16.88 26 Fee Schedule (FS) - 8/1/2016
70260 Y $40.79 General Fee Schedule - 1/1/2017
70260 Y $24.22 TC Fee Schedule - 1/1/2017
70300 Y $5.68 26 Fee Schedule (FS) - 8/1/2016
70300 Y $13.43 General Fee Schedule - 1/1/2017
70300 Y $7.82 TC Fee Schedule - 1/1/2017
70310 Y $7.63 26 Fee Schedule (FS) - 1/1/2017
70310 Y $24.33 General Fee Schedule - 12/1/2009
70310 Y $15.07 TC Fee Schedule - 12/1/2009
70320 Y $11.12 26 Fee Schedule (FS) - 8/1/2016
70320 Y $40.00 General Fee Schedule - 12/1/2009
70320 Y $28.44 TC Fee Schedule - 12/1/2009
70328 Y $8.62 26 Fee Schedule (FS) - 1/1/2017
70328 Y $25.75 General Fee Schedule - 8/1/2016
70328 Y $17.47 TC Fee Schedule - 12/1/2009
70330 Y $11.86 26 Fee Schedule (FS) - 8/1/2016
70330 Y $41.13 General Fee Schedule - 8/1/2016
70330 Y $29.27 TC Fee Schedule - 8/1/2016
70332 Y $27.24 26 Fee Schedule (FS) - 8/1/2016
70332 Y $72.76 General Fee Schedule - 1/1/2017
70332 Y $43.41 TC Fee Schedule - 1/1/2017
70336 Y $69.37 26 Fee Schedule (FS) - 1/1/2017
70336 Y $283.10 General Fee Schedule - 1/1/2017
70336 Y $213.72 TC Fee Schedule - 1/1/2017
70350 Y $8.84 26 Fee Schedule (FS) - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 177 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
70350 Y $18.04 General Fee Schedule - 1/1/2017
70350 Y $8.44 TC Fee Schedule - 1/1/2017
70355 Y $10.04 26 Fee Schedule (FS) - 8/1/2016
70355 Y $18.74 General Fee Schedule - 1/1/2017
70355 Y $8.13 TC Fee Schedule - 1/1/2017
70360 Y $7.97 26 Fee Schedule (FS) - 1/1/2017
70360 Y $23.08 General Fee Schedule - 8/1/2016
70360 Y $15.07 TC Fee Schedule - 12/1/2009
70370 Y $15.48 26 Fee Schedule (FS) - 8/1/2016
70370 Y $63.39 General Fee Schedule - 12/1/2009
70370 Y $47.27 TC Fee Schedule - 12/1/2009
70371 Y $40.46 26 Fee Schedule (FS) - 1/1/2017
70371 Y $82.33 General Fee Schedule - 1/1/2017
70371 Y $41.87 TC Fee Schedule - 1/1/2017
70380 Y $8.60 26 Fee Schedule (FS) - 8/1/2016
70380 Y $31.95 General Fee Schedule - 8/1/2016
70380 Y $23.35 TC Fee Schedule - 8/1/2016
70390 Y $17.92 26 Fee Schedule (FS) - 1/1/2017
70390 Y $81.17 General Fee Schedule - 8/1/2016
70390 Y $62.49 TC Fee Schedule - 8/1/2016
70450 Y $40.18 26 Fee Schedule (FS) - 1/1/2017
70450 Y $103.40 General Fee Schedule - 1/1/2017
70450 Y $63.22 TC Fee Schedule - 1/1/2017
70460 Y $53.40 26 Fee Schedule (FS) - 1/1/2017
70460 Y $144.17 General Fee Schedule - 1/1/2017
70460 Y $90.77 TC Fee Schedule - 1/1/2017
70470 Y $60.06 26 Fee Schedule (FS) - 1/1/2017
70470 Y $170.32 General Fee Schedule - 1/1/2017
70470 Y $110.26 TC Fee Schedule - 1/1/2017
70480 Y $60.71 26 Fee Schedule (FS) - 1/1/2017
70480 Y $157.97 General Fee Schedule - 1/1/2017
70480 Y $97.26 TC Fee Schedule - 1/1/2017
70481 Y $65.39 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 178 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
70481 Y $244.36 General Fee Schedule - 1/1/2017
70481 Y $178.98 TC Fee Schedule - 1/1/2017
70482 Y $68.37 26 Fee Schedule (FS) - 1/1/2017
70482 Y $266.61 General Fee Schedule - 1/1/2017
70482 Y $198.25 TC Fee Schedule - 1/1/2017
70486 Y $40.49 26 Fee Schedule (FS) - 1/1/2017
70486 Y $124.45 General Fee Schedule - 1/1/2017
70486 Y $83.96 TC Fee Schedule - 1/1/2017
70487 Y $53.40 26 Fee Schedule (FS) - 1/1/2017
70487 Y $149.74 General Fee Schedule - 1/1/2017
70487 Y $96.34 TC Fee Schedule - 1/1/2017
70488 Y $60.06 26 Fee Schedule (FS) - 1/1/2017
70488 Y $182.39 General Fee Schedule - 1/1/2017
70488 Y $122.33 TC Fee Schedule - 1/1/2017
70490 Y $60.71 26 Fee Schedule (FS) - 1/1/2017
70490 Y $157.66 General Fee Schedule - 1/1/2017
70490 Y $96.95 TC Fee Schedule - 1/1/2017
70491 Y $65.70 26 Fee Schedule (FS) - 1/1/2017
70491 Y $209.39 General Fee Schedule - 1/1/2017
70491 Y $143.69 TC Fee Schedule - 1/1/2017
70492 Y $68.37 26 Fee Schedule (FS) - 1/1/2017
70492 Y $245.79 General Fee Schedule - 1/1/2017
70492 Y $177.43 TC Fee Schedule - 1/1/2017
70496 Y $82.65 26 Fee Schedule (FS) - 1/1/2017
70496 Y $261.71 General Fee Schedule - 1/1/2017
70496 Y $179.05 TC Fee Schedule - 1/1/2017
70498 Y $82.65 26 Fee Schedule (FS) - 1/1/2017
70498 Y $260.47 General Fee Schedule - 1/1/2017
70498 Y $177.82 TC Fee Schedule - 1/1/2017
70540 Y $63.76 26 Fee Schedule (FS) - 1/1/2017
70540 Y $299.77 General Fee Schedule - 1/1/2017
70540 Y $236.01 TC Fee Schedule - 1/1/2017
70542 Y $76.65 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 179 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
70542 Y $354.44 General Fee Schedule - 1/1/2017
70542 Y $277.79 TC Fee Schedule - 1/1/2017
70543 Y $101.24 26 Fee Schedule (FS) - 1/1/2017
70543 Y $434.12 General Fee Schedule - 1/1/2017
70543 Y $332.88 TC Fee Schedule - 1/1/2017
70544 Y $56.77 26 Fee Schedule (FS) - 1/1/2017
70544 Y $292.77 General Fee Schedule - 1/1/2017
70544 Y $236.01 TC Fee Schedule - 1/1/2017
70545 Y $56.77 26 Fee Schedule (FS) - 1/1/2017
70545 Y $340.13 General Fee Schedule - 1/1/2017
70545 Y $283.35 TC Fee Schedule - 1/1/2017
70546 Y $84.96 26 Fee Schedule (FS) - 1/1/2017
70546 Y $476.65 General Fee Schedule - 1/1/2017
70546 Y $391.69 TC Fee Schedule - 1/1/2017
70547 Y $57.08 26 Fee Schedule (FS) - 1/1/2017
70547 Y $293.08 General Fee Schedule - 1/1/2017
70547 Y $236.01 TC Fee Schedule - 1/1/2017
70548 Y $56.77 26 Fee Schedule (FS) - 1/1/2017
70548 Y $362.41 General Fee Schedule - 1/1/2017
70548 Y $305.64 TC Fee Schedule - 1/1/2017
70549 Y $84.96 26 Fee Schedule (FS) - 1/1/2017
70549 Y $476.65 General Fee Schedule - 1/1/2017
70549 Y $391.69 TC Fee Schedule - 1/1/2017
70551 Y $69.99 26 Fee Schedule (FS) - 1/1/2017
70551 Y $205.02 General Fee Schedule - 1/1/2017
70551 Y $135.02 TC Fee Schedule - 1/1/2017
70552 Y $84.28 26 Fee Schedule (FS) - 1/1/2017
70552 Y $283.46 General Fee Schedule - 1/1/2017
70552 Y $199.18 TC Fee Schedule - 1/1/2017
70553 Y $108.51 26 Fee Schedule (FS) - 1/1/2017
70553 Y $335.54 General Fee Schedule - 1/1/2017
70553 Y $227.03 TC Fee Schedule - 1/1/2017
70554 Y $88.03 26 Fee Schedule (FS) - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 180 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
70554 Y $398.89 General Fee Schedule - 1/1/2017
70554 Y $298.30 TC Fee Schedule - 1/1/2017
70555 Y $25.71 26 Fee Schedule (FS) - 12/1/2009
70557 Y $138.05 26 Fee Schedule (FS) - 1/1/2017
70558 Y $151.95 26 Fee Schedule (FS) - 1/1/2017
70559 Y $153.13 26 Fee Schedule (FS) - 1/1/2017
71045 Y $8.58 26 Fee Schedule (FS) - 1/1/2018
71045 Y $18.05 General Fee Schedule - 1/1/2018
71045 Y $9.46 TC Fee Schedule - 1/1/2018
71046 Y $10.23 26 Fee Schedule (FS) - 1/1/2018
71046 Y $27.48 General Fee Schedule - 1/1/2018
71046 Y $17.25 TC Fee Schedule - 1/1/2018
71047 Y $13.13 26 Fee Schedule (FS) - 1/1/2018
71047 Y $35.06 General Fee Schedule - 1/1/2018
71047 Y $21.93 TC Fee Schedule - 1/1/2018
71048 Y $15.09 26 Fee Schedule (FS) - 1/1/2018
71048 Y $37.64 General Fee Schedule - 1/1/2018
71048 Y $22.55 TC Fee Schedule - 1/1/2018
71100 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
71100 Y $29.23 General Fee Schedule - 1/1/2017
71100 Y $18.65 TC Fee Schedule - 1/1/2017
71101 Y $12.97 26 Fee Schedule (FS) - 1/1/2017
71101 Y $32.55 General Fee Schedule - 1/1/2017
71101 Y $19.58 TC Fee Schedule - 1/1/2017
71110 Y $12.89 26 Fee Schedule (FS) - 1/1/2017
71110 Y $33.40 General Fee Schedule - 1/1/2017
71110 Y $20.51 TC Fee Schedule - 1/1/2017
71111 Y $15.48 26 Fee Schedule (FS) - 8/1/2016
71111 Y $42.59 General Fee Schedule - 1/1/2017
71111 Y $27.01 TC Fee Schedule - 1/1/2017
71120 Y $9.61 26 Fee Schedule (FS) - 1/1/2017
71120 Y $26.40 General Fee Schedule - 1/1/2017
71120 Y $16.80 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 181 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
71130 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
71130 Y $32.03 General Fee Schedule - 1/1/2017
71130 Y $21.44 TC Fee Schedule - 1/1/2017
71250 Y $48.46 26 Fee Schedule (FS) - 1/1/2017
71250 Y $145.42 General Fee Schedule - 1/1/2017
71250 Y $96.95 TC Fee Schedule - 1/1/2017
71260 Y $59.04 26 Fee Schedule (FS) - 1/1/2017
71260 Y $203.35 General Fee Schedule - 1/1/2017
71260 Y $144.31 TC Fee Schedule - 1/1/2017
71270 Y $65.39 26 Fee Schedule (FS) - 1/1/2017
71270 Y $243.43 General Fee Schedule - 1/1/2017
71270 Y $178.05 TC Fee Schedule - 1/1/2017
71275 Y $85.94 26 Fee Schedule (FS) - 1/1/2017
71275 Y $266.24 General Fee Schedule - 1/1/2017
71275 Y $180.29 TC Fee Schedule - 1/1/2017
71550 Y $69.01 26 Fee Schedule (FS) - 1/1/2017
71550 Y $305.01 General Fee Schedule - 1/1/2017
71550 Y $236.01 TC Fee Schedule - 1/1/2017
71551 Y $81.68 26 Fee Schedule (FS) - 1/1/2017
71551 Y $403.72 General Fee Schedule - 1/1/2017
71551 Y $322.04 TC Fee Schedule - 1/1/2017
71552 Y $106.89 26 Fee Schedule (FS) - 1/1/2017
71552 Y $498.65 General Fee Schedule - 1/1/2017
71552 Y $391.76 TC Fee Schedule - 1/1/2017
71555 Y $84.59 26 Fee Schedule (FS) - 1/1/2017
71555 Y $350.93 General Fee Schedule - 1/1/2017
71555 Y $266.34 TC Fee Schedule - 1/1/2017
72020 Y $7.30 26 Fee Schedule (FS) - 1/1/2017
72020 Y $19.76 General Fee Schedule - 1/1/2017
72020 Y $12.46 TC Fee Schedule - 1/1/2017
72040 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
72040 Y $29.54 General Fee Schedule - 1/1/2017
72040 Y $18.96 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 182 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
72050 Y $15.10 26 Fee Schedule (FS) - 8/1/2016
72050 Y $40.09 General Fee Schedule - 1/1/2017
72050 Y $25.15 TC Fee Schedule - 1/1/2017
72052 Y $17.24 26 Fee Schedule (FS) - 1/1/2017
72052 Y $50.13 General Fee Schedule - 1/1/2017
72052 Y $32.89 TC Fee Schedule - 1/1/2017
72070 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
72070 Y $30.16 General Fee Schedule - 1/1/2017
72070 Y $19.58 TC Fee Schedule - 1/1/2017
72072 Y $10.27 26 Fee Schedule (FS) - 1/1/2017
72072 Y $30.79 General Fee Schedule - 1/1/2017
72072 Y $20.51 TC Fee Schedule - 1/1/2017
72074 Y $10.27 26 Fee Schedule (FS) - 1/1/2017
72074 Y $34.81 General Fee Schedule - 1/1/2017
72074 Y $24.53 TC Fee Schedule - 1/1/2017
72080 Y $10.27 26 Fee Schedule (FS) - 1/1/2017
72080 Y $27.38 General Fee Schedule - 1/1/2017
72080 Y $17.11 TC Fee Schedule - 1/1/2017
72081 Y $12.63 26 Fee Schedule (FS) - 8/1/2016
72081 Y $34.69 General Fee Schedule - 8/1/2016
72081 Y $22.05 TC Fee Schedule - 8/1/2016
72082 Y $15.25 26 Fee Schedule (FS) - 8/1/2016
72082 Y $55.25 General Fee Schedule - 8/1/2016
72082 Y $40.01 TC Fee Schedule - 8/1/2016
72083 Y $16.59 26 Fee Schedule (FS) - 8/1/2016
72083 Y $60.00 General Fee Schedule - 8/1/2016
72083 Y $43.41 TC Fee Schedule - 8/1/2016
72084 Y $19.23 26 Fee Schedule (FS) - 8/1/2016
72084 Y $71.31 General Fee Schedule - 8/1/2016
72084 Y $52.08 TC Fee Schedule - 8/1/2016
72100 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
72100 Y $31.10 General Fee Schedule - 1/1/2017
72100 Y $20.51 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 183 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
72110 Y $15.10 26 Fee Schedule (FS) - 8/1/2016
72110 Y $43.49 General Fee Schedule - 1/1/2017
72110 Y $28.56 TC Fee Schedule - 1/1/2017
72114 Y $15.59 26 Fee Schedule (FS) - 1/1/2017
72114 Y $55.28 General Fee Schedule - 1/1/2017
72114 Y $39.70 TC Fee Schedule - 1/1/2017
72120 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
72120 Y $35.74 General Fee Schedule - 1/1/2017
72120 Y $25.15 TC Fee Schedule - 1/1/2017
72125 Y $50.76 26 Fee Schedule (FS) - 1/1/2017
72125 Y $147.72 General Fee Schedule - 1/1/2017
72125 Y $96.95 TC Fee Schedule - 1/1/2017
72126 Y $57.75 26 Fee Schedule (FS) - 1/1/2017
72126 Y $202.99 General Fee Schedule - 1/1/2017
72126 Y $145.24 TC Fee Schedule - 1/1/2017
72127 Y $60.06 26 Fee Schedule (FS) - 1/1/2017
72127 Y $239.34 General Fee Schedule - 1/1/2017
72127 Y $179.29 TC Fee Schedule - 1/1/2017
72128 Y $47.48 26 Fee Schedule (FS) - 1/1/2017
72128 Y $144.43 General Fee Schedule - 1/1/2017
72128 Y $96.95 TC Fee Schedule - 1/1/2017
72129 Y $57.75 26 Fee Schedule (FS) - 1/1/2017
72129 Y $203.30 General Fee Schedule - 1/1/2017
72129 Y $145.55 TC Fee Schedule - 1/1/2017
72130 Y $60.06 26 Fee Schedule (FS) - 1/1/2017
72130 Y $240.88 General Fee Schedule - 1/1/2017
72130 Y $180.83 TC Fee Schedule - 1/1/2017
72131 Y $47.48 26 Fee Schedule (FS) - 1/1/2017
72131 Y $144.43 General Fee Schedule - 1/1/2017
72131 Y $96.95 TC Fee Schedule - 1/1/2017
72132 Y $57.75 26 Fee Schedule (FS) - 1/1/2017
72132 Y $202.37 General Fee Schedule - 1/1/2017
72132 Y $144.62 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 184 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
72133 Y $60.14 26 Fee Schedule (FS) - 1/1/2017
72133 Y $239.11 General Fee Schedule - 1/1/2017
72133 Y $178.98 TC Fee Schedule - 1/1/2017
72141 Y $70.39 26 Fee Schedule (FS) - 1/1/2017
72141 Y $199.22 General Fee Schedule - 1/1/2017
72141 Y $128.84 TC Fee Schedule - 1/1/2017
72142 Y $84.99 26 Fee Schedule (FS) - 1/1/2017
72142 Y $288.19 General Fee Schedule - 1/1/2017
72142 Y $203.20 TC Fee Schedule - 1/1/2017
72146 Y $70.39 26 Fee Schedule (FS) - 1/1/2017
72146 Y $199.53 General Fee Schedule - 1/1/2017
72146 Y $129.15 TC Fee Schedule - 1/1/2017
72147 Y $84.28 26 Fee Schedule (FS) - 1/1/2017
72147 Y $285.01 General Fee Schedule - 1/1/2017
72147 Y $200.72 TC Fee Schedule - 1/1/2017
72148 Y $70.39 26 Fee Schedule (FS) - 1/1/2017
72148 Y $198.29 General Fee Schedule - 1/1/2017
72148 Y $127.91 TC Fee Schedule - 1/1/2017
72149 Y $84.68 26 Fee Schedule (FS) - 1/1/2017
72149 Y $284.47 General Fee Schedule - 1/1/2017
72149 Y $199.80 TC Fee Schedule - 1/1/2017
72156 Y $108.51 26 Fee Schedule (FS) - 1/1/2017
72156 Y $337.09 General Fee Schedule - 1/1/2017
72156 Y $228.58 TC Fee Schedule - 1/1/2017
72157 Y $108.51 26 Fee Schedule (FS) - 1/1/2017
72157 Y $337.40 General Fee Schedule - 1/1/2017
72157 Y $228.89 TC Fee Schedule - 1/1/2017
72158 Y $108.51 26 Fee Schedule (FS) - 1/1/2017
72158 Y $336.16 General Fee Schedule - 1/1/2017
72158 Y $227.65 TC Fee Schedule - 1/1/2017
72159 Y $80.66 26 Fee Schedule (FS) - 8/1/2016
72159 Y $367.70 General Fee Schedule - 1/1/2017
72159 Y $265.24 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 185 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
72170 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
72170 Y $26.36 General Fee Schedule - 8/1/2016
72170 Y $18.50 TC Fee Schedule - 12/1/2009
72190 Y $10.41 26 Fee Schedule (FS) - 8/1/2016
72190 Y $33.76 General Fee Schedule - 8/1/2016
72190 Y $23.35 TC Fee Schedule - 8/1/2016
72191 Y $85.38 26 Fee Schedule (FS) - 1/1/2017
72191 Y $271.24 General Fee Schedule - 1/1/2017
72191 Y $185.87 TC Fee Schedule - 1/1/2017
72192 Y $51.44 26 Fee Schedule (FS) - 1/1/2017
72192 Y $130.13 General Fee Schedule - 1/1/2017
72192 Y $78.70 TC Fee Schedule - 1/1/2017
72193 Y $55.11 26 Fee Schedule (FS) - 1/1/2017
72193 Y $200.04 General Fee Schedule - 1/1/2017
72193 Y $144.93 TC Fee Schedule - 1/1/2017
72194 Y $57.44 26 Fee Schedule (FS) - 1/1/2017
72194 Y $229.91 General Fee Schedule - 1/1/2017
72194 Y $172.47 TC Fee Schedule - 1/1/2017
72195 Y $69.01 26 Fee Schedule (FS) - 1/1/2017
72195 Y $305.01 General Fee Schedule - 1/1/2017
72195 Y $236.01 TC Fee Schedule - 1/1/2017
72196 Y $81.98 26 Fee Schedule (FS) - 1/1/2017
72196 Y $362.87 General Fee Schedule - 1/1/2017
72196 Y $280.88 TC Fee Schedule - 1/1/2017
72197 Y $106.89 26 Fee Schedule (FS) - 1/1/2017
72197 Y $446.27 General Fee Schedule - 1/1/2017
72197 Y $339.38 TC Fee Schedule - 1/1/2017
72198 Y $84.34 26 Fee Schedule (FS) - 1/1/2017
72198 Y $353.46 General Fee Schedule - 1/1/2017
72198 Y $269.12 TC Fee Schedule - 1/1/2017
72200 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
72200 Y $25.39 General Fee Schedule - 1/1/2017
72200 Y $17.11 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 186 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
72202 Y $8.96 26 Fee Schedule (FS) - 1/1/2017
72202 Y $29.16 General Fee Schedule - 1/1/2017
72202 Y $20.20 TC Fee Schedule - 1/1/2017
72220 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
72220 Y $25.08 General Fee Schedule - 1/1/2017
72220 Y $16.80 TC Fee Schedule - 1/1/2017
72240 Y $43.13 26 Fee Schedule (FS) - 1/1/2017
72240 Y $88.09 General Fee Schedule - 1/1/2017
72240 Y $44.96 TC Fee Schedule - 1/1/2017
72255 Y $43.92 26 Fee Schedule (FS) - 8/1/2016
72255 Y $87.85 General Fee Schedule - 1/1/2017
72255 Y $44.03 TC Fee Schedule - 1/1/2017
72265 Y $40.30 26 Fee Schedule (FS) - 8/1/2016
72265 Y $82.92 General Fee Schedule - 1/1/2017
72265 Y $43.41 TC Fee Schedule - 1/1/2017
72270 Y $63.39 26 Fee Schedule (FS) - 1/1/2017
72270 Y $115.16 General Fee Schedule - 1/1/2017
72270 Y $51.77 TC Fee Schedule - 1/1/2017
72275 Y $36.06 26 Fee Schedule (FS) - 8/1/2016
72275 Y $103.38 General Fee Schedule - 1/1/2017
72275 Y $66.32 TC Fee Schedule - 1/1/2017
72285 Y $57.14 26 Fee Schedule (FS) - 8/1/2016
72285 Y $103.79 General Fee Schedule - 1/1/2017
72285 Y $46.20 TC Fee Schedule - 1/1/2017
72295 Y $41.63 26 Fee Schedule (FS) - 8/1/2016
72295 Y $89.19 General Fee Schedule - 1/1/2017
72295 Y $48.05 TC Fee Schedule - 1/1/2017
73000 Y $7.90 26 Fee Schedule (FS) - 8/1/2016
73000 Y $24.43 General Fee Schedule - 1/1/2017
73000 Y $16.49 TC Fee Schedule - 1/1/2017
73010 Y $8.60 26 Fee Schedule (FS) - 8/1/2016
73010 Y $26.36 General Fee Schedule - 8/1/2016
73010 Y $17.76 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 187 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
73020 Y $7.30 26 Fee Schedule (FS) - 1/1/2017
73020 Y $20.38 General Fee Schedule - 1/1/2017
73020 Y $13.08 TC Fee Schedule - 1/1/2017
73030 Y $8.98 26 Fee Schedule (FS) - 8/1/2016
73030 Y $25.73 General Fee Schedule - 1/1/2017
73030 Y $16.80 TC Fee Schedule - 1/1/2017
73040 Y $25.86 26 Fee Schedule (FS) - 1/1/2017
73040 Y $88.77 General Fee Schedule - 1/1/2017
73040 Y $62.91 TC Fee Schedule - 1/1/2017
73050 Y $10.04 26 Fee Schedule (FS) - 8/1/2016
73050 Y $31.66 General Fee Schedule - 1/1/2017
73050 Y $21.74 TC Fee Schedule - 1/1/2017
73060 Y $7.94 26 Fee Schedule (FS) - 1/1/2017
73060 Y $25.67 General Fee Schedule - 1/1/2017
73060 Y $17.72 TC Fee Schedule - 1/1/2017
73070 Y $7.54 26 Fee Schedule (FS) - 8/1/2016
73070 Y $24.40 General Fee Schedule - 1/1/2017
73070 Y $16.80 TC Fee Schedule - 1/1/2017
73080 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
73080 Y $27.55 General Fee Schedule - 1/1/2017
73080 Y $19.27 TC Fee Schedule - 1/1/2017
73085 Y $26.92 26 Fee Schedule (FS) - 8/1/2016
73085 Y $86.69 General Fee Schedule - 1/1/2017
73085 Y $59.50 TC Fee Schedule - 1/1/2017
73090 Y $7.90 26 Fee Schedule (FS) - 8/1/2016
73090 Y $22.88 General Fee Schedule - 1/1/2017
73090 Y $14.94 TC Fee Schedule - 1/1/2017
73092 Y $7.63 26 Fee Schedule (FS) - 1/1/2017
73092 Y $24.12 General Fee Schedule - 1/1/2017
73092 Y $16.77 TC Fee Schedule - 8/1/2016
73100 Y $7.90 26 Fee Schedule (FS) - 8/1/2016
73100 Y $24.67 General Fee Schedule - 8/1/2016
73100 Y $16.77 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 188 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
73110 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
73110 Y $27.79 General Fee Schedule - 12/1/2009
73110 Y $18.83 TC Fee Schedule - 12/1/2009
73115 Y $26.58 26 Fee Schedule (FS) - 8/1/2016
73115 Y $85.25 General Fee Schedule - 12/1/2009
73115 Y $57.55 TC Fee Schedule - 12/1/2009
73120 Y $7.90 26 Fee Schedule (FS) - 8/1/2016
73120 Y $23.19 General Fee Schedule - 1/1/2017
73120 Y $15.25 TC Fee Schedule - 1/1/2017
73130 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
73130 Y $26.68 General Fee Schedule - 8/1/2016
73130 Y $18.08 TC Fee Schedule - 8/1/2016
73140 Y $6.46 26 Fee Schedule (FS) - 8/1/2016
73140 Y $21.81 General Fee Schedule - 12/1/2009
73140 Y $15.07 TC Fee Schedule - 12/1/2009
73200 Y $47.48 26 Fee Schedule (FS) - 1/1/2017
73200 Y $144.43 General Fee Schedule - 1/1/2017
73200 Y $96.95 TC Fee Schedule - 1/1/2017
73201 Y $55.11 26 Fee Schedule (FS) - 1/1/2017
73201 Y $197.26 General Fee Schedule - 1/1/2017
73201 Y $142.15 TC Fee Schedule - 1/1/2017
73202 Y $57.75 26 Fee Schedule (FS) - 1/1/2017
73202 Y $245.09 General Fee Schedule - 1/1/2017
73202 Y $187.33 TC Fee Schedule - 1/1/2017
73206 Y $84.99 26 Fee Schedule (FS) - 1/1/2017
73206 Y $289.11 General Fee Schedule - 1/1/2017
73206 Y $204.12 TC Fee Schedule - 1/1/2017
73218 Y $64.07 26 Fee Schedule (FS) - 1/1/2017
73218 Y $300.08 General Fee Schedule - 1/1/2017
73218 Y $236.01 TC Fee Schedule - 1/1/2017
73219 Y $76.65 26 Fee Schedule (FS) - 1/1/2017
73219 Y $356.29 General Fee Schedule - 1/1/2017
73219 Y $279.64 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 189 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
73220 Y $101.86 26 Fee Schedule (FS) - 1/1/2017
73220 Y $441.24 General Fee Schedule - 1/1/2017
73220 Y $339.38 TC Fee Schedule - 1/1/2017
73221 Y $64.38 26 Fee Schedule (FS) - 1/1/2017
73221 Y $209.70 General Fee Schedule - 1/1/2017
73221 Y $145.32 TC Fee Schedule - 1/1/2017
73222 Y $76.96 26 Fee Schedule (FS) - 1/1/2017
73222 Y $333.70 General Fee Schedule - 1/1/2017
73222 Y $256.74 TC Fee Schedule - 1/1/2017
73223 Y $101.86 26 Fee Schedule (FS) - 1/1/2017
73223 Y $414.62 General Fee Schedule - 1/1/2017
73223 Y $312.76 TC Fee Schedule - 1/1/2017
73225 Y $80.66 26 Fee Schedule (FS) - 8/1/2016
73225 Y $357.60 General Fee Schedule - 1/1/2017
73225 Y $265.24 TC Fee Schedule - 8/1/2016
73501 Y $8.93 26 Fee Schedule (FS) - 8/1/2016
73501 Y $26.65 General Fee Schedule - 8/1/2016
73501 Y $17.72 TC Fee Schedule - 8/1/2016
73502 Y $10.58 26 Fee Schedule (FS) - 8/1/2016
73502 Y $36.67 General Fee Schedule - 8/1/2016
73502 Y $26.08 TC Fee Schedule - 8/1/2016
73503 Y $13.59 26 Fee Schedule (FS) - 8/1/2016
73503 Y $45.86 General Fee Schedule - 8/1/2016
73503 Y $32.27 TC Fee Schedule - 8/1/2016
73521 Y $10.89 26 Fee Schedule (FS) - 8/1/2016
73521 Y $35.43 General Fee Schedule - 8/1/2016
73521 Y $24.53 TC Fee Schedule - 8/1/2016
73522 Y $14.26 26 Fee Schedule (FS) - 8/1/2016
73522 Y $43.44 General Fee Schedule - 8/1/2016
73522 Y $29.18 TC Fee Schedule - 8/1/2016
73523 Y $15.25 26 Fee Schedule (FS) - 8/1/2016
73523 Y $50.30 General Fee Schedule - 8/1/2016
73523 Y $35.05 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 190 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
73525 Y $26.92 26 Fee Schedule (FS) - 8/1/2016
73525 Y $90.40 General Fee Schedule - 1/1/2017
73525 Y $63.22 TC Fee Schedule - 1/1/2017
73551 Y $7.94 26 Fee Schedule (FS) - 8/1/2016
73551 Y $24.74 General Fee Schedule - 8/1/2016
73551 Y $16.80 TC Fee Schedule - 8/1/2016
73552 Y $8.93 26 Fee Schedule (FS) - 8/1/2016
73552 Y $28.82 General Fee Schedule - 8/1/2016
73552 Y $19.89 TC Fee Schedule - 8/1/2016
73560 Y $7.94 26 Fee Schedule (FS) - 1/1/2017
73560 Y $26.36 General Fee Schedule - 8/1/2016
73560 Y $18.50 TC Fee Schedule - 12/1/2009
73562 Y $8.98 26 Fee Schedule (FS) - 8/1/2016
73562 Y $30.23 General Fee Schedule - 12/1/2009
73562 Y $20.90 TC Fee Schedule - 12/1/2009
73564 Y $10.78 26 Fee Schedule (FS) - 8/1/2016
73564 Y $32.49 General Fee Schedule - 8/1/2016
73564 Y $22.61 TC Fee Schedule - 12/1/2009
73565 Y $8.25 26 Fee Schedule (FS) - 1/1/2017
73565 Y $26.43 General Fee Schedule - 12/1/2009
73565 Y $17.47 TC Fee Schedule - 12/1/2009
73580 Y $26.59 26 Fee Schedule (FS) - 8/1/2016
73580 Y $102.16 General Fee Schedule - 1/1/2017
73580 Y $75.29 TC Fee Schedule - 1/1/2017
73590 Y $7.94 26 Fee Schedule (FS) - 1/1/2017
73590 Y $25.36 General Fee Schedule - 1/1/2017
73590 Y $17.76 TC Fee Schedule - 8/1/2016
73592 Y $7.63 26 Fee Schedule (FS) - 1/1/2017
73592 Y $24.67 General Fee Schedule - 8/1/2016
73592 Y $16.77 TC Fee Schedule - 8/1/2016
73600 Y $7.90 26 Fee Schedule (FS) - 8/1/2016
73600 Y $24.67 General Fee Schedule - 8/1/2016
73600 Y $17.47 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 191 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
73610 Y $8.28 26 Fee Schedule (FS) - 1/1/2017
73610 Y $26.68 General Fee Schedule - 8/1/2016
73610 Y $18.08 TC Fee Schedule - 8/1/2016
73615 Y $26.92 26 Fee Schedule (FS) - 8/1/2016
73615 Y $93.41 General Fee Schedule - 1/1/2017
73615 Y $66.32 TC Fee Schedule - 1/1/2017
73620 Y $7.32 26 Fee Schedule (FS) - 1/1/2017
73620 Y $23.19 General Fee Schedule - 1/1/2017
73620 Y $15.87 TC Fee Schedule - 1/1/2017
73630 Y $7.97 26 Fee Schedule (FS) - 1/1/2017
73630 Y $26.01 General Fee Schedule - 1/1/2017
73630 Y $18.08 TC Fee Schedule - 8/1/2016
73650 Y $7.63 26 Fee Schedule (FS) - 1/1/2017
73650 Y $24.02 General Fee Schedule - 8/1/2016
73650 Y $16.11 TC Fee Schedule - 8/1/2016
73660 Y $6.32 26 Fee Schedule (FS) - 1/1/2017
73660 Y $21.81 General Fee Schedule - 12/1/2009
73660 Y $15.07 TC Fee Schedule - 12/1/2009
73700 Y $47.48 26 Fee Schedule (FS) - 1/1/2017
73700 Y $144.43 General Fee Schedule - 1/1/2017
73700 Y $96.95 TC Fee Schedule - 1/1/2017
73701 Y $55.11 26 Fee Schedule (FS) - 1/1/2017
73701 Y $200.35 General Fee Schedule - 1/1/2017
73701 Y $145.24 TC Fee Schedule - 1/1/2017
73702 Y $57.44 26 Fee Schedule (FS) - 1/1/2017
73702 Y $242.60 General Fee Schedule - 1/1/2017
73702 Y $185.16 TC Fee Schedule - 1/1/2017
73706 Y $89.34 26 Fee Schedule (FS) - 1/1/2017
73706 Y $293.85 General Fee Schedule - 1/1/2017
73706 Y $204.52 TC Fee Schedule - 1/1/2017
73718 Y $64.07 26 Fee Schedule (FS) - 1/1/2017
73718 Y $300.08 General Fee Schedule - 1/1/2017
73718 Y $236.01 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 192 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
73719 Y $76.65 26 Fee Schedule (FS) - 1/1/2017
73719 Y $356.29 General Fee Schedule - 1/1/2017
73719 Y $279.64 TC Fee Schedule - 1/1/2017
73720 Y $101.55 26 Fee Schedule (FS) - 1/1/2017
73720 Y $443.41 General Fee Schedule - 1/1/2017
73720 Y $341.85 TC Fee Schedule - 1/1/2017
73721 Y $64.38 26 Fee Schedule (FS) - 1/1/2017
73721 Y $210.01 General Fee Schedule - 1/1/2017
73721 Y $145.62 TC Fee Schedule - 1/1/2017
73722 Y $76.96 26 Fee Schedule (FS) - 1/1/2017
73722 Y $337.10 General Fee Schedule - 1/1/2017
73722 Y $260.15 TC Fee Schedule - 1/1/2017
73723 Y $101.55 26 Fee Schedule (FS) - 1/1/2017
73723 Y $415.55 General Fee Schedule - 1/1/2017
73723 Y $314.00 TC Fee Schedule - 1/1/2017
73725 Y $85.01 26 Fee Schedule (FS) - 1/1/2017
73725 Y $354.45 General Fee Schedule - 1/1/2017
73725 Y $269.43 TC Fee Schedule - 1/1/2017
74018 Y $8.58 26 Fee Schedule (FS) - 1/1/2018
74018 Y $24.59 General Fee Schedule - 1/1/2018
74018 Y $19.12 TC Fee Schedule - 1/1/2018
74019 Y $10.87 26 Fee Schedule (FS) - 1/1/2018
74019 Y $30.00 General Fee Schedule - 1/1/2018
74019 Y $19.12 TC Fee Schedule - 1/1/2018
74021 Y $12.93 26 Fee Schedule (FS) - 1/1/2018
74021 Y $35.17 General Fee Schedule - 1/1/2018
74021 Y $22.24 TC Fee Schedule - 1/1/2018
74022 Y $15.48 26 Fee Schedule (FS) - 8/1/2016
74022 Y $39.81 General Fee Schedule - 1/1/2017
74022 Y $24.53 TC Fee Schedule - 1/1/2017
74150 Y $56.43 26 Fee Schedule (FS) - 1/1/2017
74150 Y $133.89 General Fee Schedule - 1/1/2017
74150 Y $77.46 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 193 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
74160 Y $60.06 26 Fee Schedule (FS) - 1/1/2017
74160 Y $204.37 General Fee Schedule - 1/1/2017
74160 Y $144.31 TC Fee Schedule - 1/1/2017
74170 Y $66.37 26 Fee Schedule (FS) - 1/1/2017
74170 Y $232.35 General Fee Schedule - 1/1/2017
74170 Y $165.98 TC Fee Schedule - 1/1/2017
74174 Y $99.20 26 Fee Schedule (FS) - 8/1/2016
74174 Y $344.59 General Fee Schedule - 1/1/2017
74174 Y $240.96 TC Fee Schedule - 1/1/2017
74175 Y $85.63 26 Fee Schedule (FS) - 1/1/2017
74175 Y $272.42 General Fee Schedule - 1/1/2017
74175 Y $186.80 TC Fee Schedule - 1/1/2017
74176 Y $80.27 26 Fee Schedule (FS) - 8/1/2016
74176 Y $179.28 General Fee Schedule - 1/1/2017
74176 Y $96.95 TC Fee Schedule - 1/1/2017
74177 Y $84.12 26 Fee Schedule (FS) - 8/1/2016
74177 Y $276.37 General Fee Schedule - 1/1/2017
74177 Y $190.12 TC Fee Schedule - 1/1/2017
74178 Y $93.16 26 Fee Schedule (FS) - 8/1/2016
74178 Y $312.95 General Fee Schedule - 1/1/2017
74178 Y $218.05 TC Fee Schedule - 1/1/2017
74181 Y $69.01 26 Fee Schedule (FS) - 1/1/2017
74181 Y $293.87 General Fee Schedule - 1/1/2017
74181 Y $224.87 TC Fee Schedule - 1/1/2017
74182 Y $81.98 26 Fee Schedule (FS) - 1/1/2017
74182 Y $400.01 General Fee Schedule - 1/1/2017
74182 Y $318.02 TC Fee Schedule - 1/1/2017
74183 Y $106.89 26 Fee Schedule (FS) - 1/1/2017
74183 Y $447.20 General Fee Schedule - 1/1/2017
74183 Y $340.31 TC Fee Schedule - 1/1/2017
74185 Y $84.65 26 Fee Schedule (FS) - 1/1/2017
74185 Y $355.94 General Fee Schedule - 1/1/2017
74185 Y $271.28 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 194 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
74190 Y $22.29 26 Fee Schedule (FS) - 1/1/2017
74210 Y $16.93 26 Fee Schedule (FS) - 1/1/2017
74210 Y $61.51 General Fee Schedule - 12/1/2009
74210 Y $42.82 TC Fee Schedule - 12/1/2009
74220 Y $21.93 26 Fee Schedule (FS) - 1/1/2017
74220 Y $66.40 General Fee Schedule - 12/1/2009
74220 Y $42.82 TC Fee Schedule - 12/1/2009
74230 Y $25.21 26 Fee Schedule (FS) - 1/1/2017
74230 Y $74.23 General Fee Schedule - 12/1/2009
74230 Y $47.27 TC Fee Schedule - 12/1/2009
74235 Y $57.96 26 Fee Schedule (FS) - 8/1/2016
74240 Y $32.85 26 Fee Schedule (FS) - 1/1/2017
74240 Y $88.29 General Fee Schedule - 12/1/2009
74240 Y $52.75 TC Fee Schedule - 12/1/2009
74241 Y $32.85 26 Fee Schedule (FS) - 1/1/2017
74241 Y $89.33 General Fee Schedule - 12/1/2009
74241 Y $53.78 TC Fee Schedule - 12/1/2009
74245 Y $43.13 26 Fee Schedule (FS) - 1/1/2017
74245 Y $133.09 General Fee Schedule - 12/1/2009
74245 Y $86.32 TC Fee Schedule - 12/1/2009
74246 Y $32.54 26 Fee Schedule (FS) - 1/1/2017
74246 Y $95.15 General Fee Schedule - 12/1/2009
74246 Y $59.61 TC Fee Schedule - 12/1/2009
74247 Y $32.85 26 Fee Schedule (FS) - 1/1/2017
74247 Y $96.86 General Fee Schedule - 12/1/2009
74247 Y $61.31 TC Fee Schedule - 12/1/2009
74249 Y $43.13 26 Fee Schedule (FS) - 1/1/2017
74249 Y $139.94 General Fee Schedule - 12/1/2009
74249 Y $93.17 TC Fee Schedule - 12/1/2009
74250 Y $22.26 26 Fee Schedule (FS) - 1/1/2017
74250 Y $71.24 General Fee Schedule - 12/1/2009
74250 Y $47.27 TC Fee Schedule - 12/1/2009
74251 Y $31.80 26 Fee Schedule (FS) - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 195 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
74251 Y $82.82 General Fee Schedule - 12/1/2009
74251 Y $47.27 TC Fee Schedule - 12/1/2009
74260 Y $23.58 26 Fee Schedule (FS) - 1/1/2017
74260 Y $79.25 General Fee Schedule - 12/1/2009
74260 Y $53.78 TC Fee Schedule - 12/1/2009
74261 Y $106.17 26 Fee Schedule (FS) - 1/1/2010
74261 Y $211.11 General Fee Schedule - 1/1/2017
74261 Y $97.26 TC Fee Schedule - 1/1/2017
74262 Y $111.87 26 Fee Schedule (FS) - 8/1/2016
74262 Y $322.50 General Fee Schedule - 1/1/2017
74262 Y $204.05 TC Fee Schedule - 1/1/2017
74263 Y $0.00 26 by Report - 1/1/2010
74263 Y $0.00 General by Report - 1/1/2010
74263 Y $0.00 TC by Report - 1/1/2010
74270 Y $32.85 26 Fee Schedule (FS) - 1/1/2017
74270 Y $97.54 General Fee Schedule - 12/1/2009
74270 Y $62.00 TC Fee Schedule - 12/1/2009
74280 Y $47.14 26 Fee Schedule (FS) - 1/1/2017
74280 Y $131.74 General Fee Schedule - 12/1/2009
74280 Y $81.19 TC Fee Schedule - 12/1/2009
74283 Y $78.60 26 Fee Schedule (FS) - 12/1/2009
74283 Y $188.64 General Fee Schedule - 8/1/2016
74283 Y $89.12 TC Fee Schedule - 8/1/2016
74290 Y $15.48 26 Fee Schedule (FS) - 8/1/2016
74290 Y $42.84 General Fee Schedule - 12/1/2009
74290 Y $26.71 TC Fee Schedule - 12/1/2009
74300 Y $17.32 26 Fee Schedule (FS) - 1/1/2017
74301 Y $10.02 26 Fee Schedule (FS) - 1/1/2017
74328 Y $34.15 26 Fee Schedule (FS) - 8/1/2016
74329 Y $34.15 26 Fee Schedule (FS) - 8/1/2016
74330 Y $42.79 26 Fee Schedule (FS) - 1/1/2017
74340 Y $25.55 26 Fee Schedule (FS) - 1/1/2017
74355 Y $36.99 26 Fee Schedule (FS) - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 196 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
74360 Y $26.64 26 Fee Schedule (FS) - 8/1/2016
74363 Y $40.57 26 Fee Schedule (FS) - 1/1/2017
74400 Y $23.25 26 Fee Schedule (FS) - 1/1/2017
74400 Y $86.40 General Fee Schedule - 12/1/2009
74400 Y $61.31 TC Fee Schedule - 12/1/2009
74410 Y $22.94 26 Fee Schedule (FS) - 1/1/2017
74410 Y $92.14 General Fee Schedule - 8/1/2016
74410 Y $68.07 TC Fee Schedule - 8/1/2016
74415 Y $23.25 26 Fee Schedule (FS) - 1/1/2017
74415 Y $102.16 General Fee Schedule - 12/1/2009
74415 Y $77.07 TC Fee Schedule - 12/1/2009
74420 Y $16.53 26 Fee Schedule (FS) - 1/1/2017
74425 Y $16.62 26 Fee Schedule (FS) - 1/1/2017
74430 Y $14.96 26 Fee Schedule (FS) - 1/1/2017
74430 Y $33.61 General Fee Schedule - 1/1/2017
74430 Y $18.65 TC Fee Schedule - 1/1/2017
74440 Y $17.21 26 Fee Schedule (FS) - 1/1/2017
74440 Y $60.23 General Fee Schedule - 12/1/2009
74440 Y $40.76 TC Fee Schedule - 12/1/2009
74445 Y $39.54 26 Fee Schedule (FS) - 12/1/2009
74450 Y $15.61 26 Fee Schedule (FS) - 1/1/2017
74455 Y $15.61 26 Fee Schedule (FS) - 1/1/2017
74455 Y $71.76 General Fee Schedule - 8/1/2016
74455 Y $55.25 TC Fee Schedule - 8/1/2016
74470 Y $24.93 26 Fee Schedule (FS) - 1/1/2017
74485 Y $24.54 26 Fee Schedule (FS) - 1/1/2017
74485 Y $81.88 General Fee Schedule - 1/1/2017
74485 Y $57.34 TC Fee Schedule - 1/1/2017
74710 Y $16.25 26 Fee Schedule (FS) - 1/1/2017
74710 Y $33.05 General Fee Schedule - 1/1/2017
74710 Y $16.80 TC Fee Schedule - 1/1/2017
74712 Y $151.43 26 Fee Schedule (FS) - 1/1/2016
74712 Y $402.50 General Fee Schedule - 1/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 197 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
74712 Y $251.07 TC Fee Schedule - 1/1/2016
74713 Y $89.66 26 Fee Schedule (FS) - 1/1/2016
74713 Y $220.15 General Fee Schedule - 1/1/2016
74713 Y $130.47 TC Fee Schedule - 1/1/2016
74740 Y $17.92 26 Fee Schedule (FS) - 1/1/2017
74740 Y $64.40 General Fee Schedule - 8/1/2016
74740 Y $45.38 TC Fee Schedule - 8/1/2016
74742 Y $27.98 26 Fee Schedule (FS) - 1/1/2017
74775 Y $29.56 26 Fee Schedule (FS) - 1/1/2017
75557 Y $97.40 26 Fee Schedule (FS) - 12/1/2009
75557 Y $283.78 General Fee Schedule - 1/1/2017
75557 Y $174.64 TC Fee Schedule - 1/1/2017
75559 Y $124.12 26 Fee Schedule (FS) - 12/1/2009
75559 Y $387.24 General Fee Schedule - 1/1/2017
75559 Y $252.63 TC Fee Schedule - 1/1/2017
75561 Y $107.73 26 Fee Schedule (FS) - 12/1/2009
75561 Y $375.30 General Fee Schedule - 1/1/2017
75561 Y $254.88 TC Fee Schedule - 1/1/2017
75563 Y $128.96 26 Fee Schedule (FS) - 12/1/2009
75563 Y $445.11 General Fee Schedule - 1/1/2017
75563 Y $307.19 TC Fee Schedule - 1/1/2017
75565 Y $11.58 26 Fee Schedule (FS) - 8/1/2016
75565 Y $48.43 General Fee Schedule - 1/1/2017
75565 Y $36.83 TC Fee Schedule - 1/1/2017
75571 Y $25.86 26 Fee Schedule (FS) - 8/1/2016
75571 Y $38.43 General Fee Schedule - 1/1/2017
75571 Y $11.22 TC Fee Schedule - 1/1/2017
75572 Y $78.46 26 Fee Schedule (FS) - 8/1/2016
75572 Y $240.13 General Fee Schedule - 1/1/2010
75572 Y $158.40 TC Fee Schedule - 1/1/2010
75573 Y $112.35 26 Fee Schedule (FS) - 8/1/2016
75573 Y $327.62 General Fee Schedule - 8/1/2016
75573 Y $204.12 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 198 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
75574 Y $106.92 26 Fee Schedule (FS) - 8/1/2016
75574 Y $315.64 General Fee Schedule - 1/1/2017
75574 Y $204.12 TC Fee Schedule - 1/1/2017
75600 Y $23.10 26 Fee Schedule (FS) - 1/1/2017
75600 Y $173.91 General Fee Schedule - 1/1/2017
75600 Y $150.81 TC Fee Schedule - 1/1/2017
75605 Y $53.14 26 Fee Schedule (FS) - 1/1/2017
75605 Y $125.33 General Fee Schedule - 1/1/2017
75605 Y $72.19 TC Fee Schedule - 1/1/2017
75625 Y $53.38 26 Fee Schedule (FS) - 1/1/2017
75625 Y $124.95 General Fee Schedule - 1/1/2017
75625 Y $71.58 TC Fee Schedule - 1/1/2017
75630 Y $84.04 26 Fee Schedule (FS) - 1/1/2017
75630 Y $155.61 General Fee Schedule - 1/1/2017
75630 Y $71.58 TC Fee Schedule - 1/1/2017
75635 Y $112.61 26 Fee Schedule (FS) - 1/1/2017
75635 Y $317.13 General Fee Schedule - 1/1/2017
75635 Y $204.52 TC Fee Schedule - 1/1/2017
75705 Y $109.08 26 Fee Schedule (FS) - 8/1/2016
75705 Y $221.41 General Fee Schedule - 1/1/2017
75705 Y $112.51 TC Fee Schedule - 1/1/2017
75710 Y $53.69 26 Fee Schedule (FS) - 1/1/2017
75710 Y $147.02 General Fee Schedule - 1/1/2017
75710 Y $93.32 TC Fee Schedule - 1/1/2017
75716 Y $61.35 26 Fee Schedule (FS) - 1/1/2017
75716 Y $168.37 General Fee Schedule - 1/1/2017
75716 Y $107.02 TC Fee Schedule - 1/1/2017
75726 Y $52.66 26 Fee Schedule (FS) - 1/1/2017
75726 Y $134.15 General Fee Schedule - 1/1/2017
75726 Y $81.48 TC Fee Schedule - 1/1/2017
75731 Y $54.05 26 Fee Schedule (FS) - 1/1/2017
75731 Y $154.18 General Fee Schedule - 1/1/2017
75731 Y $100.13 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 199 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
75733 Y $59.69 26 Fee Schedule (FS) - 1/1/2017
75733 Y $164.55 General Fee Schedule - 1/1/2017
75733 Y $104.86 TC Fee Schedule - 1/1/2017
75736 Y $52.52 26 Fee Schedule (FS) - 1/1/2017
75736 Y $143.67 General Fee Schedule - 1/1/2017
75736 Y $91.16 TC Fee Schedule - 1/1/2017
75741 Y $60.24 26 Fee Schedule (FS) - 1/1/2017
75741 Y $136.16 General Fee Schedule - 1/1/2017
75741 Y $75.91 TC Fee Schedule - 1/1/2017
75743 Y $76.30 26 Fee Schedule (FS) - 1/1/2017
75743 Y $153.14 General Fee Schedule - 1/1/2017
75743 Y $76.84 TC Fee Schedule - 1/1/2017
75746 Y $53.20 26 Fee Schedule (FS) - 1/1/2017
75746 Y $136.62 General Fee Schedule - 1/1/2017
75746 Y $83.42 TC Fee Schedule - 1/1/2017
75756 Y $53.77 26 Fee Schedule (FS) - 1/1/2017
75756 Y $149.57 General Fee Schedule - 1/1/2017
75756 Y $95.80 TC Fee Schedule - 1/1/2017
75774 Y $16.70 26 Fee Schedule (FS) - 1/1/2017
75774 Y $77.76 General Fee Schedule - 1/1/2017
75774 Y $61.05 TC Fee Schedule - 1/1/2017
75801 Y $41.13 26 Fee Schedule (FS) - 8/1/2016
75803 Y $55.37 26 Fee Schedule (FS) - 1/1/2017
75805 Y $38.52 26 Fee Schedule (FS) - 1/1/2017
75807 Y $56.92 26 Fee Schedule (FS) - 8/1/2016
75809 Y $20.96 26 Fee Schedule (FS) - 12/1/2009
75809 Y $52.40 General Fee Schedule - 12/1/2009
75809 Y $28.44 TC Fee Schedule - 12/1/2009
75810 Y $54.13 26 Fee Schedule (FS) - 1/1/2017
75820 Y $28.21 26 Fee Schedule (FS) - 12/1/2009
75820 Y $70.53 General Fee Schedule - 12/1/2009
75820 Y $34.60 TC Fee Schedule - 12/1/2009
75822 Y $43.22 26 Fee Schedule (FS) - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 200 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
75822 Y $108.07 General Fee Schedule - 12/1/2009
75822 Y $53.43 TC Fee Schedule - 12/1/2009
75825 Y $54.00 26 Fee Schedule (FS) - 1/1/2017
75825 Y $123.72 General Fee Schedule - 1/1/2017
75825 Y $69.72 TC Fee Schedule - 1/1/2017
75827 Y $53.77 26 Fee Schedule (FS) - 1/1/2017
75827 Y $125.35 General Fee Schedule - 1/1/2017
75827 Y $71.58 TC Fee Schedule - 1/1/2017
75831 Y $52.52 26 Fee Schedule (FS) - 1/1/2017
75831 Y $126.57 General Fee Schedule - 1/1/2017
75831 Y $74.05 TC Fee Schedule - 1/1/2017
75833 Y $69.29 26 Fee Schedule (FS) - 1/1/2017
75833 Y $149.30 General Fee Schedule - 1/1/2017
75833 Y $80.01 TC Fee Schedule - 1/1/2017
75840 Y $54.05 26 Fee Schedule (FS) - 1/1/2017
75840 Y $133.36 General Fee Schedule - 1/1/2017
75840 Y $79.32 TC Fee Schedule - 1/1/2017
75842 Y $70.33 26 Fee Schedule (FS) - 1/1/2017
75842 Y $162.41 General Fee Schedule - 1/1/2017
75842 Y $92.08 TC Fee Schedule - 1/1/2017
75860 Y $53.05 26 Fee Schedule (FS) - 1/1/2017
75860 Y $128.97 General Fee Schedule - 1/1/2017
75860 Y $75.91 TC Fee Schedule - 1/1/2017
75870 Y $54.05 26 Fee Schedule (FS) - 1/1/2017
75870 Y $132.75 General Fee Schedule - 1/1/2017
75870 Y $78.70 TC Fee Schedule - 1/1/2017
75872 Y $50.81 26 Fee Schedule (FS) - 1/1/2017
75872 Y $126.41 General Fee Schedule - 1/1/2017
75872 Y $75.60 TC Fee Schedule - 1/1/2017
75880 Y $28.21 26 Fee Schedule (FS) - 12/1/2009
75880 Y $70.53 General Fee Schedule - 12/1/2009
75880 Y $34.60 TC Fee Schedule - 12/1/2009
75885 Y $65.63 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 201 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
75885 Y $142.79 General Fee Schedule - 1/1/2017
75885 Y $77.15 TC Fee Schedule - 1/1/2017
75887 Y $65.87 26 Fee Schedule (FS) - 1/1/2017
75887 Y $143.32 General Fee Schedule - 1/1/2017
75887 Y $77.46 TC Fee Schedule - 1/1/2017
75889 Y $52.27 26 Fee Schedule (FS) - 1/1/2017
75889 Y $129.42 General Fee Schedule - 1/1/2017
75889 Y $77.15 TC Fee Schedule - 1/1/2017
75891 Y $52.89 26 Fee Schedule (FS) - 1/1/2017
75891 Y $130.66 General Fee Schedule - 1/1/2017
75891 Y $77.77 TC Fee Schedule - 1/1/2017
75893 Y $25.55 26 Fee Schedule (FS) - 1/1/2017
75893 Y $104.87 General Fee Schedule - 1/1/2017
75893 Y $79.32 TC Fee Schedule - 1/1/2017
75894 Y $63.22 26 Fee Schedule (FS) - 1/1/2017
75898 Y $48.67 26 Fee Schedule (FS) - 12/1/2009
75901 Y $22.63 26 Fee Schedule (FS) - 1/1/2017
75901 Y $98.60 General Fee Schedule - 12/1/2009
75901 Y $73.53 TC Fee Schedule - 12/1/2009
75902 Y $18.02 26 Fee Schedule (FS) - 1/1/2017
75902 Y $63.91 General Fee Schedule - 1/1/2017
75902 Y $45.89 TC Fee Schedule - 1/1/2017
75956 Y $339.26 26 Fee Schedule (FS) - 1/1/2017
75957 Y $291.28 26 Fee Schedule (FS) - 1/1/2017
75958 Y $193.27 26 Fee Schedule (FS) - 1/1/2017
75959 Y $168.59 26 Fee Schedule (FS) - 1/1/2017
75970 Y $37.96 26 Fee Schedule (FS) - 1/1/2017
75984 Y $33.24 26 Fee Schedule (FS) - 1/1/2017
75984 Y $95.22 General Fee Schedule - 1/1/2017
75984 Y $61.98 TC Fee Schedule - 1/1/2017
75989 Y $55.20 26 Fee Schedule (FS) - 1/1/2017
75989 Y $109.12 General Fee Schedule - 1/1/2017
75989 Y $53.94 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 202 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76000 Y $8.27 26 Fee Schedule (FS) - 8/1/2016
76000 Y $41.87 General Fee Schedule - 1/1/2017
76000 Y $33.51 TC Fee Schedule - 1/1/2017
76001 Y $33.37 26 Fee Schedule (FS) - 8/1/2016
76010 Y $8.62 26 Fee Schedule (FS) - 1/1/2017
76010 Y $23.25 General Fee Schedule - 1/1/2017
76010 Y $14.63 TC Fee Schedule - 1/1/2017
76080 Y $25.24 26 Fee Schedule (FS) - 8/1/2016
76080 Y $49.77 General Fee Schedule - 1/1/2017
76080 Y $24.84 TC Fee Schedule - 1/1/2017
76098 Y $7.63 26 Fee Schedule (FS) - 1/1/2017
76098 Y $15.14 General Fee Schedule - 1/1/2017
76098 Y $7.51 TC Fee Schedule - 1/1/2017
76100 Y $28.72 26 Fee Schedule (FS) - 8/1/2016
76100 Y $75.15 General Fee Schedule - 12/1/2009
76100 Y $45.21 TC Fee Schedule - 12/1/2009
76101 Y $29.92 26 Fee Schedule (FS) - 12/1/2009
76101 Y $81.31 General Fee Schedule - 12/1/2009
76101 Y $51.38 TC Fee Schedule - 12/1/2009
76102 Y $29.92 26 Fee Schedule (FS) - 12/1/2009
76102 Y $93.30 General Fee Schedule - 12/1/2009
76102 Y $63.37 TC Fee Schedule - 12/1/2009
76120 Y $18.23 26 Fee Schedule (FS) - 1/1/2017
76120 Y $57.83 General Fee Schedule - 12/1/2009
76120 Y $38.02 TC Fee Schedule - 12/1/2009
76125 Y $13.30 26 Fee Schedule (FS) - 8/1/2016
76125 Y $42.28 General Fee Schedule - 12/1/2009
76125 Y $28.15 TC Fee Schedule - 12/1/2009
76140 Y $11.31 General Fee Schedule - 12/1/2009
76376 Y $9.30 26 Fee Schedule (FS) - 1/1/2017
76376 Y $20.83 General Fee Schedule - 1/1/2017
76376 Y $11.53 TC Fee Schedule - 1/1/2017
76377 Y $37.53 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 203 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76377 Y $58.98 General Fee Schedule - 1/1/2017
76377 Y $21.44 TC Fee Schedule - 1/1/2017
76380 Y $46.49 26 Fee Schedule (FS) - 1/1/2017
76380 Y $99.19 General Fee Schedule - 1/1/2017
76380 Y $52.70 TC Fee Schedule - 1/1/2017
76390 Y $424.70 General Fee Schedule - 12/1/2009
76496 Y $0.00 General by Report - 1/1/2003
76497 Y $0.00 General by Report - 1/1/2003
76498 Y $0.00 General by Report - 1/1/2003
76499 Y $0.00 26 by Report - 6/1/1981
76499 Y $0.00 General by Report - 10/1/1975
76506 Y $30.60 26 Fee Schedule (FS) - 1/1/2017
76506 Y $85.99 General Fee Schedule - 12/1/2009
76506 Y $51.38 TC Fee Schedule - 12/1/2009
76510 Y $64.62 26 Fee Schedule (FS) - 12/1/2009
76510 Y $155.08 General Fee Schedule - 8/1/2016
76510 Y $71.27 TC Fee Schedule - 1/1/2017
76511 Y $47.34 26 Fee Schedule (FS) - 8/1/2016
76511 Y $91.25 General Fee Schedule - 1/1/2017
76511 Y $42.18 TC Fee Schedule - 1/1/2017
76512 Y $42.39 26 Fee Schedule (FS) - 12/1/2009
76512 Y $83.82 General Fee Schedule - 1/1/2017
76512 Y $34.74 TC Fee Schedule - 1/1/2017
76513 Y $33.14 26 Fee Schedule (FS) - 1/1/2017
76513 Y $84.91 General Fee Schedule - 1/1/2017
76513 Y $51.77 TC Fee Schedule - 1/1/2017
76514 Y $4.68 26 Fee Schedule (FS) - 12/1/2009
76514 Y $11.70 General Fee Schedule - 12/1/2009
76514 Y $2.06 TC Fee Schedule - 12/1/2009
76516 Y $26.61 26 Fee Schedule (FS) - 12/1/2009
76516 Y $69.94 General Fee Schedule - 8/1/2016
76516 Y $41.98 TC Fee Schedule - 8/1/2016
76519 Y $28.22 26 Fee Schedule (FS) - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 204 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76519 Y $73.60 General Fee Schedule - 8/1/2016
76519 Y $45.38 TC Fee Schedule - 8/1/2016
76529 Y $26.19 26 Fee Schedule (FS) - 12/1/2009
76529 Y $68.76 General Fee Schedule - 8/1/2016
76529 Y $39.39 TC Fee Schedule - 8/1/2016
76536 Y $26.54 26 Fee Schedule (FS) - 1/1/2017
76536 Y $79.85 General Fee Schedule - 12/1/2009
76536 Y $51.38 TC Fee Schedule - 12/1/2009
76604 Y $25.58 26 Fee Schedule (FS) - 1/1/2017
76604 Y $75.35 General Fee Schedule - 12/1/2009
76604 Y $47.27 TC Fee Schedule - 12/1/2009
76641 Y $34.42 26 Fee Schedule (FS) - 8/1/2016
76641 Y $96.49 General Fee Schedule - 1/1/2017
76641 Y $63.25 TC Fee Schedule - 8/1/2016
76642 Y $32.06 26 Fee Schedule (FS) - 8/1/2016
76642 Y $79.64 General Fee Schedule - 1/1/2017
76642 Y $48.41 TC Fee Schedule - 8/1/2016
76700 Y $38.13 26 Fee Schedule (FS) - 1/1/2017
76700 Y $108.94 General Fee Schedule - 8/1/2016
76700 Y $68.73 TC Fee Schedule - 8/1/2016
76705 Y $27.85 26 Fee Schedule (FS) - 1/1/2017
76705 Y $78.42 General Fee Schedule - 8/1/2016
76705 Y $51.38 TC Fee Schedule - 12/1/2009
76706 Y $26.29 26 Fee Schedule (FS) - 1/1/2017
76706 Y $84.42 General Fee Schedule - 1/1/2017
76706 Y $58.13 TC Fee Schedule - 1/1/2017
76770 Y $34.85 26 Fee Schedule (FS) - 1/1/2017
76770 Y $101.46 General Fee Schedule - 1/1/2017
76770 Y $66.63 TC Fee Schedule - 1/1/2017
76775 Y $27.20 26 Fee Schedule (FS) - 1/1/2017
76775 Y $52.67 General Fee Schedule - 1/1/2017
76775 Y $25.46 TC Fee Schedule - 1/1/2017
76776 Y $31.80 26 Fee Schedule (FS) - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 205 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76776 Y $104.03 General Fee Schedule - 12/1/2009
76776 Y $72.23 TC Fee Schedule - 12/1/2009
76800 Y $42.90 26 Fee Schedule (FS) - 12/1/2009
76800 Y $107.26 General Fee Schedule - 12/1/2009
76800 Y $50.86 TC Fee Schedule - 12/1/2009
76801 Y $60.77 26 Fee Schedule (FS) - 12/1/2009
76801 Y $151.93 General Fee Schedule - 12/1/2009
76801 Y $90.94 TC Fee Schedule - 12/1/2009
76802 Y $39.74 26 Fee Schedule (FS) - 12/1/2009
76802 Y $99.34 General Fee Schedule - 12/1/2009
76802 Y $47.73 TC Fee Schedule - 12/1/2009
76805 Y $60.67 26 Fee Schedule (FS) - 12/1/2009
76805 Y $151.93 General Fee Schedule - 12/1/2009
76805 Y $90.94 TC Fee Schedule - 12/1/2009
76810 Y $44.95 26 Fee Schedule (FS) - 12/1/2009
76810 Y $112.37 General Fee Schedule - 12/1/2009
76810 Y $51.85 TC Fee Schedule - 12/1/2009
76811 Y $112.77 26 Fee Schedule (FS) - 12/1/2009
76811 Y $281.92 General Fee Schedule - 12/1/2009
76811 Y $161.97 TC Fee Schedule - 12/1/2009
76812 Y $68.66 26 Fee Schedule (FS) - 12/1/2009
76812 Y $171.64 General Fee Schedule - 12/1/2009
76812 Y $59.66 TC Fee Schedule - 12/1/2009
76813 Y $56.18 26 Fee Schedule (FS) - 12/1/2009
76813 Y $140.45 General Fee Schedule - 12/1/2009
76813 Y $76.25 TC Fee Schedule - 12/1/2009
76814 Y $37.55 26 Fee Schedule (FS) - 12/1/2009
76814 Y $93.88 General Fee Schedule - 12/1/2009
76814 Y $39.94 TC Fee Schedule - 12/1/2009
76815 Y $40.48 26 Fee Schedule (FS) - 12/1/2009
76815 Y $101.65 General Fee Schedule - 12/1/2009
76815 Y $61.17 TC Fee Schedule - 12/1/2009
76816 Y $40.58 26 Fee Schedule (FS) - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 206 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76816 Y $101.45 General Fee Schedule - 12/1/2009
76816 Y $47.71 TC Fee Schedule - 12/1/2009
76817 Y $44.29 26 Fee Schedule (FS) - 12/1/2009
76817 Y $110.72 General Fee Schedule - 12/1/2009
76817 Y $64.42 TC Fee Schedule - 12/1/2009
76818 Y $54.38 26 Fee Schedule (FS) - 12/1/2009
76818 Y $135.94 General Fee Schedule - 12/1/2009
76818 Y $69.73 TC Fee Schedule - 12/1/2009
76819 Y $48.02 26 Fee Schedule (FS) - 12/1/2009
76819 Y $120.67 General Fee Schedule - 12/1/2009
76819 Y $69.73 TC Fee Schedule - 12/1/2009
76820 Y $31.95 26 Fee Schedule (FS) - 12/1/2009
76820 Y $102.51 General Fee Schedule - 12/1/2009
76820 Y $70.56 TC Fee Schedule - 12/1/2009
76821 Y $44.41 26 Fee Schedule (FS) - 12/1/2009
76821 Y $114.95 General Fee Schedule - 12/1/2009
76821 Y $70.56 TC Fee Schedule - 12/1/2009
76825 Y $75.72 26 Fee Schedule (FS) - 12/1/2009
76825 Y $189.30 General Fee Schedule - 12/1/2009
76825 Y $85.22 TC Fee Schedule - 12/1/2009
76826 Y $32.87 26 Fee Schedule (FS) - 12/1/2009
76826 Y $82.19 General Fee Schedule - 12/1/2009
76826 Y $30.99 TC Fee Schedule - 12/1/2009
76827 Y $36.04 26 Fee Schedule (FS) - 12/1/2009
76827 Y $111.07 General Fee Schedule - 12/1/2009
76827 Y $75.04 TC Fee Schedule - 12/1/2009
76828 Y $33.79 26 Fee Schedule (FS) - 12/1/2009
76828 Y $84.47 General Fee Schedule - 12/1/2009
76828 Y $48.54 TC Fee Schedule - 12/1/2009
76830 Y $32.85 26 Fee Schedule (FS) - 1/1/2017
76830 Y $91.04 General Fee Schedule - 12/1/2009
76830 Y $55.49 TC Fee Schedule - 12/1/2009
76831 Y $37.15 26 Fee Schedule (FS) - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 207 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76831 Y $92.88 General Fee Schedule - 12/1/2009
76831 Y $55.49 TC Fee Schedule - 12/1/2009
76856 Y $32.54 26 Fee Schedule (FS) - 1/1/2017
76856 Y $91.04 General Fee Schedule - 12/1/2009
76856 Y $55.49 TC Fee Schedule - 12/1/2009
76857 Y $19.47 26 Fee Schedule (FS) - 12/1/2009
76857 Y $43.16 General Fee Schedule - 1/1/2017
76857 Y $19.89 TC Fee Schedule - 1/1/2017
76870 Y $30.24 26 Fee Schedule (FS) - 1/1/2017
76870 Y $61.27 General Fee Schedule - 1/1/2017
76870 Y $31.03 TC Fee Schedule - 1/1/2017
76872 Y $31.45 26 Fee Schedule (FS) - 1/1/2017
76872 Y $84.46 General Fee Schedule - 1/1/2017
76872 Y $53.01 TC Fee Schedule - 1/1/2017
76873 Y $63.13 26 Fee Schedule (FS) - 12/1/2009
76873 Y $151.52 General Fee Schedule - 8/1/2016
76873 Y $74.65 TC Fee Schedule - 8/1/2016
76881 Y $27.42 26 Fee Schedule (FS) - 8/1/2016
76881 Y $102.94 General Fee Schedule - 1/1/2017
76881 Y $73.12 TC Fee Schedule - 1/1/2017
76882 Y $19.83 26 Fee Schedule (FS) - 1/1/2011
76882 Y $29.52 General Fee Schedule - 1/1/2011
76882 Y $9.30 TC Fee Schedule - 8/1/2016
76885 Y $35.84 26 Fee Schedule (FS) - 8/1/2016
76885 Y $93.31 General Fee Schedule - 12/1/2009
76885 Y $55.49 TC Fee Schedule - 12/1/2009
76886 Y $28.86 26 Fee Schedule (FS) - 1/1/2017
76886 Y $83.19 General Fee Schedule - 12/1/2009
76886 Y $51.38 TC Fee Schedule - 12/1/2009
76930 Y $30.86 26 Fee Schedule (FS) - 1/1/2017
76930 Y $90.61 General Fee Schedule - 12/1/2009
76930 Y $55.49 TC Fee Schedule - 12/1/2009
76932 Y $30.55 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 208 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76936 Y $94.21 26 Fee Schedule (FS) - 1/1/2017
76936 Y $245.41 General Fee Schedule - 1/1/2017
76936 Y $151.20 TC Fee Schedule - 1/1/2017
76937 Y $13.00 26 Fee Schedule (FS) - 12/1/2009
76937 Y $28.53 General Fee Schedule - 1/1/2017
76937 Y $14.85 TC Fee Schedule - 1/1/2017
76940 Y $68.18 26 Fee Schedule (FS) - 12/1/2009
76941 Y $49.64 26 Fee Schedule (FS) - 12/1/2009
76942 Y $31.56 26 Fee Schedule (FS) - 1/1/2017
76942 Y $55.78 General Fee Schedule - 1/1/2017
76942 Y $24.22 TC Fee Schedule - 1/1/2017
76945 Y $31.88 26 Fee Schedule (FS) - 8/1/2016
76945 Y $89.36 General Fee Schedule - 1/1/2010
76945 Y $55.01 TC Fee Schedule - 1/1/2010
76946 Y $18.61 26 Fee Schedule (FS) - 1/1/2017
76946 Y $30.15 General Fee Schedule - 1/1/2017
76946 Y $11.53 TC Fee Schedule - 1/1/2017
76948 Y $19.81 26 Fee Schedule (FS) - 12/1/2009
76948 Y $75.31 General Fee Schedule - 12/1/2009
76948 Y $55.49 TC Fee Schedule - 12/1/2009
76965 Y $62.17 26 Fee Schedule (FS) - 1/1/2017
76965 Y $82.98 General Fee Schedule - 1/1/2017
76965 Y $20.82 TC Fee Schedule - 1/1/2017
76970 Y $18.27 26 Fee Schedule (FS) - 1/1/2017
76970 Y $58.61 General Fee Schedule - 12/1/2009
76970 Y $38.02 TC Fee Schedule - 12/1/2009
76975 Y $37.14 26 Fee Schedule (FS) - 8/1/2016
76977 Y $2.70 26 Fee Schedule (FS) - 1/1/2017
76977 Y $6.49 General Fee Schedule - 1/1/2017
76977 Y $3.80 TC Fee Schedule - 1/1/2017
76998 Y $61.09 26 Fee Schedule (FS) - 1/1/2017
76998 Y $182.66 General Fee Schedule - 1/1/2011
76998 Y $112.09 TC Fee Schedule - 1/1/2011
CPT FEES01/03/2018 at 6:55:00 AM - 209 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
76999 Y $0.00 26 by Report - 6/1/1981
76999 Y $0.00 General by Report - 7/1/1975
77001 Y $16.21 26 Fee Schedule (FS) - 12/1/2009
77001 Y $62.57 General Fee Schedule - 1/1/2017
77001 Y $44.57 TC Fee Schedule - 1/1/2017
77002 Y $22.69 26 Fee Schedule (FS) - 12/1/2009
77002 Y $63.30 General Fee Schedule - 12/1/2009
77002 Y $40.60 TC Fee Schedule - 12/1/2009
77003 Y $24.42 26 Fee Schedule (FS) - 12/1/2009
77003 Y $61.63 General Fee Schedule - 12/1/2009
77003 Y $37.19 TC Fee Schedule - 12/1/2009
77011 Y $51.70 26 Fee Schedule (FS) - 12/1/2009
77011 Y $198.01 General Fee Schedule - 1/1/2017
77011 Y $139.04 TC Fee Schedule - 1/1/2017
77012 Y $49.32 26 Fee Schedule (FS) - 12/1/2009
77012 Y $112.14 General Fee Schedule - 1/1/2017
77012 Y $57.96 TC Fee Schedule - 1/1/2017
77013 Y $184.84 26 Fee Schedule (FS) - 1/1/2017
77013 Y $625.52 General Fee Schedule - 1/1/2011
77013 Y $404.93 TC Fee Schedule - 1/1/2011
77014 Y $36.45 26 Fee Schedule (FS) - 12/1/2009
77014 Y $105.48 General Fee Schedule - 1/1/2017
77014 Y $64.46 TC Fee Schedule - 1/1/2017
77021 Y $65.11 26 Fee Schedule (FS) - 12/1/2009
77021 Y $355.26 General Fee Schedule - 1/1/2017
77021 Y $284.52 TC Fee Schedule - 1/1/2017
77022 Y $204.80 26 Fee Schedule (FS) - 8/1/2016
77022 Y $765.10 General Fee Schedule - 1/1/2011
77022 Y $528.25 TC Fee Schedule - 1/1/2011
77053 Y $15.51 26 Fee Schedule (FS) - 12/1/2009
77053 Y $51.98 General Fee Schedule - 1/1/2017
77053 Y $35.05 TC Fee Schedule - 1/1/2017
77054 Y $19.24 26 Fee Schedule (FS) - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 210 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77054 Y $68.40 General Fee Schedule - 1/1/2017
77054 Y $46.81 TC Fee Schedule - 1/1/2017
77058 Y $69.31 26 Fee Schedule (FS) - 12/1/2009
77058 Y $468.75 General Fee Schedule - 1/1/2017
77058 Y $391.76 TC Fee Schedule - 1/1/2017
77059 Y $69.31 26 Fee Schedule (FS) - 12/1/2009
77059 Y $468.75 General Fee Schedule - 1/1/2017
77059 Y $391.76 TC Fee Schedule - 1/1/2017
77061 Y $0.00 26 by Report - 1/1/2015
77061 Y $0.00 General by Report - 1/1/2015
77061 Y $0.00 TC by Report - 1/1/2015
77062 Y $0.00 26 by Report - 1/1/2015
77062 Y $0.00 General by Report - 1/1/2015
77062 Y $0.00 TC by Report - 1/1/2015
77063 Y $15.10 26 Fee Schedule (FS) - 1/1/2015
77063 Y $51.52 General Fee Schedule - 8/1/2016
77063 Y $22.36 TC Fee Schedule - 1/1/2017
77065 Y $0.00 26 by Report - 1/1/2017
77065 Y $0.00 General by Report - 1/1/2017
77065 Y $0.00 TC by Report - 1/1/2017
77066 Y $0.00 26 by Report - 1/1/2017
77066 Y $0.00 General by Report - 1/1/2017
77066 Y $0.00 TC by Report - 1/1/2017
77067 Y $0.00 26 by Report - 1/1/2017
77067 Y $0.00 General by Report - 1/1/2017
77067 Y $0.00 TC by Report - 1/1/2017
77071 Y $25.00 General Fee Schedule - 12/1/2009
77072 Y $7.80 26 Fee Schedule (FS) - 12/1/2009
77072 Y $18.95 General Fee Schedule - 12/1/2009
77072 Y $11.16 TC Fee Schedule - 12/1/2009
77073 Y $11.48 26 Fee Schedule (FS) - 12/1/2009
77073 Y $32.55 General Fee Schedule - 1/1/2017
77073 Y $18.96 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 211 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77074 Y $19.24 26 Fee Schedule (FS) - 12/1/2009
77074 Y $53.64 General Fee Schedule - 12/1/2009
77074 Y $34.41 TC Fee Schedule - 12/1/2009
77075 Y $23.31 26 Fee Schedule (FS) - 12/1/2009
77075 Y $71.77 General Fee Schedule - 8/1/2016
77075 Y $49.40 TC Fee Schedule - 8/1/2016
77076 Y $29.75 26 Fee Schedule (FS) - 12/1/2009
77076 Y $61.67 General Fee Schedule - 12/1/2009
77076 Y $31.93 TC Fee Schedule - 12/1/2009
77077 Y $13.49 26 Fee Schedule (FS) - 12/1/2009
77077 Y $33.59 General Fee Schedule - 1/1/2017
77077 Y $18.34 TC Fee Schedule - 1/1/2017
77078 Y $10.47 26 Fee Schedule (FS) - 12/1/2009
77078 Y $64.30 General Fee Schedule - 1/1/2017
77078 Y $52.70 TC Fee Schedule - 1/1/2017
77080 Y $9.00 26 Fee Schedule (FS) - 8/1/2016
77080 Y $36.61 General Fee Schedule - 1/1/2017
77080 Y $27.01 TC Fee Schedule - 1/1/2017
77081 Y $9.78 26 Fee Schedule (FS) - 12/1/2009
77081 Y $25.21 General Fee Schedule - 1/1/2017
77081 Y $14.94 TC Fee Schedule - 1/1/2017
77084 Y $68.26 26 Fee Schedule (FS) - 12/1/2009
77084 Y $311.98 General Fee Schedule - 1/1/2017
77084 Y $236.01 TC Fee Schedule - 1/1/2017
77085 Y $14.29 26 Fee Schedule (FS) - 1/1/2017
77085 Y $49.65 General Fee Schedule - 1/1/2017
77085 Y $35.36 TC Fee Schedule - 1/1/2017
77086 Y $8.45 26 Fee Schedule (FS) - 8/1/2016
77086 Y $32.18 General Fee Schedule - 8/1/2016
77086 Y $23.77 TC Fee Schedule - 8/1/2016
77261 Y $70.60 General Fee Schedule - 8/1/2016
77262 Y $106.49 General Fee Schedule - 8/1/2016
77263 Y $158.15 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 212 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77280 Y $33.73 26 Fee Schedule (FS) - 1/1/2017
77280 Y $161.30 General Fee Schedule - 12/1/2009
77280 Y $125.36 TC Fee Schedule - 12/1/2009
77285 Y $51.74 26 Fee Schedule (FS) - 8/1/2016
77285 Y $255.64 General Fee Schedule - 12/1/2009
77285 Y $201.74 TC Fee Schedule - 12/1/2009
77290 Y $76.89 26 Fee Schedule (FS) - 8/1/2016
77290 Y $315.75 General Fee Schedule - 12/1/2009
77290 Y $235.66 TC Fee Schedule - 12/1/2009
77293 Y $97.75 26 Fee Schedule (FS) - 8/1/2016
77293 Y $387.30 General Fee Schedule - 8/1/2016
77293 Y $301.62 TC Fee Schedule - 1/1/2014
77295 Y $206.92 26 Fee Schedule (FS) - 1/1/2017
77295 Y $441.62 General Fee Schedule - 1/1/2017
77295 Y $234.70 TC Fee Schedule - 1/1/2017
77299 Y $0.00 26 by Report - 6/1/1981
77299 Y $0.00 General by Report - 7/1/1975
77300 Y $30.55 26 Fee Schedule (FS) - 8/1/2016
77300 Y $60.21 General Fee Schedule - 1/1/2017
77300 Y $30.10 TC Fee Schedule - 1/1/2017
77301 Y $385.14 26 Fee Schedule (FS) - 1/1/2017
77301 Y $1,420.32 General Fee Schedule - 12/1/2009
77301 Y $1,010.11 TC Fee Schedule - 12/1/2009
77306 Y $66.60 26 Fee Schedule (FS) - 8/1/2016
77306 Y $132.85 General Fee Schedule - 8/1/2016
77306 Y $64.83 TC Fee Schedule - 8/1/2016
77307 Y $138.31 26 Fee Schedule (FS) - 8/1/2016
77307 Y $260.88 General Fee Schedule - 8/1/2016
77307 Y $118.53 TC Fee Schedule - 8/1/2016
77316 Y $67.00 26 Fee Schedule (FS) - 8/1/2016
77316 Y $169.31 General Fee Schedule - 8/1/2016
77316 Y $100.52 TC Fee Schedule - 8/1/2016
77317 Y $88.26 26 Fee Schedule (FS) - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 213 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77317 Y $221.62 General Fee Schedule - 8/1/2016
77317 Y $131.16 TC Fee Schedule - 8/1/2016
77318 Y $139.10 26 Fee Schedule (FS) - 8/1/2016
77318 Y $320.99 General Fee Schedule - 8/1/2016
77318 Y $177.91 TC Fee Schedule - 8/1/2016
77321 Y $46.71 26 Fee Schedule (FS) - 8/1/2016
77321 Y $84.09 General Fee Schedule - 1/1/2017
77321 Y $38.15 TC Fee Schedule - 1/1/2017
77331 Y $24.95 26 Fee Schedule (FS) - 12/1/2009
77331 Y $58.49 General Fee Schedule - 1/1/2017
77331 Y $16.49 TC Fee Schedule - 1/1/2017
77332 Y $26.59 26 Fee Schedule (FS) - 8/1/2016
77332 Y $72.96 General Fee Schedule - 8/1/2016
77332 Y $46.37 TC Fee Schedule - 8/1/2016
77333 Y $41.33 26 Fee Schedule (FS) - 8/1/2016
77333 Y $49.12 General Fee Schedule - 1/1/2017
77333 Y $8.44 TC Fee Schedule - 1/1/2017
77334 Y $61.08 26 Fee Schedule (FS) - 8/1/2016
77334 Y $136.96 General Fee Schedule - 1/1/2017
77334 Y $77.15 TC Fee Schedule - 1/1/2017
77336 Y $69.90 General Fee Schedule - 1/1/2017
77336 Y $57.03 TC Fee Schedule - 12/1/2009
77338 Y $206.48 26 Fee Schedule (FS) - 8/1/2016
77338 Y $422.05 General Fee Schedule - 8/1/2016
77338 Y $224.56 TC Fee Schedule - 1/1/2010
77370 Y $107.14 General Fee Schedule - 1/1/2017
77370 Y $68.00 TC Fee Schedule - 12/1/2009
77371 Y $942.08 General Fee Schedule - 12/1/2009
77372 Y $715.08 General Fee Schedule - 12/1/2009
77373 Y $1,191.36 General Fee Schedule - 1/1/2017
77385 Y $0.00 26 by Report - 1/1/2015
77385 Y $0.00 General by Report - 1/1/2015
77385 Y $0.00 TC by Report - 1/1/2015
CPT FEES01/03/2018 at 6:55:00 AM - 214 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77386 Y $0.00 26 by Report - 1/1/2015
77386 Y $0.00 General by Report - 1/1/2015
77386 Y $0.00 TC by Report - 1/1/2015
77387 Y $0.00 26 by Report - 1/1/2015
77387 Y $0.00 General by Report - 1/1/2015
77387 Y $0.00 TC by Report - 1/1/2015
77399 Y $0.00 26 by Report - 6/1/1981
77399 Y $0.00 General by Report - 7/1/1975
77401 Y $21.44 General Fee Schedule - 1/1/2017
77402 Y $64.09 General Fee Schedule - 12/1/2009
77407 Y $75.26 General Fee Schedule - 12/1/2009
77412 Y $83.74 General Fee Schedule - 12/1/2009
77417 Y $9.67 General Fee Schedule - 1/1/2017
77423 Y $81.87 General Fee Schedule - 12/1/2009
77424 Y $0.00 26 by Report - 1/1/2012
77424 Y $0.00 General by Report - 1/1/2012
77424 Y $0.00 TC by Report - 1/1/2012
77425 Y $0.00 26 by Report - 1/1/2012
77425 Y $0.00 General by Report - 1/1/2012
77425 Y $0.00 TC by Report - 1/1/2012
77427 Y $161.47 General Fee Schedule - 8/1/2016
77431 Y $91.46 General Fee Schedule - 8/1/2016
77432 Y $391.24 General Fee Schedule - 1/1/2017
77435 Y $549.52 General Fee Schedule - 8/1/2016
77469 Y $0.00 26 by Report - 1/1/2012
77469 Y $278.63 General Fee Schedule - 8/1/2016
77469 Y $0.00 TC by Report - 1/1/2012
77470 Y $100.83 26 Fee Schedule (FS) - 1/1/2017
77470 Y $143.09 General Fee Schedule - 1/1/2017
77470 Y $42.25 TC Fee Schedule - 1/1/2017
77499 Y $0.00 26 by Report - 6/1/1981
77499 Y $0.00 General by Report - 7/1/1975
77520 Y $868.55 General Fee Schedule - 1/1/2011
CPT FEES01/03/2018 at 6:55:00 AM - 215 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77522 Y $898.89 General Fee Schedule - 1/1/2011
77523 Y $933.94 General Fee Schedule - 1/1/2011
77525 Y $1,042.47 General Fee Schedule - 1/1/2011
77600 Y $68.90 26 Fee Schedule (FS) - 12/1/2009
77600 Y $188.45 General Fee Schedule - 12/1/2009
77600 Y $109.17 TC Fee Schedule - 12/1/2009
77605 Y $92.56 26 Fee Schedule (FS) - 12/1/2009
77605 Y $253.13 General Fee Schedule - 12/1/2009
77605 Y $145.45 TC Fee Schedule - 12/1/2009
77610 Y $76.29 26 Fee Schedule (FS) - 12/1/2009
77610 Y $190.73 General Fee Schedule - 12/1/2009
77610 Y $110.29 TC Fee Schedule - 12/1/2009
77615 Y $97.55 26 Fee Schedule (FS) - 8/1/2016
77615 Y $254.01 General Fee Schedule - 12/1/2009
77615 Y $146.95 TC Fee Schedule - 12/1/2009
77620 Y $74.97 26 Fee Schedule (FS) - 8/1/2016
77620 Y $195.21 General Fee Schedule - 12/1/2009
77620 Y $110.29 TC Fee Schedule - 12/1/2009
77750 Y $119.93 26 Fee Schedule (FS) - 12/1/2009
77750 Y $299.82 General Fee Schedule - 12/1/2009
77750 Y $47.95 TC Fee Schedule - 12/1/2009
77761 Y $112.53 26 Fee Schedule (FS) - 12/1/2009
77761 Y $281.33 General Fee Schedule - 12/1/2009
77761 Y $90.77 TC Fee Schedule - 12/1/2009
77762 Y $169.57 26 Fee Schedule (FS) - 12/1/2009
77762 Y $423.91 General Fee Schedule - 12/1/2009
77762 Y $130.50 TC Fee Schedule - 12/1/2009
77763 Y $240.57 26 Fee Schedule (FS) - 12/1/2009
77763 Y $601.43 General Fee Schedule - 12/1/2009
77763 Y $162.01 TC Fee Schedule - 12/1/2009
77767 Y $50.94 26 Fee Schedule (FS) - 8/1/2016
77767 Y $199.74 General Fee Schedule - 8/1/2016
77767 Y $148.80 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 216 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
77768 Y $67.45 26 Fee Schedule (FS) - 8/1/2016
77768 Y $312.05 General Fee Schedule - 8/1/2016
77768 Y $244.61 TC Fee Schedule - 8/1/2016
77770 Y $93.87 26 Fee Schedule (FS) - 8/1/2016
77770 Y $286.40 General Fee Schedule - 8/1/2016
77770 Y $192.53 TC Fee Schedule - 8/1/2016
77771 Y $183.44 26 Fee Schedule (FS) - 8/1/2016
77771 Y $534.06 General Fee Schedule - 8/1/2016
77771 Y $350.62 TC Fee Schedule - 8/1/2016
77772 Y $260.18 26 Fee Schedule (FS) - 8/1/2016
77772 Y $813.63 General Fee Schedule - 8/1/2016
77772 Y $553.44 TC Fee Schedule - 8/1/2016
77778 Y $274.58 26 Fee Schedule (FS) - 12/1/2009
77778 Y $720.94 General Fee Schedule - 8/1/2016
77778 Y $183.42 TC Fee Schedule - 12/1/2009
77789 Y $29.62 26 Fee Schedule (FS) - 12/1/2009
77789 Y $74.07 General Fee Schedule - 12/1/2009
77789 Y $16.10 TC Fee Schedule - 12/1/2009
77790 Y $28.68 26 Fee Schedule (FS) - 12/1/2009
77790 Y $13.08 General Fee Schedule - 1/1/2017
77790 Y $17.81 TC Fee Schedule - 12/1/2009
77799 Y $0.00 General by Report - 7/1/1975
78012 Y $8.63 26 Fee Schedule (FS) - 8/1/2016
78012 Y $71.95 General Fee Schedule - 1/1/2017
78012 Y $62.99 TC Fee Schedule - 1/1/2017
78013 Y $16.60 26 Fee Schedule (FS) - 8/1/2016
78013 Y $172.88 General Fee Schedule - 1/1/2017
78013 Y $155.62 TC Fee Schedule - 1/1/2017
78014 Y $22.40 26 Fee Schedule (FS) - 8/1/2016
78014 Y $214.85 General Fee Schedule - 8/1/2016
78014 Y $192.45 TC Fee Schedule - 8/1/2016
78015 Y $30.86 26 Fee Schedule (FS) - 1/1/2017
78015 Y $127.94 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 217 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78015 Y $93.17 TC Fee Schedule - 12/1/2009
78016 Y $32.34 26 Fee Schedule (FS) - 1/1/2017
78016 Y $167.98 General Fee Schedule - 12/1/2009
78016 Y $125.70 TC Fee Schedule - 12/1/2009
78018 Y $38.89 26 Fee Schedule (FS) - 1/1/2017
78018 Y $241.12 General Fee Schedule - 12/1/2009
78018 Y $196.27 TC Fee Schedule - 12/1/2009
78020 Y $26.25 26 Fee Schedule (FS) - 1/1/2017
78020 Y $77.49 General Fee Schedule - 8/1/2016
78020 Y $47.69 TC Fee Schedule - 8/1/2016
78070 Y $36.87 26 Fee Schedule (FS) - 1/1/2017
78070 Y $192.95 General Fee Schedule - 12/1/2009
78070 Y $150.33 TC Fee Schedule - 12/1/2009
78071 Y $53.12 26 Fee Schedule (FS) - 8/1/2016
78071 Y $321.56 General Fee Schedule - 8/1/2016
78071 Y $268.44 TC Fee Schedule - 8/1/2016
78072 Y $73.33 26 Fee Schedule (FS) - 8/1/2016
78072 Y $0.00 TC by Report - 1/1/2013
78075 Y $33.21 26 Fee Schedule (FS) - 1/1/2017
78075 Y $234.77 General Fee Schedule - 12/1/2009
78075 Y $196.27 TC Fee Schedule - 12/1/2009
78099 Y $0.00 26 by Report - 6/1/1981
78099 Y $0.00 General by Report - 7/1/1975
78102 Y $24.96 26 Fee Schedule (FS) - 1/1/2017
78102 Y $102.75 General Fee Schedule - 12/1/2009
78102 Y $74.33 TC Fee Schedule - 12/1/2009
78103 Y $34.25 26 Fee Schedule (FS) - 1/1/2017
78103 Y $153.63 General Fee Schedule - 12/1/2009
78103 Y $114.74 TC Fee Schedule - 12/1/2009
78104 Y $36.25 26 Fee Schedule (FS) - 1/1/2017
78104 Y $188.44 General Fee Schedule - 12/1/2009
78104 Y $147.28 TC Fee Schedule - 12/1/2009
78110 Y $8.96 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 218 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78110 Y $44.67 General Fee Schedule - 12/1/2009
78110 Y $34.60 TC Fee Schedule - 12/1/2009
78111 Y $10.27 26 Fee Schedule (FS) - 1/1/2017
78111 Y $87.28 General Fee Schedule - 1/1/2017
78111 Y $77.00 TC Fee Schedule - 1/1/2017
78120 Y $10.92 26 Fee Schedule (FS) - 1/1/2017
78120 Y $75.34 General Fee Schedule - 12/1/2009
78120 Y $63.37 TC Fee Schedule - 12/1/2009
78121 Y $15.28 26 Fee Schedule (FS) - 1/1/2017
78121 Y $92.89 General Fee Schedule - 1/1/2017
78121 Y $77.62 TC Fee Schedule - 1/1/2017
78122 Y $20.27 26 Fee Schedule (FS) - 1/1/2017
78122 Y $89.54 General Fee Schedule - 1/1/2017
78122 Y $69.26 TC Fee Schedule - 1/1/2017
78130 Y $28.44 26 Fee Schedule (FS) - 1/1/2017
78130 Y $134.52 General Fee Schedule - 12/1/2009
78130 Y $102.75 TC Fee Schedule - 12/1/2009
78135 Y $30.16 26 Fee Schedule (FS) - 1/1/2017
78135 Y $208.99 General Fee Schedule - 12/1/2009
78135 Y $175.72 TC Fee Schedule - 12/1/2009
78140 Y $28.84 26 Fee Schedule (FS) - 1/1/2017
78140 Y $124.41 General Fee Schedule - 1/1/2017
78140 Y $95.57 TC Fee Schedule - 1/1/2017
78185 Y $18.89 26 Fee Schedule (FS) - 1/1/2017
78185 Y $106.55 General Fee Schedule - 12/1/2009
78185 Y $85.63 TC Fee Schedule - 12/1/2009
78191 Y $28.44 26 Fee Schedule (FS) - 1/1/2017
78191 Y $153.50 General Fee Schedule - 1/1/2017
78191 Y $125.06 TC Fee Schedule - 1/1/2017
78195 Y $55.54 26 Fee Schedule (FS) - 1/1/2017
78195 Y $209.72 General Fee Schedule - 12/1/2009
78195 Y $147.28 TC Fee Schedule - 12/1/2009
78199 Y $0.00 26 by Report - 1/1/1996
CPT FEES01/03/2018 at 6:55:00 AM - 219 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78199 Y $0.00 General by Report - 1/1/1996
78201 Y $19.94 26 Fee Schedule (FS) - 1/1/2017
78201 Y $108.44 General Fee Schedule - 12/1/2009
78201 Y $85.63 TC Fee Schedule - 12/1/2009
78202 Y $22.60 26 Fee Schedule (FS) - 1/1/2017
78202 Y $129.98 General Fee Schedule - 12/1/2009
78202 Y $103.79 TC Fee Schedule - 12/1/2009
78205 Y $31.89 26 Fee Schedule (FS) - 1/1/2017
78205 Y $192.77 General Fee Schedule - 1/1/2017
78205 Y $160.88 TC Fee Schedule - 1/1/2017
78206 Y $44.19 26 Fee Schedule (FS) - 1/1/2017
78206 Y $256.57 General Fee Schedule - 12/1/2009
78206 Y $206.82 TC Fee Schedule - 12/1/2009
78215 Y $22.94 26 Fee Schedule (FS) - 1/1/2017
78215 Y $130.92 General Fee Schedule - 12/1/2009
78215 Y $105.84 TC Fee Schedule - 12/1/2009
78216 Y $25.94 26 Fee Schedule (FS) - 1/1/2017
78216 Y $114.70 General Fee Schedule - 1/1/2017
78216 Y $88.76 TC Fee Schedule - 1/1/2017
78226 Y $32.97 26 Fee Schedule (FS) - 8/1/2016
78226 Y $291.05 General Fee Schedule - 8/1/2016
78226 Y $258.09 TC Fee Schedule - 8/1/2016
78227 Y $39.69 26 Fee Schedule (FS) - 8/1/2016
78227 Y $310.19 General Fee Schedule - 2/6/2012
78227 Y $268.84 TC Fee Schedule - 2/6/2012
78230 Y $18.02 26 Fee Schedule (FS) - 1/1/2017
78230 Y $102.66 General Fee Schedule - 12/1/2009
78230 Y $79.47 TC Fee Schedule - 12/1/2009
78231 Y $24.56 26 Fee Schedule (FS) - 1/1/2017
78231 Y $118.59 General Fee Schedule - 1/1/2017
78231 Y $94.03 TC Fee Schedule - 1/1/2017
78232 Y $18.70 26 Fee Schedule (FS) - 1/1/2017
78232 Y $90.13 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 220 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78232 Y $71.43 TC Fee Schedule - 1/1/2017
78258 Y $34.54 26 Fee Schedule (FS) - 1/1/2017
78258 Y $141.94 General Fee Schedule - 12/1/2009
78258 Y $103.79 TC Fee Schedule - 12/1/2009
78261 Y $32.23 26 Fee Schedule (FS) - 1/1/2017
78261 Y $184.19 General Fee Schedule - 12/1/2009
78261 Y $148.31 TC Fee Schedule - 12/1/2009
78262 Y $31.19 26 Fee Schedule (FS) - 1/1/2017
78262 Y $188.61 General Fee Schedule - 12/1/2009
78262 Y $153.44 TC Fee Schedule - 12/1/2009
78264 Y $34.54 26 Fee Schedule (FS) - 1/1/2017
78264 Y $189.39 General Fee Schedule - 12/1/2009
78264 Y $149.34 TC Fee Schedule - 12/1/2009
78265 Y $45.49 26 Fee Schedule (FS) - 8/1/2016
78265 Y $332.49 General Fee Schedule - 8/1/2016
78265 Y $287.01 TC Fee Schedule - 8/1/2016
78266 Y $50.48 26 Fee Schedule (FS) - 8/1/2016
78266 Y $429.72 General Fee Schedule - 8/1/2016
78266 Y $379.24 TC Fee Schedule - 8/1/2016
78267 Y $10.40 General Fee Schedule - 1/1/2018
78268 Y $88.75 General Fee Schedule - 1/1/2018
78270 Y $10.04 26 Fee Schedule (FS) - 8/1/2016
78270 Y $66.99 General Fee Schedule - 12/1/2009
78270 Y $56.53 TC Fee Schedule - 12/1/2009
78271 Y $9.61 26 Fee Schedule (FS) - 1/1/2017
78271 Y $70.06 General Fee Schedule - 12/1/2009
78271 Y $59.61 TC Fee Schedule - 12/1/2009
78272 Y $12.58 26 Fee Schedule (FS) - 1/1/2017
78272 Y $88.03 General Fee Schedule - 1/1/2017
78272 Y $75.45 TC Fee Schedule - 1/1/2017
78278 Y $46.13 26 Fee Schedule (FS) - 1/1/2017
78278 Y $226.60 General Fee Schedule - 12/1/2009
78278 Y $175.72 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 221 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78282 Y $17.92 26 Fee Schedule (FS) - 1/1/2017
78290 Y $31.89 26 Fee Schedule (FS) - 1/1/2017
78290 Y $145.45 General Fee Schedule - 12/1/2009
78290 Y $110.29 TC Fee Schedule - 12/1/2009
78291 Y $39.87 26 Fee Schedule (FS) - 1/1/2017
78291 Y $156.26 General Fee Schedule - 12/1/2009
78291 Y $110.64 TC Fee Schedule - 12/1/2009
78299 Y $0.00 26 by Report - 6/1/1981
78299 Y $0.00 General by Report - 7/1/1975
78300 Y $29.56 26 Fee Schedule (FS) - 1/1/2017
78300 Y $122.24 General Fee Schedule - 12/1/2009
78300 Y $90.08 TC Fee Schedule - 12/1/2009
78305 Y $38.89 26 Fee Schedule (FS) - 1/1/2017
78305 Y $175.22 General Fee Schedule - 12/1/2009
78305 Y $132.21 TC Fee Schedule - 12/1/2009
78306 Y $40.20 26 Fee Schedule (FS) - 1/1/2017
78306 Y $198.64 General Fee Schedule - 12/1/2009
78306 Y $154.13 TC Fee Schedule - 12/1/2009
78315 Y $47.14 26 Fee Schedule (FS) - 1/1/2017
78315 Y $225.03 General Fee Schedule - 12/1/2009
78315 Y $172.64 TC Fee Schedule - 12/1/2009
78320 Y $47.51 26 Fee Schedule (FS) - 1/1/2017
78320 Y $208.07 General Fee Schedule - 1/1/2017
78320 Y $160.57 TC Fee Schedule - 1/1/2017
78350 Y $38.64 General Fee Schedule - 12/1/2009
78351 Y $87.10 General Fee Schedule - 12/1/2009
78399 Y $0.00 26 by Report - 1/1/1996
78399 Y $0.00 General by Report - 1/1/1996
78414 Y $20.89 26 Fee Schedule (FS) - 1/1/2017
78428 Y $35.49 26 Fee Schedule (FS) - 1/1/2017
78428 Y $122.95 General Fee Schedule - 12/1/2009
78428 Y $81.87 TC Fee Schedule - 12/1/2009
78445 Y $21.93 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 222 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78445 Y $93.25 General Fee Schedule - 12/1/2009
78445 Y $67.82 TC Fee Schedule - 12/1/2009
78451 Y $61.67 26 Fee Schedule (FS) - 8/1/2016
78451 Y $202.73 General Fee Schedule - 1/1/2010
78451 Y $138.49 TC Fee Schedule - 1/1/2010
78452 Y $72.91 26 Fee Schedule (FS) - 8/1/2016
78452 Y $343.55 General Fee Schedule - 1/1/2010
78452 Y $267.59 TC Fee Schedule - 1/1/2010
78453 Y $44.78 26 Fee Schedule (FS) - 8/1/2016
78453 Y $175.83 General Fee Schedule - 1/1/2010
78453 Y $129.18 TC Fee Schedule - 1/1/2010
78454 Y $59.40 26 Fee Schedule (FS) - 8/1/2016
78454 Y $170.50 General Fee Schedule - 1/1/2010
78454 Y $108.62 TC Fee Schedule - 1/1/2010
78456 Y $45.77 26 Fee Schedule (FS) - 1/1/2017
78456 Y $198.24 General Fee Schedule - 12/1/2009
78456 Y $146.63 TC Fee Schedule - 12/1/2009
78457 Y $36.41 26 Fee Schedule (FS) - 1/1/2017
78457 Y $135.91 General Fee Schedule - 12/1/2009
78457 Y $96.25 TC Fee Schedule - 12/1/2009
78458 Y $35.74 26 Fee Schedule (FS) - 1/1/2017
78458 Y $152.98 General Fee Schedule - 1/1/2017
78458 Y $117.24 TC Fee Schedule - 1/1/2017
78459 Y $66.48 26 Fee Schedule (FS) - 1/1/2017
78459 Y $1,397.47 General Fee Schedule - 12/1/2009
78459 Y $1,321.08 TC Fee Schedule - 12/1/2009
78466 Y $32.77 26 Fee Schedule (FS) - 1/1/2017
78466 Y $130.77 General Fee Schedule - 12/1/2009
78466 Y $94.89 TC Fee Schedule - 12/1/2009
78468 Y $36.78 26 Fee Schedule (FS) - 1/1/2017
78468 Y $166.44 General Fee Schedule - 8/1/2016
78468 Y $132.21 TC Fee Schedule - 12/1/2009
78469 Y $42.76 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 223 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78469 Y $207.35 General Fee Schedule - 1/1/2017
78469 Y $164.59 TC Fee Schedule - 1/1/2017
78472 Y $45.18 26 Fee Schedule (FS) - 1/1/2017
78472 Y $209.76 General Fee Schedule - 1/1/2017
78472 Y $164.59 TC Fee Schedule - 1/1/2017
78473 Y $67.02 26 Fee Schedule (FS) - 1/1/2017
78473 Y $264.50 General Fee Schedule - 1/1/2017
78473 Y $197.48 TC Fee Schedule - 1/1/2017
78481 Y $44.78 26 Fee Schedule (FS) - 1/1/2017
78481 Y $159.46 General Fee Schedule - 1/1/2017
78481 Y $114.68 TC Fee Schedule - 1/1/2017
78483 Y $67.02 26 Fee Schedule (FS) - 1/1/2017
78483 Y $221.40 General Fee Schedule - 1/1/2017
78483 Y $154.38 TC Fee Schedule - 1/1/2017
78491 Y $67.10 26 Fee Schedule (FS) - 1/1/2017
78491 Y $1,397.47 General Fee Schedule - 12/1/2009
78491 Y $1,321.08 TC Fee Schedule - 12/1/2009
78492 Y $84.29 26 Fee Schedule (FS) - 1/1/2017
78492 Y $1,676.97 General Fee Schedule - 12/1/2009
78492 Y $1,585.31 TC Fee Schedule - 12/1/2009
78494 Y $54.42 26 Fee Schedule (FS) - 1/1/2017
78494 Y $205.38 General Fee Schedule - 1/1/2017
78494 Y $150.97 TC Fee Schedule - 1/1/2017
78496 Y $22.88 26 Fee Schedule (FS) - 1/1/2017
78496 Y $40.92 General Fee Schedule - 1/1/2017
78496 Y $18.03 TC Fee Schedule - 1/1/2017
78499 Y $0.00 26 by Report - 6/1/1981
78499 Y $0.00 General by Report - 7/1/1975
78579 Y $21.78 26 Fee Schedule (FS) - 8/1/2016
78579 Y $161.48 General Fee Schedule - 2/6/2012
78579 Y $138.80 TC Fee Schedule - 2/6/2012
78580 Y $34.54 26 Fee Schedule (FS) - 1/1/2017
78580 Y $162.15 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 224 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78580 Y $124.00 TC Fee Schedule - 12/1/2009
78582 Y $47.07 26 Fee Schedule (FS) - 8/1/2016
78582 Y $286.30 General Fee Schedule - 8/1/2016
78582 Y $239.23 TC Fee Schedule - 8/1/2016
78597 Y $32.34 26 Fee Schedule (FS) - 8/1/2016
78597 Y $175.17 General Fee Schedule - 8/1/2016
78597 Y $142.83 TC Fee Schedule - 8/1/2016
78598 Y $36.84 26 Fee Schedule (FS) - 8/1/2016
78598 Y $268.28 General Fee Schedule - 8/1/2016
78598 Y $231.45 TC Fee Schedule - 8/1/2016
78599 Y $0.00 26 by Report - 6/1/1981
78599 Y $0.00 General by Report - 7/1/1975
78600 Y $20.94 26 Fee Schedule (FS) - 1/1/2017
78600 Y $126.59 General Fee Schedule - 12/1/2009
78600 Y $103.79 TC Fee Schedule - 12/1/2009
78601 Y $23.61 26 Fee Schedule (FS) - 1/1/2017
78601 Y $149.16 General Fee Schedule - 12/1/2009
78601 Y $122.97 TC Fee Schedule - 12/1/2009
78605 Y $25.21 26 Fee Schedule (FS) - 1/1/2017
78605 Y $150.28 General Fee Schedule - 12/1/2009
78605 Y $122.97 TC Fee Schedule - 12/1/2009
78606 Y $29.53 26 Fee Schedule (FS) - 1/1/2017
78606 Y $173.02 General Fee Schedule - 12/1/2009
78606 Y $140.10 TC Fee Schedule - 12/1/2009
78607 Y $55.85 26 Fee Schedule (FS) - 1/1/2017
78607 Y $300.95 General Fee Schedule - 12/1/2009
78607 Y $237.03 TC Fee Schedule - 12/1/2009
78608 Y $67.80 26 Fee Schedule (FS) - 1/1/2017
78608 Y $1,397.47 General Fee Schedule - 12/1/2009
78608 Y $1,321.08 TC Fee Schedule - 12/1/2009
78609 Y $77.44 26 Fee Schedule (FS) - 12/1/2009
78609 Y $1,397.47 General Fee Schedule - 12/1/2009
78609 Y $1,321.08 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 225 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78610 Y $14.29 26 Fee Schedule (FS) - 1/1/2017
78610 Y $73.24 General Fee Schedule - 12/1/2009
78610 Y $57.55 TC Fee Schedule - 12/1/2009
78630 Y $31.89 26 Fee Schedule (FS) - 1/1/2017
78630 Y $217.38 General Fee Schedule - 12/1/2009
78630 Y $182.22 TC Fee Schedule - 12/1/2009
78635 Y $28.84 26 Fee Schedule (FS) - 1/1/2017
78635 Y $124.25 General Fee Schedule - 12/1/2009
78635 Y $92.14 TC Fee Schedule - 12/1/2009
78645 Y $26.25 26 Fee Schedule (FS) - 1/1/2017
78645 Y $153.19 General Fee Schedule - 12/1/2009
78645 Y $124.00 TC Fee Schedule - 12/1/2009
78647 Y $42.48 26 Fee Schedule (FS) - 1/1/2017
78647 Y $260.47 General Fee Schedule - 12/1/2009
78647 Y $213.73 TC Fee Schedule - 12/1/2009
78650 Y $28.22 26 Fee Schedule (FS) - 1/1/2017
78650 Y $199.26 General Fee Schedule - 12/1/2009
78650 Y $167.49 TC Fee Schedule - 12/1/2009
78660 Y $25.21 26 Fee Schedule (FS) - 1/1/2017
78660 Y $104.38 General Fee Schedule - 12/1/2009
78660 Y $77.07 TC Fee Schedule - 12/1/2009
78699 Y $0.00 26 by Report - 6/1/1981
78699 Y $0.00 General by Report - 7/1/1975
78700 Y $20.89 26 Fee Schedule (FS) - 1/1/2017
78700 Y $133.48 General Fee Schedule - 12/1/2009
78700 Y $110.29 TC Fee Schedule - 12/1/2009
78701 Y $22.24 26 Fee Schedule (FS) - 1/1/2017
78701 Y $153.53 General Fee Schedule - 12/1/2009
78701 Y $128.45 TC Fee Schedule - 12/1/2009
78707 Y $44.19 26 Fee Schedule (FS) - 1/1/2017
78707 Y $202.28 General Fee Schedule - 8/1/2016
78707 Y $154.88 TC Fee Schedule - 8/1/2016
78708 Y $55.79 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 226 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78708 Y $160.10 General Fee Schedule - 1/1/2017
78708 Y $104.32 TC Fee Schedule - 1/1/2017
78709 Y $64.46 26 Fee Schedule (FS) - 1/1/2017
78709 Y $233.92 General Fee Schedule - 12/1/2009
78709 Y $161.33 TC Fee Schedule - 12/1/2009
78710 Y $28.97 26 Fee Schedule (FS) - 1/1/2017
78710 Y $182.11 General Fee Schedule - 1/1/2017
78710 Y $153.14 TC Fee Schedule - 1/1/2017
78725 Y $17.30 26 Fee Schedule (FS) - 1/1/2017
78725 Y $84.89 General Fee Schedule - 12/1/2009
78725 Y $65.09 TC Fee Schedule - 12/1/2009
78730 Y $7.30 26 Fee Schedule (FS) - 1/1/2017
78730 Y $68.59 General Fee Schedule - 8/1/2016
78730 Y $52.75 TC Fee Schedule - 12/1/2009
78740 Y $25.86 26 Fee Schedule (FS) - 1/1/2017
78740 Y $106.61 General Fee Schedule - 12/1/2009
78740 Y $77.07 TC Fee Schedule - 12/1/2009
78761 Y $33.52 26 Fee Schedule (FS) - 1/1/2017
78761 Y $152.43 General Fee Schedule - 12/1/2009
78761 Y $115.77 TC Fee Schedule - 12/1/2009
78799 Y $0.00 26 by Report - 6/1/1981
78799 Y $0.00 General by Report - 7/1/1975
78800 Y $32.00 26 Fee Schedule (FS) - 1/1/2017
78800 Y $157.36 General Fee Schedule - 12/1/2009
78800 Y $122.97 TC Fee Schedule - 12/1/2009
78801 Y $38.01 26 Fee Schedule (FS) - 1/1/2017
78801 Y $193.88 General Fee Schedule - 12/1/2009
78801 Y $152.42 TC Fee Schedule - 12/1/2009
78802 Y $39.50 26 Fee Schedule (FS) - 1/1/2017
78802 Y $244.89 General Fee Schedule - 12/1/2009
78802 Y $200.38 TC Fee Schedule - 12/1/2009
78803 Y $48.88 26 Fee Schedule (FS) - 1/1/2017
78803 Y $293.84 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 227 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78803 Y $237.03 TC Fee Schedule - 12/1/2009
78804 Y $48.82 26 Fee Schedule (FS) - 1/1/2017
78804 Y $445.40 General Fee Schedule - 12/1/2009
78804 Y $390.06 TC Fee Schedule - 12/1/2009
78805 Y $33.89 26 Fee Schedule (FS) - 1/1/2017
78805 Y $154.31 General Fee Schedule - 8/1/2016
78805 Y $122.97 TC Fee Schedule - 12/1/2009
78806 Y $39.50 26 Fee Schedule (FS) - 1/1/2017
78806 Y $277.43 General Fee Schedule - 12/1/2009
78806 Y $232.92 TC Fee Schedule - 12/1/2009
78807 Y $48.88 26 Fee Schedule (FS) - 1/1/2017
78807 Y $293.84 General Fee Schedule - 12/1/2009
78807 Y $237.03 TC Fee Schedule - 12/1/2009
78808 Y $39.28 General Fee Schedule - 12/1/2009
78811 Y $72.72 26 Fee Schedule (FS) - 1/1/2017
78811 Y $2,117.07 General Fee Schedule - 12/1/2009
78811 Y $2,040.69 TC Fee Schedule - 12/1/2009
78812 Y $88.63 26 Fee Schedule (FS) - 1/1/2017
78812 Y $2,117.07 General Fee Schedule - 12/1/2009
78812 Y $2,040.69 TC Fee Schedule - 12/1/2009
78813 Y $92.31 26 Fee Schedule (FS) - 1/1/2017
78813 Y $2,117.07 General Fee Schedule - 12/1/2009
78813 Y $2,040.69 TC Fee Schedule - 12/1/2009
78814 Y $102.23 26 Fee Schedule (FS) - 1/1/2017
78814 Y $2,294.18 General Fee Schedule - 12/1/2009
78814 Y $2,167.54 TC Fee Schedule - 12/1/2009
78815 Y $112.56 26 Fee Schedule (FS) - 1/1/2017
78815 Y $2,294.18 General Fee Schedule - 12/1/2009
78815 Y $2,167.54 TC Fee Schedule - 12/1/2009
78816 Y $113.65 26 Fee Schedule (FS) - 1/1/2017
78816 Y $2,294.18 General Fee Schedule - 12/1/2009
78816 Y $2,167.54 TC Fee Schedule - 12/1/2009
78999 Y $0.00 26 by Report - 6/1/1981
CPT FEES01/03/2018 at 6:55:00 AM - 228 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
78999 Y $0.00 General by Report - 6/1/1981
79005 Y $75.06 26 Fee Schedule (FS) - 12/1/2009
79005 Y $125.81 General Fee Schedule - 1/1/2017
79005 Y $43.18 TC Fee Schedule - 1/1/2017
79101 Y $78.49 26 Fee Schedule (FS) - 12/1/2009
79101 Y $131.43 General Fee Schedule - 1/1/2017
79101 Y $41.87 TC Fee Schedule - 1/1/2017
79200 Y $79.37 26 Fee Schedule (FS) - 12/1/2009
79200 Y $146.76 General Fee Schedule - 1/1/2017
79200 Y $51.23 TC Fee Schedule - 1/1/2017
79300 Y $74.72 26 Fee Schedule (FS) - 1/1/2017
79403 Y $104.50 26 Fee Schedule (FS) - 8/1/2016
79403 Y $176.49 General Fee Schedule - 1/1/2017
79403 Y $72.05 TC Fee Schedule - 1/1/2017
79440 Y $79.64 26 Fee Schedule (FS) - 12/1/2009
79440 Y $133.28 General Fee Schedule - 1/1/2017
79440 Y $44.03 TC Fee Schedule - 1/1/2017
79445 Y $108.73 26 Fee Schedule (FS) - 1/1/2017
79999 Y $0.00 26 by Report - 6/1/1981
79999 Y $0.00 General by Report - 7/1/1975
80047 Y $12.91 General Fee Schedule - 1/1/2018
80048 Y $9.81 General Fee Schedule - 1/1/2018
80050 Y $49.28 General Fee Schedule - 7/1/2004
80051 Y $8.14 General Fee Schedule - 1/1/2018
80053 Y $12.26 General Fee Schedule - 1/1/2018
80055 Y $55.48 General Fee Schedule - 1/1/2018
80061 Y $15.54 General Fee Schedule - 1/1/2018
80069 Y $10.08 General Fee Schedule - 1/1/2018
80074 Y $55.28 General Fee Schedule - 1/1/2018
80076 Y $9.48 General Fee Schedule - 1/1/2018
80081 Y $86.87 General Fee Schedule - 1/1/2018
80150 Y $17.49 General Fee Schedule - 1/1/2018
80155 Y $36.26 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 229 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
80156 Y $16.90 General Fee Schedule - 1/1/2018
80157 Y $15.38 General Fee Schedule - 1/1/2018
80158 Y $20.94 General Fee Schedule - 1/1/2018
80159 Y $21.46 General Fee Schedule - 1/1/2018
80162 Y $15.41 General Fee Schedule - 1/1/2018
80163 Y $15.41 General Fee Schedule - 1/1/2018
80164 Y $15.72 General Fee Schedule - 1/1/2018
80165 Y $15.72 General Fee Schedule - 1/1/2018
80168 Y $18.96 General Fee Schedule - 1/1/2018
80169 Y $15.94 General Fee Schedule - 1/1/2018
80170 Y $19.01 General Fee Schedule - 1/1/2018
80171 Y $20.37 General Fee Schedule - 1/1/2018
80173 Y $16.90 General Fee Schedule - 1/1/2018
80175 Y $15.38 General Fee Schedule - 1/1/2018
80176 Y $17.05 General Fee Schedule - 1/1/2018
80177 Y $15.38 General Fee Schedule - 1/1/2018
80178 Y $7.67 General Fee Schedule - 1/1/2018
80180 Y $20.94 General Fee Schedule - 1/1/2018
80183 Y $15.38 General Fee Schedule - 1/1/2018
80184 Y $14.38 General Fee Schedule - 1/1/2018
80185 Y $15.38 General Fee Schedule - 1/1/2018
80186 Y $15.97 General Fee Schedule - 1/1/2018
80188 Y $19.25 General Fee Schedule - 1/1/2018
80190 Y $56.40 General Fee Schedule - 1/1/2018
80192 Y $19.44 General Fee Schedule - 1/1/2018
80194 Y $16.95 General Fee Schedule - 1/1/2018
80195 Y $15.94 General Fee Schedule - 1/1/2018
80197 Y $15.94 General Fee Schedule - 1/1/2018
80198 Y $16.41 General Fee Schedule - 1/1/2018
80199 Y $25.48 General Fee Schedule - 1/1/2018
80200 Y $18.72 General Fee Schedule - 1/1/2018
80201 Y $13.84 General Fee Schedule - 1/1/2018
80202 Y $15.72 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 230 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
80203 Y $15.38 General Fee Schedule - 1/1/2018
80299 Y $17.52 General Fee Schedule - 1/1/2018
80305 Y $12.65 General Fee Schedule - 1/1/2018
80306 Y $16.88 General Fee Schedule - 1/1/2018
80307 Y $67.52 General Fee Schedule - 1/1/2018
80400 Y $37.85 General Fee Schedule - 1/1/2018
80402 Y $100.91 General Fee Schedule - 1/1/2018
80406 Y $90.82 General Fee Schedule - 1/1/2018
80408 Y $145.64 General Fee Schedule - 1/1/2018
80410 Y $31.10 General Fee Schedule - 1/1/2018
80412 Y $753.52 General Fee Schedule - 1/1/2018
80414 Y $59.93 General Fee Schedule - 1/1/2018
80415 Y $64.85 General Fee Schedule - 1/1/2018
80416 Y $196.76 General Fee Schedule - 1/1/2018
80417 Y $51.05 General Fee Schedule - 1/1/2018
80418 Y $672.50 General Fee Schedule - 1/1/2018
80420 Y $152.17 General Fee Schedule - 1/1/2018
80422 Y $53.47 General Fee Schedule - 1/1/2018
80424 Y $58.60 General Fee Schedule - 1/1/2018
80426 Y $172.23 General Fee Schedule - 1/1/2018
80428 Y $77.41 General Fee Schedule - 1/1/2018
80430 Y $121.57 General Fee Schedule - 1/1/2018
80432 Y $156.78 General Fee Schedule - 1/1/2018
80434 Y $267.93 General Fee Schedule - 1/1/2018
80435 Y $119.55 General Fee Schedule - 1/1/2018
80436 Y $105.80 General Fee Schedule - 1/1/2018
80438 Y $58.51 General Fee Schedule - 1/1/2018
80439 Y $78.00 General Fee Schedule - 1/1/2018
80500 Y $21.55 General Fee Schedule - 1/1/2018
80502 Y $68.97 General Fee Schedule - 1/1/2018
81000 Y $3.78 General Fee Schedule - 1/1/2018
81001 Y $3.68 General Fee Schedule - 1/1/2018
81002 Y $3.27 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 231 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
81003 Y $2.60 General Fee Schedule - 1/1/2018
81005 Y $2.51 General Fee Schedule - 1/1/2018
81007 Y $28.18 General Fee Schedule - 1/1/2018
81015 Y $3.53 General Fee Schedule - 1/1/2018
81020 Y $4.42 General Fee Schedule - 1/1/2018
81025 Y $8.09 General Fee Schedule - 1/1/2018
81050 Y $3.49 General Fee Schedule - 1/1/2018
81099 Y $0.00 General by Report - 6/1/1981
81162 Y $2,117.75 General Fee Schedule - 1/1/2018
81201 Y $733.20 General Fee Schedule - 1/1/2018
81202 Y $263.20 General Fee Schedule - 1/1/2018
81203 Y $188.00 General Fee Schedule - 1/1/2018
81206 Y $190.27 General Fee Schedule - 1/1/2018
81207 Y $168.08 General Fee Schedule - 1/1/2018
81208 Y $201.74 General Fee Schedule - 1/1/2018
81210 Y $164.88 General Fee Schedule - 1/1/2018
81211 Y $2,252.09 General Fee Schedule - 1/1/2018
81212 Y $413.60 General Fee Schedule - 1/1/2018
81213 Y $519.82 General Fee Schedule - 1/1/2018
81214 Y $1,223.33 General Fee Schedule - 1/1/2018
81215 Y $352.74 General Fee Schedule - 1/1/2018
81216 Y $174.01 General Fee Schedule - 1/1/2018
81217 Y $352.74 General Fee Schedule - 1/1/2018
81225 Y $273.88 General Fee Schedule - 1/1/2018
81226 Y $423.86 General Fee Schedule - 1/1/2018
81227 Y $164.32 General Fee Schedule - 1/1/2018
81235 Y $305.11 General Fee Schedule - 1/1/2018
81240 Y $61.75 General Fee Schedule - 1/1/2018
81241 Y $70.91 General Fee Schedule - 1/1/2018
81245 Y $155.58 General Fee Schedule - 1/1/2018
81256 Y $75.85 General Fee Schedule - 1/1/2018
81257 Y $96.12 General Fee Schedule - 1/1/2018
81261 Y $229.76 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 232 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
81262 Y $64.44 General Fee Schedule - 1/1/2018
81263 Y $341.78 General Fee Schedule - 1/1/2018
81264 Y $173.29 General Fee Schedule - 1/1/2018
81265 Y $249.56 General Fee Schedule - 1/1/2018
81266 Y $286.52 General Fee Schedule - 1/1/2018
81267 Y $240.75 General Fee Schedule - 1/1/2018
81268 Y $302.64 General Fee Schedule - 1/1/2018
81270 Y $106.38 General Fee Schedule - 1/1/2018
81275 Y $181.66 General Fee Schedule - 1/1/2018
81291 Y $61.42 General Fee Schedule - 1/1/2018
81292 Y $634.88 General Fee Schedule - 1/1/2018
81293 Y $311.14 General Fee Schedule - 1/1/2018
81294 Y $190.26 General Fee Schedule - 1/1/2018
81295 Y $358.80 General Fee Schedule - 1/1/2018
81296 Y $317.47 General Fee Schedule - 1/1/2018
81297 Y $200.50 General Fee Schedule - 1/1/2018
81298 Y $603.34 General Fee Schedule - 1/1/2018
81299 Y $289.52 General Fee Schedule - 1/1/2018
81300 Y $223.72 General Fee Schedule - 1/1/2018
81301 Y $336.03 General Fee Schedule - 1/1/2018
81310 Y $231.73 General Fee Schedule - 1/1/2018
81315 Y $240.58 General Fee Schedule - 1/1/2018
81316 Y $240.58 General Fee Schedule - 1/1/2018
81317 Y $664.60 General Fee Schedule - 1/1/2018
81318 Y $311.14 General Fee Schedule - 1/1/2018
81319 Y $191.29 General Fee Schedule - 1/1/2018
81321 Y $564.00 General Fee Schedule - 1/1/2018
81322 Y $49.68 General Fee Schedule - 1/1/2018
81323 Y $282.00 General Fee Schedule - 1/1/2018
81324 Y $712.86 General Fee Schedule - 1/1/2018
81325 Y $723.41 General Fee Schedule - 1/1/2018
81326 Y $49.68 General Fee Schedule - 1/1/2018
81332 Y $50.66 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 233 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
81340 Y $242.44 General Fee Schedule - 1/1/2018
81341 Y $57.55 General Fee Schedule - 1/1/2018
81342 Y $233.83 General Fee Schedule - 1/1/2018
81355 Y $82.91 General Fee Schedule - 1/1/2018
81370 Y $466.66 General Fee Schedule - 1/1/2018
81371 Y $380.25 General Fee Schedule - 1/1/2018
81372 Y $379.37 General Fee Schedule - 1/1/2018
81373 Y $129.23 General Fee Schedule - 1/1/2018
81374 Y $84.42 General Fee Schedule - 1/1/2018
81375 Y $256.17 General Fee Schedule - 1/1/2018
81376 Y $141.84 General Fee Schedule - 1/1/2018
81377 Y $106.55 General Fee Schedule - 1/1/2018
81378 Y $401.03 General Fee Schedule - 1/1/2018
81379 Y $389.21 General Fee Schedule - 1/1/2018
81380 Y $205.70 General Fee Schedule - 1/1/2018
81381 Y $159.71 General Fee Schedule - 1/1/2018
81382 Y $143.53 General Fee Schedule - 1/1/2018
81383 Y $126.65 General Fee Schedule - 1/1/2018
81400 Y $60.12 General Fee Schedule - 1/1/2018
81401 Y $128.78 General Fee Schedule - 1/1/2018
81402 Y $141.31 General Fee Schedule - 1/1/2018
81500 Y $244.87 General Fee Schedule - 1/1/2018
81503 Y $843.18 General Fee Schedule - 1/1/2018
81506 Y $76.17 General Fee Schedule - 1/1/2018
81508 Y $51.04 General Fee Schedule - 1/1/2018
81509 Y $1,398.13 General Fee Schedule - 1/1/2018
81510 Y $52.21 General Fee Schedule - 1/1/2018
81511 Y $144.29 General Fee Schedule - 1/1/2018
81512 Y $65.35 General Fee Schedule - 1/1/2018
81519 Y $3,640.62 General Fee Schedule - 1/1/2018
81528 Y $478.34 General Fee Schedule - 1/1/2018
81599 Y $0.00 General by Report - 1/1/2013
82009 Y $5.25 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 234 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
82010 Y $9.48 General Fee Schedule - 1/1/2018
82013 Y $12.96 General Fee Schedule - 1/1/2018
82016 Y $16.10 General Fee Schedule - 1/1/2018
82017 Y $19.58 General Fee Schedule - 1/1/2018
82024 Y $44.82 General Fee Schedule - 1/1/2018
82030 Y $29.94 General Fee Schedule - 1/1/2018
82040 Y $5.74 General Fee Schedule - 1/1/2018
82042 Y $7.31 General Fee Schedule - 1/1/2018
82043 Y $6.71 General Fee Schedule - 1/1/2018
82044 Y $5.86 General Fee Schedule - 1/1/2018
82045 Y $39.39 General Fee Schedule - 1/1/2018
82075 Y $28.20 General Fee Schedule - 1/1/2018
82085 Y $11.27 General Fee Schedule - 1/1/2018
82088 Y $47.29 General Fee Schedule - 1/1/2018
82103 Y $15.59 General Fee Schedule - 1/1/2018
82104 Y $16.79 General Fee Schedule - 1/1/2018
82105 Y $19.47 General Fee Schedule - 1/1/2018
82106 Y $19.47 General Fee Schedule - 1/1/2018
82107 Y $74.75 General Fee Schedule - 1/1/2018
82108 Y $29.57 General Fee Schedule - 1/1/2018
82120 Y $5.63 General Fee Schedule - 1/1/2018
82127 Y $16.10 General Fee Schedule - 1/1/2018
82128 Y $16.10 General Fee Schedule - 1/1/2018
82131 Y $21.60 General Fee Schedule - 1/1/2018
82135 Y $19.09 General Fee Schedule - 1/1/2018
82136 Y $19.58 General Fee Schedule - 1/1/2018
82139 Y $19.58 General Fee Schedule - 1/1/2018
82140 Y $16.91 General Fee Schedule - 1/1/2018
82143 Y $8.79 General Fee Schedule - 1/1/2018
82150 Y $7.52 General Fee Schedule - 1/1/2018
82154 Y $33.46 General Fee Schedule - 1/1/2018
82157 Y $33.97 General Fee Schedule - 1/1/2018
82160 Y $29.02 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 235 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
82163 Y $23.82 General Fee Schedule - 1/1/2018
82164 Y $16.95 General Fee Schedule - 1/1/2018
82172 Y $19.82 General Fee Schedule - 1/1/2018
82175 Y $22.01 General Fee Schedule - 1/1/2018
82180 Y $11.47 General Fee Schedule - 1/1/2018
82190 Y $17.31 General Fee Schedule - 1/1/2018
82232 Y $18.77 General Fee Schedule - 1/1/2018
82239 Y $19.87 General Fee Schedule - 1/1/2018
82240 Y $30.84 General Fee Schedule - 1/1/2018
82247 Y $5.82 General Fee Schedule - 1/1/2018
82248 Y $5.82 General Fee Schedule - 1/1/2018
82252 Y $5.29 General Fee Schedule - 1/1/2018
82261 Y $19.58 General Fee Schedule - 1/1/2018
82270 Y $4.12 General Fee Schedule - 1/1/2018
82271 Y $5.00 General Fee Schedule - 1/1/2018
82272 Y $3.98 General Fee Schedule - 1/1/2018
82274 Y $18.46 General Fee Schedule - 1/1/2018
82286 Y $5.99 General Fee Schedule - 1/1/2018
82300 Y $26.87 General Fee Schedule - 1/1/2018
82306 Y $34.36 General Fee Schedule - 1/1/2018
82308 Y $31.10 General Fee Schedule - 1/1/2018
82310 Y $5.99 General Fee Schedule - 1/1/2018
82330 Y $15.87 General Fee Schedule - 1/1/2018
82331 Y $12.54 General Fee Schedule - 1/1/2018
82340 Y $6.99 General Fee Schedule - 1/1/2018
82355 Y $13.43 General Fee Schedule - 1/1/2018
82360 Y $14.94 General Fee Schedule - 1/1/2018
82365 Y $14.96 General Fee Schedule - 1/1/2018
82370 Y $14.53 General Fee Schedule - 1/1/2018
82373 Y $20.95 General Fee Schedule - 1/1/2018
82374 Y $5.67 General Fee Schedule - 1/1/2018
82375 Y $14.30 General Fee Schedule - 1/1/2018
82376 Y $13.23 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 236 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
82378 Y $22.01 General Fee Schedule - 1/1/2018
82379 Y $19.58 General Fee Schedule - 1/1/2018
82380 Y $10.71 General Fee Schedule - 1/1/2018
82382 Y $25.66 General Fee Schedule - 1/1/2018
82383 Y $29.07 General Fee Schedule - 1/1/2018
82384 Y $29.31 General Fee Schedule - 1/1/2018
82387 Y $20.95 General Fee Schedule - 1/1/2018
82390 Y $12.46 General Fee Schedule - 1/1/2018
82397 Y $16.38 General Fee Schedule - 1/1/2018
82415 Y $14.70 General Fee Schedule - 1/1/2018
82435 Y $5.34 General Fee Schedule - 1/1/2018
82436 Y $5.84 General Fee Schedule - 1/1/2018
82438 Y $5.67 General Fee Schedule - 1/1/2018
82441 Y $6.97 General Fee Schedule - 1/1/2018
82465 Y $5.05 General Fee Schedule - 1/1/2018
82480 Y $9.14 General Fee Schedule - 1/1/2018
82482 Y $9.22 General Fee Schedule - 1/1/2018
82485 Y $23.97 General Fee Schedule - 1/1/2018
82495 Y $23.54 General Fee Schedule - 1/1/2018
82507 Y $32.27 General Fee Schedule - 1/1/2018
82523 Y $21.69 General Fee Schedule - 1/1/2018
82525 Y $14.40 General Fee Schedule - 1/1/2018
82528 Y $26.13 General Fee Schedule - 1/1/2018
82530 Y $19.39 General Fee Schedule - 1/1/2018
82533 Y $18.91 General Fee Schedule - 1/1/2018
82540 Y $5.38 General Fee Schedule - 1/1/2018
82542 Y $22.64 General Fee Schedule - 1/1/2018
82550 Y $7.56 General Fee Schedule - 1/1/2018
82552 Y $15.54 General Fee Schedule - 1/1/2018
82553 Y $13.40 General Fee Schedule - 1/1/2018
82554 Y $13.77 General Fee Schedule - 1/1/2018
82565 Y $5.95 General Fee Schedule - 1/1/2018
82570 Y $6.01 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 237 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
82575 Y $10.97 General Fee Schedule - 1/1/2018
82585 Y $13.29 General Fee Schedule - 1/1/2018
82595 Y $7.50 General Fee Schedule - 1/1/2018
82600 Y $22.51 General Fee Schedule - 1/1/2018
82607 Y $17.49 General Fee Schedule - 1/1/2018
82608 Y $16.62 General Fee Schedule - 1/1/2018
82610 Y $17.41 General Fee Schedule - 1/1/2018
82615 Y $9.48 General Fee Schedule - 1/1/2018
82626 Y $29.33 General Fee Schedule - 1/1/2018
82627 Y $25.80 General Fee Schedule - 1/1/2018
82633 Y $35.96 General Fee Schedule - 1/1/2018
82634 Y $33.97 General Fee Schedule - 1/1/2018
82638 Y $14.21 General Fee Schedule - 1/1/2018
82652 Y $44.68 General Fee Schedule - 1/1/2018
82656 Y $13.39 General Fee Schedule - 1/1/2018
82657 Y $20.95 General Fee Schedule - 1/1/2018
82658 Y $41.39 General Fee Schedule - 1/1/2018
82664 Y $57.81 General Fee Schedule - 1/1/2018
82668 Y $21.81 General Fee Schedule - 1/1/2018
82670 Y $32.42 General Fee Schedule - 1/1/2018
82671 Y $37.49 General Fee Schedule - 1/1/2018
82672 Y $25.17 General Fee Schedule - 1/1/2018
82677 Y $28.06 General Fee Schedule - 1/1/2018
82679 Y $28.96 General Fee Schedule - 1/1/2018
82693 Y $17.30 General Fee Schedule - 1/1/2018
82696 Y $27.37 General Fee Schedule - 1/1/2018
82705 Y $5.91 General Fee Schedule - 1/1/2018
82710 Y $19.51 General Fee Schedule - 1/1/2018
82715 Y $21.59 General Fee Schedule - 1/1/2018
82725 Y $17.64 General Fee Schedule - 1/1/2018
82726 Y $20.95 General Fee Schedule - 1/1/2018
82728 Y $15.82 General Fee Schedule - 1/1/2018
82731 Y $74.75 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 238 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
82735 Y $21.52 General Fee Schedule - 1/1/2018
82746 Y $17.06 General Fee Schedule - 1/1/2018
82747 Y $20.10 General Fee Schedule - 1/1/2018
82757 Y $20.12 General Fee Schedule - 1/1/2018
82759 Y $24.93 General Fee Schedule - 1/1/2018
82760 Y $12.99 General Fee Schedule - 1/1/2018
82775 Y $24.45 General Fee Schedule - 1/1/2018
82776 Y $11.04 General Fee Schedule - 1/1/2018
82777 Y $41.60 General Fee Schedule - 1/1/2018
82784 Y $10.79 General Fee Schedule - 1/1/2018
82785 Y $19.10 General Fee Schedule - 1/1/2018
82787 Y $9.31 General Fee Schedule - 1/1/2018
82800 Y $10.34 General Fee Schedule - 1/1/2018
82803 Y $24.51 General Fee Schedule - 1/1/2018
82805 Y $74.04 General Fee Schedule - 1/1/2018
82810 Y $10.12 General Fee Schedule - 1/1/2018
82820 Y $12.54 General Fee Schedule - 1/1/2018
82930 Y $6.32 General Fee Schedule - 1/1/2018
82938 Y $20.53 General Fee Schedule - 1/1/2018
82941 Y $20.46 General Fee Schedule - 1/1/2018
82943 Y $16.58 General Fee Schedule - 1/1/2018
82945 Y $4.56 General Fee Schedule - 1/1/2018
82946 Y $17.49 General Fee Schedule - 1/1/2018
82947 Y $4.56 General Fee Schedule - 1/1/2018
82948 Y $4.74 General Fee Schedule - 1/1/2018
82950 Y $5.51 General Fee Schedule - 1/1/2018
82951 Y $14.94 General Fee Schedule - 1/1/2018
82952 Y $4.55 General Fee Schedule - 1/1/2018
82955 Y $11.25 General Fee Schedule - 1/1/2018
82960 Y $7.02 General Fee Schedule - 1/1/2018
82962 Y $3.08 General Fee Schedule - 1/1/2018
82963 Y $24.93 General Fee Schedule - 1/1/2018
82965 Y $12.36 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 239 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
82977 Y $8.36 General Fee Schedule - 1/1/2018
82978 Y $16.54 General Fee Schedule - 1/1/2018
82979 Y $10.96 General Fee Schedule - 1/1/2018
82985 Y $17.49 General Fee Schedule - 1/1/2018
83001 Y $21.56 General Fee Schedule - 1/1/2018
83002 Y $21.49 General Fee Schedule - 1/1/2018
83003 Y $19.35 General Fee Schedule - 1/1/2018
83006 Y $71.06 General Fee Schedule - 1/1/2018
83009 Y $78.17 General Fee Schedule - 1/1/2018
83010 Y $14.60 General Fee Schedule - 1/1/2018
83012 Y $25.28 General Fee Schedule - 1/1/2018
83013 Y $78.17 General Fee Schedule - 1/1/2018
83014 Y $9.12 General Fee Schedule - 1/1/2018
83015 Y $21.86 General Fee Schedule - 1/1/2018
83018 Y $25.49 General Fee Schedule - 1/1/2018
83020 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
83020 Y $14.94 General Fee Schedule - 1/1/2018
83021 Y $20.95 General Fee Schedule - 1/1/2018
83026 Y $3.77 General Fee Schedule - 1/1/2018
83030 Y $10.10 General Fee Schedule - 1/1/2018
83033 Y $7.52 General Fee Schedule - 1/1/2018
83036 Y $11.27 General Fee Schedule - 1/1/2018
83037 Y $11.27 General Fee Schedule - 1/1/2018
83045 Y $6.10 General Fee Schedule - 1/1/2018
83050 Y $8.51 General Fee Schedule - 1/1/2018
83051 Y $8.49 General Fee Schedule - 1/1/2018
83060 Y $9.60 General Fee Schedule - 1/1/2018
83065 Y $8.46 General Fee Schedule - 1/1/2018
83068 Y $9.82 General Fee Schedule - 1/1/2018
83069 Y $4.59 General Fee Schedule - 1/1/2018
83070 Y $5.51 General Fee Schedule - 1/1/2018
83080 Y $19.58 General Fee Schedule - 1/1/2018
83088 Y $34.27 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 240 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
83090 Y $19.58 General Fee Schedule - 1/1/2018
83150 Y $22.46 General Fee Schedule - 1/1/2018
83491 Y $20.34 General Fee Schedule - 1/1/2018
83497 Y $14.96 General Fee Schedule - 1/1/2018
83498 Y $31.53 General Fee Schedule - 1/1/2018
83500 Y $26.28 General Fee Schedule - 1/1/2018
83505 Y $28.21 General Fee Schedule - 1/1/2018
83516 Y $13.39 General Fee Schedule - 1/1/2018
83518 Y $9.84 General Fee Schedule - 1/1/2018
83519 Y $17.30 General Fee Schedule - 1/1/2018
83520 Y $16.23 General Fee Schedule - 1/1/2018
83525 Y $13.26 General Fee Schedule - 1/1/2018
83527 Y $15.02 General Fee Schedule - 1/1/2018
83528 Y $18.63 General Fee Schedule - 1/1/2018
83540 Y $7.51 General Fee Schedule - 1/1/2018
83550 Y $10.14 General Fee Schedule - 1/1/2018
83570 Y $10.27 General Fee Schedule - 1/1/2018
83582 Y $16.45 General Fee Schedule - 1/1/2018
83586 Y $14.85 General Fee Schedule - 1/1/2018
83593 Y $30.52 General Fee Schedule - 1/1/2018
83605 Y $12.40 General Fee Schedule - 1/1/2018
83615 Y $7.00 General Fee Schedule - 1/1/2018
83625 Y $14.85 General Fee Schedule - 1/1/2018
83630 Y $22.79 General Fee Schedule - 1/1/2018
83631 Y $22.79 General Fee Schedule - 1/1/2018
83632 Y $23.47 General Fee Schedule - 1/1/2018
83633 Y $10.58 General Fee Schedule - 1/1/2018
83655 Y $14.05 General Fee Schedule - 1/1/2018
83661 Y $25.51 General Fee Schedule - 1/1/2018
83662 Y $21.95 General Fee Schedule - 1/1/2018
83663 Y $21.95 General Fee Schedule - 1/1/2018
83664 Y $21.95 General Fee Schedule - 1/1/2018
83670 Y $10.63 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 241 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
83690 Y $8.00 General Fee Schedule - 1/1/2018
83695 Y $15.02 General Fee Schedule - 1/1/2018
83698 Y $43.53 General Fee Schedule - 1/1/2018
83700 Y $13.07 General Fee Schedule - 1/1/2018
83701 Y $31.83 General Fee Schedule - 1/1/2018
83704 Y $36.61 General Fee Schedule - 1/1/2018
83718 Y $9.51 General Fee Schedule - 1/1/2018
83719 Y $13.50 General Fee Schedule - 1/1/2018
83721 Y $11.07 General Fee Schedule - 1/1/2018
83727 Y $19.95 General Fee Schedule - 1/1/2018
83735 Y $7.77 General Fee Schedule - 1/1/2018
83775 Y $8.55 General Fee Schedule - 1/1/2018
83785 Y $28.55 General Fee Schedule - 1/1/2018
83789 Y $22.66 General Fee Schedule - 1/1/2018
83825 Y $18.87 General Fee Schedule - 1/1/2018
83835 Y $19.66 General Fee Schedule - 1/1/2018
83857 Y $12.46 General Fee Schedule - 1/1/2018
83861 Y $21.13 General Fee Schedule - 1/1/2018
83864 Y $26.79 General Fee Schedule - 1/1/2018
83872 Y $6.81 General Fee Schedule - 1/1/2018
83873 Y $19.97 General Fee Schedule - 1/1/2018
83874 Y $14.99 General Fee Schedule - 1/1/2018
83876 Y $47.81 General Fee Schedule - 1/1/2018
83880 Y $39.39 General Fee Schedule - 1/1/2018
83883 Y $15.78 General Fee Schedule - 1/1/2018
83885 Y $28.44 General Fee Schedule - 1/1/2018
83915 Y $12.94 General Fee Schedule - 1/1/2018
83916 Y $25.75 General Fee Schedule - 1/1/2018
83918 Y $22.18 General Fee Schedule - 1/1/2018
83919 Y $19.09 General Fee Schedule - 1/1/2018
83921 Y $19.94 General Fee Schedule - 1/1/2018
83930 Y $7.67 General Fee Schedule - 1/1/2018
83935 Y $7.91 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 242 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
83937 Y $34.64 General Fee Schedule - 1/1/2018
83945 Y $14.94 General Fee Schedule - 1/1/2018
83950 Y $74.75 General Fee Schedule - 1/1/2018
83951 Y $74.75 General Fee Schedule - 1/1/2018
83970 Y $47.90 General Fee Schedule - 1/1/2018
83986 Y $4.15 General Fee Schedule - 1/1/2018
83987 Y $4.15 General Fee Schedule - 1/1/2018
83992 Y $18.96 General Fee Schedule - 1/1/2017
83993 Y $22.79 General Fee Schedule - 1/1/2018
84030 Y $6.38 General Fee Schedule - 1/1/2018
84035 Y $4.25 General Fee Schedule - 1/1/2018
84060 Y $8.57 General Fee Schedule - 1/1/2018
84066 Y $11.21 General Fee Schedule - 1/1/2018
84075 Y $6.01 General Fee Schedule - 1/1/2018
84078 Y $8.47 General Fee Schedule - 1/1/2018
84080 Y $17.16 General Fee Schedule - 1/1/2018
84081 Y $19.17 General Fee Schedule - 1/1/2018
84085 Y $10.96 General Fee Schedule - 1/1/2018
84087 Y $11.98 General Fee Schedule - 1/1/2018
84100 Y $5.50 General Fee Schedule - 1/1/2018
84105 Y $6.01 General Fee Schedule - 1/1/2018
84106 Y $5.47 General Fee Schedule - 1/1/2018
84110 Y $9.79 General Fee Schedule - 1/1/2018
84112 Y $92.22 General Fee Schedule - 1/1/2018
84119 Y $12.56 General Fee Schedule - 1/1/2018
84120 Y $17.07 General Fee Schedule - 1/1/2018
84126 Y $36.76 General Fee Schedule - 1/1/2018
84132 Y $5.34 General Fee Schedule - 1/1/2018
84133 Y $5.00 General Fee Schedule - 1/1/2018
84134 Y $16.93 General Fee Schedule - 1/1/2018
84135 Y $22.21 General Fee Schedule - 1/1/2018
84138 Y $21.97 General Fee Schedule - 1/1/2018
84140 Y $23.99 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 243 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
84143 Y $26.47 General Fee Schedule - 1/1/2018
84144 Y $24.21 General Fee Schedule - 1/1/2018
84145 Y $31.10 General Fee Schedule - 1/1/2018
84146 Y $22.48 General Fee Schedule - 1/1/2018
84150 Y $39.26 General Fee Schedule - 1/1/2018
84152 Y $21.35 General Fee Schedule - 1/1/2018
84153 Y $21.35 General Fee Schedule - 1/1/2018
84154 Y $21.35 General Fee Schedule - 1/1/2018
84155 Y $4.26 General Fee Schedule - 1/1/2018
84156 Y $4.26 General Fee Schedule - 1/1/2018
84157 Y $4.26 General Fee Schedule - 1/1/2018
84160 Y $6.01 General Fee Schedule - 1/1/2018
84163 Y $17.47 General Fee Schedule - 1/1/2018
84165 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
84165 Y $12.46 General Fee Schedule - 1/1/2018
84166 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
84166 Y $20.69 General Fee Schedule - 1/1/2018
84181 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
84181 Y $19.76 General Fee Schedule - 1/1/2018
84182 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
84182 Y $27.46 General Fee Schedule - 1/1/2018
84202 Y $16.65 General Fee Schedule - 1/1/2018
84203 Y $9.99 General Fee Schedule - 1/1/2018
84206 Y $25.09 General Fee Schedule - 1/1/2018
84207 Y $32.61 General Fee Schedule - 1/1/2018
84210 Y $13.61 General Fee Schedule - 1/1/2018
84220 Y $10.96 General Fee Schedule - 1/1/2018
84228 Y $13.50 General Fee Schedule - 1/1/2018
84233 Y $82.61 General Fee Schedule - 1/1/2018
84234 Y $75.29 General Fee Schedule - 1/1/2018
84235 Y $66.96 General Fee Schedule - 1/1/2018
84238 Y $42.43 General Fee Schedule - 1/1/2018
84244 Y $25.52 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 244 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
84252 Y $23.48 General Fee Schedule - 1/1/2018
84255 Y $29.63 General Fee Schedule - 1/1/2018
84260 Y $35.96 General Fee Schedule - 1/1/2018
84270 Y $25.22 General Fee Schedule - 1/1/2018
84275 Y $15.59 General Fee Schedule - 1/1/2018
84285 Y $27.32 General Fee Schedule - 1/1/2018
84295 Y $5.58 General Fee Schedule - 1/1/2018
84300 Y $5.64 General Fee Schedule - 1/1/2018
84302 Y $5.64 General Fee Schedule - 1/1/2018
84305 Y $24.68 General Fee Schedule - 1/1/2018
84307 Y $21.21 General Fee Schedule - 1/1/2018
84311 Y $8.11 General Fee Schedule - 1/1/2018
84315 Y $3.08 General Fee Schedule - 1/1/2018
84375 Y $36.66 General Fee Schedule - 1/1/2018
84376 Y $6.38 General Fee Schedule - 1/1/2018
84377 Y $6.38 General Fee Schedule - 1/1/2018
84378 Y $13.38 General Fee Schedule - 1/1/2018
84379 Y $13.38 General Fee Schedule - 1/1/2018
84392 Y $5.51 General Fee Schedule - 1/1/2018
84402 Y $29.56 General Fee Schedule - 1/1/2018
84403 Y $29.96 General Fee Schedule - 1/1/2018
84410 Y $59.52 General Fee Schedule - 1/1/2018
84425 Y $24.64 General Fee Schedule - 1/1/2018
84430 Y $13.50 General Fee Schedule - 1/1/2018
84431 Y $33.00 General Fee Schedule - 1/1/2018
84432 Y $18.64 General Fee Schedule - 1/1/2018
84436 Y $7.97 General Fee Schedule - 1/1/2018
84437 Y $7.50 General Fee Schedule - 1/1/2018
84439 Y $10.46 General Fee Schedule - 1/1/2018
84442 Y $17.16 General Fee Schedule - 1/1/2018
84443 Y $19.51 General Fee Schedule - 1/1/2018
84445 Y $59.01 General Fee Schedule - 1/1/2018
84446 Y $16.46 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 245 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
84449 Y $20.89 General Fee Schedule - 1/1/2018
84450 Y $6.01 General Fee Schedule - 1/1/2018
84460 Y $6.15 General Fee Schedule - 1/1/2018
84466 Y $14.81 General Fee Schedule - 1/1/2018
84478 Y $6.66 General Fee Schedule - 1/1/2018
84479 Y $7.50 General Fee Schedule - 1/1/2018
84480 Y $16.46 General Fee Schedule - 1/1/2018
84481 Y $19.66 General Fee Schedule - 1/1/2018
84482 Y $18.29 General Fee Schedule - 1/1/2018
84484 Y $11.72 General Fee Schedule - 1/1/2018
84485 Y $8.36 General Fee Schedule - 1/1/2018
84488 Y $8.47 General Fee Schedule - 1/1/2018
84490 Y $9.33 General Fee Schedule - 1/1/2018
84510 Y $12.07 General Fee Schedule - 1/1/2018
84512 Y $9.48 General Fee Schedule - 1/1/2018
84520 Y $4.59 General Fee Schedule - 1/1/2018
84525 Y $4.82 General Fee Schedule - 1/1/2018
84540 Y $5.51 General Fee Schedule - 1/1/2018
84545 Y $7.67 General Fee Schedule - 1/1/2018
84550 Y $5.25 General Fee Schedule - 1/1/2018
84560 Y $5.51 General Fee Schedule - 1/1/2018
84577 Y $19.51 General Fee Schedule - 1/1/2018
84578 Y $4.20 General Fee Schedule - 1/1/2018
84580 Y $9.48 General Fee Schedule - 1/1/2018
84583 Y $5.84 General Fee Schedule - 1/1/2018
84585 Y $17.98 General Fee Schedule - 1/1/2018
84586 Y $41.00 General Fee Schedule - 1/1/2018
84588 Y $39.39 General Fee Schedule - 1/1/2018
84590 Y $13.47 General Fee Schedule - 1/1/2018
84591 Y $16.04 General Fee Schedule - 1/1/2018
84597 Y $15.92 General Fee Schedule - 1/1/2018
84600 Y $18.66 General Fee Schedule - 1/1/2018
84620 Y $13.75 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 246 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
84630 Y $13.22 General Fee Schedule - 1/1/2018
84681 Y $24.16 General Fee Schedule - 1/1/2018
84702 Y $17.47 General Fee Schedule - 1/1/2018
84703 Y $8.73 General Fee Schedule - 1/1/2018
84704 Y $17.47 General Fee Schedule - 1/1/2018
84830 Y $11.94 General Fee Schedule - 1/1/2018
84999 Y $0.00 General by Report - 7/1/1975
85002 Y $5.24 General Fee Schedule - 1/1/2018
85004 Y $7.50 General Fee Schedule - 1/1/2018
85007 Y $3.99 General Fee Schedule - 1/1/2018
85008 Y $3.99 General Fee Schedule - 1/1/2018
85009 Y $4.77 General Fee Schedule - 1/1/2018
85013 Y $6.58 General Fee Schedule - 1/1/2018
85014 Y $2.75 General Fee Schedule - 1/1/2018
85018 Y $2.75 General Fee Schedule - 1/1/2018
85025 Y $9.01 General Fee Schedule - 1/1/2018
85027 Y $7.50 General Fee Schedule - 1/1/2018
85032 Y $5.00 General Fee Schedule - 1/1/2018
85041 Y $3.51 General Fee Schedule - 1/1/2018
85044 Y $5.00 General Fee Schedule - 1/1/2018
85045 Y $4.63 General Fee Schedule - 1/1/2018
85046 Y $6.47 General Fee Schedule - 1/1/2018
85048 Y $2.94 General Fee Schedule - 1/1/2018
85049 Y $5.20 General Fee Schedule - 1/1/2018
85055 Y $33.60 General Fee Schedule - 1/1/2018
85060 Y $23.27 General Fee Schedule - 1/1/2018
85097 Y $83.53 General Fee Schedule - 1/1/2018
85130 Y $13.80 General Fee Schedule - 1/1/2018
85170 Y $15.32 General Fee Schedule - 1/1/2018
85175 Y $19.15 General Fee Schedule - 1/1/2018
85210 Y $15.07 General Fee Schedule - 1/1/2018
85220 Y $20.48 General Fee Schedule - 1/1/2018
85230 Y $20.77 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 247 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
85240 Y $20.77 General Fee Schedule - 1/1/2018
85244 Y $23.70 General Fee Schedule - 1/1/2018
85245 Y $26.62 General Fee Schedule - 1/1/2018
85246 Y $26.62 General Fee Schedule - 1/1/2018
85247 Y $26.62 General Fee Schedule - 1/1/2018
85250 Y $22.10 General Fee Schedule - 1/1/2018
85260 Y $20.77 General Fee Schedule - 1/1/2018
85270 Y $20.77 General Fee Schedule - 1/1/2018
85280 Y $22.46 General Fee Schedule - 1/1/2018
85290 Y $18.96 General Fee Schedule - 1/1/2018
85291 Y $10.32 General Fee Schedule - 1/1/2018
85292 Y $21.97 General Fee Schedule - 1/1/2018
85293 Y $21.97 General Fee Schedule - 1/1/2018
85300 Y $13.75 General Fee Schedule - 1/1/2018
85301 Y $12.55 General Fee Schedule - 1/1/2018
85302 Y $13.94 General Fee Schedule - 1/1/2018
85303 Y $16.06 General Fee Schedule - 1/1/2018
85305 Y $13.47 General Fee Schedule - 1/1/2018
85306 Y $17.78 General Fee Schedule - 1/1/2018
85307 Y $17.78 General Fee Schedule - 1/1/2018
85335 Y $14.94 General Fee Schedule - 1/1/2018
85337 Y $16.23 General Fee Schedule - 1/1/2018
85345 Y $5.00 General Fee Schedule - 1/1/2018
85347 Y $4.94 General Fee Schedule - 1/1/2018
85348 Y $4.32 General Fee Schedule - 1/1/2018
85360 Y $9.76 General Fee Schedule - 1/1/2018
85362 Y $8.00 General Fee Schedule - 1/1/2018
85366 Y $75.63 General Fee Schedule - 1/1/2018
85370 Y $13.18 General Fee Schedule - 1/1/2018
85378 Y $9.14 General Fee Schedule - 1/1/2018
85379 Y $11.81 General Fee Schedule - 1/1/2018
85380 Y $11.81 General Fee Schedule - 1/1/2018
85384 Y $9.86 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 248 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
85385 Y $13.59 General Fee Schedule - 1/1/2018
85390 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
85390 Y $14.55 General Fee Schedule - 1/1/2018
85396 Y $19.37 General Fee Schedule - 1/1/2018
85397 Y $29.01 General Fee Schedule - 1/1/2018
85400 Y $8.94 General Fee Schedule - 1/1/2018
85410 Y $8.94 General Fee Schedule - 1/1/2018
85415 Y $19.95 General Fee Schedule - 1/1/2018
85420 Y $7.58 General Fee Schedule - 1/1/2018
85421 Y $11.82 General Fee Schedule - 1/1/2018
85441 Y $4.87 General Fee Schedule - 1/1/2018
85445 Y $7.91 General Fee Schedule - 1/1/2018
85460 Y $8.98 General Fee Schedule - 1/1/2018
85461 Y $8.80 General Fee Schedule - 1/1/2018
85475 Y $10.29 General Fee Schedule - 1/1/2018
85520 Y $15.19 General Fee Schedule - 1/1/2018
85525 Y $13.74 General Fee Schedule - 1/1/2018
85530 Y $15.19 General Fee Schedule - 1/1/2018
85536 Y $7.50 General Fee Schedule - 1/1/2018
85540 Y $9.98 General Fee Schedule - 1/1/2018
85547 Y $9.98 General Fee Schedule - 1/1/2018
85549 Y $21.76 General Fee Schedule - 1/1/2018
85555 Y $7.76 General Fee Schedule - 1/1/2018
85557 Y $15.50 General Fee Schedule - 1/1/2018
85576 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
85576 Y $24.93 General Fee Schedule - 1/1/2018
85597 Y $20.86 General Fee Schedule - 1/1/2018
85598 Y $20.86 General Fee Schedule - 1/1/2018
85610 Y $4.56 General Fee Schedule - 1/1/2018
85611 Y $4.58 General Fee Schedule - 1/1/2018
85612 Y $16.44 General Fee Schedule - 1/1/2018
85613 Y $11.12 General Fee Schedule - 1/1/2018
85635 Y $11.43 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 249 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
85651 Y $4.12 General Fee Schedule - 1/1/2018
85652 Y $3.13 General Fee Schedule - 1/1/2018
85660 Y $6.39 General Fee Schedule - 1/1/2018
85670 Y $6.69 General Fee Schedule - 1/1/2018
85675 Y $7.94 General Fee Schedule - 1/1/2018
85705 Y $11.18 General Fee Schedule - 1/1/2018
85730 Y $6.97 General Fee Schedule - 1/1/2018
85732 Y $7.50 General Fee Schedule - 1/1/2018
85810 Y $13.55 General Fee Schedule - 1/1/2018
85999 Y $0.00 General by Report - 7/1/1975
86000 Y $8.10 General Fee Schedule - 1/1/2018
86001 Y $7.35 General Fee Schedule - 1/1/2018
86003 Y $6.05 General Fee Schedule - 1/1/2018
86005 Y $9.25 General Fee Schedule - 1/1/2018
86008 Y $0.00 General by Report - 1/1/2018
86021 Y $17.47 General Fee Schedule - 1/1/2018
86022 Y $21.32 General Fee Schedule - 1/1/2018
86023 Y $14.46 General Fee Schedule - 1/1/2018
86038 Y $14.02 General Fee Schedule - 1/1/2018
86039 Y $12.95 General Fee Schedule - 1/1/2018
86060 Y $8.47 General Fee Schedule - 1/1/2018
86063 Y $6.69 General Fee Schedule - 1/1/2018
86077 Y $52.36 General Fee Schedule - 1/1/2018
86078 Y $52.36 General Fee Schedule - 1/1/2018
86079 Y $52.05 General Fee Schedule - 1/1/2018
86140 Y $6.01 General Fee Schedule - 1/1/2018
86141 Y $15.02 General Fee Schedule - 1/1/2018
86146 Y $29.53 General Fee Schedule - 1/1/2018
86147 Y $29.53 General Fee Schedule - 1/1/2018
86148 Y $18.65 General Fee Schedule - 1/1/2018
86152 Y $285.14 General Fee Schedule - 1/1/2018
86153 Y $32.19 26 Fee Schedule (FS) - 1/1/2018
86153 Y $34.92 General Fee Schedule - 1/1/2015
CPT FEES01/03/2018 at 6:55:00 AM - 250 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86155 Y $18.56 General Fee Schedule - 1/1/2018
86156 Y $7.77 General Fee Schedule - 1/1/2018
86157 Y $9.35 General Fee Schedule - 1/1/2018
86160 Y $13.92 General Fee Schedule - 1/1/2018
86161 Y $13.92 General Fee Schedule - 1/1/2018
86162 Y $23.58 General Fee Schedule - 1/1/2018
86171 Y $11.62 General Fee Schedule - 1/1/2018
86200 Y $15.02 General Fee Schedule - 1/1/2018
86215 Y $15.37 General Fee Schedule - 1/1/2018
86225 Y $15.95 General Fee Schedule - 1/1/2018
86226 Y $14.05 General Fee Schedule - 1/1/2018
86235 Y $20.81 General Fee Schedule - 1/1/2018
86255 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
86255 Y $13.99 General Fee Schedule - 1/1/2018
86256 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
86256 Y $13.99 General Fee Schedule - 1/1/2018
86277 Y $18.26 General Fee Schedule - 1/1/2018
86280 Y $9.51 General Fee Schedule - 1/1/2018
86294 Y $24.04 General Fee Schedule - 1/1/2018
86300 Y $24.16 General Fee Schedule - 1/1/2018
86301 Y $24.16 General Fee Schedule - 1/1/2018
86304 Y $24.16 General Fee Schedule - 1/1/2018
86305 Y $24.16 General Fee Schedule - 1/1/2018
86308 Y $6.01 General Fee Schedule - 1/1/2018
86309 Y $7.50 General Fee Schedule - 1/1/2018
86310 Y $8.55 General Fee Schedule - 1/1/2018
86316 Y $24.16 General Fee Schedule - 1/1/2018
86317 Y $17.39 General Fee Schedule - 1/1/2018
86318 Y $17.00 General Fee Schedule - 1/1/2018
86320 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
86320 Y $28.12 General Fee Schedule - 1/1/2018
86325 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
86325 Y $25.95 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 251 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86327 Y $19.36 26 Fee Schedule (FS) - 1/1/2018
86327 Y $28.12 General Fee Schedule - 1/1/2018
86329 Y $16.30 General Fee Schedule - 1/1/2018
86331 Y $13.90 General Fee Schedule - 1/1/2018
86332 Y $28.28 General Fee Schedule - 1/1/2018
86334 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
86334 Y $25.93 General Fee Schedule - 1/1/2018
86335 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
86335 Y $34.06 General Fee Schedule - 1/1/2018
86336 Y $18.09 General Fee Schedule - 1/1/2018
86337 Y $24.84 General Fee Schedule - 1/1/2018
86340 Y $17.49 General Fee Schedule - 1/1/2018
86341 Y $22.96 General Fee Schedule - 1/1/2018
86343 Y $14.46 General Fee Schedule - 1/1/2018
86344 Y $9.77 General Fee Schedule - 1/1/2018
86352 Y $157.67 General Fee Schedule - 1/1/2018
86353 Y $56.90 General Fee Schedule - 1/1/2018
86355 Y $43.79 General Fee Schedule - 1/1/2018
86356 Y $31.08 General Fee Schedule - 1/1/2018
86357 Y $43.79 General Fee Schedule - 1/1/2018
86359 Y $43.79 General Fee Schedule - 1/1/2018
86360 Y $54.53 General Fee Schedule - 1/1/2018
86361 Y $31.08 General Fee Schedule - 1/1/2018
86367 Y $73.11 General Fee Schedule - 1/1/2018
86376 Y $16.88 General Fee Schedule - 1/1/2018
86382 Y $19.63 General Fee Schedule - 1/1/2018
86384 Y $13.22 General Fee Schedule - 1/1/2018
86386 Y $20.47 General Fee Schedule - 1/1/2018
86403 Y $11.83 General Fee Schedule - 1/1/2018
86406 Y $12.34 General Fee Schedule - 1/1/2018
86430 Y $6.58 General Fee Schedule - 1/1/2018
86431 Y $6.58 General Fee Schedule - 1/1/2018
86480 Y $71.93 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 252 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86481 Y $94.00 General Fee Schedule - 1/1/2018
86485 Y $15.63 General Fee Schedule - 1/1/2018
86486 Y $4.47 General Fee Schedule - 1/1/2018
86490 Y $79.27 General Fee Schedule - 1/1/2018
86510 Y $5.72 General Fee Schedule - 1/1/2018
86580 Y $7.28 General Fee Schedule - 1/1/2018
86590 Y $12.82 General Fee Schedule - 1/1/2018
86592 Y $4.95 General Fee Schedule - 1/1/2018
86593 Y $5.11 General Fee Schedule - 1/1/2018
86602 Y $11.81 General Fee Schedule - 1/1/2018
86603 Y $14.94 General Fee Schedule - 1/1/2018
86606 Y $17.47 General Fee Schedule - 1/1/2018
86609 Y $14.95 General Fee Schedule - 1/1/2018
86611 Y $11.81 General Fee Schedule - 1/1/2018
86612 Y $14.97 General Fee Schedule - 1/1/2018
86615 Y $15.30 General Fee Schedule - 1/1/2018
86617 Y $17.98 General Fee Schedule - 1/1/2018
86618 Y $19.76 General Fee Schedule - 1/1/2018
86619 Y $15.53 General Fee Schedule - 1/1/2018
86622 Y $10.37 General Fee Schedule - 1/1/2018
86625 Y $15.23 General Fee Schedule - 1/1/2018
86628 Y $13.93 General Fee Schedule - 1/1/2018
86631 Y $13.72 General Fee Schedule - 1/1/2018
86632 Y $14.72 General Fee Schedule - 1/1/2018
86635 Y $13.32 General Fee Schedule - 1/1/2018
86638 Y $14.07 General Fee Schedule - 1/1/2018
86641 Y $16.72 General Fee Schedule - 1/1/2018
86644 Y $16.70 General Fee Schedule - 1/1/2018
86645 Y $19.55 General Fee Schedule - 1/1/2018
86648 Y $17.64 General Fee Schedule - 1/1/2018
86651 Y $15.30 General Fee Schedule - 1/1/2018
86652 Y $15.30 General Fee Schedule - 1/1/2018
86653 Y $15.30 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 253 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86654 Y $15.30 General Fee Schedule - 1/1/2018
86658 Y $15.12 General Fee Schedule - 1/1/2018
86663 Y $15.23 General Fee Schedule - 1/1/2018
86664 Y $17.75 General Fee Schedule - 1/1/2018
86665 Y $21.06 General Fee Schedule - 1/1/2018
86666 Y $11.81 General Fee Schedule - 1/1/2018
86668 Y $13.31 General Fee Schedule - 1/1/2018
86671 Y $14.22 General Fee Schedule - 1/1/2018
86674 Y $17.08 General Fee Schedule - 1/1/2018
86677 Y $16.84 General Fee Schedule - 1/1/2018
86682 Y $15.10 General Fee Schedule - 1/1/2018
86684 Y $18.39 General Fee Schedule - 1/1/2018
86687 Y $9.74 General Fee Schedule - 1/1/2018
86688 Y $16.25 General Fee Schedule - 1/1/2018
86689 Y $22.47 General Fee Schedule - 1/1/2018
86692 Y $19.92 General Fee Schedule - 1/1/2018
86694 Y $16.70 General Fee Schedule - 1/1/2018
86695 Y $15.30 General Fee Schedule - 1/1/2018
86696 Y $22.47 General Fee Schedule - 1/1/2018
86698 Y $14.50 General Fee Schedule - 1/1/2018
86701 Y $10.31 General Fee Schedule - 1/1/2018
86702 Y $15.69 General Fee Schedule - 1/1/2018
86703 Y $15.90 General Fee Schedule - 1/1/2018
86704 Y $13.99 General Fee Schedule - 1/1/2018
86705 Y $13.67 General Fee Schedule - 1/1/2018
86706 Y $12.46 General Fee Schedule - 1/1/2018
86707 Y $13.42 General Fee Schedule - 1/1/2018
86708 Y $14.37 General Fee Schedule - 1/1/2018
86709 Y $13.07 General Fee Schedule - 1/1/2018
86710 Y $15.73 General Fee Schedule - 1/1/2018
86711 Y $16.70 General Fee Schedule - 1/1/2018
86713 Y $17.76 General Fee Schedule - 1/1/2018
86717 Y $14.21 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 254 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86720 Y $15.30 General Fee Schedule - 1/1/2018
86723 Y $15.30 General Fee Schedule - 1/1/2018
86727 Y $14.94 General Fee Schedule - 1/1/2018
86732 Y $15.30 General Fee Schedule - 1/1/2018
86735 Y $15.14 General Fee Schedule - 1/1/2018
86738 Y $15.36 General Fee Schedule - 1/1/2018
86741 Y $15.30 General Fee Schedule - 1/1/2018
86744 Y $15.30 General Fee Schedule - 1/1/2018
86747 Y $17.45 General Fee Schedule - 1/1/2018
86750 Y $15.30 General Fee Schedule - 1/1/2018
86753 Y $14.37 General Fee Schedule - 1/1/2018
86756 Y $14.96 General Fee Schedule - 1/1/2018
86757 Y $22.47 General Fee Schedule - 1/1/2018
86759 Y $17.14 General Fee Schedule - 1/1/2018
86762 Y $16.70 General Fee Schedule - 1/1/2018
86765 Y $14.95 General Fee Schedule - 1/1/2018
86768 Y $15.30 General Fee Schedule - 1/1/2018
86771 Y $23.01 General Fee Schedule - 1/1/2018
86774 Y $17.17 General Fee Schedule - 1/1/2018
86777 Y $16.70 General Fee Schedule - 1/1/2018
86778 Y $16.71 General Fee Schedule - 1/1/2018
86780 Y $15.36 General Fee Schedule - 1/1/2018
86784 Y $14.58 General Fee Schedule - 1/1/2018
86787 Y $14.95 General Fee Schedule - 1/1/2018
86788 Y $19.55 General Fee Schedule - 1/1/2018
86789 Y $16.70 General Fee Schedule - 1/1/2018
86790 Y $14.95 General Fee Schedule - 1/1/2018
86793 Y $15.30 General Fee Schedule - 1/1/2018
86800 Y $18.46 General Fee Schedule - 1/1/2018
86803 Y $16.55 General Fee Schedule - 1/1/2018
86804 Y $17.98 General Fee Schedule - 1/1/2018
86805 Y $178.14 General Fee Schedule - 1/1/2018
86806 Y $55.23 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 255 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86807 Y $73.93 General Fee Schedule - 1/1/2018
86808 Y $34.44 General Fee Schedule - 1/1/2018
86812 Y $29.95 General Fee Schedule - 1/1/2018
86813 Y $67.30 General Fee Schedule - 1/1/2018
86816 Y $32.33 General Fee Schedule - 1/1/2018
86817 Y $99.77 General Fee Schedule - 1/1/2018
86821 Y $42.43 General Fee Schedule - 1/1/2018
86825 Y $102.92 General Fee Schedule - 1/1/2018
86826 Y $34.34 General Fee Schedule - 1/1/2018
86828 Y $60.34 General Fee Schedule - 1/1/2018
86829 Y $60.34 General Fee Schedule - 1/1/2018
86830 Y $93.70 General Fee Schedule - 1/1/2018
86831 Y $80.31 General Fee Schedule - 1/1/2018
86832 Y $304.33 General Fee Schedule - 1/1/2018
86833 Y $306.25 General Fee Schedule - 1/1/2018
86834 Y $414.94 General Fee Schedule - 1/1/2018
86835 Y $374.80 General Fee Schedule - 1/1/2018
86849 Y $0.00 General by Report - 1/1/1993
86850 Y $9.18 General Fee Schedule - 1/1/2018
86860 Y $23.64 General Fee Schedule - 7/1/2004
86870 Y $9.06 General Fee Schedule - 7/1/2004
86880 Y $6.25 General Fee Schedule - 1/1/2018
86885 Y $6.65 General Fee Schedule - 1/1/2018
86886 Y $6.01 General Fee Schedule - 1/1/2018
86890 Y $39.40 General Fee Schedule - 7/1/2004
86891 Y $39.40 General Fee Schedule - 7/1/2004
86900 Y $3.47 General Fee Schedule - 1/1/2018
86901 Y $3.47 General Fee Schedule - 1/1/2018
86902 Y $5.97 General Fee Schedule - 1/1/2018
86904 Y $15.36 General Fee Schedule - 1/1/2018
86905 Y $4.45 General Fee Schedule - 1/1/2018
86906 Y $9.00 General Fee Schedule - 1/1/2018
86910 Y $23.99 General Fee Schedule - 7/1/2004
CPT FEES01/03/2018 at 6:55:00 AM - 256 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
86911 Y $7.29 General Fee Schedule - 7/1/2004
86920 Y $149.44 General Fee Schedule - 7/1/2004
86921 Y $0.00 General by Report - 1/1/1993
86922 Y $0.00 General by Report - 1/1/1993
86923 Y $0.00 General by Report - 1/1/2006
86927 Y $23.64 General Fee Schedule - 7/1/2004
86930 Y $7.88 General Fee Schedule - 7/1/2004
86931 Y $23.64 General Fee Schedule - 7/1/2004
86932 Y $23.64 General Fee Schedule - 7/1/2004
86940 Y $9.52 General Fee Schedule - 1/1/2018
86941 Y $14.05 General Fee Schedule - 1/1/2018
86945 Y $0.00 General by Report - 1/1/1993
86950 Y $76.68 General Fee Schedule - 7/1/2004
86960 Y $0.00 General by Report - 1/1/2006
86965 Y $10.34 General Fee Schedule - 7/1/2004
86970 Y $42.10 General Fee Schedule - 7/1/2004
86971 Y $38.63 General Fee Schedule - 7/1/2004
86972 Y $38.63 General Fee Schedule - 7/1/2004
86975 Y $135.89 General Fee Schedule - 7/1/2004
86976 Y $135.89 General Fee Schedule - 7/1/2004
86977 Y $135.89 General Fee Schedule - 7/1/2004
86978 Y $135.89 General Fee Schedule - 7/1/2004
86985 Y $23.64 General Fee Schedule - 7/1/2004
86999 Y $0.00 General by Report - 7/1/1975
87003 Y $19.54 General Fee Schedule - 1/1/2018
87015 Y $7.75 General Fee Schedule - 1/1/2018
87040 Y $11.98 General Fee Schedule - 1/1/2018
87045 Y $10.96 General Fee Schedule - 1/1/2018
87046 Y $10.96 General Fee Schedule - 1/1/2018
87070 Y $10.00 General Fee Schedule - 1/1/2018
87071 Y $10.96 General Fee Schedule - 1/1/2018
87073 Y $10.96 General Fee Schedule - 1/1/2018
87075 Y $10.99 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 257 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87076 Y $9.37 General Fee Schedule - 1/1/2018
87077 Y $9.37 General Fee Schedule - 1/1/2018
87081 Y $7.69 General Fee Schedule - 1/1/2018
87084 Y $25.45 General Fee Schedule - 1/1/2018
87086 Y $9.36 General Fee Schedule - 1/1/2018
87088 Y $9.39 General Fee Schedule - 1/1/2018
87101 Y $8.94 General Fee Schedule - 1/1/2018
87102 Y $9.76 General Fee Schedule - 1/1/2018
87103 Y $19.23 General Fee Schedule - 1/1/2018
87106 Y $11.98 General Fee Schedule - 1/1/2018
87107 Y $11.98 General Fee Schedule - 1/1/2018
87109 Y $17.86 General Fee Schedule - 1/1/2018
87110 Y $22.74 General Fee Schedule - 1/1/2018
87116 Y $12.54 General Fee Schedule - 1/1/2018
87118 Y $13.73 General Fee Schedule - 1/1/2018
87140 Y $6.47 General Fee Schedule - 1/1/2018
87143 Y $14.53 General Fee Schedule - 1/1/2018
87147 Y $6.01 General Fee Schedule - 1/1/2018
87149 Y $23.27 General Fee Schedule - 1/1/2018
87150 Y $40.73 General Fee Schedule - 1/1/2018
87152 Y $7.28 General Fee Schedule - 1/1/2018
87153 Y $133.87 General Fee Schedule - 1/1/2018
87158 Y $7.28 General Fee Schedule - 1/1/2018
87164 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
87164 Y $12.46 General Fee Schedule - 1/1/2018
87166 Y $13.11 General Fee Schedule - 1/1/2018
87168 Y $4.95 General Fee Schedule - 1/1/2018
87169 Y $4.95 General Fee Schedule - 1/1/2018
87172 Y $4.95 General Fee Schedule - 1/1/2018
87176 Y $6.82 General Fee Schedule - 1/1/2018
87177 Y $10.33 General Fee Schedule - 1/1/2018
87181 Y $5.51 General Fee Schedule - 1/1/2018
87184 Y $8.00 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 258 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87185 Y $5.51 General Fee Schedule - 1/1/2018
87186 Y $10.03 General Fee Schedule - 1/1/2018
87187 Y $37.76 General Fee Schedule - 1/1/2018
87188 Y $7.71 General Fee Schedule - 1/1/2018
87190 Y $6.87 General Fee Schedule - 1/1/2018
87197 Y $17.44 General Fee Schedule - 1/1/2018
87205 Y $4.95 General Fee Schedule - 1/1/2018
87206 Y $6.25 General Fee Schedule - 1/1/2018
87207 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
87207 Y $6.96 General Fee Schedule - 1/1/2018
87209 Y $20.86 General Fee Schedule - 1/1/2018
87210 Y $5.47 General Fee Schedule - 1/1/2018
87220 Y $4.95 General Fee Schedule - 1/1/2018
87230 Y $22.91 General Fee Schedule - 1/1/2018
87250 Y $22.70 General Fee Schedule - 1/1/2018
87252 Y $30.25 General Fee Schedule - 1/1/2018
87253 Y $23.44 General Fee Schedule - 1/1/2018
87254 Y $22.70 General Fee Schedule - 1/1/2018
87255 Y $39.30 General Fee Schedule - 1/1/2018
87260 Y $13.91 General Fee Schedule - 1/1/2018
87265 Y $13.91 General Fee Schedule - 1/1/2018
87267 Y $13.91 General Fee Schedule - 1/1/2018
87269 Y $13.91 General Fee Schedule - 1/1/2018
87270 Y $13.91 General Fee Schedule - 1/1/2018
87271 Y $13.91 General Fee Schedule - 1/1/2018
87272 Y $13.91 General Fee Schedule - 1/1/2018
87273 Y $13.91 General Fee Schedule - 1/1/2018
87274 Y $13.91 General Fee Schedule - 1/1/2018
87275 Y $13.91 General Fee Schedule - 1/1/2018
87276 Y $15.11 General Fee Schedule - 1/1/2018
87278 Y $14.66 General Fee Schedule - 1/1/2018
87279 Y $15.44 General Fee Schedule - 1/1/2018
87280 Y $13.91 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 259 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87281 Y $13.91 General Fee Schedule - 1/1/2018
87283 Y $57.15 General Fee Schedule - 1/1/2018
87285 Y $13.91 General Fee Schedule - 1/1/2018
87290 Y $13.91 General Fee Schedule - 1/1/2018
87299 Y $15.13 General Fee Schedule - 1/1/2018
87300 Y $13.91 General Fee Schedule - 1/1/2018
87301 Y $13.91 General Fee Schedule - 1/1/2018
87305 Y $13.91 General Fee Schedule - 1/1/2018
87320 Y $14.10 General Fee Schedule - 1/1/2018
87324 Y $13.91 General Fee Schedule - 1/1/2018
87327 Y $13.91 General Fee Schedule - 1/1/2018
87328 Y $13.91 General Fee Schedule - 1/1/2018
87329 Y $13.91 General Fee Schedule - 1/1/2018
87332 Y $13.91 General Fee Schedule - 1/1/2018
87335 Y $13.91 General Fee Schedule - 1/1/2018
87336 Y $15.04 General Fee Schedule - 1/1/2018
87337 Y $13.91 General Fee Schedule - 1/1/2018
87338 Y $16.69 General Fee Schedule - 1/1/2018
87339 Y $15.04 General Fee Schedule - 1/1/2018
87340 Y $11.99 General Fee Schedule - 1/1/2018
87341 Y $11.99 General Fee Schedule - 1/1/2018
87350 Y $13.38 General Fee Schedule - 1/1/2018
87380 Y $19.04 General Fee Schedule - 1/1/2018
87385 Y $13.91 General Fee Schedule - 1/1/2018
87389 Y $27.95 General Fee Schedule - 1/1/2018
87390 Y $22.62 General Fee Schedule - 1/1/2018
87391 Y $20.59 General Fee Schedule - 1/1/2018
87400 Y $13.91 General Fee Schedule - 1/1/2018
87420 Y $13.91 General Fee Schedule - 1/1/2018
87425 Y $13.91 General Fee Schedule - 1/1/2018
87427 Y $13.91 General Fee Schedule - 1/1/2018
87430 Y $15.80 General Fee Schedule - 1/1/2018
87449 Y $13.91 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 260 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87450 Y $11.13 General Fee Schedule - 1/1/2018
87451 Y $11.13 General Fee Schedule - 1/1/2018
87471 Y $40.73 General Fee Schedule - 1/1/2018
87472 Y $49.71 General Fee Schedule - 1/1/2018
87475 Y $23.27 General Fee Schedule - 1/1/2018
87476 Y $40.73 General Fee Schedule - 1/1/2018
87480 Y $23.27 General Fee Schedule - 1/1/2018
87481 Y $40.73 General Fee Schedule - 1/1/2018
87482 Y $52.40 General Fee Schedule - 1/1/2018
87483 Y $483.68 General Fee Schedule - 1/1/2018
87485 Y $23.27 General Fee Schedule - 1/1/2018
87486 Y $40.73 General Fee Schedule - 1/1/2018
87487 Y $49.71 General Fee Schedule - 1/1/2018
87490 Y $23.27 General Fee Schedule - 1/1/2018
87491 Y $40.73 General Fee Schedule - 1/1/2018
87492 Y $50.26 General Fee Schedule - 1/1/2018
87493 Y $40.73 General Fee Schedule - 1/1/2018
87495 Y $28.23 General Fee Schedule - 1/1/2018
87496 Y $40.73 General Fee Schedule - 1/1/2018
87497 Y $49.71 General Fee Schedule - 1/1/2018
87498 Y $40.73 General Fee Schedule - 1/1/2018
87500 Y $40.73 General Fee Schedule - 1/1/2018
87501 Y $59.55 General Fee Schedule - 1/1/2018
87502 Y $98.76 General Fee Schedule - 1/1/2018
87503 Y $27.47 General Fee Schedule - 1/1/2018
87505 Y $148.88 General Fee Schedule - 1/1/2018
87506 Y $247.68 General Fee Schedule - 1/1/2018
87507 Y $483.68 General Fee Schedule - 1/1/2018
87510 Y $23.27 General Fee Schedule - 1/1/2018
87511 Y $40.73 General Fee Schedule - 1/1/2018
87512 Y $48.46 General Fee Schedule - 1/1/2018
87516 Y $40.73 General Fee Schedule - 1/1/2018
87517 Y $49.71 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 261 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87520 Y $29.35 General Fee Schedule - 1/1/2018
87521 Y $40.73 General Fee Schedule - 1/1/2018
87522 Y $49.71 General Fee Schedule - 1/1/2018
87525 Y $28.01 General Fee Schedule - 1/1/2018
87526 Y $40.73 General Fee Schedule - 1/1/2018
87527 Y $48.46 General Fee Schedule - 1/1/2018
87528 Y $23.27 General Fee Schedule - 1/1/2018
87529 Y $40.73 General Fee Schedule - 1/1/2018
87530 Y $49.71 General Fee Schedule - 1/1/2018
87531 Y $54.52 General Fee Schedule - 1/1/2018
87532 Y $40.73 General Fee Schedule - 1/1/2018
87533 Y $48.46 General Fee Schedule - 1/1/2018
87534 Y $23.27 General Fee Schedule - 1/1/2018
87535 Y $40.73 General Fee Schedule - 1/1/2018
87536 Y $98.76 General Fee Schedule - 1/1/2018
87537 Y $23.27 General Fee Schedule - 1/1/2018
87538 Y $40.73 General Fee Schedule - 1/1/2018
87539 Y $55.10 General Fee Schedule - 1/1/2018
87540 Y $23.27 General Fee Schedule - 1/1/2018
87541 Y $40.73 General Fee Schedule - 1/1/2018
87542 Y $48.46 General Fee Schedule - 1/1/2018
87550 Y $23.27 General Fee Schedule - 1/1/2018
87551 Y $45.35 General Fee Schedule - 1/1/2018
87552 Y $49.71 General Fee Schedule - 1/1/2018
87555 Y $25.27 General Fee Schedule - 1/1/2018
87556 Y $40.73 General Fee Schedule - 1/1/2018
87557 Y $49.71 General Fee Schedule - 1/1/2018
87560 Y $25.65 General Fee Schedule - 1/1/2018
87561 Y $40.73 General Fee Schedule - 1/1/2018
87562 Y $49.71 General Fee Schedule - 1/1/2018
87580 Y $23.27 General Fee Schedule - 1/1/2018
87581 Y $40.73 General Fee Schedule - 1/1/2018
87582 Y $284.46 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 262 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87590 Y $25.27 General Fee Schedule - 1/1/2018
87591 Y $40.73 General Fee Schedule - 1/1/2018
87592 Y $49.71 General Fee Schedule - 1/1/2018
87623 Y $40.73 General Fee Schedule - 1/1/2018
87624 Y $40.73 General Fee Schedule - 1/1/2018
87625 Y $40.73 General Fee Schedule - 1/1/2018
87631 Y $148.88 General Fee Schedule - 1/1/2018
87632 Y $247.68 General Fee Schedule - 1/1/2018
87633 Y $483.68 General Fee Schedule - 1/1/2018
87640 Y $40.73 General Fee Schedule - 1/1/2018
87641 Y $40.73 General Fee Schedule - 1/1/2018
87650 Y $23.27 General Fee Schedule - 1/1/2018
87651 Y $40.73 General Fee Schedule - 1/1/2018
87652 Y $48.46 General Fee Schedule - 1/1/2018
87653 Y $40.73 General Fee Schedule - 1/1/2018
87660 Y $23.27 General Fee Schedule - 1/1/2018
87661 Y $40.73 General Fee Schedule - 1/1/2018
87797 Y $28.23 General Fee Schedule - 1/1/2018
87798 Y $40.73 General Fee Schedule - 1/1/2018
87799 Y $49.71 General Fee Schedule - 1/1/2018
87800 Y $46.56 General Fee Schedule - 1/1/2018
87801 Y $81.46 General Fee Schedule - 1/1/2018
87802 Y $13.91 General Fee Schedule - 1/1/2018
87803 Y $15.04 General Fee Schedule - 1/1/2018
87804 Y $15.56 General Fee Schedule - 1/1/2018
87806 Y $30.80 General Fee Schedule - 1/1/2018
87807 Y $13.91 General Fee Schedule - 1/1/2018
87808 Y $14.37 General Fee Schedule - 1/1/2018
87809 Y $20.45 General Fee Schedule - 1/1/2018
87810 Y $33.17 General Fee Schedule - 1/1/2018
87850 Y $23.09 General Fee Schedule - 1/1/2018
87880 Y $15.54 General Fee Schedule - 1/1/2018
87899 Y $15.11 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 263 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
87900 Y $151.26 General Fee Schedule - 1/1/2018
87901 Y $298.77 General Fee Schedule - 1/1/2018
87902 Y $298.77 General Fee Schedule - 1/1/2018
87903 Y $567.08 General Fee Schedule - 1/1/2018
87904 Y $30.25 General Fee Schedule - 1/1/2018
87905 Y $14.18 General Fee Schedule - 1/1/2018
87906 Y $149.38 General Fee Schedule - 1/1/2018
87910 Y $298.77 General Fee Schedule - 1/1/2018
87912 Y $298.77 General Fee Schedule - 1/1/2018
87999 Y $0.00 General by Report - 7/1/1975
88104 Y $27.14 26 Fee Schedule (FS) - 1/1/2018
88104 Y $65.58 General Fee Schedule - 1/1/2018
88104 Y $38.45 TC Fee Schedule - 1/1/2018
88106 Y $18.64 26 Fee Schedule (FS) - 1/1/2018
88106 Y $58.02 General Fee Schedule - 1/1/2018
88106 Y $39.38 TC Fee Schedule - 1/1/2018
88108 Y $21.59 26 Fee Schedule (FS) - 1/1/2018
88108 Y $55.05 General Fee Schedule - 1/1/2018
88108 Y $33.45 TC Fee Schedule - 1/1/2018
88112 Y $26.82 26 Fee Schedule (FS) - 1/1/2018
88112 Y $62.15 General Fee Schedule - 1/1/2018
88112 Y $35.33 TC Fee Schedule - 1/1/2018
88120 Y $55.48 26 Fee Schedule (FS) - 1/1/2018
88120 Y $565.58 General Fee Schedule - 1/1/2018
88120 Y $510.10 TC Fee Schedule - 1/1/2018
88121 Y $47.48 26 Fee Schedule (FS) - 1/1/2018
88121 Y $471.45 General Fee Schedule - 1/1/2018
88121 Y $423.97 TC Fee Schedule - 1/1/2018
88125 Y $13.42 26 Fee Schedule (FS) - 1/1/2018
88125 Y $24.44 General Fee Schedule - 1/1/2018
88125 Y $11.02 TC Fee Schedule - 1/1/2018
88130 Y $20.86 General Fee Schedule - 1/1/2018
88140 Y $9.27 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 264 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88141 Y $29.76 General Fee Schedule - 1/1/2018
88142 Y $23.51 General Fee Schedule - 1/1/2018
88143 Y $23.51 General Fee Schedule - 1/1/2018
88147 Y $47.53 General Fee Schedule - 1/1/2018
88148 Y $17.63 General Fee Schedule - 1/1/2018
88150 Y $13.77 General Fee Schedule - 1/1/2018
88152 Y $25.98 General Fee Schedule - 1/1/2018
88153 Y $22.59 General Fee Schedule - 1/1/2018
88155 Y $13.77 General Fee Schedule - 1/1/2018
88160 Y $24.83 26 Fee Schedule (FS) - 1/1/2018
88160 Y $65.45 General Fee Schedule - 1/1/2018
88160 Y $40.63 TC Fee Schedule - 1/1/2018
88161 Y $23.89 26 Fee Schedule (FS) - 1/1/2018
88161 Y $59.53 General Fee Schedule - 1/1/2018
88161 Y $35.64 TC Fee Schedule - 1/1/2018
88162 Y $37.01 26 Fee Schedule (FS) - 1/1/2018
88162 Y $87.72 General Fee Schedule - 1/1/2018
88162 Y $50.71 TC Fee Schedule - 1/1/2018
88164 Y $13.77 General Fee Schedule - 1/1/2018
88165 Y $39.69 General Fee Schedule - 1/1/2018
88166 Y $13.77 General Fee Schedule - 1/1/2018
88167 Y $13.77 General Fee Schedule - 1/1/2018
88172 Y $34.68 26 Fee Schedule (FS) - 1/1/2018
88172 Y $52.87 General Fee Schedule - 1/1/2018
88172 Y $18.19 TC Fee Schedule - 1/1/2018
88173 Y $68.03 26 Fee Schedule (FS) - 1/1/2018
88173 Y $140.24 General Fee Schedule - 1/1/2018
88173 Y $72.21 TC Fee Schedule - 1/1/2018
88174 Y $24.80 General Fee Schedule - 1/1/2018
88175 Y $30.75 General Fee Schedule - 1/1/2018
88177 Y $21.23 26 Fee Schedule (FS) - 1/1/2018
88177 Y $28.10 General Fee Schedule - 1/1/2018
88177 Y $6.85 TC Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 265 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88182 Y $37.03 26 Fee Schedule (FS) - 1/1/2018
88182 Y $118.08 General Fee Schedule - 1/1/2018
88182 Y $81.06 TC Fee Schedule - 1/1/2018
88184 Y $59.13 General Fee Schedule - 1/1/2018
88185 Y $26.49 General Fee Schedule - 1/1/2018
88187 Y $43.73 General Fee Schedule - 1/1/2018
88188 Y $60.80 General Fee Schedule - 1/1/2018
88189 Y $81.38 General Fee Schedule - 1/1/2018
88199 Y $0.00 26 by Report - 6/1/1981
88199 Y $0.00 General by Report - 7/1/1975
88230 Y $135.19 General Fee Schedule - 1/1/2018
88233 Y $163.32 General Fee Schedule - 1/1/2018
88235 Y $170.90 General Fee Schedule - 1/1/2018
88237 Y $146.57 General Fee Schedule - 1/1/2018
88239 Y $171.19 General Fee Schedule - 1/1/2018
88240 Y $12.29 General Fee Schedule - 1/1/2018
88241 Y $11.72 General Fee Schedule - 1/1/2018
88245 Y $200.97 General Fee Schedule - 1/1/2018
88248 Y $200.97 General Fee Schedule - 1/1/2018
88249 Y $200.97 General Fee Schedule - 1/1/2018
88261 Y $248.48 General Fee Schedule - 1/1/2018
88262 Y $144.65 General Fee Schedule - 1/1/2018
88263 Y $174.41 General Fee Schedule - 1/1/2018
88264 Y $144.65 General Fee Schedule - 1/1/2018
88267 Y $208.63 General Fee Schedule - 1/1/2018
88269 Y $193.02 General Fee Schedule - 1/1/2018
88271 Y $24.85 General Fee Schedule - 1/1/2018
88272 Y $38.26 General Fee Schedule - 1/1/2018
88273 Y $37.28 General Fee Schedule - 1/1/2018
88274 Y $40.40 General Fee Schedule - 1/1/2018
88275 Y $48.12 General Fee Schedule - 1/1/2018
88280 Y $31.46 General Fee Schedule - 1/1/2018
88283 Y $79.61 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 266 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88285 Y $25.30 General Fee Schedule - 1/1/2018
88289 Y $39.96 General Fee Schedule - 1/1/2018
88291 Y $30.59 General Fee Schedule - 1/1/2018
88299 Y $0.00 General by Report - 7/1/1975
88300 Y $4.32 26 Fee Schedule (FS) - 1/1/2018
88300 Y $15.03 General Fee Schedule - 1/1/2018
88300 Y $10.71 TC Fee Schedule - 1/1/2018
88302 Y $6.93 26 Fee Schedule (FS) - 1/1/2018
88302 Y $27.92 General Fee Schedule - 1/1/2018
88302 Y $20.99 TC Fee Schedule - 1/1/2018
88304 Y $11.16 26 Fee Schedule (FS) - 1/1/2018
88304 Y $36.83 General Fee Schedule - 1/1/2018
88304 Y $25.66 TC Fee Schedule - 1/1/2018
88305 Y $36.36 26 Fee Schedule (FS) - 1/1/2018
88305 Y $62.65 General Fee Schedule - 1/1/2018
88305 Y $26.29 TC Fee Schedule - 1/1/2018
88307 Y $79.77 26 Fee Schedule (FS) - 1/1/2018
88307 Y $237.69 General Fee Schedule - 1/1/2018
88307 Y $157.92 TC Fee Schedule - 1/1/2018
88309 Y $141.50 26 Fee Schedule (FS) - 1/1/2018
88309 Y $361.86 General Fee Schedule - 1/1/2018
88309 Y $220.36 TC Fee Schedule - 1/1/2018
88311 Y $12.14 26 Fee Schedule (FS) - 1/1/2018
88311 Y $20.35 General Fee Schedule - 1/1/2018
88311 Y $8.22 TC Fee Schedule - 1/1/2018
88312 Y $25.53 26 Fee Schedule (FS) - 1/1/2018
88312 Y $87.35 General Fee Schedule - 1/1/2018
88312 Y $61.82 TC Fee Schedule - 1/1/2018
88313 Y $11.52 26 Fee Schedule (FS) - 1/1/2018
88313 Y $63.05 General Fee Schedule - 1/1/2018
88313 Y $51.53 TC Fee Schedule - 1/1/2018
88314 Y $21.61 26 Fee Schedule (FS) - 1/1/2018
88314 Y $76.57 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 267 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88314 Y $54.96 TC Fee Schedule - 1/1/2018
88319 Y $25.51 26 Fee Schedule (FS) - 1/1/2018
88319 Y $79.23 General Fee Schedule - 1/1/2018
88319 Y $53.72 TC Fee Schedule - 1/1/2018
88321 Y $95.25 General Fee Schedule - 1/1/2018
88323 Y $83.27 26 Fee Schedule (FS) - 1/1/2018
88323 Y $112.37 General Fee Schedule - 1/1/2018
88323 Y $29.09 TC Fee Schedule - 1/1/2018
88325 Y $171.67 General Fee Schedule - 1/1/2018
88329 Y $47.95 General Fee Schedule - 1/1/2018
88331 Y $60.44 26 Fee Schedule (FS) - 1/1/2018
88331 Y $89.22 General Fee Schedule - 1/1/2018
88331 Y $28.78 TC Fee Schedule - 1/1/2018
88332 Y $29.69 26 Fee Schedule (FS) - 1/1/2018
88332 Y $48.50 General Fee Schedule - 1/1/2018
88332 Y $18.81 TC Fee Schedule - 1/1/2018
88333 Y $60.47 26 Fee Schedule (FS) - 1/1/2018
88333 Y $82.39 General Fee Schedule - 1/1/2018
88333 Y $21.93 TC Fee Schedule - 1/1/2018
88334 Y $36.94 26 Fee Schedule (FS) - 1/1/2018
88334 Y $50.97 General Fee Schedule - 1/1/2018
88334 Y $14.02 TC Fee Schedule - 1/1/2018
88341 Y $27.14 26 Fee Schedule (FS) - 1/1/2018
88341 Y $83.24 General Fee Schedule - 1/1/2018
88341 Y $56.10 TC Fee Schedule - 1/1/2018
88342 Y $34.08 26 Fee Schedule (FS) - 1/1/2018
88342 Y $98.39 General Fee Schedule - 1/1/2018
88342 Y $64.31 TC Fee Schedule - 1/1/2018
88344 Y $37.34 26 Fee Schedule (FS) - 1/1/2018
88344 Y $156.50 General Fee Schedule - 1/1/2018
88344 Y $119.16 TC Fee Schedule - 1/1/2018
88346 Y $34.37 26 Fee Schedule (FS) - 1/1/2018
88346 Y $84.65 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 268 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88346 Y $50.29 TC Fee Schedule - 1/1/2018
88348 Y $72.63 26 Fee Schedule (FS) - 1/1/2018
88348 Y $310.68 General Fee Schedule - 1/1/2018
88348 Y $238.04 TC Fee Schedule - 1/1/2018
88350 Y $27.50 26 Fee Schedule (FS) - 1/1/2018
88350 Y $65.22 General Fee Schedule - 1/1/2018
88350 Y $37.71 TC Fee Schedule - 1/1/2018
88355 Y $78.10 26 Fee Schedule (FS) - 1/1/2018
88355 Y $120.29 General Fee Schedule - 1/1/2018
88355 Y $42.19 TC Fee Schedule - 1/1/2018
88356 Y $118.53 26 Fee Schedule (FS) - 1/1/2018
88356 Y $201.76 General Fee Schedule - 1/1/2018
88356 Y $83.24 TC Fee Schedule - 1/1/2018
88358 Y $44.57 26 Fee Schedule (FS) - 1/1/2018
88358 Y $86.13 General Fee Schedule - 1/1/2018
88358 Y $41.56 TC Fee Schedule - 1/1/2018
88360 Y $42.49 26 Fee Schedule (FS) - 1/1/2018
88360 Y $120.21 General Fee Schedule - 1/1/2018
88360 Y $77.71 TC Fee Schedule - 1/1/2018
88361 Y $45.20 26 Fee Schedule (FS) - 1/1/2018
88361 Y $130.70 General Fee Schedule - 1/1/2018
88361 Y $85.50 TC Fee Schedule - 1/1/2018
88362 Y $105.61 26 Fee Schedule (FS) - 1/1/2018
88362 Y $190.28 General Fee Schedule - 1/1/2018
88362 Y $84.68 TC Fee Schedule - 1/1/2018
88363 Y $22.17 General Fee Schedule - 1/1/2018
88364 Y $33.45 26 Fee Schedule (FS) - 1/1/2018
88364 Y $118.65 General Fee Schedule - 1/1/2018
88364 Y $85.19 TC Fee Schedule - 1/1/2018
88365 Y $42.24 26 Fee Schedule (FS) - 1/1/2018
88365 Y $161.10 General Fee Schedule - 1/1/2018
88365 Y $118.85 TC Fee Schedule - 1/1/2018
88366 Y $59.61 26 Fee Schedule (FS) - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 269 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88366 Y $235.19 General Fee Schedule - 1/1/2018
88366 Y $175.57 TC Fee Schedule - 1/1/2018
88367 Y $33.10 26 Fee Schedule (FS) - 1/1/2018
88367 Y $96.47 General Fee Schedule - 1/1/2018
88367 Y $63.37 TC Fee Schedule - 1/1/2018
88368 Y $39.75 26 Fee Schedule (FS) - 1/1/2018
88368 Y $109.05 General Fee Schedule - 1/1/2018
88368 Y $69.30 TC Fee Schedule - 1/1/2018
88369 Y $30.85 26 Fee Schedule (FS) - 1/1/2018
88369 Y $98.28 General Fee Schedule - 1/1/2018
88369 Y $67.43 TC Fee Schedule - 1/1/2018
88371 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
88371 Y $25.79 General Fee Schedule - 1/1/2018
88372 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
88372 Y $26.40 General Fee Schedule - 1/1/2018
88373 Y $26.24 26 Fee Schedule (FS) - 1/1/2018
88373 Y $70.81 General Fee Schedule - 1/1/2018
88373 Y $44.57 TC Fee Schedule - 1/1/2018
88374 Y $41.92 26 Fee Schedule (FS) - 1/1/2018
88374 Y $306.33 General Fee Schedule - 1/1/2018
88374 Y $264.40 TC Fee Schedule - 1/1/2018
88375 Y $47.62 General Fee Schedule - 1/1/2018
88377 Y $61.08 26 Fee Schedule (FS) - 1/1/2018
88377 Y $364.86 General Fee Schedule - 1/1/2018
88377 Y $303.78 TC Fee Schedule - 1/1/2018
88380 Y $52.44 26 Fee Schedule (FS) - 1/1/2018
88380 Y $124.03 General Fee Schedule - 1/1/2018
88380 Y $71.59 TC Fee Schedule - 1/1/2018
88381 Y $23.95 26 Fee Schedule (FS) - 1/1/2018
88381 Y $109.58 General Fee Schedule - 1/1/2018
88381 Y $85.62 TC Fee Schedule - 1/1/2018
88387 Y $27.05 26 Fee Schedule (FS) - 1/1/2018
88387 Y $32.47 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 270 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
88387 Y $5.41 TC Fee Schedule - 1/1/2018
88388 Y $22.85 26 Fee Schedule (FS) - 1/1/2018
88388 Y $31.70 General Fee Schedule - 8/1/2016
88388 Y $8.84 TC Fee Schedule - 1/1/2018
88399 Y $0.00 26 by Report - 6/1/1981
88399 Y $0.00 General by Report - 7/1/1975
88720 Y $5.82 General Fee Schedule - 1/1/2018
88738 Y $5.82 General Fee Schedule - 1/1/2018
88740 Y $8.81 General Fee Schedule - 1/1/2018
88741 Y $8.81 General Fee Schedule - 1/1/2018
88749 Y $0.00 General by Report - 1/1/2011
89049 Y $219.06 General Fee Schedule - 1/1/2018
89050 Y $5.48 General Fee Schedule - 1/1/2018
89051 Y $6.39 General Fee Schedule - 1/1/2018
89055 Y $4.95 General Fee Schedule - 1/1/2018
89060 Y $17.08 26 Fee Schedule (FS) - 1/1/2018
89060 Y $8.30 General Fee Schedule - 1/1/2018
89125 Y $5.53 General Fee Schedule - 1/1/2018
89160 Y $4.56 General Fee Schedule - 1/1/2018
89190 Y $5.51 General Fee Schedule - 1/1/2018
89220 Y $14.45 General Fee Schedule - 1/1/2018
89230 Y $3.22 General Fee Schedule - 1/1/2018
89240 Y $0.00 General by Report - 1/1/2004
89300 Y $10.37 General Fee Schedule - 1/1/2018
89310 Y $9.99 General Fee Schedule - 1/1/2018
89320 Y $13.99 General Fee Schedule - 1/1/2018
89321 Y $13.99 General Fee Schedule - 1/1/2018
89322 Y $17.98 General Fee Schedule - 1/1/2018
89330 Y $11.48 General Fee Schedule - 1/1/2018
89331 Y $22.73 General Fee Schedule - 1/1/2018
89337 Y $0.00 General by Report - 1/1/2015
89398 Y $0.00 General by Report - 1/1/2010
90281 Y $8.86 General Fee Schedule - 7/1/2004
CPT FEES01/03/2018 at 6:55:00 AM - 271 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
90283 Y $59.10 General Fee Schedule - 7/1/2004
90284 Y $0.00 General by Report - 1/1/2008
90287 Y $0.00 General by Report - 1/1/1999
90288 Y $0.00 General by Report - 1/1/1999
90291 Y $366.42 General Fee Schedule - 7/1/2004
90296 Y $41.37 General Fee Schedule - 7/1/2004
90371 Y $116.00 General Fee Schedule - 1/1/2018
90375 Y $302.47 General Fee Schedule - 1/1/2018
90376 Y $332.43 General Fee Schedule - 1/1/2018
90378 Y $630.40 General Fee Schedule - 7/1/2004
90384 Y $56.14 General Fee Schedule - 7/1/2004
90385 Y $34.66 General Fee Schedule - 7/1/2014
90386 Y $3.94 General Fee Schedule - 7/1/2004
90389 Y $11.82 General Fee Schedule - 7/1/2004
90393 Y $0.00 General by Report - 1/1/1999
90396 Y $114.75 General Fee Schedule - 7/1/2006
90399 Y $57.13 General Fee Schedule - 7/1/2004
90460 Y $20.80 General Fee Schedule - 3/1/2013
90461 Y $20.80 General Fee Schedule - 3/1/2013
90471 Y $20.80 General Fee Schedule - 3/1/2013
90472 Y $20.80 General Fee Schedule - 3/1/2013
90473 Y $20.80 General Fee Schedule - 3/1/2013
90474 Y $20.80 General Fee Schedule - 3/1/2013
90585 Y $132.79 General Fee Schedule - 1/1/2018
90586 Y $132.79 General Fee Schedule - 1/1/2018
90587 Y $0.00 General by Report - 1/1/2018
90620 Y $169.60 General Fee Schedule VFC Antigen
- 2/1/2015
90621 Y $121.90 General Fee Schedule VFC Antigen
- 2/1/2015
90625 Y $0.00 General by Report - 1/1/2016
90630 Y $20.34 General Fee Schedule - 10/1/2016
90632 Y $51.38 General Fee Schedule - 1/1/2018
90633 Y $34.34 General Fee Schedule VFC Antigen
- 4/1/2011
CPT FEES01/03/2018 at 6:55:00 AM - 272 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
90634 Y $34.34 General Fee Schedule VFC Antigen
- 4/1/2011
90636 Y $113.28 General Fee Schedule - 7/1/2004
90644 Y $0.00 General by Report - 1/1/2010
90647 Y $20.37 General Fee Schedule VFC Antigen
- 4/1/2011
90648 Y $23.34 General Fee Schedule VFC Antigen
- 4/1/2011
90649 Y $130.00 General Fee Schedule VFC Antigen
- 4/1/2011
90650 Y $128.75 General Fee Schedule VFC Antigen
- 4/1/2011
90651 Y $176.95 General Fee Schedule - 1/1/2015
90653 Y $50.22 General Fee Schedule - 10/1/2017
90654 Y $18.92 General Fee Schedule VFC Antigen
- 10/1/2013
90655 Y $17.24 General Fee Schedule VFC Antigen
- 10/1/2013
90656 Y $19.25 General Fee Schedule VFC Antigen
- 10/1/2017
90657 Y $6.02 General Fee Schedule VFC Antigen
- 10/1/2012
90658 Y $11.37 General Fee Schedule VFC Antigen
- 4/1/2011
90660 Y $23.46 General Fee Schedule VFC Antigen
- 10/1/2012
90661 Y $22.29 General Fee Schedule - 10/1/2015
90662 Y $49.03 General Fee Schedule - 10/1/2017
90664 Y $0.00 General by Report - 7/1/2010
90666 Y $0.00 General by Report - 7/1/2010
90667 Y $0.00 General by Report - 7/1/2010
90668 Y $0.00 General by Report - 7/1/2010
90670 Y $192.64 General Fee Schedule VFC Antigen
- 4/1/2017
90672 Y $26.88 General Fee Schedule - 1/1/2016
90673 Y $40.61 General Fee Schedule - 10/1/2016
90674 Y $24.05 General Fee Schedule VFC Antigen
- 10/1/2017
90675 Y $284.98 General Fee Schedule - 1/1/2018
CPT FEES01/03/2018 at 6:55:00 AM - 273 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
90676 Y $81.76 General Fee Schedule - 7/1/2004
90680 Y $83.35 General Fee Schedule VFC Antigen
- 4/1/2011
90681 Y $122.85 General Fee Schedule VFC Antigen
- 4/1/2011
90682 Y $46.31 General Fee Schedule - 10/1/2017
90685 Y $21.20 General Fee Schedule - 10/1/2017
90686 Y $19.03 General Fee Schedule - 10/1/2016
90687 Y $9.40 General Fee Schedule - 10/1/2016
90688 Y $17.84 General Fee Schedule - 10/1/2016
90690 Y $12.06 General Fee Schedule - 4/1/2011
90691 Y $109.18 General Fee Schedule - 1/1/2018
90696 Y $57.00 General Fee Schedule VFC Antigen
- 4/1/2011
90697 Y $0.00 General by Report - 2/1/2015
90698 Y $89.65 General Fee Schedule VFC Antigen
- 4/1/2011
90700 Y $26.37 General Fee Schedule VFC Antigen
- 4/1/2011
90702 Y $13.98 General Fee Schedule VFC Antigen
- 4/1/2011
90707 Y $47.07 General Fee Schedule VFC Antigen
- 4/1/2011
90710 Y $154.07 General Fee Schedule VFC Antigen
- 4/1/2011
90713 Y $29.50 General Fee Schedule VFC Antigen
- 4/1/2011
90714 Y $25.80 General Fee Schedule VFC Antigen
- 1/1/2018
90715 Y $30.96 General Fee Schedule VFC Antigen
- 1/1/2018
90716 Y $81.67 General Fee Schedule VFC Antigen
- 4/1/2011
90717 Y $75.06 General Fee Schedule - 4/1/2013
90723 Y $15.00 General Fee Schedule VFC Antigen
- 4/1/2011
90732 Y $107.75 General Fee Schedule VFC Antigen
- 1/1/2018
90733 Y $106.49 General Fee Schedule - 4/1/2011
CPT FEES01/03/2018 at 6:55:00 AM - 274 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
90734 Y $127.15 General Fee Schedule VFC Antigen
- 4/1/2011
90736 Y $201.88 General Fee Schedule - 1/1/2008
90738 Y $0.00 General by Report - 1/1/2009
90739 Y $0.00 General by Report - 1/1/2013
90740 Y $126.60 General Fee Schedule - 7/1/2017
90743 Y $26.13 General Fee Schedule VFC Antigen
- 10/1/2017
90744 Y $26.14 General Fee Schedule VFC Antigen
- 7/1/2017
90746 Y $63.30 General Fee Schedule - 7/1/2017
90747 Y $126.60 General Fee Schedule - 7/1/2017
90748 Y $45.62 General Fee Schedule - 7/1/2004
90750 Y $0.00 General by Report - 1/1/2017
90756 Y $22.80 General Fee Schedule - 1/1/2018
90865 Y $122.64 General Fee Schedule - 12/1/2009
90867 Y $354.69 General Fee Schedule - 2/6/2012
90868 Y $167.61 General Fee Schedule - 2/6/2012
90869 Y $434.21 General Fee Schedule - 2/6/2012
90885 Y $51.42 General Fee Schedule - 12/1/2009
90935 Y $68.55 General Fee Schedule - 8/1/2016
90937 Y $97.42 General Fee Schedule - 1/1/2017
90940 Y $0.00 General by Report - 1/1/2001
90945 Y $74.41 General Fee Schedule - 12/1/2009
90947 Y $114.90 General Fee Schedule - 8/1/2016
90951 Y $869.61 General Fee Schedule - 8/1/2016
90952 Y $0.00 General by Report - 1/1/2009
90953 Y $0.00 General by Report - 1/1/2009
90954 Y $716.03 General Fee Schedule - 8/1/2016
90955 Y $404.97 General Fee Schedule - 8/1/2016
90956 Y $274.15 General Fee Schedule - 8/1/2016
90957 Y $573.68 General Fee Schedule - 8/1/2016
90958 Y $386.95 General Fee Schedule - 8/1/2016
90959 Y $253.75 General Fee Schedule - 8/1/2016
90960 Y $253.76 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 275 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
90961 Y $205.02 General Fee Schedule - 8/1/2016
90962 Y $154.51 General Fee Schedule - 12/1/2009
90963 Y $491.65 General Fee Schedule - 8/1/2016
90964 Y $411.18 General Fee Schedule - 8/1/2016
90965 Y $390.71 General Fee Schedule - 8/1/2016
90966 Y $211.38 General Fee Schedule - 12/1/2009
90967 Y $16.90 General Fee Schedule - 1/1/2017
90968 Y $13.74 General Fee Schedule - 8/1/2016
90969 Y $13.40 General Fee Schedule - 8/1/2016
90970 Y $7.41 General Fee Schedule - 8/1/2016
90989 Y $143.08 General Fee Schedule - 12/1/2009
90993 Y $13.38 General Fee Schedule - 12/1/2009
90997 Y $87.63 General Fee Schedule - 1/1/2017
90999 Y $0.00 General by Report - 6/1/1981
91010 Y $62.77 26 Fee Schedule (FS) - 8/1/2016
91010 Y $158.05 General Fee Schedule - 1/1/2017
91010 Y $94.79 TC Fee Schedule - 1/1/2017
91013 Y $8.93 26 Fee Schedule (FS) - 1/1/2017
91013 Y $21.39 General Fee Schedule - 8/1/2016
91013 Y $12.08 TC Fee Schedule - 8/1/2016
91020 Y $71.79 26 Fee Schedule (FS) - 8/1/2016
91020 Y $206.56 General Fee Schedule - 8/1/2016
91020 Y $134.77 TC Fee Schedule - 8/1/2016
91022 Y $70.65 26 Fee Schedule (FS) - 1/1/2017
91022 Y $150.90 General Fee Schedule - 1/1/2017
91022 Y $80.24 TC Fee Schedule - 1/1/2017
91030 Y $44.28 26 Fee Schedule (FS) - 1/1/2017
91030 Y $115.91 General Fee Schedule - 8/1/2016
91030 Y $73.27 TC Fee Schedule - 12/1/2009
91034 Y $49.10 26 Fee Schedule (FS) - 8/1/2016
91034 Y $168.88 General Fee Schedule - 1/1/2017
91034 Y $120.48 TC Fee Schedule - 1/1/2017
91035 Y $79.32 26 Fee Schedule (FS) - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 276 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
91035 Y $418.86 General Fee Schedule - 8/1/2016
91035 Y $339.53 TC Fee Schedule - 8/1/2016
91037 Y $47.62 26 Fee Schedule (FS) - 1/1/2017
91037 Y $136.55 General Fee Schedule - 8/1/2016
91037 Y $91.08 TC Fee Schedule - 12/1/2009
91038 Y $54.25 26 Fee Schedule (FS) - 1/1/2017
91038 Y $122.96 General Fee Schedule - 12/1/2009
91038 Y $65.07 TC Fee Schedule - 12/1/2009
91040 Y $46.84 26 Fee Schedule (FS) - 1/1/2017
91040 Y $382.11 General Fee Schedule - 1/1/2017
91040 Y $335.27 TC Fee Schedule - 1/1/2017
91065 Y $9.61 26 Fee Schedule (FS) - 1/1/2017
91065 Y $58.74 General Fee Schedule - 12/1/2009
91065 Y $48.28 TC Fee Schedule - 12/1/2009
91110 Y $179.93 26 Fee Schedule (FS) - 8/1/2016
91110 Y $782.60 General Fee Schedule - 1/1/2017
91110 Y $603.92 TC Fee Schedule - 1/1/2017
91111 Y $46.62 26 Fee Schedule (FS) - 12/1/2009
91111 Y $586.87 General Fee Schedule - 8/1/2016
91111 Y $542.11 TC Fee Schedule - 8/1/2016
91112 Y $104.43 26 Fee Schedule (FS) - 8/1/2016
91112 Y $951.00 General Fee Schedule - 1/1/2017
91112 Y $847.81 TC Fee Schedule - 1/1/2017
91117 Y $129.94 General Fee Schedule - 1/1/2017
91120 Y $47.48 26 Fee Schedule (FS) - 1/1/2017
91120 Y $375.01 General Fee Schedule - 1/1/2017
91120 Y $327.53 TC Fee Schedule - 1/1/2017
91122 Y $85.43 26 Fee Schedule (FS) - 1/1/2017
91122 Y $204.44 General Fee Schedule - 1/1/2017
91122 Y $119.01 TC Fee Schedule - 1/1/2017
91132 Y $26.64 26 Fee Schedule (FS) - 8/1/2016
91132 Y $129.53 General Fee Schedule - 8/1/2016
91132 Y $102.89 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 277 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
91133 Y $32.37 26 Fee Schedule (FS) - 1/1/2017
91133 Y $152.23 General Fee Schedule - 1/1/2017
91133 Y $119.86 TC Fee Schedule - 1/1/2017
91200 Y $12.27 26 Fee Schedule (FS) - 1/1/2017
91200 Y $25.66 General Fee Schedule - 1/1/2017
91200 Y $13.39 TC Fee Schedule - 1/1/2017
91299 Y $0.00 General by Report - 6/1/1981
92002 Y $67.86 General Fee Schedule - 12/1/2009
92004 Y $124.04 General Fee Schedule - 12/1/2009
92012 Y $61.81 General Fee Schedule - 12/1/2009
92014 Y $91.77 General Fee Schedule - 12/1/2009
92014 Y $39.52 TC Fee Schedule - 12/1/2009
92015 Y $6.69 General Fee Schedule - 12/1/2009
92018 Y $130.13 General Fee Schedule - 8/1/2016
92019 Y $67.94 General Fee Schedule - 8/1/2016
92020 Y $24.30 General Fee Schedule - 1/1/2017
92025 Y $14.85 26 Fee Schedule (FS) - 12/1/2009
92025 Y $25.08 General Fee Schedule - 12/1/2009
92025 Y $10.23 TC Fee Schedule - 12/1/2009
92060 Y $35.77 26 Fee Schedule (FS) - 8/1/2016
92060 Y $52.67 General Fee Schedule - 12/1/2009
92060 Y $15.41 TC Fee Schedule - 12/1/2009
92071 Y $34.68 General Fee Schedule - 8/1/2016
92072 Y $115.37 General Fee Schedule - 2/6/2012
92081 Y $15.13 26 Fee Schedule (FS) - 1/1/2017
92081 Y $30.38 General Fee Schedule - 1/1/2017
92081 Y $15.25 TC Fee Schedule - 1/1/2017
92082 Y $20.05 26 Fee Schedule (FS) - 1/1/2017
92082 Y $42.72 General Fee Schedule - 1/1/2017
92082 Y $22.67 TC Fee Schedule - 1/1/2017
92083 Y $26.08 26 Fee Schedule (FS) - 8/1/2016
92083 Y $57.55 General Fee Schedule - 1/1/2017
92083 Y $31.65 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 278 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92100 Y $71.47 General Fee Schedule - 1/1/2017
92132 Y $17.75 26 Fee Schedule (FS) - 1/1/2017
92132 Y $31.45 General Fee Schedule - 1/1/2017
92132 Y $13.94 TC Fee Schedule - 8/1/2016
92133 Y $25.90 26 Fee Schedule (FS) - 1/1/2017
92133 Y $39.90 General Fee Schedule - 1/1/2017
92133 Y $13.94 TC Fee Schedule - 8/1/2016
92134 Y $26.52 26 Fee Schedule (FS) - 1/1/2017
92134 Y $41.47 General Fee Schedule - 8/1/2016
92134 Y $13.94 TC Fee Schedule - 8/1/2016
92136 Y $28.22 26 Fee Schedule (FS) - 8/1/2016
92136 Y $76.89 General Fee Schedule - 8/1/2016
92136 Y $48.66 TC Fee Schedule - 8/1/2016
92145 Y $8.45 26 Fee Schedule (FS) - 8/1/2016
92145 Y $14.52 General Fee Schedule - 8/1/2016
92145 Y $5.96 TC Fee Schedule - 8/1/2016
92225 Y $22.55 General Fee Schedule - 12/1/2009
92226 Y $20.27 General Fee Schedule - 12/1/2009
92227 Y $10.98 General Fee Schedule - 1/1/2011
92228 Y $16.99 26 Fee Schedule (FS) - 1/1/2011
92228 Y $28.93 General Fee Schedule - 1/1/2011
92228 Y $11.46 TC Fee Schedule - 8/1/2016
92230 Y $52.64 General Fee Schedule - 1/1/2017
92235 Y $42.84 26 Fee Schedule (FS) - 8/1/2016
92235 Y $98.31 General Fee Schedule - 1/1/2017
92235 Y $54.87 TC Fee Schedule - 1/1/2017
92240 Y $58.20 26 Fee Schedule (FS) - 8/1/2016
92240 Y $226.40 General Fee Schedule - 1/1/2017
92240 Y $167.22 TC Fee Schedule - 1/1/2017
92242 Y $51.48 26 Fee Schedule (FS) - 1/1/2017
92242 Y $201.49 General Fee Schedule - 1/1/2017
92242 Y $150.01 TC Fee Schedule - 1/1/2017
92250 Y $22.01 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 279 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92250 Y $67.25 General Fee Schedule - 8/1/2016
92250 Y $44.37 TC Fee Schedule - 8/1/2016
92260 Y $16.29 General Fee Schedule - 8/1/2016
92265 Y $40.54 26 Fee Schedule (FS) - 8/1/2016
92265 Y $70.93 General Fee Schedule - 1/1/2017
92265 Y $31.03 TC Fee Schedule - 1/1/2017
92270 Y $38.66 26 Fee Schedule (FS) - 1/1/2017
92270 Y $81.96 General Fee Schedule - 8/1/2016
92270 Y $41.78 TC Fee Schedule - 12/1/2009
92275 Y $49.89 26 Fee Schedule (FS) - 1/1/2017
92275 Y $107.14 General Fee Schedule - 12/1/2009
92275 Y $52.39 TC Fee Schedule - 12/1/2009
92283 Y $8.59 26 Fee Schedule (FS) - 1/1/2017
92283 Y $36.02 General Fee Schedule - 12/1/2009
92283 Y $26.70 TC Fee Schedule - 12/1/2009
92284 Y $11.57 26 Fee Schedule (FS) - 1/1/2017
92284 Y $53.43 General Fee Schedule - 1/1/2017
92284 Y $41.87 TC Fee Schedule - 1/1/2017
92286 Y $20.36 26 Fee Schedule (FS) - 1/1/2017
92286 Y $34.37 General Fee Schedule - 1/1/2017
92286 Y $14.01 TC Fee Schedule - 1/1/2017
92287 Y $113.79 General Fee Schedule - 12/1/2009
92310 Y $218.59 General Fee Schedule - 12/1/2009
92311 Y $80.04 General Fee Schedule - 12/1/2009
92312 Y $86.64 General Fee Schedule - 12/1/2009
92313 Y $72.50 General Fee Schedule - 12/1/2009
92325 Y $14.05 General Fee Schedule - 12/1/2009
92340 Y $36.29 General Fee Schedule - 12/1/2009
92341 Y $36.29 General Fee Schedule - 12/1/2009
92358 Y $18.37 General Fee Schedule - 12/1/2009
92370 Y $3.82 General Fee Schedule - 12/1/2009
92371 Y $3.82 General Fee Schedule - 12/1/2009
92499 Y $0.00 Manual Review Fee Schedule - 10/1/1987
CPT FEES01/03/2018 at 6:55:00 AM - 280 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92502 Y $90.75 General Fee Schedule - 1/1/2017
92504 Y $24.41 General Fee Schedule - 12/1/2009
92507 Y $58.77 General Fee Schedule - 12/1/2009
92508 Y $27.85 General Fee Schedule - 12/1/2009
92511 Y $100.41 General Fee Schedule - 1/1/2017
92512 Y $55.37 General Fee Schedule - 1/1/2017
92516 Y $58.03 General Fee Schedule - 12/1/2009
92520 Y $47.44 General Fee Schedule - 12/1/2009
92521 Y $102.30 General Fee Schedule - 1/1/2017
92522 Y $86.16 General Fee Schedule - 8/1/2016
92523 Y $178.69 General Fee Schedule - 8/1/2016
92524 Y $82.65 General Fee Schedule - 1/1/2017
92526 Y $74.95 General Fee Schedule - 8/1/2016
92531 Y $8.00 General Fee Schedule - 12/1/2009
92532 Y $8.00 General Fee Schedule - 12/1/2009
92533 Y $6.71 General Fee Schedule - 12/1/2009
92534 Y $3.37 General Fee Schedule - 12/1/2009
92537 Y $29.66 26 Fee Schedule (FS) - 8/1/2016
92537 Y $37.17 General Fee Schedule - 8/1/2016
92537 Y $7.51 TC Fee Schedule - 8/1/2016
92538 Y $14.82 26 Fee Schedule (FS) - 8/1/2016
92538 Y $18.93 General Fee Schedule - 8/1/2016
92538 Y $4.11 TC Fee Schedule - 8/1/2016
92540 Y $71.43 26 Fee Schedule (FS) - 8/1/2016
92540 Y $89.25 General Fee Schedule - 1/1/2010
92540 Y $14.85 TC Fee Schedule - 1/1/2010
92541 Y $19.43 26 Fee Schedule (FS) - 1/1/2017
92541 Y $22.30 General Fee Schedule - 1/1/2017
92541 Y $2.87 TC Fee Schedule - 1/1/2017
92542 Y $18.56 26 Fee Schedule (FS) - 12/1/2009
92542 Y $26.00 General Fee Schedule - 1/1/2017
92542 Y $2.56 TC Fee Schedule - 1/1/2017
92544 Y $13.20 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 281 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92544 Y $15.44 General Fee Schedule - 1/1/2017
92544 Y $2.25 TC Fee Schedule - 1/1/2017
92545 Y $12.21 26 Fee Schedule (FS) - 8/1/2016
92545 Y $14.16 General Fee Schedule - 1/1/2017
92545 Y $1.94 TC Fee Schedule - 1/1/2017
92546 Y $13.87 26 Fee Schedule (FS) - 1/1/2017
92546 Y $80.36 General Fee Schedule - 12/1/2009
92546 Y $64.37 TC Fee Schedule - 12/1/2009
92547 Y $4.81 General Fee Schedule - 12/1/2009
92548 Y $24.43 26 Fee Schedule (FS) - 1/1/2017
92548 Y $90.75 General Fee Schedule - 1/1/2017
92548 Y $66.32 TC Fee Schedule - 1/1/2017
92550 Y $18.65 General Fee Schedule - 8/1/2016
92551 Y $11.21 General Fee Schedule - 12/1/2009
92552 Y $16.45 General Fee Schedule - 12/1/2009
92553 Y $24.67 General Fee Schedule - 12/1/2009
92555 Y $14.39 General Fee Schedule - 12/1/2009
92556 Y $21.59 General Fee Schedule - 12/1/2009
92557 Y $34.69 General Fee Schedule - 1/1/2017
92558 Y $0.00 General by Report - 1/1/2012
92559 Y $32.32 General Fee Schedule - 12/1/2009
92560 Y $10.08 General Fee Schedule - 12/1/2009
92561 Y $26.72 General Fee Schedule - 12/1/2009
92562 Y $15.42 General Fee Schedule - 12/1/2009
92563 Y $14.39 General Fee Schedule - 12/1/2009
92564 Y $17.83 General Fee Schedule - 12/1/2009
92565 Y $14.01 General Fee Schedule - 1/1/2017
92567 Y $13.32 General Fee Schedule - 1/1/2017
92568 Y $13.81 General Fee Schedule - 8/1/2016
92570 Y $28.55 General Fee Schedule - 8/1/2016
92571 Y $14.73 General Fee Schedule - 12/1/2009
92572 Y $3.42 General Fee Schedule - 12/1/2009
92575 Y $10.96 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 282 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92576 Y $16.79 General Fee Schedule - 12/1/2009
92577 Y $14.63 General Fee Schedule - 1/1/2017
92579 Y $27.06 General Fee Schedule - 12/1/2009
92582 Y $27.06 General Fee Schedule - 12/1/2009
92583 Y $33.23 General Fee Schedule - 12/1/2009
92584 Y $64.23 General Fee Schedule - 1/1/2017
92585 Y $25.05 26 Fee Schedule (FS) - 1/1/2017
92585 Y $96.05 General Fee Schedule - 12/1/2009
92585 Y $68.51 TC Fee Schedule - 12/1/2009
92586 Y $68.51 General Fee Schedule - 12/1/2009
92587 Y $7.41 26 Fee Schedule (FS) - 12/1/2009
92587 Y $19.99 General Fee Schedule - 1/1/2017
92587 Y $2.87 TC Fee Schedule - 1/1/2017
92588 Y $19.72 26 Fee Schedule (FS) - 12/1/2009
92588 Y $30.45 General Fee Schedule - 1/1/2017
92588 Y $3.49 TC Fee Schedule - 1/1/2017
92596 Y $22.27 General Fee Schedule - 1/1/2006
92601 Y $122.59 General Fee Schedule - 12/1/2009
92602 Y $80.87 General Fee Schedule - 8/1/2016
92603 Y $76.03 General Fee Schedule - 12/1/2009
92604 Y $48.64 General Fee Schedule - 12/1/2009
92605 Y $58.76 General Fee Schedule - 12/1/2009
92606 Y $45.50 General Fee Schedule - 12/1/2009
92607 Y $107.52 General Fee Schedule - 12/1/2009
92608 Y $20.55 General Fee Schedule - 12/1/2009
92609 Y $55.81 General Fee Schedule - 12/1/2009
92610 Y $78.62 General Fee Schedule - 1/1/2017
92611 Y $80.53 General Fee Schedule - 1/1/2017
92612 Y $144.56 General Fee Schedule - 12/1/2009
92613 Y $36.16 General Fee Schedule - 1/1/2017
92614 Y $130.88 General Fee Schedule - 8/1/2016
92615 Y $31.75 General Fee Schedule - 1/1/2017
92616 Y $183.40 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 283 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92617 Y $39.40 General Fee Schedule - 1/1/2017
92618 Y $0.00 General by Report - 1/1/2012
92620 Y $41.11 General Fee Schedule - 12/1/2009
92621 Y $10.63 General Fee Schedule - 12/1/2009
92625 Y $40.41 General Fee Schedule - 12/1/2009
92626 Y $77.40 General Fee Schedule - 12/1/2009
92627 Y $18.75 General Fee Schedule - 8/1/2016
92630 Y $0.00 Manual Review Fee Schedule - 2/1/2013
92633 Y $0.00 General by Report - 1/1/2006
92640 Y $43.73 General Fee Schedule - 12/1/2009
92700 Y $0.00 General by Report - 1/1/2003
92920 Y $511.90 General Fee Schedule - 8/1/2016
92921 Y $261.28 General Fee Schedule - 10/1/2014
92924 Y $608.55 General Fee Schedule - 8/1/2016
92925 Y $310.61 General Fee Schedule - 10/1/2014
92928 Y $568.59 General Fee Schedule - 8/1/2016
92929 Y $290.22 General Fee Schedule - 10/1/2014
92933 Y $635.84 General Fee Schedule - 8/1/2016
92934 Y $324.54 General Fee Schedule - 10/1/2014
92937 Y $567.96 General Fee Schedule - 8/1/2016
92938 Y $289.90 General Fee Schedule - 10/1/2014
92941 Y $637.11 General Fee Schedule - 8/1/2016
92943 Y $637.11 General Fee Schedule - 8/1/2016
92944 Y $325.19 General Fee Schedule - 10/1/2014
92950 Y $280.02 General Fee Schedule - 1/1/2017
92953 Y $10.70 General Fee Schedule - 1/1/2017
92960 Y $187.18 General Fee Schedule - 1/1/2017
92961 Y $248.39 General Fee Schedule - 8/1/2016
92970 Y $170.21 General Fee Schedule - 8/1/2016
92971 Y $95.51 General Fee Schedule - 8/1/2016
92973 Y $171.56 General Fee Schedule - 8/1/2016
92974 Y $156.91 General Fee Schedule - 8/1/2016
92975 Y $377.55 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 284 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
92977 Y $55.22 General Fee Schedule - 1/1/2017
92978 Y $92.04 26 Fee Schedule (FS) - 8/1/2016
92978 Y $260.61 General Fee Schedule - 12/1/2009
92979 Y $73.75 26 Fee Schedule (FS) - 8/1/2016
92979 Y $160.07 General Fee Schedule - 12/1/2009
92986 Y $1,246.57 General Fee Schedule - 8/1/2016
92987 Y $1,295.39 General Fee Schedule - 8/1/2016
92990 Y $1,003.98 General Fee Schedule - 8/1/2016
92992 Y $674.93 General Fee Schedule - 12/1/2009
92993 Y $675.14 General Fee Schedule - 12/1/2009
92997 Y $615.94 General Fee Schedule - 8/1/2016
92998 Y $303.88 General Fee Schedule - 8/1/2016
93000 Y $15.48 General Fee Schedule - 1/1/2017
93005 Y $7.51 General Fee Schedule - 1/1/2017
93010 Y $7.97 General Fee Schedule - 1/1/2017
93015 Y $68.30 General Fee Schedule - 1/1/2017
93016 Y $20.58 General Fee Schedule - 1/1/2017
93017 Y $34.13 General Fee Schedule - 1/1/2017
93018 Y $13.59 General Fee Schedule - 1/1/2017
93024 Y $53.35 26 Fee Schedule (FS) - 1/1/2017
93024 Y $98.94 General Fee Schedule - 8/1/2016
93024 Y $41.11 TC Fee Schedule - 12/1/2009
93025 Y $34.48 26 Fee Schedule (FS) - 1/1/2017
93025 Y $141.34 General Fee Schedule - 1/1/2017
93025 Y $106.86 TC Fee Schedule - 1/1/2017
93040 Y $11.71 General Fee Schedule - 1/1/2017
93041 Y $5.03 General Fee Schedule - 1/1/2017
93042 Y $6.68 General Fee Schedule - 1/1/2017
93050 Y $7.99 26 Fee Schedule (FS) - 8/1/2016
93050 Y $16.10 General Fee Schedule - 8/1/2016
93050 Y $7.82 TC Fee Schedule - 1/1/2017
93224 Y $81.29 General Fee Schedule - 1/1/2017
93225 Y $23.29 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 285 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93226 Y $33.20 General Fee Schedule - 1/1/2017
93227 Y $24.80 General Fee Schedule - 1/1/2017
93228 Y $23.28 General Fee Schedule - 8/1/2016
93229 Y $619.35 General Fee Schedule - 8/1/2016
93260 Y $42.41 26 Fee Schedule (FS) - 8/1/2016
93260 Y $62.31 General Fee Schedule - 8/1/2016
93260 Y $18.72 TC Fee Schedule - 8/1/2016
93261 Y $35.92 26 Fee Schedule (FS) - 1/1/2017
93261 Y $55.19 General Fee Schedule - 1/1/2017
93261 Y $18.72 TC Fee Schedule - 8/1/2016
93268 Y $180.33 General Fee Schedule - 1/1/2017
93270 Y $8.13 General Fee Schedule - 1/1/2017
93271 Y $148.33 General Fee Schedule - 1/1/2017
93272 Y $23.87 General Fee Schedule - 1/1/2017
93278 Y $11.60 26 Fee Schedule (FS) - 1/1/2017
93278 Y $27.16 General Fee Schedule - 1/1/2017
93278 Y $15.56 TC Fee Schedule - 1/1/2017
93279 Y $30.10 26 Fee Schedule (FS) - 1/1/2017
93279 Y $45.35 General Fee Schedule - 1/1/2017
93279 Y $15.25 TC Fee Schedule - 1/1/2017
93280 Y $35.77 26 Fee Schedule (FS) - 1/1/2017
93280 Y $52.88 General Fee Schedule - 1/1/2017
93280 Y $17.11 TC Fee Schedule - 1/1/2017
93281 Y $42.01 26 Fee Schedule (FS) - 1/1/2017
93281 Y $62.21 General Fee Schedule - 1/1/2017
93281 Y $20.20 TC Fee Schedule - 1/1/2017
93282 Y $39.71 26 Fee Schedule (FS) - 1/1/2017
93282 Y $57.42 General Fee Schedule - 1/1/2017
93282 Y $17.72 TC Fee Schedule - 1/1/2017
93283 Y $53.48 26 Fee Schedule (FS) - 8/1/2016
93283 Y $74.73 General Fee Schedule - 1/1/2017
93283 Y $20.82 TC Fee Schedule - 1/1/2017
93284 Y $58.91 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 286 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93284 Y $82.51 General Fee Schedule - 1/1/2017
93284 Y $23.60 TC Fee Schedule - 1/1/2017
93285 Y $24.49 26 Fee Schedule (FS) - 1/1/2017
93285 Y $38.49 General Fee Schedule - 1/1/2017
93285 Y $14.01 TC Fee Schedule - 1/1/2017
93286 Y $13.80 26 Fee Schedule (FS) - 8/1/2016
93286 Y $24.10 General Fee Schedule - 8/1/2016
93286 Y $10.30 TC Fee Schedule - 8/1/2016
93287 Y $19.97 26 Fee Schedule (FS) - 8/1/2016
93287 Y $31.29 General Fee Schedule - 12/1/2009
93287 Y $11.53 TC Fee Schedule - 1/1/2017
93288 Y $19.91 26 Fee Schedule (FS) - 1/1/2017
93288 Y $33.61 General Fee Schedule - 1/1/2017
93288 Y $13.70 TC Fee Schedule - 1/1/2017
93289 Y $40.82 26 Fee Schedule (FS) - 12/1/2009
93289 Y $58.22 General Fee Schedule - 8/1/2016
93289 Y $17.11 TC Fee Schedule - 1/1/2017
93290 Y $19.36 26 Fee Schedule (FS) - 8/1/2016
93290 Y $28.61 General Fee Schedule - 8/1/2016
93290 Y $8.44 TC Fee Schedule - 1/1/2017
93291 Y $20.22 26 Fee Schedule (FS) - 1/1/2017
93291 Y $32.98 General Fee Schedule - 1/1/2017
93291 Y $12.77 TC Fee Schedule - 1/1/2017
93292 Y $19.91 26 Fee Schedule (FS) - 1/1/2017
93292 Y $29.58 General Fee Schedule - 1/1/2017
93292 Y $9.67 TC Fee Schedule - 1/1/2017
93293 Y $14.57 26 Fee Schedule (FS) - 1/1/2017
93293 Y $47.46 General Fee Schedule - 1/1/2017
93293 Y $32.89 TC Fee Schedule - 1/1/2017
93294 Y $31.81 General Fee Schedule - 1/1/2017
93295 Y $59.60 General Fee Schedule - 8/1/2016
93296 Y $22.67 General Fee Schedule - 1/1/2017
93297 Y $23.28 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 287 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93298 Y $24.87 General Fee Schedule - 1/1/2017
93299 Y $38.07 General Fee Schedule - 1/1/2017
93303 Y $59.97 26 Fee Schedule (FS) - 1/1/2017
93303 Y $200.09 General Fee Schedule - 8/1/2016
93303 Y $140.44 TC Fee Schedule - 12/1/2009
93304 Y $34.48 26 Fee Schedule (FS) - 1/1/2017
93304 Y $110.47 General Fee Schedule - 12/1/2009
93304 Y $71.26 TC Fee Schedule - 12/1/2009
93306 Y $59.66 26 Fee Schedule (FS) - 1/1/2017
93306 Y $202.81 General Fee Schedule - 1/1/2017
93306 Y $143.15 TC Fee Schedule - 1/1/2017
93307 Y $42.38 26 Fee Schedule (FS) - 1/1/2017
93307 Y $116.42 General Fee Schedule - 1/1/2017
93307 Y $74.05 TC Fee Schedule - 1/1/2017
93308 Y $24.21 26 Fee Schedule (FS) - 1/1/2017
93308 Y $99.25 General Fee Schedule - 12/1/2009
93308 Y $71.26 TC Fee Schedule - 12/1/2009
93312 Y $110.13 26 Fee Schedule (FS) - 8/1/2016
93312 Y $254.50 General Fee Schedule - 12/1/2009
93312 Y $139.78 TC Fee Schedule - 12/1/2009
93313 Y $21.84 General Fee Schedule - 1/1/2017
93314 Y $65.73 26 Fee Schedule (FS) - 12/1/2009
93314 Y $205.50 General Fee Schedule - 12/1/2009
93314 Y $139.78 TC Fee Schedule - 12/1/2009
93315 Y $133.81 26 Fee Schedule (FS) - 1/1/2017
93316 Y $36.93 General Fee Schedule - 1/1/2017
93317 Y $92.49 26 Fee Schedule (FS) - 8/1/2016
93318 Y $101.94 26 Fee Schedule (FS) - 8/1/2016
93320 Y $17.21 26 Fee Schedule (FS) - 1/1/2017
93320 Y $48.48 General Fee Schedule - 1/1/2017
93320 Y $31.26 TC Fee Schedule - 1/1/2017
93321 Y $6.99 26 Fee Schedule (FS) - 1/1/2017
93321 Y $24.32 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 288 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93321 Y $17.33 TC Fee Schedule - 1/1/2017
93325 Y $2.98 26 Fee Schedule (FS) - 1/1/2017
93325 Y $22.48 General Fee Schedule - 1/1/2017
93325 Y $19.50 TC Fee Schedule - 1/1/2017
93350 Y $66.60 26 Fee Schedule (FS) - 1/1/2017
93350 Y $143.45 General Fee Schedule - 12/1/2009
93350 Y $65.10 TC Fee Schedule - 12/1/2009
93351 Y $79.85 26 Fee Schedule (FS) - 1/1/2017
93351 Y $228.48 General Fee Schedule - 8/1/2016
93351 Y $147.80 TC Fee Schedule - 1/1/2011
93352 Y $30.39 General Fee Schedule - 1/1/2017
93355 Y $218.45 General Fee Schedule - 8/1/2016
93451 Y $141.74 26 Fee Schedule (FS) - 8/1/2016
93451 Y $700.93 General Fee Schedule - 8/1/2016
93451 Y $559.19 TC Fee Schedule - 8/1/2016
93452 Y $248.52 26 Fee Schedule (FS) - 8/1/2016
93452 Y $782.69 General Fee Schedule - 8/1/2016
93452 Y $534.17 TC Fee Schedule - 8/1/2016
93453 Y $325.69 26 Fee Schedule (FS) - 8/1/2016
93453 Y $1,024.22 General Fee Schedule - 8/1/2016
93453 Y $698.53 TC Fee Schedule - 8/1/2016
93454 Y $250.44 26 Fee Schedule (FS) - 8/1/2016
93454 Y $806.85 General Fee Schedule - 8/1/2016
93454 Y $556.41 TC Fee Schedule - 8/1/2016
93455 Y $289.02 26 Fee Schedule (FS) - 8/1/2016
93455 Y $941.21 General Fee Schedule - 8/1/2016
93455 Y $652.20 TC Fee Schedule - 8/1/2016
93456 Y $320.46 26 Fee Schedule (FS) - 8/1/2016
93456 Y $1,010.03 General Fee Schedule - 8/1/2016
93456 Y $689.58 TC Fee Schedule - 8/1/2016
93457 Y $359.40 26 Fee Schedule (FS) - 8/1/2016
93457 Y $1,144.42 General Fee Schedule - 8/1/2016
93457 Y $785.02 TC Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 289 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93458 Y $305.59 26 Fee Schedule (FS) - 8/1/2016
93458 Y $973.84 General Fee Schedule - 8/1/2016
93458 Y $668.26 TC Fee Schedule - 8/1/2016
93459 Y $343.82 26 Fee Schedule (FS) - 8/1/2016
93459 Y $1,075.71 General Fee Schedule - 8/1/2016
93459 Y $731.89 TC Fee Schedule - 8/1/2016
93460 Y $383.05 26 Fee Schedule (FS) - 8/1/2016
93460 Y $1,152.01 General Fee Schedule - 8/1/2016
93460 Y $768.96 TC Fee Schedule - 8/1/2016
93461 Y $422.66 26 Fee Schedule (FS) - 8/1/2016
93461 Y $1,319.22 General Fee Schedule - 8/1/2016
93461 Y $896.56 TC Fee Schedule - 8/1/2016
93462 Y $194.57 General Fee Schedule - 8/1/2016
93463 Y $93.48 General Fee Schedule - 1/1/2017
93464 Y $82.24 26 Fee Schedule (FS) - 1/1/2017
93464 Y $233.56 General Fee Schedule - 8/1/2016
93464 Y $148.69 TC Fee Schedule - 1/1/2011
93503 Y $126.35 General Fee Schedule - 1/1/2017
93505 Y $227.09 26 Fee Schedule (FS) - 8/1/2016
93505 Y $310.22 General Fee Schedule - 12/1/2009
93530 Y $214.45 26 Fee Schedule (FS) - 1/1/2017
93530 Y $855.92 General Fee Schedule - 12/1/2009
93531 Y $418.29 26 Fee Schedule (FS) - 1/1/2017
93531 Y $2,227.98 General Fee Schedule - 12/1/2009
93532 Y $533.08 26 Fee Schedule (FS) - 8/1/2016
93533 Y $355.52 26 Fee Schedule (FS) - 8/1/2016
93561 Y $24.45 26 Fee Schedule (FS) - 8/1/2016
93561 Y $45.35 General Fee Schedule - 12/1/2009
93562 Y $7.63 26 Fee Schedule (FS) - 1/1/2017
93562 Y $20.57 General Fee Schedule - 12/1/2009
93563 Y $53.23 General Fee Schedule - 8/1/2016
93564 Y $56.49 General Fee Schedule - 1/1/2011
93565 Y $42.70 General Fee Schedule - 1/1/2011
CPT FEES01/03/2018 at 6:55:00 AM - 290 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93566 Y $155.59 General Fee Schedule - 8/1/2016
93567 Y $128.91 General Fee Schedule - 8/1/2016
93568 Y $140.80 General Fee Schedule - 8/1/2016
93571 Y $91.05 26 Fee Schedule (FS) - 8/1/2016
93571 Y $259.58 General Fee Schedule - 12/1/2009
93572 Y $71.13 26 Fee Schedule (FS) - 8/1/2016
93580 Y $950.55 General Fee Schedule - 8/1/2016
93581 Y $1,270.08 General Fee Schedule - 8/1/2016
93582 Y $664.59 General Fee Schedule - 8/1/2016
93583 Y $739.77 General Fee Schedule - 8/1/2016
93590 Y $1,183.92 General Fee Schedule - 1/1/2017
93591 Y $982.50 General Fee Schedule - 1/1/2017
93592 Y $433.36 General Fee Schedule - 1/1/2017
93600 Y $111.14 26 Fee Schedule (FS) - 8/1/2016
93600 Y $187.37 General Fee Schedule - 12/1/2009
93602 Y $111.14 26 Fee Schedule (FS) - 8/1/2016
93602 Y $156.20 General Fee Schedule - 12/1/2009
93603 Y $111.15 26 Fee Schedule (FS) - 8/1/2016
93603 Y $177.09 General Fee Schedule - 12/1/2009
93609 Y $260.93 26 Fee Schedule (FS) - 8/1/2016
93609 Y $371.14 General Fee Schedule - 12/1/2009
93610 Y $157.99 26 Fee Schedule (FS) - 8/1/2016
93610 Y $214.25 General Fee Schedule - 12/1/2009
93612 Y $158.32 26 Fee Schedule (FS) - 8/1/2016
93612 Y $223.84 General Fee Schedule - 12/1/2009
93613 Y $366.31 General Fee Schedule - 8/1/2016
93615 Y $46.55 26 Fee Schedule (FS) - 8/1/2016
93615 Y $60.14 General Fee Schedule - 12/1/2009
93616 Y $62.20 26 Fee Schedule (FS) - 1/1/2017
93618 Y $222.33 26 Fee Schedule (FS) - 8/1/2016
93618 Y $375.80 General Fee Schedule - 12/1/2009
93619 Y $392.63 26 Fee Schedule (FS) - 8/1/2016
93619 Y $689.53 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 291 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93620 Y $614.66 26 Fee Schedule (FS) - 8/1/2016
93620 Y $934.56 General Fee Schedule - 12/1/2009
93620 Y $310.95 TC Fee Schedule - 12/1/2009
93621 Y $109.74 26 Fee Schedule (FS) - 8/1/2016
93622 Y $161.93 26 Fee Schedule (FS) - 8/1/2016
93623 Y $148.72 26 Fee Schedule (FS) - 8/1/2016
93624 Y $261.11 26 Fee Schedule (FS) - 8/1/2016
93624 Y $344.62 General Fee Schedule - 12/1/2009
93624 Y $72.62 TC Fee Schedule - 12/1/2009
93631 Y $391.84 26 Fee Schedule (FS) - 1/1/2017
93640 Y $182.72 26 Fee Schedule (FS) - 8/1/2016
93640 Y $451.01 General Fee Schedule - 12/1/2009
93641 Y $309.22 26 Fee Schedule (FS) - 8/1/2016
93641 Y $582.77 General Fee Schedule - 12/1/2009
93642 Y $258.76 26 Fee Schedule (FS) - 8/1/2016
93642 Y $397.69 General Fee Schedule - 1/1/2017
93642 Y $133.10 TC Fee Schedule - 1/1/2017
93644 Y $161.76 26 Fee Schedule (FS) - 1/1/2017
93644 Y $253.84 General Fee Schedule - 1/1/2017
93644 Y $93.43 TC Fee Schedule - 8/1/2016
93650 Y $558.85 General Fee Schedule - 8/1/2016
93653 Y $773.23 General Fee Schedule - 8/1/2016
93654 Y $1,031.88 General Fee Schedule - 8/1/2016
93655 Y $386.60 General Fee Schedule - 8/1/2016
93656 Y $1,032.23 General Fee Schedule - 8/1/2016
93657 Y $386.93 General Fee Schedule - 8/1/2016
93660 Y $88.36 26 Fee Schedule (FS) - 1/1/2017
93660 Y $143.92 General Fee Schedule - 1/1/2017
93660 Y $55.88 TC Fee Schedule - 8/1/2016
93662 Y $133.80 26 Fee Schedule (FS) - 1/1/2017
93668 Y $0.00 General by Report - 1/1/2001
93701 Y $9.30 26 Fee Schedule (FS) - 12/1/2009
93701 Y $21.13 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 292 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93701 Y $31.51 TC Fee Schedule - 12/1/2009
93702 Y $94.48 General Fee Schedule - 1/1/2017
93724 Y $227.09 26 Fee Schedule (FS) - 1/1/2017
93724 Y $251.63 General Fee Schedule - 1/1/2017
93724 Y $24.53 TC Fee Schedule - 1/1/2017
93740 Y $43.70 General Fee Schedule - 12/1/2009
93745 Y $17.02 26 Fee Schedule (FS) - 1/1/2011
93745 Y $56.74 General Fee Schedule - 1/1/2011
93745 Y $39.73 TC Fee Schedule - 1/1/2011
93750 Y $49.30 General Fee Schedule - 1/1/2010
93770 Y $8.40 General Fee Schedule - 12/1/2009
93784 Y $48.33 General Fee Schedule - 1/1/2017
93786 Y $26.08 General Fee Schedule - 1/1/2017
93788 Y $4.73 General Fee Schedule - 1/1/2017
93790 Y $17.52 General Fee Schedule - 1/1/2017
93792 Y $47.90 General Fee Schedule - 1/1/2018
93793 Y $11.08 General Fee Schedule - 1/1/2018
93797 Y $14.81 General Fee Schedule - 1/1/2017
93798 Y $22.90 General Fee Schedule - 1/1/2017
93799 Y $0.00 General by Report - 1/1/1991
93880 Y $31.39 26 Fee Schedule (FS) - 12/1/2009
93880 Y $170.67 General Fee Schedule - 1/1/2017
93880 Y $132.63 TC Fee Schedule - 1/1/2017
93882 Y $21.61 26 Fee Schedule (FS) - 12/1/2009
93882 Y $115.60 General Fee Schedule - 1/1/2017
93882 Y $91.39 TC Fee Schedule - 1/1/2017
93886 Y $44.84 26 Fee Schedule (FS) - 1/1/2017
93886 Y $177.08 General Fee Schedule - 1/1/2017
93886 Y $132.24 TC Fee Schedule - 1/1/2017
93888 Y $24.28 26 Fee Schedule (FS) - 1/1/2017
93888 Y $130.84 General Fee Schedule - 1/1/2017
93888 Y $106.55 TC Fee Schedule - 1/1/2017
93890 Y $48.71 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 293 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93890 Y $180.95 General Fee Schedule - 1/1/2017
93890 Y $132.24 TC Fee Schedule - 1/1/2017
93892 Y $57.89 26 Fee Schedule (FS) - 1/1/2017
93892 Y $137.51 General Fee Schedule - 1/1/2017
93892 Y $79.63 TC Fee Schedule - 1/1/2017
93893 Y $56.40 26 Fee Schedule (FS) - 1/1/2017
93893 Y $136.03 General Fee Schedule - 1/1/2017
93893 Y $79.63 TC Fee Schedule - 1/1/2017
93895 Y $0.00 26 by Report - 1/1/2015
93895 Y $0.00 General by Report - 1/1/2015
93895 Y $0.00 TC by Report - 1/1/2015
93922 Y $12.07 26 Fee Schedule (FS) - 1/1/2017
93922 Y $79.01 General Fee Schedule - 1/1/2017
93922 Y $66.94 TC Fee Schedule - 1/1/2017
93923 Y $21.44 26 Fee Schedule (FS) - 1/1/2017
93923 Y $123.12 General Fee Schedule - 1/1/2017
93923 Y $101.68 TC Fee Schedule - 1/1/2017
93924 Y $23.74 26 Fee Schedule (FS) - 1/1/2017
93924 Y $154.21 General Fee Schedule - 1/1/2017
93924 Y $130.46 TC Fee Schedule - 1/1/2017
93925 Y $30.61 26 Fee Schedule (FS) - 12/1/2009
93925 Y $169.58 General Fee Schedule - 1/1/2017
93925 Y $132.24 TC Fee Schedule - 1/1/2017
93926 Y $20.89 26 Fee Schedule (FS) - 12/1/2009
93926 Y $136.26 General Fee Schedule - 1/1/2017
93926 Y $113.13 TC Fee Schedule - 1/1/2017
93930 Y $24.62 26 Fee Schedule (FS) - 12/1/2009
93930 Y $170.75 General Fee Schedule - 1/1/2017
93930 Y $132.63 TC Fee Schedule - 1/1/2017
93931 Y $16.43 26 Fee Schedule (FS) - 12/1/2009
93931 Y $114.51 General Fee Schedule - 1/1/2017
93931 Y $91.08 TC Fee Schedule - 1/1/2017
93970 Y $33.04 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 294 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
93970 Y $165.67 General Fee Schedule - 1/1/2017
93970 Y $132.63 TC Fee Schedule - 1/1/2017
93971 Y $21.37 26 Fee Schedule (FS) - 1/1/2017
93971 Y $107.18 General Fee Schedule - 1/1/2017
93971 Y $85.81 TC Fee Schedule - 1/1/2017
93975 Y $55.05 26 Fee Schedule (FS) - 1/1/2017
93975 Y $187.29 General Fee Schedule - 1/1/2017
93975 Y $132.24 TC Fee Schedule - 1/1/2017
93976 Y $37.56 26 Fee Schedule (FS) - 1/1/2017
93976 Y $145.66 General Fee Schedule - 1/1/2017
93976 Y $108.10 TC Fee Schedule - 1/1/2017
93978 Y $34.69 26 Fee Schedule (FS) - 12/1/2009
93978 Y $170.52 General Fee Schedule - 1/1/2017
93978 Y $132.63 TC Fee Schedule - 1/1/2017
93979 Y $22.22 26 Fee Schedule (FS) - 8/1/2016
93979 Y $107.17 General Fee Schedule - 1/1/2017
93979 Y $83.34 TC Fee Schedule - 1/1/2017
93980 Y $57.67 26 Fee Schedule (FS) - 1/1/2017
93980 Y $109.75 General Fee Schedule - 1/1/2017
93980 Y $52.08 TC Fee Schedule - 1/1/2017
93981 Y $21.10 26 Fee Schedule (FS) - 1/1/2017
93981 Y $66.06 General Fee Schedule - 1/1/2017
93981 Y $44.96 TC Fee Schedule - 1/1/2017
93990 Y $13.77 26 Fee Schedule (FS) - 12/1/2009
93990 Y $103.31 General Fee Schedule - 1/1/2017
93990 Y $79.32 TC Fee Schedule - 1/1/2017
93998 Y $0.00 General by Report - 1/1/2012
94002 Y $75.82 General Fee Schedule - 12/1/2009
94003 Y $55.03 General Fee Schedule - 12/1/2009
94004 Y $40.10 General Fee Schedule - 12/1/2009
94005 Y $0.00 General by Report - 1/1/2007
94010 Y $7.97 26 Fee Schedule (FS) - 1/1/2017
94010 Y $29.32 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 295 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
94010 Y $21.92 TC Fee Schedule - 12/1/2009
94011 Y $88.81 General Fee Schedule - 8/1/2016
94012 Y $136.58 General Fee Schedule - 8/1/2016
94013 Y $30.14 General Fee Schedule - 1/1/2010
94014 Y $47.12 General Fee Schedule - 12/1/2009
94015 Y $20.54 General Fee Schedule - 12/1/2009
94016 Y $23.87 General Fee Schedule - 1/1/2017
94060 Y $12.27 26 Fee Schedule (FS) - 1/1/2017
94060 Y $51.01 General Fee Schedule - 12/1/2009
94060 Y $35.63 TC Fee Schedule - 12/1/2009
94070 Y $27.26 26 Fee Schedule (FS) - 1/1/2017
94070 Y $53.50 General Fee Schedule - 8/1/2016
94070 Y $25.38 TC Fee Schedule - 12/1/2009
94150 Y $7.38 General Fee Schedule - 12/1/2009
94200 Y $5.40 26 Fee Schedule (FS) - 8/1/2016
94200 Y $20.35 General Fee Schedule - 12/1/2009
94200 Y $14.72 TC Fee Schedule - 12/1/2009
94250 Y $5.02 26 Fee Schedule (FS) - 1/1/2017
94250 Y $23.37 General Fee Schedule - 1/1/2017
94250 Y $18.34 TC Fee Schedule - 1/1/2017
94375 Y $13.93 26 Fee Schedule (FS) - 1/1/2017
94375 Y $33.54 General Fee Schedule - 12/1/2009
94375 Y $18.15 TC Fee Schedule - 12/1/2009
94400 Y $18.58 26 Fee Schedule (FS) - 1/1/2017
94400 Y $47.31 General Fee Schedule - 12/1/2009
94400 Y $26.72 TC Fee Schedule - 12/1/2009
94450 Y $18.89 26 Fee Schedule (FS) - 1/1/2017
94450 Y $45.92 General Fee Schedule - 12/1/2009
94450 Y $25.69 TC Fee Schedule - 12/1/2009
94452 Y $13.62 26 Fee Schedule (FS) - 1/1/2017
94452 Y $48.27 General Fee Schedule - 12/1/2009
94452 Y $32.53 TC Fee Schedule - 12/1/2009
94453 Y $17.96 26 Fee Schedule (FS) - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 296 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
94453 Y $65.77 General Fee Schedule - 8/1/2016
94453 Y $48.28 TC Fee Schedule - 12/1/2009
94610 Y $52.95 General Fee Schedule - 8/1/2016
94617 Y $31.39 26 Fee Schedule (FS) - 1/1/2018
94617 Y $86.14 General Fee Schedule - 1/1/2018
94617 Y $54.76 TC Fee Schedule - 1/1/2018
94618 Y $21.47 26 Fee Schedule (FS) - 1/1/2018
94618 Y $31.56 General Fee Schedule - 1/1/2018
94618 Y $10.09 TC Fee Schedule - 1/1/2018
94621 Y $64.72 26 Fee Schedule (FS) - 1/1/2017
94621 Y $136.00 General Fee Schedule - 12/1/2009
94621 Y $64.05 TC Fee Schedule - 12/1/2009
94640 Y $10.96 General Fee Schedule - 12/1/2009
94642 Y $28.57 General Fee Schedule - 12/1/2009
94644 Y $29.15 General Fee Schedule - 12/1/2009
94645 Y $11.16 General Fee Schedule - 12/1/2009
94660 Y $52.97 General Fee Schedule - 12/1/2009
94662 Y $35.45 General Fee Schedule - 1/1/2017
94664 Y $12.00 General Fee Schedule - 12/1/2009
94667 Y $19.54 General Fee Schedule - 12/1/2009
94668 Y $16.10 General Fee Schedule - 12/1/2009
94669 Y $28.94 General Fee Schedule - 1/1/2017
94680 Y $11.93 26 Fee Schedule (FS) - 1/1/2017
94680 Y $51.01 General Fee Schedule - 1/1/2017
94680 Y $39.08 TC Fee Schedule - 1/1/2017
94681 Y $9.30 26 Fee Schedule (FS) - 1/1/2017
94681 Y $46.82 General Fee Schedule - 1/1/2017
94681 Y $37.53 TC Fee Schedule - 1/1/2017
94690 Y $3.57 26 Fee Schedule (FS) - 8/1/2016
94690 Y $43.99 General Fee Schedule - 1/1/2017
94690 Y $40.32 TC Fee Schedule - 1/1/2017
94726 Y $11.52 26 Fee Schedule (FS) - 8/1/2016
94726 Y $46.99 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 297 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
94726 Y $35.36 TC Fee Schedule - 1/1/2017
94727 Y $11.52 26 Fee Schedule (FS) - 8/1/2016
94727 Y $37.88 General Fee Schedule - 8/1/2016
94727 Y $26.36 TC Fee Schedule - 8/1/2016
94728 Y $11.52 26 Fee Schedule (FS) - 8/1/2016
94728 Y $36.15 General Fee Schedule - 1/1/2017
94728 Y $24.22 TC Fee Schedule - 1/1/2017
94729 Y $8.00 26 Fee Schedule (FS) - 2/6/2012
94729 Y $47.51 General Fee Schedule - 8/1/2016
94729 Y $39.83 TC Fee Schedule - 8/1/2016
94750 Y $10.61 26 Fee Schedule (FS) - 1/1/2017
94750 Y $56.48 General Fee Schedule - 12/1/2009
94750 Y $44.86 TC Fee Schedule - 12/1/2009
94760 Y $2.06 General Fee Schedule - 12/1/2009
94761 Y $4.29 General Fee Schedule - 8/1/2016
94762 Y $19.55 General Fee Schedule - 12/1/2009
94770 Y $7.51 26 Fee Schedule (FS) - 12/1/2009
94770 Y $6.99 General Fee Schedule - 1/1/2017
94770 Y $26.72 TC Fee Schedule - 12/1/2009
94772 Y $97.83 General Fee Schedule - 12/1/2009
94774 Y $0.00 General by Report - 1/1/2007
94775 Y $0.00 General by Report - 1/1/2007
94776 Y $0.00 General by Report - 1/1/2007
94777 Y $0.00 General by Report - 1/1/2007
94780 Y $47.91 General Fee Schedule - 2/6/2012
94781 Y $18.60 General Fee Schedule - 2/6/2012
94799 Y $0.00 26 by Report - 1/10/1986
94799 Y $0.00 General by Report - 1/1/1991
95004 Y $3.77 General Fee Schedule - 12/1/2009
95012 Y $15.20 General Fee Schedule - 12/1/2009
95018 Y $18.41 General Fee Schedule - 1/1/2017
95024 Y $5.48 General Fee Schedule - 12/1/2009
95028 Y $8.22 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 298 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95044 Y $5.03 General Fee Schedule - 1/1/2017
95052 Y $5.96 General Fee Schedule - 1/1/2017
95056 Y $6.16 General Fee Schedule - 12/1/2009
95060 Y $12.67 General Fee Schedule - 12/1/2009
95065 Y $7.19 General Fee Schedule - 12/1/2009
95070 Y $26.78 General Fee Schedule - 1/1/2017
95071 Y $30.80 General Fee Schedule - 1/1/2017
95076 Y $107.16 General Fee Schedule - 8/1/2016
95079 Y $76.32 General Fee Schedule - 8/1/2016
95115 Y $7.82 General Fee Schedule - 1/1/2017
95117 Y $9.06 General Fee Schedule - 1/1/2017
95120 Y $6.71 General Fee Schedule - 12/1/2009
95125 Y $15.80 General Fee Schedule - 12/1/2009
95130 Y $16.82 General Fee Schedule - 12/1/2009
95131 Y $16.82 General Fee Schedule - 12/1/2009
95132 Y $17.66 General Fee Schedule - 12/1/2009
95133 Y $18.54 General Fee Schedule - 12/1/2009
95134 Y $18.54 General Fee Schedule - 12/1/2009
95145 Y $13.62 General Fee Schedule - 12/1/2009
95146 Y $17.72 General Fee Schedule - 12/1/2009
95147 Y $17.04 General Fee Schedule - 12/1/2009
95148 Y $22.52 General Fee Schedule - 12/1/2009
95149 Y $30.06 General Fee Schedule - 12/1/2009
95165 Y $9.17 General Fee Schedule - 12/1/2009
95170 Y $7.11 General Fee Schedule - 12/1/2009
95180 Y $123.13 General Fee Schedule - 1/1/2017
95199 Y $0.00 General by Report - 6/1/1981
95249 Y $48.95 General Fee Schedule - 1/1/2018
95250 Y $135.43 General Fee Schedule - 8/1/2016
95251 Y $27.27 General Fee Schedule - 12/1/2009
95782 Y $119.60 26 Fee Schedule (FS) - 8/1/2016
95782 Y $906.40 General Fee Schedule - 1/1/2017
95782 Y $787.21 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 299 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95783 Y $130.75 26 Fee Schedule (FS) - 8/1/2016
95783 Y $952.66 General Fee Schedule - 1/1/2017
95783 Y $821.03 TC Fee Schedule - 1/1/2017
95800 Y $48.68 26 Fee Schedule (FS) - 1/1/2017
95800 Y $158.64 General Fee Schedule - 1/1/2017
95800 Y $109.95 TC Fee Schedule - 1/1/2017
95801 Y $46.46 26 Fee Schedule (FS) - 1/1/2017
95801 Y $82.45 General Fee Schedule - 1/1/2017
95801 Y $35.98 TC Fee Schedule - 1/1/2017
95803 Y $41.16 26 Fee Schedule (FS) - 1/1/2017
95803 Y $126.35 General Fee Schedule - 1/1/2017
95803 Y $85.19 TC Fee Schedule - 1/1/2017
95805 Y $55.68 26 Fee Schedule (FS) - 1/1/2017
95805 Y $377.51 General Fee Schedule - 1/1/2017
95805 Y $321.84 TC Fee Schedule - 1/1/2017
95806 Y $57.36 26 Fee Schedule (FS) - 1/1/2017
95806 Y $150.92 General Fee Schedule - 1/1/2017
95806 Y $93.55 TC Fee Schedule - 1/1/2017
95807 Y $58.76 26 Fee Schedule (FS) - 1/1/2017
95807 Y $422.69 General Fee Schedule - 1/1/2017
95807 Y $363.93 TC Fee Schedule - 1/1/2017
95808 Y $82.47 26 Fee Schedule (FS) - 1/1/2017
95808 Y $551.27 General Fee Schedule - 8/1/2016
95808 Y $435.97 TC Fee Schedule - 12/1/2009
95810 Y $114.80 26 Fee Schedule (FS) - 1/1/2017
95810 Y $553.17 General Fee Schedule - 1/1/2017
95810 Y $438.37 TC Fee Schedule - 1/1/2017
95811 Y $119.49 26 Fee Schedule (FS) - 1/1/2017
95811 Y $581.16 General Fee Schedule - 1/1/2017
95811 Y $461.66 TC Fee Schedule - 1/1/2017
95812 Y $54.19 26 Fee Schedule (FS) - 1/1/2017
95812 Y $185.88 General Fee Schedule - 12/1/2009
95812 Y $126.71 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 300 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95813 Y $86.24 26 Fee Schedule (FS) - 1/1/2017
95813 Y $245.90 General Fee Schedule - 12/1/2009
95813 Y $152.04 TC Fee Schedule - 12/1/2009
95816 Y $54.19 26 Fee Schedule (FS) - 1/1/2017
95816 Y $174.57 General Fee Schedule - 12/1/2009
95816 Y $115.07 TC Fee Schedule - 12/1/2009
95819 Y $54.19 26 Fee Schedule (FS) - 1/1/2017
95819 Y $149.58 General Fee Schedule - 12/1/2009
95819 Y $90.07 TC Fee Schedule - 12/1/2009
95822 Y $54.19 26 Fee Schedule (FS) - 1/1/2017
95822 Y $206.09 General Fee Schedule - 12/1/2009
95822 Y $146.58 TC Fee Schedule - 12/1/2009
95824 Y $37.01 26 Fee Schedule (FS) - 1/1/2017
95827 Y $53.57 26 Fee Schedule (FS) - 1/1/2017
95827 Y $141.03 General Fee Schedule - 12/1/2009
95827 Y $83.58 TC Fee Schedule - 12/1/2009
95829 Y $321.91 26 Fee Schedule (FS) - 8/1/2016
95829 Y $1,321.01 General Fee Schedule - 12/1/2009
95829 Y $985.68 TC Fee Schedule - 12/1/2009
95830 Y $182.40 General Fee Schedule - 12/1/2009
95831 Y $25.82 General Fee Schedule - 8/1/2016
95832 Y $23.18 General Fee Schedule - 12/1/2009
95833 Y $33.94 General Fee Schedule - 1/1/2017
95834 Y $43.93 General Fee Schedule - 8/1/2016
95851 Y $16.61 General Fee Schedule - 1/1/2017
95852 Y $13.49 General Fee Schedule - 12/1/2009
95857 Y $41.69 General Fee Schedule - 12/1/2009
95860 Y $48.44 26 Fee Schedule (FS) - 1/1/2017
95860 Y $88.09 General Fee Schedule - 12/1/2009
95860 Y $34.92 TC Fee Schedule - 12/1/2009
95861 Y $77.97 26 Fee Schedule (FS) - 1/1/2017
95861 Y $112.21 General Fee Schedule - 12/1/2009
95861 Y $27.06 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 301 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95863 Y $93.74 26 Fee Schedule (FS) - 1/1/2017
95863 Y $136.93 General Fee Schedule - 12/1/2009
95863 Y $34.25 TC Fee Schedule - 12/1/2009
95864 Y $101.59 26 Fee Schedule (FS) - 1/1/2017
95864 Y $175.13 General Fee Schedule - 12/1/2009
95864 Y $65.43 TC Fee Schedule - 12/1/2009
95865 Y $79.77 26 Fee Schedule (FS) - 1/1/2017
95865 Y $114.04 General Fee Schedule - 12/1/2009
95865 Y $24.32 TC Fee Schedule - 12/1/2009
95866 Y $62.93 26 Fee Schedule (FS) - 1/1/2017
95866 Y $77.73 General Fee Schedule - 12/1/2009
95866 Y $7.89 TC Fee Schedule - 12/1/2009
95867 Y $39.31 26 Fee Schedule (FS) - 1/1/2017
95867 Y $64.76 General Fee Schedule - 12/1/2009
95867 Y $21.23 TC Fee Schedule - 12/1/2009
95868 Y $59.50 26 Fee Schedule (FS) - 1/1/2017
95868 Y $90.43 General Fee Schedule - 12/1/2009
95868 Y $25.70 TC Fee Schedule - 12/1/2009
95869 Y $18.81 26 Fee Schedule (FS) - 1/1/2017
95869 Y $28.33 General Fee Schedule - 12/1/2009
95869 Y $7.89 TC Fee Schedule - 12/1/2009
95870 Y $18.51 26 Fee Schedule (FS) - 1/1/2017
95870 Y $28.33 General Fee Schedule - 12/1/2009
95870 Y $7.89 TC Fee Schedule - 12/1/2009
95872 Y $82.24 26 Fee Schedule (FS) - 12/1/2009
95872 Y $104.50 General Fee Schedule - 12/1/2009
95872 Y $22.26 TC Fee Schedule - 12/1/2009
95873 Y $18.73 26 Fee Schedule (FS) - 1/1/2017
95873 Y $27.98 General Fee Schedule - 12/1/2009
95873 Y $7.54 TC Fee Schedule - 12/1/2009
95874 Y $18.81 26 Fee Schedule (FS) - 1/1/2017
95874 Y $28.33 General Fee Schedule - 12/1/2009
95874 Y $7.54 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 302 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95875 Y $55.56 26 Fee Schedule (FS) - 1/1/2017
95875 Y $95.90 General Fee Schedule - 12/1/2009
95875 Y $35.63 TC Fee Schedule - 12/1/2009
95885 Y $16.55 26 Fee Schedule (FS) - 8/1/2016
95885 Y $50.10 General Fee Schedule - 8/1/2016
95885 Y $33.55 TC Fee Schedule - 8/1/2016
95886 Y $43.22 26 Fee Schedule (FS) - 1/1/2017
95886 Y $79.56 General Fee Schedule - 8/1/2016
95886 Y $36.82 TC Fee Schedule - 2/6/2012
95887 Y $34.68 26 Fee Schedule (FS) - 8/1/2016
95887 Y $70.63 General Fee Schedule - 8/1/2016
95887 Y $35.94 TC Fee Schedule - 8/1/2016
95905 Y $2.68 26 Fee Schedule (FS) - 8/1/2016
95905 Y $61.89 General Fee Schedule - 1/1/2017
95905 Y $59.20 TC Fee Schedule - 1/1/2017
95907 Y $48.30 26 Fee Schedule (FS) - 8/1/2016
95907 Y $86.07 General Fee Schedule - 8/1/2016
95907 Y $36.60 TC Fee Schedule - 1/1/2017
95908 Y $60.68 26 Fee Schedule (FS) - 8/1/2016
95908 Y $106.23 General Fee Schedule - 8/1/2016
95908 Y $45.55 TC Fee Schedule - 8/1/2016
95909 Y $72.43 26 Fee Schedule (FS) - 8/1/2016
95909 Y $127.32 General Fee Schedule - 8/1/2016
95909 Y $54.88 TC Fee Schedule - 8/1/2016
95910 Y $96.89 26 Fee Schedule (FS) - 8/1/2016
95910 Y $167.66 General Fee Schedule - 8/1/2016
95910 Y $70.76 TC Fee Schedule - 8/1/2016
95911 Y $121.04 26 Fee Schedule (FS) - 8/1/2016
95911 Y $203.22 General Fee Schedule - 8/1/2016
95911 Y $82.19 TC Fee Schedule - 8/1/2016
95912 Y $145.20 26 Fee Schedule (FS) - 8/1/2016
95912 Y $238.19 General Fee Schedule - 8/1/2016
95912 Y $87.36 TC Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 303 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95913 Y $172.19 26 Fee Schedule (FS) - 8/1/2016
95913 Y $276.30 General Fee Schedule - 8/1/2016
95913 Y $94.17 TC Fee Schedule - 1/1/2017
95921 Y $42.70 26 Fee Schedule (FS) - 1/1/2017
95921 Y $61.12 General Fee Schedule - 12/1/2009
95921 Y $13.70 TC Fee Schedule - 12/1/2009
95922 Y $45.66 26 Fee Schedule (FS) - 1/1/2017
95922 Y $66.18 General Fee Schedule - 12/1/2009
95922 Y $13.70 TC Fee Schedule - 12/1/2009
95923 Y $43.79 26 Fee Schedule (FS) - 1/1/2017
95923 Y $103.59 General Fee Schedule - 12/1/2009
95923 Y $54.11 TC Fee Schedule - 12/1/2009
95924 Y $81.25 26 Fee Schedule (FS) - 8/1/2016
95924 Y $134.83 General Fee Schedule - 8/1/2016
95924 Y $51.77 TC Fee Schedule - 1/1/2017
95925 Y $26.48 26 Fee Schedule (FS) - 1/1/2017
95925 Y $62.98 General Fee Schedule - 12/1/2009
95925 Y $33.22 TC Fee Schedule - 12/1/2009
95926 Y $25.86 26 Fee Schedule (FS) - 1/1/2017
95926 Y $62.98 General Fee Schedule - 12/1/2009
95926 Y $33.22 TC Fee Schedule - 12/1/2009
95927 Y $25.86 26 Fee Schedule (FS) - 1/1/2017
95927 Y $64.01 General Fee Schedule - 12/1/2009
95927 Y $33.22 TC Fee Schedule - 12/1/2009
95928 Y $75.31 26 Fee Schedule (FS) - 1/1/2017
95928 Y $164.74 General Fee Schedule - 12/1/2009
95928 Y $82.52 TC Fee Schedule - 12/1/2009
95929 Y $75.78 26 Fee Schedule (FS) - 1/1/2017
95929 Y $171.25 General Fee Schedule - 12/1/2009
95929 Y $89.03 TC Fee Schedule - 12/1/2009
95930 Y $17.13 26 Fee Schedule (FS) - 1/1/2017
95930 Y $91.59 General Fee Schedule - 12/1/2009
95930 Y $72.25 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 304 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95933 Y $29.40 26 Fee Schedule (FS) - 1/1/2017
95933 Y $61.15 General Fee Schedule - 12/1/2009
95933 Y $28.77 TC Fee Schedule - 12/1/2009
95937 Y $32.43 26 Fee Schedule (FS) - 1/1/2017
95937 Y $49.43 General Fee Schedule - 12/1/2009
95937 Y $12.34 TC Fee Schedule - 12/1/2009
95938 Y $40.78 26 Fee Schedule (FS) - 8/1/2016
95938 Y $273.59 General Fee Schedule - 2/6/2012
95938 Y $231.11 TC Fee Schedule - 2/6/2012
95939 Y $107.34 26 Fee Schedule (FS) - 8/1/2016
95939 Y $413.64 General Fee Schedule - 8/1/2016
95939 Y $306.31 TC Fee Schedule - 8/1/2016
95940 Y $0.00 26 by Report - 1/1/2013
95940 Y $29.85 General Fee Schedule - 8/1/2016
95940 Y $0.00 TC by Report - 1/1/2013
95943 Y $0.00 26 by Report - 1/1/2013
95943 Y $0.00 General by Report - 1/1/2013
95943 Y $0.00 TC by Report - 1/1/2013
95950 Y $75.03 26 Fee Schedule (FS) - 1/1/2017
95950 Y $210.80 General Fee Schedule - 12/1/2009
95950 Y $127.84 TC Fee Schedule - 12/1/2009
95951 Y $300.06 26 Fee Schedule (FS) - 1/1/2017
95951 Y $941.48 General Fee Schedule - 12/1/2009
95951 Y $620.37 TC Fee Schedule - 12/1/2009
95953 Y $154.09 26 Fee Schedule (FS) - 1/1/2017
95953 Y $385.12 General Fee Schedule - 8/1/2016
95953 Y $222.97 TC Fee Schedule - 8/1/2016
95954 Y $117.92 26 Fee Schedule (FS) - 1/1/2017
95954 Y $245.95 General Fee Schedule - 12/1/2009
95954 Y $111.29 TC Fee Schedule - 12/1/2009
95955 Y $50.91 26 Fee Schedule (FS) - 8/1/2016
95955 Y $126.35 General Fee Schedule - 12/1/2009
95955 Y $73.32 TC Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 305 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95956 Y $168.92 26 Fee Schedule (FS) - 12/1/2009
95956 Y $668.22 General Fee Schedule - 12/1/2009
95956 Y $499.31 TC Fee Schedule - 12/1/2009
95957 Y $98.84 26 Fee Schedule (FS) - 1/1/2017
95957 Y $171.68 General Fee Schedule - 12/1/2009
95957 Y $62.35 TC Fee Schedule - 12/1/2009
95958 Y $213.02 26 Fee Schedule (FS) - 1/1/2017
95958 Y $295.23 General Fee Schedule - 12/1/2009
95958 Y $64.41 TC Fee Schedule - 12/1/2009
95961 Y $153.46 26 Fee Schedule (FS) - 1/1/2017
95961 Y $223.68 General Fee Schedule - 12/1/2009
95961 Y $47.27 TC Fee Schedule - 12/1/2009
95962 Y $163.21 26 Fee Schedule (FS) - 1/1/2017
95962 Y $220.62 General Fee Schedule - 8/1/2016
95962 Y $47.27 TC Fee Schedule - 12/1/2009
95965 Y $394.45 26 Fee Schedule (FS) - 1/1/2017
95966 Y $199.93 26 Fee Schedule (FS) - 1/1/2017
95966 Y $304.30 TC Fee Schedule - 12/1/2009
95967 Y $173.40 26 Fee Schedule (FS) - 8/1/2016
95967 Y $251.45 TC Fee Schedule - 12/1/2009
95970 Y $47.50 General Fee Schedule - 12/1/2009
95971 Y $46.65 General Fee Schedule - 1/1/2017
95972 Y $54.21 General Fee Schedule - 1/1/2017
95974 Y $179.53 General Fee Schedule - 12/1/2009
95975 Y $96.22 General Fee Schedule - 8/1/2016
95978 Y $207.74 General Fee Schedule - 12/1/2009
95979 Y $95.86 General Fee Schedule - 12/1/2009
95980 Y $32.12 General Fee Schedule - 12/1/2009
95981 Y $21.92 General Fee Schedule - 12/1/2009
95982 Y $33.75 General Fee Schedule - 12/1/2009
95990 Y $53.43 General Fee Schedule - 12/1/2009
95991 Y $83.15 General Fee Schedule - 12/1/2009
95992 Y $40.08 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 306 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
95999 Y $0.00 General by Report - 1/1/1991
96000 Y $87.76 General Fee Schedule - 8/1/2016
96001 Y $101.75 General Fee Schedule - 1/1/2017
96002 Y $20.24 General Fee Schedule - 1/1/2017
96003 Y $16.87 General Fee Schedule - 1/1/2017
96004 Y $109.90 General Fee Schedule - 1/1/2017
96020 Y $31.89 26 Fee Schedule (FS) - 12/1/2009
96105 Y $58.84 General Fee Schedule - 12/1/2009
96110 Y $12.05 General Fee Schedule - 12/1/2009
96125 Y $61.49 General Fee Schedule - 12/1/2009
96153 Y $4.38 General Fee Schedule - 1/1/2017
96154 Y $18.41 General Fee Schedule - 1/1/2017
96160 Y $4.29 General Fee Schedule - 1/1/2017
96161 Y $4.29 General Fee Schedule - 1/1/2017
96360 Y $48.04 General Fee Schedule - 8/1/2016
96361 Y $13.64 General Fee Schedule - 1/1/2017
96365 Y $58.35 General Fee Schedule - 8/1/2016
96366 Y $16.98 General Fee Schedule - 1/1/2017
96367 Y $27.30 General Fee Schedule - 1/1/2017
96368 Y $17.94 General Fee Schedule - 8/1/2016
96369 Y $130.46 General Fee Schedule - 12/1/2009
96370 Y $13.57 General Fee Schedule - 1/1/2017
96371 Y $60.14 General Fee Schedule - 8/1/2016
96372 Y $17.52 General Fee Schedule - 12/1/2009
96373 Y $17.16 General Fee Schedule - 8/1/2016
96374 Y $50.73 General Fee Schedule - 8/1/2016
96375 Y $19.85 General Fee Schedule - 1/1/2017
96376 Y $0.00 General by Report - 1/1/2009
96377 Y $0.00 General by Report - 1/1/2017
96379 Y $159.40 General Fee Schedule - 12/1/2009
96401 Y $48.51 General Fee Schedule - 12/1/2009
96402 Y $28.85 General Fee Schedule - 1/1/2017
96405 Y $73.47 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 307 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
96406 Y $104.42 General Fee Schedule - 1/1/2017
96409 Y $97.48 General Fee Schedule - 1/1/2017
96411 Y $55.04 General Fee Schedule - 1/1/2017
96413 Y $119.02 General Fee Schedule - 1/1/2017
96415 Y $25.45 General Fee Schedule - 1/1/2017
96416 Y $123.48 General Fee Schedule - 1/1/2017
96417 Y $55.38 General Fee Schedule - 1/1/2017
96420 Y $91.10 General Fee Schedule - 1/1/2017
96422 Y $148.91 General Fee Schedule - 1/1/2017
96423 Y $69.07 General Fee Schedule - 8/1/2016
96425 Y $156.20 General Fee Schedule - 8/1/2016
96440 Y $376.39 General Fee Schedule - 12/1/2009
96446 Y $168.56 General Fee Schedule - 1/1/2011
96450 Y $163.93 General Fee Schedule - 1/1/2017
96521 Y $120.92 General Fee Schedule - 1/1/2017
96522 Y $96.86 General Fee Schedule - 8/1/2016
96523 Y $21.86 General Fee Schedule - 1/1/2017
96542 Y $107.76 General Fee Schedule - 1/1/2017
96549 Y $0.00 Manual Review Fee Schedule - 4/1/1990
96567 Y $68.48 General Fee Schedule - 12/1/2009
96570 Y $56.57 General Fee Schedule - 8/1/2016
96571 Y $25.74 General Fee Schedule - 1/1/2017
96573 Y $168.68 General Fee Schedule - 1/1/2018
96574 Y $218.31 General Fee Schedule - 1/1/2018
96900 Y $15.75 General Fee Schedule - 12/1/2009
96902 Y $0.00 General by Report - 1/1/1998
96904 Y $55.08 General Fee Schedule - 8/1/2016
96910 Y $35.28 General Fee Schedule - 12/1/2009
96912 Y $44.86 General Fee Schedule - 12/1/2009
96913 Y $60.97 General Fee Schedule - 12/1/2009
96920 Y $132.04 General Fee Schedule - 12/1/2009
96921 Y $135.55 General Fee Schedule - 12/1/2009
96922 Y $201.92 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 308 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
96931 Y $0.00 General by Report - 1/1/2016
96932 Y $0.00 General by Report - 1/1/2016
96933 Y $0.00 General by Report - 1/1/2016
96934 Y $0.00 General by Report - 1/1/2016
96935 Y $0.00 General by Report - 1/1/2016
96936 Y $0.00 General by Report - 1/1/2016
96999 Y $0.00 General by Report - 6/1/1981
97010 Y $16.78 General Fee Schedule - 12/1/2009
97012 Y $13.86 General Fee Schedule - 8/1/2016
97014 Y $14.92 General Fee Schedule - 12/1/2009
97016 Y $13.45 General Fee Schedule - 12/1/2009
97018 Y $6.08 General Fee Schedule - 12/1/2009
97022 Y $14.09 General Fee Schedule - 12/1/2009
97024 Y $5.06 General Fee Schedule - 12/1/2009
97026 Y $4.71 General Fee Schedule - 12/1/2009
97028 Y $5.83 General Fee Schedule - 12/1/2009
97032 Y $15.47 General Fee Schedule - 12/1/2009
97033 Y $19.62 General Fee Schedule - 12/1/2009
97034 Y $13.59 General Fee Schedule - 12/1/2009
97035 Y $11.40 General Fee Schedule - 8/1/2016
97036 Y $22.12 General Fee Schedule - 12/1/2009
97039 Y $12.03 General Fee Schedule - 12/1/2009
97110 Y $27.31 General Fee Schedule - 12/1/2009
97112 Y $28.32 General Fee Schedule - 12/1/2009
97113 Y $30.68 General Fee Schedule - 12/1/2009
97116 Y $24.01 General Fee Schedule - 12/1/2009
97124 Y $21.73 General Fee Schedule - 12/1/2009
97139 Y $14.53 General Fee Schedule - 12/1/2009
97140 Y $25.50 General Fee Schedule - 12/1/2009
97150 Y $16.25 General Fee Schedule - 8/1/2016
97161 Y $22.77 General Fee Schedule - 1/1/2017
97162 Y $45.53 General Fee Schedule - 1/1/2017
97163 Y $68.99 General Fee Schedule - 1/1/2017
CPT FEES01/03/2018 at 6:55:00 AM - 309 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
97164 Y $12.33 General Fee Schedule - 1/1/2017
97165 Y $24.66 General Fee Schedule - 1/1/2017
97166 Y $37.36 General Fee Schedule - 1/1/2017
97167 Y $75.37 General Fee Schedule - 1/1/2017
97168 Y $44.92 General Fee Schedule - 1/1/2017
97169 Y $17.59 General Fee Schedule - 1/1/2017
97170 Y $35.17 General Fee Schedule - 1/1/2017
97171 Y $53.29 General Fee Schedule - 1/1/2017
97172 Y $17.59 General Fee Schedule - 1/1/2017
97530 Y $28.29 General Fee Schedule - 12/1/2009
97533 Y $24.52 General Fee Schedule - 8/1/2016
97535 Y $29.01 General Fee Schedule - 12/1/2009
97537 Y $25.56 General Fee Schedule - 8/1/2016
97542 Y $26.22 General Fee Schedule - 8/1/2016
97597 Y $46.71 General Fee Schedule - 12/1/2009
97598 Y $22.09 General Fee Schedule - 1/1/2017
97602 Y $33.43 General Fee Schedule - 12/1/2009
97605 Y $33.56 General Fee Schedule - 12/1/2009
97606 Y $36.18 General Fee Schedule - 12/1/2009
97607 Y $0.00 General by Report - 1/1/2015
97608 Y $0.00 General by Report - 1/1/2015
97610 Y $0.00 General by Report - 1/1/2014
97750 Y $27.85 General Fee Schedule - 8/1/2016
97755 Y $32.84 General Fee Schedule - 8/1/2016
97760 Y $30.05 General Fee Schedule - 12/1/2009
97761 Y $27.65 General Fee Schedule - 12/1/2009
97763 Y $43.91 General Fee Schedule - 1/1/2018
97799 Y $0.00 General by Report - 1/1/1991
97802 Y $16.44 General Fee Schedule - 12/1/2009
97803 Y $16.44 General Fee Schedule - 12/1/2009
97804 Y $13.11 General Fee Schedule - 1/1/2011
98925 Y $27.85 General Fee Schedule - 8/1/2016
98926 Y $40.16 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 310 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
98927 Y $51.74 General Fee Schedule - 12/1/2009
98928 Y $61.33 General Fee Schedule - 12/1/2009
98929 Y $70.61 General Fee Schedule - 12/1/2009
99050 Y $7.65 General Fee Schedule - 12/1/2009
99051 Y $7.65 General Fee Schedule - 12/1/2009
99053 Y $7.65 General Fee Schedule - 12/1/2009
99056 Y $7.65 General Fee Schedule - 12/1/2009
99058 Y $7.65 General Fee Schedule - 12/1/2009
99060 Y $7.65 General Fee Schedule - 12/1/2009
99070 Y $47.77 General Fee Schedule - 12/1/2009
99080 Y $22.10 General Fee Schedule - 12/1/2009
99090 Y $15.28 General Fee Schedule - 12/1/2009
99091 Y $15.28 General Fee Schedule - 12/1/2009
99151 Y $69.48 General Fee Schedule - 1/1/2017
99152 Y $45.87 General Fee Schedule - 1/1/2017
99153 Y $9.72 General Fee Schedule - 1/1/2017
99155 Y $88.38 General Fee Schedule - 1/1/2017
99156 Y $72.62 General Fee Schedule - 1/1/2017
99157 Y $55.02 General Fee Schedule - 1/1/2017
99170 Y $118.44 26 Fee Schedule (FS) - 12/1/2009
99170 Y $130.91 General Fee Schedule - 12/1/2009
99172 Y $39.93 General Fee Schedule - 12/1/2009
99173 Y $39.93 General Fee Schedule - 12/1/2009
99177 Y $0.00 General by Report - 1/1/2016
99183 Y $104.67 General Fee Schedule - 1/1/2017
99184 Y $215.34 General Fee Schedule - 1/1/2017
99190 Y $289.23 General Fee Schedule - 12/1/2009
99191 Y $215.23 General Fee Schedule - 12/1/2009
99192 Y $142.94 General Fee Schedule - 12/1/2009
99195 Y $15.75 General Fee Schedule - 12/1/2009
99199 Y $0.00 General by Report - 6/1/1981
99201 Y $35.18 General Fee Schedule - 12/1/2009
99202 Y $62.74 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 311 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
99203 Y $93.52 General Fee Schedule - 12/1/2009
99204 Y $132.70 General Fee Schedule - 12/1/2009
99205 Y $169.19 General Fee Schedule - 12/1/2009
99211 Y $17.91 General Fee Schedule - 1/1/2017
99212 Y $36.89 General Fee Schedule - 12/1/2009
99213 Y $50.52 General Fee Schedule - 12/1/2009
99214 Y $79.45 General Fee Schedule - 12/1/2009
99215 Y $116.27 General Fee Schedule - 12/1/2009
99217 Y $66.84 General Fee Schedule - 8/1/2016
99218 Y $66.54 General Fee Schedule - 12/1/2009
99219 Y $110.72 General Fee Schedule - 12/1/2009
99220 Y $155.51 General Fee Schedule - 12/1/2009
99221 Y $67.23 General Fee Schedule - 12/1/2009
99222 Y $111.39 General Fee Schedule - 12/1/2009
99223 Y $155.17 General Fee Schedule - 12/1/2009
99224 Y $27.50 General Fee Schedule - 1/1/2011
99225 Y $48.57 General Fee Schedule - 1/1/2011
99226 Y $72.71 General Fee Schedule - 1/1/2011
99231 Y $33.61 General Fee Schedule - 12/1/2009
99232 Y $54.97 General Fee Schedule - 12/1/2009
99233 Y $78.16 General Fee Schedule - 12/1/2009
99234 Y $124.98 General Fee Schedule - 1/1/2017
99235 Y $158.03 General Fee Schedule - 1/1/2017
99236 Y $203.55 General Fee Schedule - 1/1/2017
99238 Y $66.84 General Fee Schedule - 8/1/2016
99239 Y $94.95 General Fee Schedule - 12/1/2009
99241 Y $48.34 General Fee Schedule - 12/1/2009
99242 Y $88.85 General Fee Schedule - 12/1/2009
99243 Y $118.48 General Fee Schedule - 12/1/2009
99244 Y $167.77 General Fee Schedule - 12/1/2009
99245 Y $217.32 General Fee Schedule - 12/1/2009
99251 Y $35.42 General Fee Schedule - 12/1/2009
99252 Y $71.17 General Fee Schedule - 12/1/2009
CPT FEES01/03/2018 at 6:55:00 AM - 312 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
99253 Y $97.33 General Fee Schedule - 12/1/2009
99254 Y $139.94 General Fee Schedule - 12/1/2009
99255 Y $192.93 General Fee Schedule - 12/1/2009
99281 Y $16.51 General Fee Schedule - 12/1/2009
99282 Y $27.41 General Fee Schedule - 12/1/2009
99283 Y $59.13 General Fee Schedule - 8/1/2016
99284 Y $96.19 General Fee Schedule - 12/1/2009
99285 Y $150.71 General Fee Schedule - 12/1/2009
99288 Y $68.06 General Fee Schedule - 12/1/2009
99291 Y $239.61 General Fee Schedule - 8/1/2016
99292 Y $107.34 General Fee Schedule - 8/1/2016
99304 Y $70.99 General Fee Schedule - 12/1/2009
99305 Y $94.34 General Fee Schedule - 12/1/2009
99306 Y $116.51 General Fee Schedule - 12/1/2009
99307 Y $36.62 General Fee Schedule - 12/1/2009
99308 Y $60.66 General Fee Schedule - 12/1/2009
99309 Y $82.12 General Fee Schedule - 8/1/2016
99310 Y $107.10 General Fee Schedule - 12/1/2009
99315 Y $63.88 General Fee Schedule - 8/1/2016
99316 Y $87.80 General Fee Schedule - 12/1/2009
99318 Y $70.99 General Fee Schedule - 12/1/2009
99324 Y $51.61 General Fee Schedule - 1/1/2017
99325 Y $75.22 General Fee Schedule - 1/1/2017
99326 Y $122.58 General Fee Schedule - 12/1/2009
99327 Y $161.51 General Fee Schedule - 12/1/2009
99328 Y $192.04 General Fee Schedule - 8/1/2016
99334 Y $44.41 General Fee Schedule - 12/1/2009
99335 Y $70.56 General Fee Schedule - 12/1/2009
99336 Y $109.15 General Fee Schedule - 12/1/2009
99337 Y $160.83 General Fee Schedule - 12/1/2009
99341 Y $51.61 General Fee Schedule - 1/1/2017
99342 Y $74.29 General Fee Schedule - 1/1/2017
99343 Y $118.33 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 313 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
99344 Y $161.84 General Fee Schedule - 12/1/2009
99345 Y $192.37 General Fee Schedule - 8/1/2016
99347 Y $44.41 General Fee Schedule - 12/1/2009
99348 Y $70.56 General Fee Schedule - 12/1/2009
99349 Y $109.50 General Fee Schedule - 12/1/2009
99350 Y $155.37 General Fee Schedule - 8/1/2016
99354 Y $93.55 General Fee Schedule - 8/1/2016
99355 Y $90.61 General Fee Schedule - 8/1/2016
99356 Y $86.06 General Fee Schedule - 8/1/2016
99357 Y $86.74 General Fee Schedule - 8/1/2016
99381 Y $150.55 General Fee Schedule - 7/1/2007
99382 Y $150.55 General Fee Schedule - 7/1/2007
99383 Y $150.55 General Fee Schedule - 7/1/2007
99384 Y $150.55 General Fee Schedule - 7/1/2007
99385 Y $150.55 General Fee Schedule - 7/1/2007
99386 Y $150.55 General Fee Schedule - 1/1/2014
99387 Y $150.55 General Fee Schedule - 1/1/2014
99391 Y $89.83 General Fee Schedule - 7/1/2007
99392 Y $89.83 General Fee Schedule - 7/1/2007
99393 Y $89.83 General Fee Schedule - 7/1/2007
99394 Y $89.83 General Fee Schedule - 7/1/2007
99395 Y $89.83 General Fee Schedule - 7/1/2007
99396 Y $89.83 General Fee Schedule - 1/1/2014
99397 Y $89.83 General Fee Schedule - 1/1/2014
99401 Y $22.79 General Fee Schedule - 1/1/2014
99402 Y $25.07 General Fee Schedule - 1/1/2014
99403 Y $27.58 General Fee Schedule - 1/1/2014
99404 Y $30.33 General Fee Schedule - 1/1/2014
99406 Y $12.66 General Fee Schedule - 8/1/2016
99407 Y $24.80 General Fee Schedule - 8/1/2016
99408 Y $13.59 General Fee Schedule - 1/1/2014
99409 Y $26.96 General Fee Schedule - 1/1/2014
99415 Y $7.82 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 314 - REF-FeeSchedC-1017
NEW MEXICO MEDICAID FEE FOR SERVICECPT CODE FEE SCHEDULE
CPT Code
Tax Rate PRICING NOTE VFC MODIFIER RATE 2 PRICE START DATE
99416 Y $0.71 General Fee Schedule - 8/1/2016
99455 Y $124.60 General Fee Schedule - 1/1/2010
99460 Y $65.60 General Fee Schedule - 12/1/2009
99461 Y $87.16 General Fee Schedule - 8/1/2016
99462 Y $34.47 General Fee Schedule - 12/1/2009
99463 Y $87.80 General Fee Schedule - 12/1/2009
99464 Y $83.30 General Fee Schedule - 12/1/2009
99465 Y $142.94 General Fee Schedule - 1/1/2017
99466 Y $216.71 General Fee Schedule - 1/1/2017
99467 Y $109.12 General Fee Schedule - 1/1/2017
99468 Y $883.61 General Fee Schedule - 1/1/2017
99469 Y $373.22 General Fee Schedule - 1/1/2017
99471 Y $823.69 General Fee Schedule - 1/1/2017
99472 Y $384.55 General Fee Schedule - 1/1/2017
99475 Y $511.99 General Fee Schedule - 12/1/2009
99476 Y $303.65 General Fee Schedule - 12/1/2009
99477 Y $304.23 General Fee Schedule - 12/1/2009
99478 Y $128.44 General Fee Schedule - 1/1/2017
99479 Y $116.76 General Fee Schedule - 1/1/2017
99480 Y $112.08 General Fee Schedule - 1/1/2017
99490 Y $37.27 General Fee Schedule - 1/1/2017
99497 Y $79.19 General Fee Schedule - 8/1/2016
99498 Y $69.32 General Fee Schedule - 8/1/2016
CPT FEES01/03/2018 at 6:55:00 AM - 315 - REF-FeeSchedC-1017