Physicians Fee Schedule - Alabama Medicaid Agency
Physicians Fee Schedule - Alabama Medicaid Agency
Physicians Fee Schedule - Alabama Medicaid Agency
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<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong><br />
<strong>Fee</strong> <strong>Schedule</strong> for Physician Codes<br />
The information displayed indicates generalized coverage and prices. The procedure codes are grouped into three broad<br />
categories for reference purposes: 1) Global, 2) Technical Component Only, and 3) Professional Component Only. A<br />
FIND FEATURE is available to assist in locating specific codes. The fees listed in this document are the maximum<br />
allowed amount reimbursable by <strong>Medicaid</strong>.<br />
As a general rule, CPT guidelines, definitions, and descriptions are utilized with exceptions specified in the Provider Billing<br />
Manual. For program specific coverage/limitations, please refer to the appropriate chapter(s) of the Provider Billing<br />
Manual. Specific coverage questions should be addressed to the Provider Assistance Center at 1-800-688-7989.<br />
Inclusion of codes in this fee schedule does not imply or guarantee coverage. Some procedure codes in the 70000,<br />
80000, 90000, and G series are a combination of a professional component and a technical component. Therefore, these<br />
codes may be billed one of three different ways: (1) as a global (includes both professional and technical component), (2)<br />
as a professional component, or (3) as a technical component, dependent upon the serve(s) actually provided. No<br />
fragmentation of services is allowed. Please note that not all providers are allowed to bill any or all the ways listed above.
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
Global <strong>Fee</strong><br />
10021 $97.00<br />
11302 $67.00<br />
11601 $128.00<br />
11952 $100.00<br />
12046 $204.00<br />
15050 $323.00<br />
10022 $106.00<br />
11303 $80.00<br />
11602 $135.00<br />
11954 $110.00<br />
12047 $232.00<br />
15100 $630.00<br />
10040 $63.00<br />
11305 $44.00<br />
11603 $150.00<br />
11960 $574.00<br />
12051 $165.00<br />
15101 $155.00<br />
10060 $70.00<br />
11306 $60.00<br />
11604 $165.00<br />
11970 $397.00 Yes<br />
12052 $172.00<br />
15110 $494.76<br />
10061 $126.00<br />
11307 $70.00<br />
11606 $218.00<br />
11971 $308.00<br />
12053 $184.00<br />
15111 $79.44<br />
10080 $119.00<br />
11308 $83.00<br />
11620 $106.00<br />
11976 $80.00<br />
12054 $204.00<br />
15115 $468.50<br />
10081 $186.00<br />
11310 $52.00<br />
11621 $126.00<br />
11980 $73.00<br />
12055 $261.00<br />
15116 $103.45<br />
10120 $96.00<br />
11311 $65.00<br />
11622 $144.00<br />
11981 $92.00<br />
12056 $261.00<br />
15120 $603.00<br />
10121 $180.00<br />
11312 $75.00<br />
11623 $170.00<br />
11982 $108.00<br />
12057 $290.00<br />
15121 $206.00<br />
10140 $97.00<br />
11313 $98.00<br />
11624 $196.00<br />
11983 $165.00<br />
13100 $206.00<br />
15130 $407.62<br />
10160 $81.00<br />
11400 $79.00<br />
11626 $261.00<br />
12001 $107.00<br />
13101 $246.00<br />
15131 $64.91<br />
10180 $153.00<br />
11401 $93.00<br />
11640 $112.00<br />
12002 $114.00<br />
13102 $71.00<br />
15135 $501.42<br />
11000 $35.00<br />
11402 $106.00<br />
11641 $148.00<br />
12004 $133.00<br />
13120 $214.00<br />
15136 $60.87<br />
11001 $16.00<br />
11403 $120.00<br />
11642 $171.00<br />
12005 $166.00<br />
13121 $264.00<br />
15150 $412.31<br />
11004 $429.00<br />
11404 $137.00<br />
11643 $199.00<br />
12006 $208.00<br />
13122 $86.00<br />
15151 $84.04<br />
11005 $583.00<br />
11406 $171.00<br />
11644 $252.00<br />
12007 $234.00<br />
13131 $234.00<br />
15152 $103.40<br />
11006 $470.45<br />
11420 $78.00<br />
11646 $343.00<br />
12011 $113.00<br />
13132 $342.00<br />
15155 $415.88<br />
11008 $218.00<br />
11421 $100.00<br />
11720 $19.00<br />
12013 $124.00<br />
13133 $114.00<br />
15156 $109.92<br />
11010 $319.00<br />
11422 $111.00<br />
11721 $29.00<br />
12014 $147.00<br />
13150 $250.00<br />
15157 $121.53<br />
11011 $378.00<br />
11423 $133.00<br />
11730 $64.00<br />
12015 $185.00<br />
13151 $267.00<br />
15170 $219.36<br />
11012 $549.00<br />
11424 $152.00<br />
11732 $30.00<br />
12016 $220.00<br />
13152 $358.00<br />
15171 $57.44<br />
11040 $30.00<br />
11426 $214.00<br />
11740 $28.00<br />
12017 $227.00<br />
13153 $128.00<br />
15175 $309.43<br />
11041 $44.00<br />
11440 $91.00<br />
11750 $118.00<br />
12018 $277.00<br />
13160 $537.00<br />
15176 $91.35<br />
11042 $62.00<br />
11441 $108.00<br />
11752 $167.00<br />
12020 $186.00<br />
14000 $396.00<br />
15200 $510.00<br />
11043 $167.00<br />
11442 $122.00<br />
11755 $84.00<br />
12021 $108.00<br />
14001 $520.00<br />
15201 $68.00<br />
11044 $218.00<br />
11443 $150.00<br />
11760 $121.00<br />
12031 $129.00<br />
14020 $438.00<br />
15220 $496.00<br />
11055 $29.00<br />
11444 $192.00<br />
11762 $130.00<br />
12032 $179.00<br />
14021 $583.00<br />
15221 $100.00<br />
11056 $37.00<br />
11446 $250.00<br />
11765 $69.00<br />
12034 $177.00<br />
14040 $482.00<br />
15240 $561.00<br />
11057 $45.00<br />
11450 $221.00<br />
11770 $177.00<br />
12035 $247.00<br />
14041 $641.00<br />
15241 $117.00<br />
11100 $58.00<br />
11451 $303.00<br />
11771 $344.00<br />
12036 $279.00<br />
14060 $501.00<br />
15260 $586.00<br />
11101 $22.00<br />
11462 $216.00<br />
11772 $426.00<br />
12037 $314.00<br />
14061 $691.00<br />
15261 $111.00<br />
11200 $52.00<br />
11463 $308.00<br />
11900 $33.00<br />
12041 $142.00<br />
14300 $672.00<br />
15300 $179.14<br />
11201 $14.00<br />
11470 $239.00<br />
11901 $42.00<br />
12042 $172.00<br />
14350 $399.00<br />
15301 $38.06<br />
11300 $42.00<br />
11471 $320.00<br />
11950 $50.00<br />
12044 $185.00<br />
15000 $231.00<br />
15320 $207.84<br />
11301 $56.00<br />
11600 $110.00<br />
11951 $61.00<br />
12045 $256.00<br />
15001 $69.00<br />
15321 $56.77<br />
p. 1
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
15330 $178.93<br />
15781 $334.00<br />
15945 $749.00<br />
17281 $103.00<br />
19291 $51.00<br />
20245 $435.00<br />
15331 $37.84<br />
15782 $395.00<br />
15946 $1,098.00<br />
17282 $120.00<br />
19295 $70.00<br />
20250 $299.00<br />
15335 $198.99<br />
15783 $184.00 Yes<br />
15950 $299.00<br />
17283 $149.00<br />
19296 $3,380.00<br />
20251 $339.00<br />
15336 $54.80<br />
15786 $80.00<br />
15951 $472.00<br />
17284 $152.00<br />
19297 $63.59<br />
20500 $90.00<br />
15340 $187.92<br />
15787 $15.00<br />
15952 $476.00<br />
17286 $202.00<br />
19298 $1,127.36<br />
20501 $112.00<br />
15341 $26.87<br />
15788 $104.00<br />
15953 $657.00<br />
17304 $452.00<br />
19316 $555.00 Yes<br />
20520 $137.00<br />
15360 $202.17<br />
15789 $210.00<br />
15956 $831.00<br />
17305 $190.00<br />
19318 $863.00 Yes<br />
20525 $355.00<br />
15361 $44.21<br />
15792 $85.00<br />
15958 $831.00<br />
17306 $123.00<br />
19328 $248.00 Yes<br />
20526 $56.00<br />
15365 $211.55<br />
15793 $141.00<br />
16000 $51.00<br />
17307 $126.00<br />
19330 $310.00 Yes<br />
20550 $47.00<br />
15366 $54.96<br />
15819 $422.00<br />
16020 $60.00<br />
17310 $72.00<br />
19340 $294.00 Yes<br />
20551 $42.00<br />
15400 $236.00<br />
15820 $296.00 Yes<br />
16025 $106.00<br />
17340 $38.00<br />
19342 $612.00 Yes<br />
20552 $40.00<br />
15401 $36.00<br />
15821 $375.00 Yes<br />
16030 $125.00<br />
19000 $79.00<br />
19350 $457.00 Yes<br />
20553 $45.00<br />
15420 $226.48<br />
15822 $294.00 Yes<br />
16035 $185.00<br />
19001 $23.00<br />
19355 $405.00 Yes<br />
20600 $39.00<br />
15421 $70.27<br />
15823 $483.00 Yes<br />
16036 $58.00<br />
19020 $283.00<br />
19357 $1,021.00 Yes<br />
20605 $42.00<br />
15430 $306.43<br />
15831 $627.00 Yes<br />
17000 $44.00<br />
19030 $138.00<br />
19361 $899.00 Yes<br />
20610 $51.00<br />
15570 $420.00<br />
15840 $822.00<br />
17003 $8.00<br />
19100 $96.00<br />
19364 $1,591.00 Yes<br />
20612 $42.00<br />
15572 $555.00<br />
15841 $1,008.00<br />
17004 $147.00<br />
19101 $225.00<br />
19366 $910.00 Yes<br />
20615 $165.00<br />
15574 $604.00<br />
15842 $1,678.00<br />
17106 $266.00<br />
19102 $163.00<br />
19367 $1,303.00 Yes<br />
20650 $136.00<br />
15576 $537.00<br />
15845 $773.00<br />
17107 $480.00<br />
19103 $418.00<br />
19368 $1,330.00 Yes<br />
20660 $168.00<br />
15600 $176.00<br />
15850 $125.00<br />
17108 $659.00<br />
19110 $293.00<br />
19369 $1,483.00 Yes<br />
20661 $301.00<br />
15610 $203.00<br />
15851 $71.00<br />
17110 $63.00<br />
19112 $206.00<br />
19370 $358.00 Yes<br />
20662 $300.00<br />
15620 $185.00<br />
15852 $76.00<br />
17111 $72.00<br />
19120 $303.00<br />
19371 $523.00 Yes<br />
20663 $311.00<br />
15630 $290.00<br />
15860 $86.00<br />
17250 $48.00<br />
19125 $326.00<br />
19380 $509.00 Yes<br />
20664 $366.00<br />
15650 $240.00<br />
15920 $409.00<br />
17260 $62.00<br />
19126 $139.00<br />
20000 $140.00<br />
20665 $66.00<br />
15732 $1,054.00<br />
15922 $419.00<br />
17261 $78.00<br />
19140 $360.00<br />
20005 $204.00<br />
20670 $359.00<br />
15734 $1,067.00<br />
15930 $179.99<br />
17262 $98.00<br />
19160 $300.00<br />
20100 $449.00<br />
20680 $342.00<br />
15736 $900.00<br />
15931 $456.00<br />
17263 $109.00<br />
19162 $675.00<br />
20101 $261.00<br />
20690 $185.00<br />
15738 $1,069.00<br />
15932 $349.99<br />
17264 $118.00<br />
19180 $424.00<br />
20102 $324.00<br />
20692 $355.00<br />
15740 $589.00<br />
15933 $467.00<br />
17266 $141.00<br />
19182 $429.00<br />
20103 $400.00<br />
20693 $341.00<br />
15750 $612.00<br />
15934 $527.00<br />
17270 $86.00<br />
19200 $809.00<br />
20150 $659.00<br />
20694 $327.00<br />
15756 $1,705.00<br />
15935 $756.00<br />
17271 $93.00<br />
19220 $736.00<br />
20200 $128.00<br />
20802 $1,877.00<br />
15757 $1,717.00<br />
15936 $628.00<br />
17272 $107.00<br />
19240 $810.00<br />
20205 $180.00<br />
20805 $2,329.00<br />
15758 $1,649.00<br />
15937 $823.00<br />
17273 $121.00<br />
19260 $805.00<br />
20206 $201.00<br />
20808 $2,872.00<br />
15760 $545.00<br />
15940 $473.00<br />
17274 $166.00<br />
19271 $844.00<br />
20220 $159.00<br />
20816 $1,639.00<br />
15770 $425.00<br />
15941 $498.00<br />
17276 $151.00<br />
19272 $1,169.00<br />
20225 $698.00<br />
20822 $1,755.00<br />
15780 $300.00<br />
15944 $663.00<br />
17280 $78.00<br />
19290 $114.00<br />
20240 $174.00<br />
20824 $1,622.00<br />
p. 2
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
20827 $1,413.00<br />
21044 $518.00<br />
21146 $1,098.00 Yes<br />
21249 $1,058.00<br />
21387 $561.00<br />
21555 $287.00<br />
20838 $1,883.00<br />
21045 $846.00<br />
21147 $892.00 Yes<br />
21256 $791.00<br />
21390 $597.00<br />
21556 $290.00<br />
20900 $409.00<br />
21046 $745.00<br />
21150 $1,061.00 Yes<br />
21260 $748.00<br />
21395 $722.00<br />
21557 $487.00<br />
20902 $437.00<br />
21047 $725.10<br />
21151 $1,578.00 Yes<br />
21263 $1,641.00<br />
21400 $114.00<br />
21600 $405.00<br />
20910 $311.00<br />
21048 $764.00<br />
21154 $1,651.00 Yes<br />
21267 $1,071.00<br />
21401 $206.00<br />
21610 $589.00<br />
20912 $359.00<br />
21049 $688.23<br />
21155 $1,435.00 Yes<br />
21268 $1,357.00<br />
21406 $407.00<br />
21615 $527.00<br />
20920 $285.00<br />
21050 $704.00<br />
21159 $2,230.00 Yes<br />
21270 $617.00<br />
21407 $511.00<br />
21616 $693.00<br />
20922 $412.00<br />
21060 $529.00<br />
21160 $2,214.00 Yes<br />
21275 $520.00<br />
21408 $701.00<br />
21620 $383.00<br />
20924 $403.00<br />
21070 $367.00<br />
21172 $1,476.00 Yes<br />
21280 $306.00<br />
21421 $414.00<br />
21627 $442.00<br />
20926 $309.00<br />
21076 $642.00 Yes<br />
21175 $1,413.00 Yes<br />
21282 $248.00<br />
21422 $526.00<br />
21630 $786.00<br />
20931 $95.00<br />
21077 $1,369.00 Yes<br />
21179 $988.00 Yes<br />
21295 $94.00<br />
21423 $617.00<br />
21632 $840.00<br />
20937 $146.00<br />
21079 $1,120.00 Yes<br />
21180 $1,396.00 Yes<br />
21300 $75.00<br />
21431 $323.00<br />
21685 $599.63<br />
20938 $158.00<br />
21080 $1,260.00 Yes<br />
21181 $440.00 Yes<br />
21310 $78.00<br />
21432 $516.00<br />
21700 $313.00<br />
20950 $220.00<br />
21081 $1,148.00 Yes<br />
21182 $1,791.00 Yes<br />
21315 $159.00<br />
21433 $1,382.00<br />
21705 $405.00<br />
20955 $1,928.00<br />
21082 $834.00 Yes<br />
21183 $1,503.00 Yes<br />
21320 $162.00<br />
21435 $977.00<br />
21720 $281.00<br />
20956 $1,716.00<br />
21083 $803.00 Yes<br />
21188 $969.00 Yes<br />
21325 $345.00<br />
21436 $1,433.00<br />
21725 $380.00<br />
20957 $1,724.00<br />
21084 $922.00 Yes<br />
21193 $723.00 Yes<br />
21330 $428.00<br />
21440 $275.00<br />
21740 $775.00<br />
20962 $1,693.00<br />
21086 $1,023.00 Yes<br />
21194 $836.00<br />
21335 $540.00<br />
21445 $434.00<br />
21742 $300.00<br />
20969 $2,500.00<br />
21087 $1,194.00 Yes<br />
21195 $949.00 Yes<br />
21336 $332.00<br />
21450 $289.00<br />
21743 $400.00<br />
20970 $2,113.00<br />
21088 $974.00 Yes<br />
21196 $1,028.00 Yes<br />
21337 $247.00<br />
21451 $404.00<br />
21750 $585.00<br />
20972 $1,854.00<br />
21100 $175.00<br />
21198 $792.00<br />
21338 $382.00<br />
21452 $151.00<br />
21800 $66.00<br />
20973 $2,066.00<br />
21110 $285.00<br />
21206 $603.00<br />
21339 $479.00<br />
21453 $464.00<br />
21805 $163.00<br />
20974 $44.00<br />
21116 $139.00<br />
21208 $915.00<br />
21340 $630.00<br />
21454 $404.00<br />
21810 $358.00<br />
20975 $135.00<br />
21120 $438.00 Yes<br />
21209 $504.00<br />
21343 $828.00<br />
21461 $903.00<br />
21820 $98.00<br />
20979 $42.00<br />
21121 $351.00<br />
21210 $985.00<br />
21344 $1,080.00<br />
21462 $1,043.00<br />
21825 $467.00<br />
20982 $3,086.00<br />
21122 $374.00 Yes<br />
21215 $1,450.00<br />
21345 $511.00<br />
21465 $645.00<br />
21920 $151.00<br />
21010 $594.00<br />
21123 $457.00 Yes<br />
21230 $564.00<br />
21346 $636.00<br />
21470 $923.00<br />
21925 $284.00<br />
21015 $344.00<br />
21125 $428.00 Yes<br />
21235 $473.00<br />
21347 $838.00<br />
21480 $66.00<br />
21930 $314.00<br />
21025 $653.00<br />
21127 $492.00 Yes<br />
21240 $812.00<br />
21348 $699.00<br />
21485 $346.00<br />
21935 $899.00<br />
21026 $365.00<br />
21137 $432.00 Yes<br />
21242 $823.00<br />
21355 $185.00<br />
21490 $607.00<br />
22010 $503.66<br />
21029 $376.00<br />
21138 $521.00 Yes<br />
21243 $1,133.00<br />
21356 $321.00<br />
21495 $346.00<br />
22015 $499.21<br />
21030 $347.00<br />
21139 $633.00 Yes<br />
21244 $702.00<br />
21360 $408.00<br />
21497 $257.00<br />
22100 $458.00<br />
21031 $243.00<br />
21141 $820.00 Yes<br />
21245 $719.00<br />
21365 $861.00<br />
21501 $292.00<br />
22101 $465.00<br />
21032 $248.00<br />
21142 $851.00 Yes<br />
21246 $703.00<br />
21366 $968.00<br />
21502 $330.00<br />
22102 $546.00<br />
21034 $623.00<br />
21143 $821.00 Yes<br />
21247 $1,079.00<br />
21385 $561.00<br />
21510 $288.00<br />
22103 $137.00<br />
21040 $314.00<br />
21145 $839.00 Yes<br />
21248 $674.00<br />
21386 $544.00<br />
21550 $159.00<br />
22110 $766.00<br />
p. 3
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
22112 $757.00<br />
22595 $974.00<br />
23040 $519.00<br />
23332 $639.00<br />
23570 $154.00<br />
24105 $237.00<br />
22114 $737.00<br />
22600 $863.00<br />
23044 $379.00<br />
23350 $129.00<br />
23575 $262.00<br />
24110 $425.00<br />
22116 $121.00<br />
22610 $860.00<br />
23065 $96.00<br />
23395 $908.00<br />
23585 $505.00<br />
24115 $482.00<br />
22210 $1,026.00<br />
22612 $1,105.00<br />
23066 $199.00<br />
23397 $756.00<br />
23600 $218.00<br />
24116 $640.00<br />
22212 $918.00<br />
22614 $325.00<br />
23075 $175.00<br />
23400 $780.00<br />
23605 $326.00<br />
24120 $320.00<br />
22214 $889.00<br />
22630 $1,089.00<br />
23076 $400.00<br />
23405 $429.00<br />
23615 $549.00<br />
24125 $358.00<br />
22216 $343.00<br />
22632 $275.00<br />
23077 $858.00<br />
23406 $526.00<br />
23616 $1,095.00<br />
24126 $394.00<br />
22220 $1,116.00<br />
22800 $968.00<br />
23100 $329.00<br />
23410 $669.00<br />
23620 $175.00<br />
24130 $319.00<br />
22222 $1,123.00<br />
22802 $1,583.00<br />
23101 $400.00<br />
23412 $712.00<br />
23625 $277.00<br />
24134 $517.00<br />
22224 $1,114.00<br />
22804 $1,846.00<br />
23105 $560.00<br />
23415 $549.00<br />
23630 $423.00<br />
24136 $387.00<br />
22226 $300.00<br />
22808 $1,400.00<br />
23106 $311.00<br />
23420 $736.00<br />
23650 $207.00<br />
24138 $476.00<br />
22305 $130.00<br />
22810 $1,645.00<br />
23107 $548.00<br />
23430 $552.00<br />
23655 $262.00<br />
24140 $549.00<br />
22310 $183.00<br />
22812 $1,631.00<br />
23120 $411.00<br />
23440 $489.00<br />
23660 $422.00<br />
24145 $392.00<br />
22315 $560.00<br />
22818 $1,459.00<br />
23125 $470.00<br />
23450 $714.00<br />
23665 $236.00<br />
24147 $481.00<br />
22318 $950.00<br />
22819 $1,607.00<br />
23130 $443.00<br />
23455 $762.00<br />
23670 $447.00<br />
24149 $785.00<br />
22319 $1,073.00<br />
22830 $660.00<br />
23140 $368.00<br />
23460 $821.00<br />
23675 $383.00<br />
24150 $800.00<br />
22325 $954.00<br />
22840 $660.00<br />
23145 $503.00<br />
23462 $744.00<br />
23680 $507.00<br />
24151 $800.00<br />
22326 $1,020.00<br />
22841 $1,300.00<br />
23146 $379.00<br />
23465 $753.00<br />
23700 $143.00<br />
24152 $520.00<br />
22327 $991.00<br />
22842 $655.00<br />
23150 $407.00<br />
23466 $802.00<br />
23800 $722.00<br />
24153 $507.00<br />
22328 $240.00<br />
22843 $643.00<br />
23155 $508.00<br />
23470 $904.00<br />
23802 $740.00<br />
24155 $550.00<br />
22505 $99.00<br />
22844 $797.00<br />
23156 $427.00<br />
23472 $1,095.00<br />
23900 $846.00<br />
24160 $360.00<br />
22520 $1,906.00<br />
22845 $643.00<br />
23170 $346.00<br />
23480 $610.00<br />
23920 $700.00<br />
24164 $303.00<br />
22521 $1,739.00<br />
22846 $606.00<br />
23172 $343.00<br />
23485 $716.00<br />
23921 $268.00<br />
24200 $146.00<br />
22522 $113.00<br />
22847 $585.00<br />
23174 $474.00<br />
23490 $559.00<br />
23930 $263.00<br />
24201 $408.00<br />
22523 $380.46<br />
22848 $314.00<br />
23180 $435.00<br />
23491 $674.00<br />
23931 $214.00<br />
24220 $153.00<br />
22524 $364.50<br />
22849 $952.00<br />
23182 $471.00<br />
23500 $144.00<br />
23935 $339.00<br />
24300 $276.00<br />
22525 $175.76<br />
22850 $580.00<br />
23184 $514.00<br />
23505 $240.00<br />
24000 $339.00<br />
24301 $469.00<br />
22532 $1,056.05<br />
22851 $353.00<br />
23190 $353.00<br />
23515 $424.00<br />
24006 $517.00<br />
24305 $426.00<br />
22533 $988.18<br />
22852 $553.00<br />
23195 $485.00<br />
23520 $144.00<br />
24065 $150.00<br />
24310 $348.00<br />
22534 $249.70<br />
22855 $787.00<br />
23200 $712.00<br />
23525 $172.00<br />
24066 $407.00<br />
24320 $555.00<br />
22548 $1,224.00<br />
22900 $311.00<br />
23210 $759.00<br />
23530 $355.00<br />
24075 $322.00<br />
24330 $532.00<br />
22554 $1,106.00<br />
23000 $369.00<br />
23220 $703.00<br />
23532 $392.00<br />
24076 $338.00<br />
24331 $564.00<br />
22556 $1,108.00<br />
23020 $434.00<br />
23221 $840.00<br />
23540 $148.00<br />
24077 $732.00<br />
24332 $316.00<br />
22558 $1,087.00<br />
23030 $308.00<br />
23222 $1,041.00<br />
23545 $215.00<br />
24100 $294.00<br />
24340 $451.00<br />
22585 $300.00<br />
23031 $137.00<br />
23330 $157.00<br />
23550 $413.00<br />
24101 $363.00<br />
24341 $378.00<br />
22590 $1,073.00<br />
23035 $467.00<br />
23331 $428.00<br />
23552 $480.00<br />
24102 $451.00<br />
24342 $584.00<br />
p. 4
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
24343 $506.00<br />
24576 $221.00<br />
25035 $423.00<br />
25251 $500.00<br />
25420 $834.00<br />
25622 $199.00<br />
24344 $626.00<br />
24577 $377.00<br />
25040 $433.00<br />
25259 $276.00<br />
25425 $997.00<br />
25624 $318.00<br />
24345 $502.00<br />
24579 $626.00<br />
25065 $148.00<br />
25260 $609.00<br />
25426 $760.00<br />
25628 $490.00<br />
24346 $626.00<br />
24582 $529.00<br />
25066 $323.00<br />
25263 $445.00<br />
25430 $413.00<br />
25630 $206.00<br />
24350 $324.00<br />
24586 $811.00<br />
25075 $278.00<br />
25265 $534.00<br />
25431 $412.00<br />
25635 $303.00<br />
24351 $356.00<br />
24587 $691.00<br />
25076 $414.00<br />
25270 $516.00<br />
25440 $597.00<br />
25645 $366.00<br />
24352 $320.00<br />
24600 $265.00<br />
25077 $659.00<br />
25272 $378.00<br />
25441 $618.00<br />
25650 $214.00<br />
24354 $381.00<br />
24605 $323.00<br />
25085 $371.00<br />
25274 $650.00<br />
25442 $505.00<br />
25651 $245.00<br />
24356 $437.00<br />
24615 $451.00<br />
25100 $224.00<br />
25275 $399.00<br />
25443 $521.00<br />
25652 $440.00<br />
24360 $605.00<br />
24620 $397.00<br />
25101 $263.00<br />
25280 $571.00<br />
25444 $554.00<br />
25660 $280.00<br />
24361 $656.00<br />
24635 $816.00<br />
25105 $388.00<br />
25290 $568.00<br />
25445 $513.00<br />
25670 $450.00<br />
24362 $685.00<br />
24640 $98.00<br />
25107 $342.00<br />
25295 $353.00<br />
25446 $1,065.00<br />
25671 $297.00<br />
24363 $1,107.00<br />
24650 $171.00<br />
25110 $316.00<br />
25300 $515.00<br />
25447 $575.00<br />
25675 $301.00<br />
24365 $402.00<br />
24655 $303.00<br />
25111 $244.00<br />
25301 $407.00<br />
25449 $642.00<br />
25676 $399.00<br />
24366 $587.00<br />
24665 $473.00<br />
25112 $290.00<br />
25310 $613.00<br />
25450 $430.00<br />
25680 $321.00<br />
24400 $607.00<br />
24666 $534.00<br />
25115 $662.00<br />
25312 $685.00<br />
25455 $482.00<br />
25685 $477.00<br />
24410 $710.00<br />
24670 $193.00<br />
25116 $582.00<br />
25315 $538.00<br />
25490 $511.00<br />
25690 $278.00<br />
24420 $679.00<br />
24675 $270.00<br />
25118 $297.00<br />
25316 $645.00<br />
25491 $538.00<br />
25695 $467.00<br />
24430 $691.00<br />
24685 $496.00<br />
25119 $447.00<br />
25320 $660.00<br />
25492 $628.00<br />
25800 $567.00<br />
24435 $732.00<br />
24800 $530.00<br />
25120 $378.00<br />
25332 $680.00<br />
25500 $175.00<br />
25805 $600.00<br />
24470 $417.00<br />
24802 $637.00<br />
25125 $428.00<br />
25335 $800.00<br />
25505 $346.00<br />
25810 $615.00<br />
24495 $399.00<br />
24900 $508.00<br />
25126 $418.00<br />
25337 $632.00<br />
25515 $507.00<br />
25820 $507.00<br />
24498 $610.00<br />
24920 $458.00<br />
25130 $269.00<br />
25350 $662.00<br />
25520 $391.00<br />
25825 $617.00<br />
24500 $234.00<br />
24925 $355.00<br />
25135 $339.00<br />
25355 $727.00<br />
25525 $676.00<br />
25830 $714.00<br />
24505 $348.00<br />
24930 $499.00<br />
25136 $293.00<br />
25360 $648.00<br />
25526 $692.00<br />
25900 $629.00<br />
24515 $680.00<br />
24931 $574.00<br />
25145 $379.00<br />
25365 $831.00<br />
25530 $168.00<br />
25905 $482.00<br />
24516 $635.00<br />
24935 $717.00<br />
25150 $454.00<br />
25370 $653.00<br />
25535 $331.00<br />
25907 $427.00<br />
24530 $254.00<br />
24940 $801.54<br />
25151 $412.00<br />
25375 $686.00<br />
25545 $503.00<br />
25909 $622.00<br />
24535 $438.00<br />
25000 $293.00<br />
25170 $768.00<br />
25390 $558.00<br />
25560 $177.00<br />
25915 $820.00<br />
24538 $548.00<br />
25001 $224.00<br />
25210 $377.00<br />
25391 $722.00<br />
25565 $365.00<br />
25920 $415.00<br />
24545 $580.00<br />
25020 $449.00<br />
25215 $494.00<br />
25392 $894.00<br />
25574 $466.00<br />
25922 $360.00<br />
24546 $830.00<br />
25023 $608.00<br />
25230 $284.00<br />
25393 $1,017.00<br />
25575 $673.00<br />
25924 $413.00<br />
24560 $211.00<br />
25024 $512.00<br />
25240 $355.00<br />
25394 $467.00<br />
25600 $195.00<br />
25927 $446.00<br />
24565 $361.00<br />
25025 $715.00<br />
25246 $142.00<br />
25400 $766.00<br />
25605 $386.00<br />
25929 $349.00<br />
24566 $478.00<br />
25028 $389.00<br />
25248 $393.00<br />
25405 $937.00<br />
25611 $498.00<br />
25931 $421.00<br />
24575 $583.00<br />
25031 $213.00<br />
25250 $381.00<br />
25415 $882.00<br />
25620 $480.00<br />
26010 $195.00<br />
p. 5
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
26011 $303.00<br />
26235 $360.00<br />
26455 $312.00<br />
26546 $694.00<br />
26706 $304.00<br />
27005 $534.00<br />
26020 $297.00<br />
26236 $300.00<br />
26460 $185.00<br />
26548 $604.00<br />
26715 $338.00<br />
27006 $539.00<br />
26025 $297.00<br />
26250 $434.00<br />
26471 $325.00<br />
26550 $1,003.00<br />
26720 $128.00<br />
27025 $601.00<br />
26030 $349.00<br />
26255 $635.00<br />
26474 $322.00<br />
26551 $2,245.00<br />
26725 $236.00<br />
27030 $695.00<br />
26034 $376.00<br />
26260 $404.00<br />
26476 $295.00<br />
26553 $2,229.00<br />
26727 $339.00<br />
27033 $716.00<br />
26035 $525.00<br />
26261 $520.00<br />
26477 $308.00<br />
26554 $2,660.00<br />
26735 $347.00<br />
27035 $763.00<br />
26037 $391.00<br />
26262 $339.00<br />
26478 $504.00<br />
26555 $841.00<br />
26740 $147.00<br />
27036 $700.00<br />
26040 $231.00<br />
26320 $263.00<br />
26479 $347.00<br />
26556 $2,356.00<br />
26742 $259.00<br />
27040 $229.00<br />
26045 $336.00<br />
26340 $211.00<br />
26480 $617.00<br />
26560 $437.00<br />
26746 $378.00<br />
27041 $382.00<br />
26055 $465.00<br />
26350 $582.00<br />
26483 $523.00<br />
26561 $685.00<br />
26750 $121.00<br />
27047 $433.00<br />
26060 $159.00<br />
26352 $478.00<br />
26485 $474.00<br />
26562 $951.00<br />
26755 $218.00<br />
27048 $335.00<br />
26070 $234.00<br />
26356 $750.00<br />
26489 $450.00<br />
26565 $389.00<br />
26756 $298.00<br />
27049 $763.00<br />
26075 $253.00<br />
26357 $497.00<br />
26490 $464.00<br />
26567 $541.00<br />
26765 $255.00<br />
27050 $240.00<br />
26080 $269.00<br />
26358 $522.00<br />
26492 $519.00<br />
26568 $710.00<br />
26770 $187.00<br />
27052 $411.00<br />
26100 $212.00<br />
26370 $633.00<br />
26494 $623.00<br />
26580 $855.00<br />
26775 $259.00<br />
27054 $581.00<br />
26105 $263.00<br />
26372 $727.00<br />
26496 $508.00<br />
26587 $700.00<br />
26785 $260.00<br />
27060 $264.00<br />
26110 $236.00<br />
26373 $481.00<br />
26497 $506.00<br />
26590 $866.00<br />
26820 $457.00<br />
27062 $344.00<br />
26115 $470.00<br />
26390 $496.00<br />
26498 $707.00<br />
26591 $293.00<br />
26841 $587.00<br />
27065 $312.00<br />
26116 $342.00<br />
26392 $610.00<br />
26500 $333.00<br />
26593 $468.00<br />
26842 $627.00<br />
27066 $572.00<br />
26117 $433.00<br />
26410 $467.00<br />
26502 $554.00<br />
26596 $455.00<br />
26843 $427.00<br />
27067 $665.00<br />
26121 $444.00<br />
26412 $396.00<br />
26504 $582.00<br />
26600 $160.00<br />
26844 $468.00<br />
27070 $558.00<br />
26123 $544.00<br />
26415 $581.00<br />
26508 $342.00<br />
26605 $215.00<br />
26850 $552.00<br />
27071 $653.00<br />
26125 $239.00<br />
26416 $610.00<br />
26510 $477.00<br />
26607 $345.00<br />
26852 $444.00<br />
27075 $801.00<br />
26130 $365.00<br />
26418 $464.00<br />
26516 $376.00<br />
26608 $345.00<br />
26860 $449.00<br />
27076 $1,270.00<br />
26135 $398.00<br />
26420 $584.00<br />
26517 $476.00<br />
26615 $319.00<br />
26861 $105.00<br />
27077 $1,269.00<br />
26140 $365.00<br />
26426 $550.00<br />
26518 $470.00<br />
26641 $247.00<br />
26862 $569.00<br />
27078 $790.00<br />
26145 $372.00<br />
26428 $430.00<br />
26520 $357.00<br />
26645 $282.00<br />
26863 $221.00<br />
27079 $796.00<br />
26160 $428.00<br />
26432 $403.00<br />
26525 $543.00<br />
26650 $368.00<br />
26910 $548.00<br />
27080 $340.00<br />
26170 $244.00<br />
26433 $435.00<br />
26530 $425.00<br />
26665 $422.00<br />
26951 $419.00<br />
27086 $105.00<br />
26180 $315.00<br />
26434 $350.00<br />
26531 $476.00<br />
26670 $198.00<br />
26952 $516.00<br />
27087 $365.00<br />
26185 $274.00<br />
26437 $331.00<br />
26535 $306.00<br />
26675 $300.00<br />
26990 $441.00<br />
27090 $609.00<br />
26200 $325.00<br />
26440 $518.00<br />
26536 $465.00<br />
26676 $361.00<br />
26991 $318.00<br />
27091 $1,120.00<br />
26205 $421.00<br />
26442 $689.00<br />
26540 $526.00<br />
26685 $395.00<br />
26992 $713.00<br />
27093 $158.00<br />
26210 $314.00<br />
26445 $487.00<br />
26541 $638.00<br />
26686 $448.00<br />
27000 $329.00<br />
27095 $197.00<br />
26215 $401.00<br />
26449 $423.00<br />
26542 $401.00<br />
26700 $217.00<br />
27001 $396.00<br />
27096 $178.00<br />
26230 $368.00<br />
26450 $315.00<br />
26545 $549.00<br />
26705 $279.00<br />
27003 $416.00<br />
27097 $428.00<br />
p. 6
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
27098 $531.00<br />
27217 $745.00<br />
27305 $336.00<br />
27393 $369.00<br />
27468 $1,120.00<br />
27540 $695.00<br />
27100 $532.00<br />
27218 $985.00<br />
27306 $281.00<br />
27394 $478.00<br />
27470 $856.00<br />
27550 $347.00<br />
27105 $513.00<br />
27220 $360.00<br />
27307 $339.00<br />
27395 $644.00<br />
27472 $935.00<br />
27552 $450.00<br />
27110 $632.00<br />
27222 $692.00<br />
27310 $578.00<br />
27396 $512.00<br />
27475 $480.00<br />
27556 $691.00<br />
27111 $591.00<br />
27226 $726.00<br />
27315 $323.00<br />
27397 $618.00<br />
27477 $538.00<br />
27557 $797.00<br />
27120 $921.00<br />
27227 $1,201.00<br />
27320 $323.00<br />
27400 $553.00<br />
27479 $701.00<br />
27558 $825.00<br />
27122 $799.00<br />
27228 $1,386.00<br />
27323 $166.00<br />
27403 $531.00<br />
27485 $495.00<br />
27560 $251.00<br />
27125 $778.00<br />
27230 $330.00<br />
27324 $274.00<br />
27405 $552.00<br />
27486 $1,136.00<br />
27562 $320.00<br />
27130 $1,163.00<br />
27232 $548.00<br />
27327 $305.00<br />
27407 $636.00<br />
27487 $1,294.00<br />
27566 $661.00<br />
27132 $1,353.00<br />
27235 $744.00<br />
27328 $301.00<br />
27409 $837.00<br />
27488 $843.00<br />
27570 $119.00<br />
27134 $1,617.00<br />
27236 $882.00<br />
27329 $799.00<br />
27418 $678.00<br />
27495 $915.00<br />
27580 $1,046.00<br />
27137 $1,222.00<br />
27238 $321.00<br />
27330 $324.00<br />
27420 $615.00<br />
27496 $353.00<br />
27590 $644.00<br />
27138 $1,273.00<br />
27240 $564.00<br />
27331 $387.00<br />
27422 $614.00<br />
27497 $351.00<br />
27591 $635.00<br />
27140 $588.00<br />
27244 $943.00<br />
27332 $527.00<br />
27424 $499.00<br />
27498 $378.00<br />
27592 $490.00<br />
27146 $910.00<br />
27245 $1,175.00<br />
27333 $476.00<br />
27425 $362.00<br />
27500 $405.00<br />
27594 $367.00<br />
27147 $942.00<br />
27246 $311.00<br />
27334 $490.00<br />
27427 $615.00<br />
27501 $387.00<br />
27596 $533.00<br />
27151 $941.00<br />
27248 $526.00<br />
27335 $618.00<br />
27428 $867.00<br />
27502 $600.00<br />
27598 $538.00<br />
27156 $1,257.00<br />
27250 $344.00<br />
27340 $261.00<br />
27429 $886.00<br />
27503 $624.00<br />
27600 $308.00<br />
27158 $1,000.00<br />
27252 $544.00<br />
27345 $390.00<br />
27430 $539.00<br />
27506 $928.00<br />
27601 $320.00<br />
27161 $778.00<br />
27253 $696.00<br />
27347 $338.00<br />
27435 $546.00<br />
27507 $825.00<br />
27602 $381.00<br />
27165 $948.00<br />
27254 $936.00<br />
27350 $526.00<br />
27437 $439.00<br />
27508 $366.00<br />
27603 $360.00<br />
27170 $782.00<br />
27256 $226.00<br />
27355 $438.00<br />
27438 $682.00<br />
27509 $471.00<br />
27604 $309.00<br />
27175 $409.00<br />
27257 $247.00<br />
27356 $474.00<br />
27440 $677.00<br />
27510 $525.00<br />
27605 $296.00<br />
27176 $711.00<br />
27258 $809.00<br />
27357 $511.00<br />
27441 $653.00<br />
27511 $852.00<br />
27606 $230.00<br />
27177 $799.00<br />
27259 $1,200.00<br />
27358 $274.00<br />
27442 $705.00<br />
27513 $1,075.00<br />
27607 $431.00<br />
27178 $708.00<br />
27265 $291.00<br />
27360 $606.00<br />
27443 $715.00<br />
27514 $938.00<br />
27610 $466.00<br />
27179 $598.00<br />
27266 $421.00<br />
27365 $859.00<br />
27445 $870.00<br />
27516 $345.00<br />
27612 $406.00<br />
27181 $705.00<br />
27275 $132.00<br />
27370 $144.00<br />
27446 $940.00<br />
27517 $450.00<br />
27613 $155.00<br />
27185 $368.00<br />
27280 $727.00<br />
27372 $433.00<br />
27447 $1,255.00<br />
27519 $814.00<br />
27614 $374.00<br />
27187 $823.00<br />
27282 $540.00<br />
27380 $434.00<br />
27448 $602.00<br />
27520 $230.00<br />
27615 $596.00<br />
27193 $322.00<br />
27284 $775.00<br />
27381 $589.00<br />
27450 $753.00<br />
27524 $625.00<br />
27618 $326.00<br />
27194 $528.00<br />
27286 $1,040.00<br />
27385 $464.00<br />
27454 $822.00<br />
27530 $267.00<br />
27619 $530.00<br />
27200 $119.00<br />
27290 $1,435.00<br />
27386 $608.00<br />
27455 $783.00<br />
27532 $441.00<br />
27620 $345.00<br />
27202 $422.00<br />
27295 $1,000.00<br />
27390 $271.00<br />
27457 $718.00<br />
27535 $656.00<br />
27625 $449.00<br />
27215 $532.00<br />
27301 $481.00<br />
27391 $348.00<br />
27465 $742.00<br />
27536 $837.00<br />
27626 $530.00<br />
27216 $770.00<br />
27303 $464.00<br />
27392 $512.00<br />
27466 $865.00<br />
27538 $325.00<br />
27630 $359.00<br />
p. 7
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
27635 $495.00<br />
27709 $620.00<br />
27825 $382.00<br />
28030 $247.00<br />
28130 $449.00<br />
28290 $353.00<br />
27637 $551.00<br />
27712 $767.00<br />
27826 $587.00<br />
28035 $322.00<br />
28140 $418.00<br />
28292 $428.00<br />
27638 $576.00<br />
27715 $705.00<br />
27827 $914.00<br />
28043 $217.00<br />
28150 $261.00<br />
28293 $454.00<br />
27640 $654.00<br />
27720 $647.00<br />
27828 $1,025.00<br />
28045 $297.00<br />
28153 $233.00<br />
28294 $478.00<br />
27641 $493.00<br />
27722 $618.00<br />
27829 $409.00<br />
28046 $567.00<br />
28160 $243.00<br />
28296 $517.00<br />
27645 $796.00<br />
27724 $944.00<br />
27830 $226.00<br />
28050 $222.00<br />
28171 $427.00<br />
28297 $580.00<br />
27646 $650.00<br />
27725 $750.00<br />
27831 $223.00<br />
28052 $215.00<br />
28173 $403.00<br />
28298 $452.00<br />
27647 $608.00<br />
27727 $817.00<br />
27832 $331.00<br />
28054 $183.00<br />
28175 $306.00<br />
28299 $579.00<br />
27648 $122.00<br />
27730 $401.00<br />
27840 $247.00<br />
28060 $317.00<br />
28190 $153.00<br />
28300 $507.00<br />
27650 $525.00<br />
27732 $350.00<br />
27842 $343.00<br />
28062 $386.00<br />
28192 $296.00<br />
28302 $498.00<br />
27652 $503.00<br />
27734 $412.00<br />
27846 $472.00<br />
28070 $255.00<br />
28193 $336.00<br />
28304 $513.00<br />
27654 $524.00<br />
27740 $555.00<br />
27848 $709.00<br />
28072 $297.00<br />
28200 $285.00<br />
28305 $552.00<br />
27656 $292.00<br />
27742 $646.00<br />
27860 $131.00<br />
28080 $252.00<br />
28202 $330.00<br />
28306 $374.00<br />
27658 $310.00<br />
27745 $556.00<br />
27870 $788.00<br />
28086 $369.00<br />
28208 $271.00<br />
28307 $499.00<br />
27659 $387.00<br />
27750 $261.00<br />
27871 $574.00<br />
28088 $280.00<br />
28210 $372.00<br />
28308 $325.00<br />
27664 $274.00<br />
27752 $372.00<br />
27880 $644.00<br />
28090 $281.00<br />
28220 $233.00<br />
28309 $530.00<br />
27665 $346.00<br />
27756 $400.00<br />
27881 $648.00<br />
28092 $257.00<br />
28222 $322.00<br />
28310 $330.00<br />
27675 $392.00<br />
27758 $638.00<br />
27882 $468.00<br />
28100 $397.00<br />
28225 $190.00<br />
28312 $293.00<br />
27676 $410.00<br />
27759 $738.00<br />
27884 $426.00<br />
28102 $376.00<br />
28226 $228.00<br />
28313 $305.00<br />
27680 $328.00<br />
27760 $223.00<br />
27886 $543.00<br />
28103 $392.00<br />
28230 $262.00<br />
28315 $319.00<br />
27681 $340.00<br />
27762 $342.00<br />
27888 $489.00<br />
28104 $313.00<br />
28232 $230.00<br />
28320 $486.00<br />
27685 $409.00<br />
27766 $525.00<br />
27889 $474.00<br />
28106 $341.00<br />
28234 $233.00<br />
28322 $520.00<br />
27686 $423.00<br />
27780 $198.00<br />
27892 $325.00<br />
28107 $278.00<br />
28238 $447.00<br />
28340 $394.00<br />
27687 $350.00<br />
27781 $292.00<br />
27893 $314.00<br />
28108 $257.00<br />
28240 $266.00<br />
28341 $521.00<br />
27690 $459.00<br />
27784 $411.00<br />
27894 $433.00<br />
28110 $271.00<br />
28250 $344.00<br />
28344 $290.00<br />
27691 $541.00<br />
27786 $212.00<br />
27899 $325.00 Yes<br />
28111 $360.00<br />
28260 $347.00<br />
28345 $385.00<br />
27692 $91.00<br />
27788 $298.00<br />
28001 $168.00<br />
28112 $301.00<br />
28261 $615.00<br />
28360 $644.00<br />
27695 $420.00<br />
27792 $443.00<br />
28002 $284.00<br />
28113 $317.00<br />
28262 $890.00<br />
28400 $168.00<br />
27696 $447.00<br />
27808 $221.00<br />
28003 $442.00<br />
28114 $479.00<br />
28264 $491.00<br />
28405 $302.00<br />
27698 $498.00<br />
27810 $378.00<br />
28005 $447.00<br />
28116 $435.00<br />
28270 $285.00<br />
28406 $392.00<br />
27700 $578.00<br />
27814 $587.00<br />
28008 $266.00<br />
28118 $362.00<br />
28272 $234.00<br />
28415 $945.00<br />
27702 $832.00<br />
27816 $211.00<br />
28010 $176.00<br />
28119 $337.00<br />
28280 $336.00<br />
28420 $989.00<br />
27703 $929.00<br />
27818 $350.00<br />
28011 $209.00<br />
28120 $370.00<br />
28285 $279.00<br />
28430 $160.00<br />
27704 $368.00<br />
27822 $734.00<br />
28020 $324.00<br />
28122 $421.00<br />
28286 $276.00<br />
28435 $209.00<br />
27705 $566.00<br />
27823 $835.00<br />
28022 $291.00<br />
28124 $289.00<br />
28288 $312.00<br />
28436 $319.00<br />
27707 $278.00<br />
27824 $208.00<br />
28024 $281.00<br />
28126 $226.00<br />
28289 $444.00<br />
28445 $818.00<br />
p. 8
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
28450 $154.00<br />
28675 $241.00<br />
29130 $29.00<br />
29804 $539.00 Yes<br />
29871 $424.00<br />
30124 $194.00<br />
28455 $221.00<br />
28705 $962.00<br />
29131 $37.00<br />
29805 $349.00<br />
29873 $376.00<br />
30125 $448.00<br />
28456 $200.00<br />
28715 $786.00<br />
29200 $36.00<br />
29806 $781.00<br />
29874 $396.00<br />
30130 $255.00<br />
28465 $451.00<br />
28725 $608.00<br />
29220 $39.00<br />
29807 $761.00<br />
29875 $414.00<br />
30140 $273.00<br />
28470 $148.00<br />
28730 $585.00<br />
29240 $45.00<br />
29819 $491.00<br />
29876 $510.00<br />
30150 $584.00<br />
28475 $186.00<br />
28735 $570.00<br />
29260 $37.00<br />
29820 $454.00<br />
29877 $480.00<br />
30160 $480.00<br />
28476 $244.00<br />
28737 $502.00<br />
29280 $37.00<br />
29821 $495.00<br />
29879 $460.00<br />
30200 $67.00<br />
28485 $375.00<br />
28740 $553.00<br />
29305 $175.00<br />
29822 $428.00<br />
29880 $542.00<br />
30210 $89.00<br />
28490 $89.00<br />
28750 $556.00<br />
29325 $190.00<br />
29823 $525.00<br />
29881 $502.00<br />
30220 $83.00<br />
28495 $109.00<br />
28755 $317.00<br />
29345 $105.00<br />
29824 $478.00<br />
29882 $484.00<br />
30300 $154.00<br />
28496 $293.00<br />
28760 $466.00<br />
29355 $108.00<br />
29825 $490.00<br />
29883 $614.00<br />
30310 $144.00<br />
28505 $339.00<br />
28800 $425.00<br />
29358 $115.00<br />
29826 $566.00<br />
29884 $478.00<br />
30320 $225.00<br />
28510 $76.00<br />
28805 $450.00<br />
29365 $94.00<br />
29827 $825.00<br />
29885 $518.00<br />
30400 $610.00 Yes<br />
28515 $98.00<br />
28810 $324.00<br />
29405 $69.00<br />
29830 $362.00<br />
29886 $482.00<br />
30410 $631.00 Yes<br />
28525 $298.00<br />
28820 $344.00<br />
29425 $74.00<br />
29834 $366.00<br />
29887 $580.00<br />
30420 $980.00 Yes<br />
28530 $84.00<br />
28825 $302.00<br />
29435 $91.00<br />
29835 $414.00<br />
29888 $833.00<br />
30430 $337.00 Yes<br />
28531 $234.00<br />
28890 $214.14<br />
29440 $42.00<br />
29836 $470.00<br />
29889 $873.00<br />
30435 $542.00 Yes<br />
28540 $109.00<br />
29000 $197.00<br />
29445 $120.00<br />
29837 $434.00<br />
29891 $481.00<br />
30450 $785.00 Yes<br />
28545 $122.00<br />
29010 $196.00<br />
29450 $107.00<br />
29838 $478.00<br />
29892 $449.00<br />
30460 $584.00<br />
28546 $174.00<br />
29015 $192.00<br />
29505 $60.00<br />
29840 $344.00<br />
29893 $254.00<br />
30462 $1,176.00<br />
28555 $349.00<br />
29020 $177.00<br />
29515 $53.00<br />
29843 $400.00<br />
29894 $435.00<br />
30465 $536.00<br />
28570 $120.00<br />
29025 $207.00<br />
29520 $32.00<br />
29844 $414.00<br />
29895 $426.00<br />
30520 $368.00<br />
28575 $165.00<br />
29035 $206.00<br />
29530 $39.00<br />
29845 $471.00<br />
29897 $447.00<br />
30540 $491.00<br />
28576 $205.00<br />
29040 $180.00<br />
29540 $28.00<br />
29846 $434.00<br />
29898 $497.00<br />
30545 $588.00<br />
28585 $431.00<br />
29044 $251.00<br />
29550 $27.00<br />
29847 $400.00<br />
29899 $749.00<br />
30560 $165.00<br />
28600 $121.00<br />
29046 $260.00<br />
29580 $36.00<br />
29848 $330.00<br />
29900 $278.00<br />
30580 $425.00<br />
28605 $168.00<br />
29049 $95.00<br />
29590 $38.00<br />
29850 $482.00<br />
29901 $307.00<br />
30600 $393.00<br />
28606 $325.00<br />
29055 $170.00<br />
29700 $42.00<br />
29851 $704.00<br />
29902 $330.00<br />
30620 $423.00<br />
28615 $533.00<br />
29058 $94.00<br />
29705 $47.00<br />
29855 $598.00<br />
30000 $152.00<br />
30630 $337.00<br />
28630 $78.00<br />
29065 $72.00<br />
29710 $85.00<br />
29856 $664.00<br />
30020 $131.00<br />
30801 $143.00<br />
28635 $101.00<br />
29075 $66.00<br />
29715 $87.00<br />
29860 $455.00<br />
30100 $81.00<br />
30802 $185.00<br />
28636 $194.00<br />
29085 $70.00<br />
29720 $70.00<br />
29861 $454.00<br />
30110 $137.00<br />
30901 $75.00<br />
28645 $270.00<br />
29086 $35.00<br />
29730 $47.00<br />
29862 $488.00<br />
30115 $291.00<br />
30903 $120.00<br />
28660 $82.00<br />
29105 $62.00<br />
29740 $69.00<br />
29863 $474.00<br />
30117 $444.00<br />
30905 $155.00<br />
28665 $101.00<br />
29125 $47.00<br />
29750 $65.00<br />
29868 $1,094.35<br />
30118 $551.00<br />
30906 $180.00<br />
28666 $243.00<br />
29126 $58.00<br />
29800 $304.00<br />
29870 $300.00<br />
30120 $294.00<br />
30915 $322.00<br />
p. 9
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
30920 $549.00<br />
31267 $274.00<br />
31529 $147.00<br />
31622 $236.00<br />
31785 $718.00<br />
32442 $1,135.00<br />
30930 $83.00<br />
31276 $422.00<br />
31530 $180.00<br />
31623 $258.00<br />
31786 $1,013.00<br />
32445 $1,131.00<br />
31000 $111.00<br />
31287 $215.00<br />
31531 $215.00<br />
31624 $241.00<br />
31800 $339.00<br />
32480 $1,123.00<br />
31002 $146.00<br />
31288 $250.00<br />
31535 $173.00<br />
31625 $258.00<br />
31805 $813.00<br />
32482 $924.00<br />
31020 $318.00<br />
31290 $869.00<br />
31536 $194.00<br />
31628 $302.00<br />
31820 $292.00<br />
32484 $956.00<br />
31030 $492.00<br />
31291 $837.00<br />
31540 $224.00<br />
31629 $499.00<br />
31825 $418.00<br />
32486 $1,068.00<br />
31032 $418.00<br />
31292 $667.00<br />
31541 $245.00<br />
31630 $176.00<br />
31830 $296.00<br />
32488 $1,134.00<br />
31033 $577.79<br />
31293 $728.00<br />
31545 $253.49<br />
31631 $186.00<br />
32000 $128.00<br />
32491 $1,239.00<br />
31040 $560.00<br />
31294 $858.00<br />
31546 $386.81<br />
31632 $57.00<br />
32002 $153.00<br />
32500 $1,059.00<br />
31050 $337.00<br />
31300 $697.00<br />
31560 $310.00<br />
31633 $58.65<br />
32005 $239.00<br />
32501 $241.00<br />
31051 $452.00<br />
31320 $309.00<br />
31561 $315.00<br />
31635 $276.00<br />
32019 $573.31<br />
32503 $1,166.66<br />
31070 $293.00<br />
31360 $984.00<br />
31570 $272.00<br />
31636 $160.31<br />
32020 $165.00<br />
32504 $1,336.03<br />
31075 $549.00<br />
31365 $1,307.00<br />
31571 $210.00<br />
31637 $57.25<br />
32035 $443.00<br />
32540 $740.00<br />
31080 $510.00<br />
31367 $1,273.00<br />
31575 $88.00<br />
31638 $204.00<br />
32036 $487.00<br />
32601 $259.00<br />
31081 $739.00<br />
31368 $1,398.00<br />
31576 $158.00<br />
31640 $216.00<br />
32095 $454.00<br />
32602 $267.00<br />
31084 $838.00<br />
31370 $1,019.00<br />
31577 $159.00<br />
31641 $236.00<br />
32100 $714.00<br />
32603 $318.00<br />
31085 $886.00<br />
31375 $929.00<br />
31578 $203.00<br />
31643 $150.00<br />
32110 $658.00<br />
32604 $361.00<br />
31086 $584.00<br />
31380 $960.00<br />
31579 $171.00<br />
31645 $234.00<br />
32120 $579.00<br />
32605 $299.00<br />
31087 $582.00<br />
31382 $982.00<br />
31580 $650.00<br />
31646 $213.00<br />
32124 $616.00<br />
32606 $346.00<br />
31090 $636.00<br />
31390 $1,351.00<br />
31582 $1,365.00<br />
31656 $119.00<br />
32140 $690.00<br />
32650 $535.00<br />
31200 $270.00<br />
31395 $1,576.00<br />
31584 $1,105.00<br />
31700 $94.00<br />
32141 $682.00<br />
32651 $627.00<br />
31201 $497.00<br />
31400 $588.00<br />
31587 $547.00<br />
31708 $51.00<br />
32150 $661.00<br />
32652 $888.00<br />
31205 $460.00<br />
31420 $520.00<br />
31588 $820.00<br />
31710 $49.00<br />
32151 $664.00<br />
32653 $616.00<br />
31220 $5.99<br />
31500 $100.00<br />
31590 $370.00<br />
31715 $38.00<br />
32160 $453.00<br />
32654 $590.00<br />
31225 $907.00<br />
31502 $33.00<br />
31595 $436.00<br />
31717 $109.00<br />
32200 $617.00<br />
32655 $662.00<br />
31230 $1,029.00<br />
31505 $57.00<br />
31600 $319.00<br />
31720 $48.00<br />
32201 $665.00<br />
32656 $656.00<br />
31231 $123.00<br />
31510 $99.00<br />
31601 $206.00<br />
31725 $75.00<br />
32215 $551.00<br />
32657 $702.00<br />
31233 $183.00<br />
31511 $151.00<br />
31603 $185.00<br />
31730 $132.00<br />
32220 $1,141.00<br />
32658 $612.00<br />
31235 $165.00<br />
31512 $150.00<br />
31605 $166.00<br />
31750 $876.00<br />
32225 $682.00<br />
32659 $654.00<br />
31237 $232.00<br />
31513 $98.00<br />
31610 $427.00<br />
31755 $779.00<br />
32310 $657.00<br />
32660 $907.00<br />
31238 $241.00<br />
31515 $150.00<br />
31611 $365.00<br />
31760 $898.00<br />
32320 $1,120.00<br />
32661 $628.00<br />
31239 $518.00<br />
31520 $123.00<br />
31612 $58.00<br />
31766 $1,259.00<br />
32400 $111.00<br />
32662 $786.00<br />
31240 $146.00<br />
31525 $179.00<br />
31613 $305.00<br />
31770 $1,210.00<br />
32402 $426.00<br />
32663 $896.00<br />
31254 $253.00<br />
31526 $143.00<br />
31614 $456.00<br />
31775 $1,067.00<br />
32405 $88.00<br />
32664 $682.00<br />
31255 $376.00<br />
31527 $154.00<br />
31615 $146.00<br />
31780 $860.00<br />
32420 $87.00<br />
32665 $733.00<br />
31256 $183.00<br />
31528 $129.00<br />
31620 $167.71<br />
31781 $1,048.00<br />
32440 $1,173.00<br />
32800 $629.00<br />
p. 10
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
32810 $587.00<br />
33222 $271.00<br />
33403 $1,271.00<br />
33505 $1,304.00<br />
33641 $1,088.00<br />
33779 $1,684.00<br />
32815 $1,037.00<br />
33223 $325.00<br />
33404 $1,629.00<br />
33506 $1,316.00<br />
33645 $1,262.00<br />
33780 $1,843.00<br />
32820 $997.00<br />
33224 $391.00<br />
33405 $1,710.00<br />
33507 $1,129.93<br />
33647 $1,464.00<br />
33781 $1,652.00<br />
32900 $937.00<br />
33225 $348.00<br />
33406 $1,593.00<br />
33508 $13.00<br />
33660 $1,311.00<br />
33786 $1,613.00<br />
32905 $961.00<br />
33226 $311.23<br />
33410 $1,428.00<br />
33510 $1,530.00<br />
33665 $1,450.00<br />
33788 $1,234.00<br />
32906 $1,140.00<br />
33233 $190.00<br />
33411 $1,706.00<br />
33511 $1,633.00<br />
33670 $1,613.00<br />
33800 $830.00<br />
32940 $897.00<br />
33234 $378.00<br />
33412 $1,727.00<br />
33512 $1,716.00<br />
33681 $1,425.00<br />
33802 $938.00<br />
32960 $82.00<br />
33235 $479.00<br />
33413 $1,763.00<br />
33513 $1,729.00<br />
33684 $1,473.00<br />
33803 $941.00<br />
32997 $214.00<br />
33236 $529.00<br />
33414 $1,558.00<br />
33514 $1,764.00<br />
33688 $1,405.00<br />
33813 $1,336.00<br />
33010 $92.00<br />
33237 $639.00<br />
33415 $1,374.00<br />
33516 $2,070.00<br />
33690 $1,010.00<br />
33814 $1,322.00<br />
33011 $85.00<br />
33238 $669.00<br />
33416 $1,446.00<br />
33517 $122.00<br />
33692 $1,515.00<br />
33820 $861.00<br />
33015 $356.00<br />
33240 $360.00<br />
33417 $1,474.00<br />
33518 $229.00<br />
33694 $1,613.00<br />
33822 $839.00<br />
33020 $633.00<br />
33241 $180.00<br />
33420 $974.00<br />
33519 $328.00<br />
33697 $1,648.00<br />
33824 $1,010.00<br />
33025 $625.00<br />
33243 $900.00<br />
33422 $1,306.00<br />
33521 $432.00<br />
33702 $1,367.00<br />
33840 $1,059.00<br />
33030 $958.00<br />
33244 $671.00<br />
33425 $1,348.00<br />
33522 $537.00<br />
33710 $1,468.00<br />
33845 $1,142.00<br />
33031 $1,263.00<br />
33245 $769.00<br />
33426 $1,553.00<br />
33523 $642.00<br />
33720 $1,346.00<br />
33851 $1,118.00<br />
33050 $661.00<br />
33246 $1,073.00<br />
33427 $2,078.00<br />
33530 $277.00<br />
33722 $1,451.00<br />
33852 $1,239.00<br />
33120 $1,267.00<br />
33249 $751.00<br />
33430 $1,710.00<br />
33532 $940.79<br />
33730 $1,517.00<br />
33853 $1,639.00<br />
33130 $939.00<br />
33250 $917.00<br />
33460 $1,190.00<br />
33533 $1,435.00<br />
33732 $1,409.00<br />
33860 $1,639.00<br />
33140 $853.00<br />
33251 $1,136.00<br />
33463 $1,287.00<br />
33534 $1,539.00<br />
33735 $1,093.00<br />
33861 $1,871.00<br />
33141 $203.00<br />
33253 $1,401.00<br />
33464 $1,368.00<br />
33535 $1,792.00<br />
33736 $1,227.00<br />
33863 $1,996.00<br />
33200 $700.00<br />
33261 $1,080.00<br />
33465 $1,432.00<br />
33536 $1,822.00<br />
33737 $1,063.00<br />
33870 $2,150.00<br />
33201 $562.00<br />
33282 $250.00<br />
33468 $1,582.00<br />
33542 $1,470.00<br />
33750 $1,012.00<br />
33875 $1,551.00<br />
33206 $371.00<br />
33284 $192.00<br />
33470 $945.00<br />
33545 $1,751.00<br />
33755 $989.00<br />
33877 $2,076.00<br />
33207 $426.00<br />
33300 $849.00<br />
33471 $1,040.00<br />
33548 $1,481.03<br />
33762 $1,025.00<br />
33880 $1,177.31<br />
33208 $432.00<br />
33305 $1,018.00<br />
33472 $1,077.00<br />
33572 $201.00<br />
33764 $1,022.00<br />
33881 $1,010.12<br />
33210 $154.00<br />
33310 $852.00<br />
33474 $1,167.00<br />
33600 $1,423.00<br />
33766 $1,138.00<br />
33883 $743.79<br />
33211 $151.00<br />
33315 $1,163.00<br />
33475 $1,432.00<br />
33602 $1,376.00<br />
33767 $1,171.00<br />
33884 $279.31<br />
33212 $289.00<br />
33320 $800.00<br />
33476 $1,223.00<br />
33606 $1,522.00<br />
33768 $282.46<br />
33886 $641.34<br />
33213 $302.00<br />
33321 $1,015.00<br />
33478 $1,365.00<br />
33608 $1,578.00<br />
33770 $1,591.00<br />
33889 $555.67<br />
33214 $375.00<br />
33322 $1,039.00<br />
33496 $1,392.00<br />
33610 $1,542.00<br />
33771 $1,580.00<br />
33891 $707.82<br />
33215 $235.00<br />
33330 $941.00<br />
33500 $1,638.00<br />
33611 $1,605.00<br />
33774 $1,505.00<br />
33910 $1,183.00<br />
33216 $322.00<br />
33332 $1,038.00<br />
33501 $834.00<br />
33612 $1,692.00<br />
33775 $1,505.00<br />
33915 $864.00<br />
33217 $293.00<br />
33335 $1,344.00<br />
33502 $1,042.00<br />
33615 $1,637.00<br />
33776 $1,537.00<br />
33916 $1,135.00<br />
33218 $263.00<br />
33400 $1,289.00<br />
33503 $1,066.00<br />
33617 $1,755.00<br />
33777 $1,505.00<br />
33917 $1,258.00<br />
33220 $266.00<br />
33401 $1,197.00<br />
33504 $1,344.00<br />
33619 $2,049.00<br />
33778 $1,723.00<br />
33920 $1,602.00<br />
p. 11
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
33922 $1,195.00<br />
34802 $1,002.00<br />
35141 $902.00<br />
35361 $1,176.00<br />
35507 $869.00<br />
35616 $726.00<br />
33924 $257.00<br />
34803 $908.77<br />
35142 $930.00<br />
35363 $1,397.00<br />
35508 $925.00<br />
35621 $896.00<br />
33925 $1,149.59<br />
34804 $1,002.00<br />
35151 $753.00<br />
35371 $674.00<br />
35509 $860.00<br />
35623 $651.00<br />
33926 $1,561.53<br />
34805 $826.70<br />
35152 $861.00<br />
35372 $813.00<br />
35510 $874.36<br />
35626 $1,040.00<br />
33960 $773.00<br />
34808 $153.19<br />
35180 $664.00<br />
35381 $806.00<br />
35511 $726.00<br />
35631 $1,028.00<br />
33961 $445.00<br />
34812 $289.00<br />
35182 $941.00<br />
35390 $135.00<br />
35512 $857.42<br />
35636 $902.00<br />
33967 $203.00<br />
34813 $178.00<br />
35184 $640.00<br />
35400 $122.00<br />
35515 $925.00<br />
35637 $825.77<br />
33968 $28.00<br />
34820 $362.00<br />
35188 $664.00<br />
35450 $595.00<br />
35516 $751.00<br />
35638 $825.77<br />
33970 $318.00<br />
34825 $552.00<br />
35189 $966.00<br />
35452 $362.00<br />
35518 $912.00<br />
35641 $1,066.00<br />
33971 $537.00<br />
34826 $170.00<br />
35190 $669.00<br />
35454 $295.00<br />
35521 $751.00<br />
35642 $826.00<br />
33973 $411.00<br />
34830 $1,252.00<br />
35201 $748.00<br />
35456 $357.00<br />
35522 $960.00<br />
35645 $826.00<br />
33974 $680.00<br />
34831 $1,353.00<br />
35206 $613.00<br />
35458 $452.00<br />
35525 $916.00<br />
35646 $1,465.00<br />
33975 $1,460.00<br />
34832 $1,353.00<br />
35207 $598.00<br />
35459 $397.00<br />
35526 $848.00<br />
35647 $1,243.00<br />
33976 $1,668.00<br />
34833 $428.31<br />
35211 $1,145.00<br />
35460 $293.00<br />
35531 $1,587.00<br />
35650 $858.00<br />
33977 $845.00<br />
34834 $236.00<br />
35216 $875.00<br />
35470 $2,589.00<br />
35533 $928.00<br />
35651 $1,249.00<br />
33978 $950.00<br />
34900 $736.00<br />
35221 $1,071.00<br />
35471 $2,929.00<br />
35536 $1,022.00<br />
35654 $1,113.00<br />
33979 $1,642.00<br />
35001 $848.00<br />
35226 $677.00<br />
35472 $1,897.00<br />
35541 $1,155.00<br />
35656 $987.00<br />
33980 $2,105.00<br />
35002 $1,084.00<br />
35231 $730.00<br />
35473 $1,751.00<br />
35546 $1,280.00<br />
35661 $868.00<br />
34001 $549.00<br />
35005 $891.00<br />
35236 $778.00<br />
35474 $2,518.00<br />
35548 $948.00<br />
35663 $858.00<br />
34051 $618.00<br />
35011 $809.00<br />
35241 $1,042.00<br />
35475 $1,762.00<br />
35549 $1,030.00<br />
35665 $949.00<br />
34101 $498.00<br />
35013 $987.00<br />
35246 $918.00<br />
35476 $1,355.00<br />
35551 $1,107.00<br />
35666 $1,020.00<br />
34111 $473.00<br />
35021 $1,075.00<br />
35251 $884.00<br />
35480 $505.00<br />
35556 $1,104.00<br />
35671 $911.00<br />
34151 $900.00<br />
35022 $1,182.00<br />
35256 $832.00<br />
35481 $308.00<br />
35558 $726.00<br />
35681 $76.00<br />
34201 $536.00<br />
35045 $782.00<br />
35261 $805.00<br />
35482 $400.00<br />
35560 $1,323.00<br />
35682 $338.00<br />
34203 $762.00<br />
35081 $1,235.00<br />
35266 $680.00<br />
35483 $483.00<br />
35563 $781.00<br />
35683 $380.00<br />
34401 $519.00<br />
35082 $1,451.00<br />
35271 $1,141.00<br />
35484 $462.00<br />
35565 $910.00<br />
35685 $142.00<br />
34421 $562.00<br />
35091 $1,435.00<br />
35276 $1,072.00<br />
35485 $366.00<br />
35566 $1,197.00<br />
35686 $141.00<br />
34451 $780.00<br />
35092 $1,691.00<br />
35281 $780.00<br />
35490 $498.00<br />
35571 $1,088.00<br />
35691 $855.00<br />
34471 $472.00<br />
35102 $1,352.00<br />
35286 $751.00<br />
35491 $295.00<br />
35572 $287.00<br />
35693 $621.00<br />
34490 $360.00<br />
35103 $1,709.00<br />
35301 $952.00<br />
35492 $331.00<br />
35583 $1,139.00<br />
35694 $740.00<br />
34501 $755.00<br />
35111 $971.00<br />
35311 $1,080.00<br />
35493 $376.00<br />
35585 $1,426.00<br />
35695 $739.00<br />
34502 $1,112.00<br />
35112 $948.00<br />
35321 $556.00<br />
35494 $452.00<br />
35587 $1,176.00<br />
35697 $127.00<br />
34510 $870.00<br />
35121 $1,087.00<br />
35331 $940.00<br />
35495 $418.00<br />
35600 $208.00<br />
35700 $143.00<br />
34520 $752.00<br />
35122 $1,301.00<br />
35341 $1,075.00<br />
35500 $298.00<br />
35601 $807.00<br />
35701 $417.00<br />
34530 $743.00<br />
35131 $887.00<br />
35351 $1,021.00<br />
35501 $849.00<br />
35606 $861.00<br />
35721 $356.00<br />
34800 $803.00<br />
35132 $1,327.00<br />
35355 $929.00<br />
35506 $905.00<br />
35612 $728.00<br />
35741 $388.00<br />
p. 12
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
35761 $319.00<br />
36248 $138.00<br />
36560 $974.00<br />
36821 $471.00<br />
37209 $92.00<br />
38201 $587.99<br />
35800 $355.00<br />
36260 $523.00<br />
36561 $964.00<br />
36822 $332.00<br />
37215 $829.00<br />
38220 $131.00<br />
35820 $620.00<br />
36400 $19.00<br />
36563 $1,015.00<br />
36825 $517.00<br />
37216 $698.25<br />
38221 $145.00<br />
35840 $480.00<br />
36405 $19.00<br />
36565 $837.00<br />
36830 $604.00<br />
37250 $81.00<br />
38230 $232.00<br />
35860 $327.00<br />
36406 $13.00<br />
36566 $873.00<br />
36831 $369.00<br />
37251 $62.00<br />
38300 $178.00<br />
35870 $865.00<br />
36410 $14.00<br />
36568 $257.00<br />
36832 $532.00<br />
37500 $480.23<br />
38305 $316.00<br />
35875 $473.00<br />
36415 $2.00<br />
36569 $250.00<br />
36833 $534.00<br />
37565 $253.00<br />
38308 $312.00<br />
35876 $764.00<br />
36416 $1.60<br />
36570 $1,066.47<br />
36834 $513.00<br />
37600 $286.00<br />
38380 $370.00<br />
35879 $736.00<br />
36420 $46.00<br />
36571 $1,038.00<br />
36835 $379.00<br />
37605 $294.00<br />
38381 $587.00<br />
35881 $697.00<br />
36425 $34.00<br />
36575 $130.00<br />
36838 $812.11<br />
37606 $390.00<br />
38382 $433.00<br />
35901 $412.00<br />
36430 $28.00<br />
36576 $282.00<br />
36860 $110.00<br />
37607 $298.00<br />
38500 $220.00<br />
35903 $474.00<br />
36440 $43.00<br />
36578 $400.00<br />
36861 $121.00<br />
37609 $216.00<br />
38505 $98.00<br />
35905 $732.00<br />
36450 $102.00<br />
36580 $225.00<br />
36870 $1,543.00<br />
37615 $324.00<br />
38510 $356.00<br />
35907 $1,538.00<br />
36455 $102.00<br />
36581 $616.00<br />
37070 $19.99<br />
37616 $652.00<br />
38520 $326.00<br />
36000 $21.00<br />
36460 $262.00<br />
36582 $839.00<br />
37140 $1,032.00<br />
37617 $973.00<br />
38525 $288.00<br />
36002 $138.00<br />
36470 $63.00<br />
36583 $841.00<br />
37145 $951.00<br />
37618 $287.00<br />
38530 $279.00<br />
36005 $229.00<br />
36471 $132.00<br />
36584 $222.00<br />
37160 $940.00<br />
37620 $489.00<br />
38542 $348.00<br />
36010 $580.00<br />
36475 $1,549.00<br />
36585 $944.00<br />
37180 $966.00<br />
37650 $380.00<br />
38550 $331.00<br />
36011 $825.00<br />
36476 $272.62<br />
36589 $133.00<br />
37181 $1,349.00<br />
37660 $430.00<br />
38555 $756.00<br />
36012 $605.00<br />
36478 $1,429.00<br />
36590 $222.00<br />
37182 $695.00<br />
37700 $200.00<br />
38562 $557.00<br />
36013 $637.00<br />
36479 $275.12<br />
36595 $563.00<br />
37183 $331.00<br />
37718 $261.05<br />
38570 $378.00<br />
36014 $619.00<br />
36481 $373.00<br />
36596 $120.00<br />
37184 $1,770.17<br />
37722 $308.34<br />
38571 $492.00<br />
36015 $727.00<br />
36500 $147.00<br />
36597 $105.00<br />
37185 $578.75<br />
37735 $459.00<br />
38572 $572.00<br />
36100 $412.00<br />
36510 $137.00<br />
36598 $76.47<br />
37186 $1,191.82<br />
37760 $442.00<br />
38700 $593.00<br />
36120 $343.00<br />
36511 $57.00<br />
36600 $23.00<br />
37187 $1,720.89<br />
37765 $354.00<br />
38720 $739.00<br />
36140 $397.00<br />
36512 $57.00<br />
36620 $48.00<br />
37188 $1,483.15<br />
37766 $372.18<br />
38724 $734.00<br />
36145 $390.00<br />
36513 $57.00<br />
36625 $83.00<br />
37195 $192.00<br />
37780 $163.00<br />
38740 $462.00<br />
36160 $433.00<br />
36514 $496.00<br />
36640 $96.00<br />
37200 $154.00<br />
37785 $263.00<br />
38745 $593.00<br />
36200 $527.00<br />
36515 $57.00<br />
36660 $58.00<br />
37201 $254.00<br />
37788 $900.00<br />
38746 $206.00<br />
36215 $852.00<br />
36516 $2,225.00<br />
36680 $58.00<br />
37202 $294.00<br />
37790 $373.00<br />
38747 $206.00<br />
36216 $925.00<br />
36522 $165.00<br />
36800 $126.00<br />
37203 $1,015.00<br />
38100 $675.00<br />
38760 $590.00<br />
36217 $1,643.00<br />
36550 $19.00<br />
36810 $239.00<br />
37204 $737.00<br />
38101 $689.00<br />
38765 $890.00<br />
36218 $165.00<br />
36555 $234.00<br />
36815 $163.00<br />
37205 $362.00<br />
38102 $202.00<br />
38770 $601.00<br />
36245 $984.00<br />
36556 $226.00<br />
36818 $549.00<br />
37206 $169.00<br />
38115 $557.00<br />
38780 $823.00<br />
36246 $948.00<br />
36557 $717.00<br />
36819 $633.00<br />
37207 $359.00<br />
38120 $757.00<br />
38790 $262.00<br />
36247 $1,490.00<br />
36558 $706.00<br />
36820 $634.00<br />
37208 $174.00<br />
38200 $99.00<br />
38792 $32.00<br />
p. 13
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
38794 $198.00<br />
40806 $58.00<br />
41120 $713.00<br />
42140 $149.00<br />
42505 $367.00<br />
42894 $1,272.00<br />
39000 $354.00<br />
40808 $100.00<br />
41130 $781.00<br />
42145 $510.00<br />
42507 $362.00<br />
42900 $232.00<br />
39010 $615.00<br />
40810 $118.00<br />
41135 $1,012.00<br />
42160 $119.00<br />
42508 $415.00<br />
42950 $570.00<br />
39200 $672.00<br />
40812 $173.00<br />
41140 $1,088.00<br />
42180 $160.00<br />
42509 $496.00<br />
42953 $523.00<br />
39220 $1,068.00<br />
40814 $241.00<br />
41145 $1,304.00<br />
42182 $175.00<br />
42510 $464.00<br />
42955 $360.00<br />
39400 $342.00<br />
40816 $255.00<br />
41150 $1,026.00<br />
42200 $658.00<br />
42550 $138.00<br />
42960 $126.00<br />
39501 $682.00<br />
40818 $144.00<br />
41153 $1,280.00<br />
42205 $464.00<br />
42600 $308.00<br />
42961 $309.00<br />
39502 $820.00<br />
40819 $185.00<br />
41155 $1,696.00<br />
42210 $786.00<br />
42650 $54.00<br />
42962 $383.00<br />
39503 $1,482.00<br />
40820 $144.00<br />
41250 $134.00<br />
42215 $533.00<br />
42660 $48.00<br />
42970 $195.00<br />
39520 $747.00<br />
40830 $154.00<br />
41251 $159.00<br />
42220 $407.00<br />
42665 $190.00<br />
42971 $333.00<br />
39530 $700.00<br />
40831 $202.00<br />
41252 $198.00<br />
42225 $753.00<br />
42700 $121.00<br />
42972 $380.00<br />
39531 $676.00<br />
40840 $373.00<br />
41500 $180.00<br />
42226 $708.00<br />
42720 $300.00<br />
43020 $411.00<br />
39540 $612.00<br />
40842 $371.00<br />
41510 $217.00<br />
42227 $531.00<br />
42725 $432.00<br />
43030 $441.00<br />
39541 $660.00<br />
40843 $514.00<br />
41520 $209.00<br />
42235 $563.00<br />
42800 $101.00<br />
43045 $855.00<br />
39545 $722.00<br />
40844 $669.00<br />
41800 $106.00<br />
42260 $384.00<br />
42802 $81.00<br />
43100 $518.00<br />
39560 $562.00<br />
40845 $860.00<br />
41805 $110.00<br />
42280 $102.00<br />
42804 $72.00<br />
43101 $699.00<br />
39561 $722.00<br />
41000 $66.00<br />
41806 $118.00<br />
42281 $131.00<br />
42806 $89.00<br />
43107 $1,800.00<br />
40490 $81.00<br />
41005 $62.00<br />
41820 $320.00<br />
42300 $136.00<br />
42808 $154.00<br />
43108 $1,557.00<br />
40500 $318.00<br />
41006 $231.00<br />
41821 $29.99<br />
42305 $319.00<br />
42809 $119.00<br />
43112 $1,341.00<br />
40510 $325.00<br />
41007 $152.00<br />
41822 $160.00<br />
42310 $109.00<br />
42810 $254.00<br />
43113 $1,496.00<br />
40520 $349.00<br />
41008 $137.00<br />
41823 $167.00<br />
42320 $112.00<br />
42815 $400.00<br />
43116 $1,486.00<br />
40525 $463.00<br />
41009 $248.00<br />
41825 $123.00<br />
42330 $153.00<br />
42820 $225.00<br />
43117 $1,776.00<br />
40527 $588.00<br />
41010 $123.00<br />
41826 $146.00<br />
42335 $235.00<br />
42821 $248.00<br />
43118 $1,483.00<br />
40530 $379.00<br />
41015 $271.00<br />
41827 $222.00<br />
42340 $221.00<br />
42825 $206.00<br />
43121 $1,273.00<br />
40650 $295.00<br />
41016 $193.00<br />
41828 $163.00<br />
42400 $68.00<br />
42826 $211.00<br />
43122 $1,783.00<br />
40652 $342.00<br />
41017 $282.00<br />
41830 $240.00<br />
42405 $210.00<br />
42830 $149.00<br />
43123 $1,487.00<br />
40654 $398.00<br />
41018 $229.00<br />
41850 $192.00<br />
42408 $301.00<br />
42831 $161.00<br />
43124 $1,239.00<br />
40700 $645.00<br />
41100 $116.00<br />
41870 $325.00<br />
42409 $209.00<br />
42835 $139.00<br />
43130 $579.00<br />
40701 $859.00<br />
41105 $106.00<br />
41874 $197.00<br />
42410 $465.00<br />
42836 $179.00<br />
43135 $750.00<br />
40702 $638.00<br />
41108 $88.00<br />
41900 $4.99<br />
42415 $827.00<br />
42842 $568.00<br />
43200 $159.00<br />
40720 $708.00<br />
41110 $126.00<br />
42000 $63.00<br />
42420 $953.00<br />
42844 $635.00<br />
43201 $187.00<br />
40761 $650.00<br />
41112 $206.00<br />
42100 $97.00<br />
42425 $593.00<br />
42845 $1,364.00<br />
43202 $205.00<br />
40800 $115.00<br />
41113 $228.00<br />
42104 $119.00<br />
42426 $1,014.00<br />
42860 $143.00<br />
43204 $180.00<br />
40801 $188.00<br />
41114 $369.00<br />
42106 $153.00<br />
42440 $361.00<br />
42870 $396.00<br />
43205 $161.00<br />
40804 $128.00<br />
41115 $142.00<br />
42107 $293.00<br />
42450 $303.00<br />
42890 $785.00<br />
43215 $130.00<br />
40805 $205.00<br />
41116 $192.00<br />
42120 $505.00<br />
42500 $219.00<br />
42892 $736.00<br />
43216 $136.00<br />
p. 14
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
43217 $275.00<br />
43264 $379.00<br />
43456 $440.00<br />
43773 $727.00 Yes<br />
44120 $755.00<br />
44213 $123.15<br />
43218 $112.89<br />
43265 $361.00<br />
43458 $271.00<br />
43774 $556.00 Yes<br />
44121 $187.00<br />
44227 $963.42<br />
43219 $141.00<br />
43267 $367.00<br />
43460 $138.00<br />
43800 $608.00<br />
44125 $794.00<br />
44300 $545.00<br />
43220 $104.00<br />
43268 $350.00<br />
43496 $3,051.00<br />
43810 $460.00<br />
44126 $1,285.00<br />
44310 $701.00<br />
43226 $115.00<br />
43269 $342.00<br />
43500 $496.00<br />
43820 $677.00<br />
44127 $1,478.00<br />
44312 $368.00<br />
43227 $172.00<br />
43271 $347.00<br />
43501 $882.00<br />
43825 $848.00<br />
44128 $159.00<br />
44314 $666.00<br />
43228 $213.00<br />
43272 $347.00<br />
43502 $682.00<br />
43830 $442.00<br />
44130 $656.00<br />
44316 $667.00<br />
43231 $153.00<br />
43280 $762.00<br />
43510 $468.00<br />
43831 $377.00<br />
44139 $94.00<br />
44320 $784.00<br />
43232 $181.00<br />
43300 $579.00<br />
43520 $469.00<br />
43832 $694.00<br />
44140 $946.00<br />
44322 $698.00<br />
43234 $203.00<br />
43305 $840.00<br />
43530 $6.99<br />
43840 $693.00<br />
44141 $909.00<br />
44340 $367.00<br />
43235 $211.00<br />
43310 $1,109.00<br />
43600 $78.00<br />
43842 $728.00 Yes<br />
44143 $1,041.00<br />
44345 $690.00<br />
43236 $260.00<br />
43312 $1,260.00<br />
43605 $468.00<br />
43843 $728.00 Yes<br />
44144 $1,008.00<br />
44346 $754.00<br />
43237 $172.00<br />
43313 $1,718.00<br />
43610 $645.00<br />
43845 $1,093.55 Yes<br />
44145 $1,155.00<br />
44360 $125.00<br />
43238 $213.00<br />
43314 $1,890.00<br />
43611 $790.00<br />
43846 $1,060.00 Yes<br />
44146 $1,245.00<br />
44361 $138.00<br />
43239 $241.00<br />
43320 $704.00<br />
43620 $1,305.00<br />
43847 $1,017.00 Yes<br />
44147 $1,012.00<br />
44363 $199.00<br />
43240 $275.00<br />
43324 $913.00<br />
43621 $935.00<br />
43848 $1,017.00 Yes<br />
44150 $1,106.00<br />
44364 $237.00<br />
43241 $126.00<br />
43325 $895.00<br />
43622 $980.00<br />
43850 $777.00<br />
44151 $1,042.00<br />
44365 $159.00<br />
43242 $304.00<br />
43326 $652.00<br />
43631 $989.00<br />
43855 $795.00<br />
44152 $1,042.00<br />
44366 $217.00<br />
43243 $217.00<br />
43330 $671.00<br />
43632 $989.00<br />
43860 $1,090.00<br />
44153 $1,145.00<br />
44369 $213.00<br />
43244 $212.00<br />
43331 $928.00<br />
43633 $1,011.00<br />
43865 $845.00<br />
44155 $1,263.00<br />
44370 $156.00<br />
43245 $153.00<br />
43340 $705.00<br />
43634 $1,042.00<br />
43870 $439.00<br />
44156 $948.00<br />
44372 $210.00<br />
43246 $206.00<br />
43341 $732.00<br />
43635 $98.00<br />
43880 $1,076.00<br />
44160 $863.00<br />
44373 $168.00<br />
43247 $162.00<br />
43350 $535.00<br />
43640 $754.00<br />
43886 $173.00 Yes<br />
44180 $534.30<br />
44376 $222.00<br />
43248 $152.00<br />
43351 $640.00<br />
43641 $764.00<br />
43887 $169.00 Yes<br />
44186 $374.44<br />
44377 $233.00<br />
43249 $140.00<br />
43352 $576.00<br />
43644 $1,207.00 Yes<br />
43888 $241.00 Yes<br />
44187 $618.15<br />
44378 $298.00<br />
43250 $154.00<br />
43360 $1,300.00<br />
43645 $1,138.17 Yes<br />
44005 $713.00<br />
44188 $678.45<br />
44379 $254.00<br />
43251 $177.00<br />
43361 $1,407.00<br />
43651 $391.00<br />
44010 $557.00<br />
44202 $963.00<br />
44380 $54.00<br />
43255 $203.00<br />
43400 $687.00<br />
43652 $468.00<br />
44015 $124.00<br />
44203 $187.00<br />
44382 $65.00<br />
43256 $184.00<br />
43401 $911.00<br />
43653 $366.00<br />
44020 $619.00<br />
44204 $1,088.00<br />
44383 $87.00<br />
43257 $203.16<br />
43405 $720.00<br />
43750 $203.00<br />
44021 $622.00<br />
44205 $788.00<br />
44385 $149.00<br />
43258 $200.00<br />
43410 $560.00<br />
43752 $36.00<br />
44025 $630.00<br />
44206 $1,188.00<br />
44386 $129.00<br />
43259 $217.00<br />
43415 $749.00<br />
43760 $90.00<br />
44050 $621.00<br />
44207 $1,066.43<br />
44388 $224.00<br />
43260 $281.00<br />
43420 $660.00<br />
43761 $95.00<br />
44055 $957.00<br />
44208 $1,152.23<br />
44389 $273.00<br />
43261 $262.00<br />
43425 $764.00<br />
43770 $630.00 Yes<br />
44100 $83.00<br />
44210 $1,234.00<br />
44390 $206.00<br />
43262 $347.00<br />
43450 $113.00<br />
43771 $727.00 Yes<br />
44110 $528.00<br />
44211 $1,266.32<br />
44392 $281.00<br />
43263 $305.00<br />
43453 $206.00<br />
43772 $554.00 Yes<br />
44111 $558.00<br />
44212 $1,182.64<br />
44393 $262.00<br />
p. 15
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
44394 $346.00<br />
45114 $1,212.00<br />
45342 $156.00<br />
45990 $65.74<br />
46611 $146.00<br />
46940 $127.00<br />
44397 $162.00<br />
45116 $1,043.00<br />
45345 $104.00<br />
46020 $144.00<br />
46612 $212.00<br />
46942 $90.00<br />
44500 $20.00<br />
45119 $1,333.00<br />
45355 $138.00<br />
46030 $75.00<br />
46614 $118.00<br />
46945 $107.00<br />
44602 $698.00<br />
45120 $995.00<br />
45378 $278.00<br />
46040 $307.00<br />
46615 $110.00<br />
46946 $181.00<br />
44603 $808.00<br />
45121 $1,211.00<br />
45379 $350.00<br />
46045 $218.00<br />
46700 $407.00<br />
46947 $245.00<br />
44604 $700.00<br />
45123 $683.00<br />
45380 $329.00<br />
46050 $105.00<br />
46705 $340.00<br />
47000 $152.00<br />
44605 $617.00<br />
45126 $1,346.00<br />
45381 $319.00<br />
46060 $305.00<br />
46706 $91.50<br />
47001 $80.00<br />
44615 $702.00<br />
45130 $714.00<br />
45382 $441.00<br />
46070 $120.00<br />
46710 $597.93<br />
47010 $428.00<br />
44620 $542.00<br />
45135 $764.00<br />
45383 $395.00<br />
46080 $162.00<br />
46712 $1,253.78<br />
47011 $167.00<br />
44625 $661.00<br />
45136 $1,000.00<br />
45384 $328.00<br />
46083 $111.00<br />
46715 $382.00<br />
47015 $410.00<br />
44626 $1,096.00<br />
45150 $295.00<br />
45385 $378.00<br />
46200 $223.00<br />
46716 $614.00<br />
47100 $544.00<br />
44640 $940.00<br />
45160 $558.00<br />
45386 $470.00<br />
46210 $138.00<br />
46730 $845.00<br />
47120 $1,572.00<br />
44650 $588.00<br />
45170 $514.00<br />
45387 $282.00<br />
46211 $205.00<br />
46735 $1,002.00<br />
47122 $1,372.00<br />
44660 $912.00<br />
45190 $339.00<br />
45391 $188.24<br />
46220 $111.00<br />
46740 $887.00<br />
47125 $1,251.00<br />
44661 $720.00<br />
45300 $52.00<br />
45392 $238.32<br />
46221 $136.00<br />
46742 $1,217.00<br />
47130 $2,314.00<br />
44680 $588.00<br />
45303 $500.00<br />
45395 $1,135.04<br />
46230 $164.00<br />
46744 $1,315.00<br />
47300 $450.00<br />
44700 $605.00<br />
45305 $102.00<br />
45397 $1,237.08<br />
46250 $266.00<br />
46746 $1,484.00<br />
47350 $880.00<br />
44701 $130.00<br />
45307 $92.00<br />
45400 $664.00<br />
46255 $342.00<br />
46748 $1,600.00<br />
47360 $1,191.00<br />
44800 $512.00<br />
45308 $74.00<br />
45402 $902.08<br />
46257 $284.00<br />
46750 $466.00<br />
47361 $1,164.00<br />
44820 $412.00<br />
45309 $139.00<br />
45500 $316.00<br />
46258 $292.00<br />
46751 $352.00<br />
47362 $464.00<br />
44850 $385.00<br />
45315 $114.00<br />
45505 $323.00<br />
46260 $329.00<br />
46753 $357.00<br />
47370 $622.00<br />
44900 $458.00<br />
45317 $126.00<br />
45520 $30.00<br />
46261 $367.00<br />
46754 $113.00<br />
47371 $586.00<br />
44901 $833.00<br />
45320 $133.00<br />
45540 $711.00<br />
46262 $386.00<br />
46760 $461.00<br />
47380 $731.00<br />
44950 $445.00<br />
45321 $108.00<br />
45541 $617.00<br />
46270 $253.00<br />
46761 $539.00<br />
47381 $723.00<br />
44955 $73.00<br />
45327 $60.00<br />
45550 $995.00<br />
46275 $270.00<br />
46762 $513.00<br />
47382 $433.00<br />
44960 $549.00<br />
45330 $90.00<br />
45560 $477.00<br />
46280 $315.00<br />
46900 $129.00<br />
47400 $786.00<br />
44970 $395.00<br />
45331 $117.00<br />
45562 $689.00<br />
46285 $231.00<br />
46910 $136.00<br />
47420 $888.00<br />
45000 $179.00<br />
45332 $111.00<br />
45563 $792.00<br />
46288 $329.00<br />
46916 $93.00<br />
47425 $693.00<br />
45005 $171.00<br />
45333 $184.00<br />
45800 $588.00<br />
46320 $108.00<br />
46917 $298.00<br />
47460 $685.00<br />
45020 $240.00<br />
45334 $132.00<br />
45805 $780.00<br />
46500 $107.00<br />
46922 $146.00<br />
47480 $525.00<br />
45100 $182.00<br />
45335 $130.00<br />
45820 $588.00<br />
46505 $140.43<br />
46924 $315.00<br />
47490 $374.00<br />
45108 $226.00<br />
45337 $115.00<br />
45825 $780.00<br />
46600 $57.00<br />
46934 $245.00<br />
47500 $79.00<br />
45110 $980.00<br />
45338 $211.00<br />
45900 $66.00<br />
46604 $280.00<br />
46935 $145.00<br />
47505 $35.00<br />
45111 $690.00<br />
45339 $191.00<br />
45905 $113.00<br />
46606 $125.00<br />
46936 $229.00<br />
47510 $378.00<br />
45112 $1,038.00<br />
45340 $221.00<br />
45910 $135.00<br />
46608 $164.00<br />
46937 $143.00<br />
47511 $464.00<br />
45113 $1,076.00<br />
45341 $125.00<br />
45915 $214.00<br />
46610 $148.00<br />
46938 $219.00<br />
47525 $568.00<br />
p. 16
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
47530 $217.00<br />
47900 $752.00<br />
49080 $147.00<br />
49525 $391.00<br />
50075 $1,003.00<br />
50396 $67.00<br />
47550 $114.00<br />
48000 $1,226.00<br />
49081 $107.00<br />
49540 $364.00<br />
50080 $711.00<br />
50398 $471.00<br />
47552 $201.00<br />
48001 $714.00<br />
49085 $546.00<br />
49550 $394.00<br />
50081 $1,038.00<br />
50400 $930.00<br />
47553 $231.00<br />
48005 $840.00<br />
49180 $136.00<br />
49553 $429.00<br />
50100 $736.00<br />
50405 $999.00<br />
47554 $355.00<br />
48020 $588.00<br />
49200 $468.00<br />
49555 $336.00<br />
50120 $642.00<br />
50500 $801.00<br />
47555 $252.00<br />
48100 $551.00<br />
49201 $672.00<br />
49557 $389.00<br />
50125 $669.00<br />
50520 $698.00<br />
47556 $343.00<br />
48102 $355.00<br />
49215 $1,067.00<br />
49560 $518.00<br />
50130 $769.00<br />
50525 $896.00<br />
47560 $188.00<br />
48120 $589.00<br />
49220 $824.00<br />
49561 $631.00<br />
50135 $817.00<br />
50526 $898.00<br />
47561 $221.00<br />
48140 $1,010.00<br />
49250 $388.00<br />
49565 $527.00<br />
50200 $132.00<br />
50540 $823.00<br />
47562 $498.00<br />
48145 $903.00<br />
49255 $515.00<br />
49566 $638.00<br />
50205 $502.00<br />
50541 $570.00<br />
47563 $535.00<br />
48146 $1,279.00<br />
49320 $237.00<br />
49568 $206.00<br />
50220 $739.00<br />
50542 $718.77<br />
47564 $628.00<br />
48148 $699.00<br />
49321 $248.00<br />
49570 $271.00<br />
50225 $858.00<br />
50543 $905.22<br />
47570 $523.00<br />
48150 $1,694.00<br />
49322 $266.00<br />
49572 $317.00<br />
50230 $1,037.00<br />
50544 $786.00<br />
47600 $611.00<br />
48152 $1,575.00<br />
49323 $431.00<br />
49580 $223.00<br />
50234 $944.00<br />
50545 $1,005.00<br />
47605 $657.00<br />
48153 $2,100.00<br />
49400 $70.00<br />
49582 $311.00<br />
50236 $1,019.00<br />
50546 $873.00<br />
47610 $832.00<br />
48154 $1,579.00<br />
49419 $264.25<br />
49585 $293.00<br />
50240 $936.00<br />
50547 $934.00<br />
47612 $889.00<br />
48155 $1,003.00<br />
49420 $113.00<br />
49587 $348.00<br />
50250 $728.86<br />
50548 $856.00<br />
47620 $908.00<br />
48180 $1,085.00<br />
49421 $266.00<br />
49590 $390.00<br />
50280 $637.00<br />
50551 $287.00<br />
47630 $418.00<br />
48400 $79.00<br />
49422 $300.00<br />
49600 $500.00<br />
50290 $589.00<br />
50553 $362.00<br />
47700 $687.00<br />
48500 $552.00<br />
49423 $58.00<br />
49605 $848.00<br />
50300 $301.99<br />
50555 $369.00<br />
47701 $1,223.00<br />
48510 $642.00<br />
49424 $121.00<br />
49606 $818.00<br />
50320 $914.00<br />
50557 $434.00<br />
47711 $791.00<br />
48511 $670.00<br />
49425 $495.00<br />
49610 $427.00<br />
50340 $588.00<br />
50561 $445.00<br />
47712 $980.00<br />
48520 $692.00<br />
49426 $395.00<br />
49611 $416.00<br />
50360 $1,343.00<br />
50562 $382.52<br />
47715 $631.00<br />
48540 $865.00<br />
49427 $41.00<br />
49650 $294.00<br />
50365 $1,594.00<br />
50570 $305.00<br />
47716 $540.00<br />
48545 $810.00<br />
49428 $114.00<br />
49651 $338.00<br />
50370 $610.00<br />
50572 $398.00<br />
47720 $723.00<br />
48547 $892.00<br />
49429 $285.00<br />
49900 $569.00<br />
50380 $941.00<br />
50574 $417.00<br />
47721 $678.00<br />
49000 $537.00<br />
49491 $500.00<br />
49904 $901.35<br />
50382 $921.73<br />
50575 $566.00<br />
47740 $646.00<br />
49002 $478.00<br />
49492 $624.00<br />
49905 $275.00<br />
50384 $889.22<br />
50576 $437.00<br />
47741 $889.00<br />
49010 $565.00<br />
49495 $272.00<br />
50010 $538.00<br />
50387 $444.14<br />
50580 $401.00<br />
47760 $1,141.00<br />
49020 $1,019.00<br />
49496 $402.00<br />
50020 $674.00<br />
50389 $302.99<br />
50590 $612.00<br />
47765 $882.00<br />
49021 $654.00<br />
49500 $285.00<br />
50021 $670.00<br />
50390 $79.00<br />
50592 $3,380.94<br />
47780 $891.00<br />
49040 $614.00<br />
49501 $403.00<br />
50040 $590.00<br />
50391 $90.75<br />
50600 $627.00<br />
47785 $1,022.00<br />
49041 $634.00<br />
49505 $356.00<br />
50045 $620.00<br />
50392 $146.00<br />
50605 $585.00<br />
47800 $808.00<br />
49060 $713.00<br />
49507 $434.00<br />
50060 $819.00<br />
50393 $178.00<br />
50610 $765.00<br />
47801 $600.00<br />
49061 $627.00<br />
49520 $441.00<br />
50065 $826.00<br />
50394 $106.00<br />
50620 $730.00<br />
47802 $736.00<br />
49062 $517.00<br />
49521 $534.00<br />
50070 $805.00<br />
50395 $160.00<br />
50630 $743.00<br />
p. 17
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
50650 $706.00<br />
50951 $226.00<br />
51597 $1,611.00<br />
51980 $529.00<br />
52327 $224.00<br />
53080 $305.00<br />
50660 $778.00<br />
50953 $370.00<br />
51600 $178.00<br />
51990 $466.00<br />
52330 $1,171.00<br />
53085 $582.00<br />
50684 $175.00<br />
50955 $348.00<br />
51605 $177.00<br />
51992 $617.00<br />
52332 $270.00<br />
53200 $132.00<br />
50686 $138.00<br />
50957 $349.00<br />
51610 $104.00<br />
52000 $150.00<br />
52334 $186.00<br />
53210 $493.00<br />
50688 $51.00<br />
50961 $438.00<br />
51700 $70.00<br />
52001 $306.00<br />
52341 $249.00<br />
53215 $622.00<br />
50690 $95.00<br />
50970 $278.00<br />
51701 $57.00<br />
52005 $220.00<br />
52342 $239.00<br />
53220 $321.00<br />
50700 $647.00<br />
50972 $226.00<br />
51702 $70.00<br />
52007 $524.00<br />
52343 $265.00<br />
53230 $429.00<br />
50715 $847.00<br />
50974 $361.00<br />
51703 $118.00<br />
52010 $157.00<br />
52344 $318.00<br />
53235 $394.00<br />
50722 $660.00<br />
50976 $350.00<br />
51705 $92.00<br />
52202 $157.50<br />
52345 $302.00<br />
53240 $275.00<br />
50725 $764.00<br />
50980 $243.00<br />
51710 $134.00<br />
52204 $453.00<br />
52346 $380.00<br />
53250 $323.00<br />
50727 $373.00<br />
51000 $75.00<br />
51715 $221.00<br />
52214 $1,109.00<br />
52351 $243.00<br />
53260 $155.00<br />
50728 $502.00<br />
51005 $155.00<br />
51720 $108.00<br />
52224 $1,048.00<br />
52352 $284.00<br />
53265 $171.00<br />
50740 $754.00<br />
51010 $259.00<br />
51725 $195.00<br />
52234 $215.00<br />
52353 $328.00<br />
53270 $153.00<br />
50750 $793.00<br />
51020 $316.00<br />
51726 $251.00<br />
52235 $252.00<br />
52354 $282.00<br />
53275 $203.00<br />
50760 $755.00<br />
51030 $362.00<br />
51736 $35.00<br />
52240 $445.00<br />
52355 $363.00<br />
53400 $566.00<br />
50770 $807.00<br />
51040 $239.00<br />
51741 $58.00<br />
52250 $188.00<br />
52400 $406.00<br />
53405 $592.00<br />
50780 $886.00<br />
51045 $339.00<br />
51772 $198.00<br />
52260 $162.00<br />
52402 $186.48<br />
53410 $708.00<br />
50782 $855.00<br />
51050 $350.00<br />
51784 $154.00<br />
52265 $441.00<br />
52450 $339.00<br />
53415 $897.00<br />
50783 $881.00<br />
51060 $533.00<br />
51785 $165.00<br />
52270 $394.00<br />
52500 $381.00<br />
53420 $613.00<br />
50785 $872.00<br />
51065 $382.00<br />
51792 $194.00<br />
52275 $554.00<br />
52510 $418.00<br />
53425 $628.00<br />
50800 $662.00<br />
51080 $283.00<br />
51795 $241.00<br />
52276 $231.00<br />
52601 $593.00<br />
53430 $611.00<br />
50810 $882.00<br />
51500 $421.00<br />
51797 $203.00<br />
52277 $245.00<br />
52606 $352.00<br />
53431 $694.00<br />
50815 $967.00<br />
51520 $413.00<br />
51798 $12.00<br />
52281 $274.00<br />
52612 $493.00<br />
53440 $590.00<br />
50820 $938.00<br />
51525 $605.00<br />
51800 $705.00<br />
52282 $295.00<br />
52614 $350.00<br />
53444 $495.00<br />
50825 $1,294.00<br />
51530 $520.00<br />
51820 $870.00<br />
52283 $184.00<br />
52620 $300.00<br />
53445 $712.00<br />
50830 $1,249.00<br />
51535 $567.00<br />
51840 $555.00<br />
52285 $219.00<br />
52630 $354.00<br />
53446 $453.00<br />
50840 $882.00<br />
51550 $680.00<br />
51841 $589.00<br />
52290 $212.00<br />
52640 $312.00<br />
53447 $680.00<br />
50845 $825.00<br />
51555 $827.00<br />
51845 $491.00<br />
52300 $219.00<br />
52647 $2,254.00<br />
53448 $525.00<br />
50860 $667.00<br />
51565 $925.00<br />
51860 $540.00<br />
52301 $229.00<br />
52648 $542.00<br />
53450 $281.00<br />
50900 $588.00<br />
51570 $961.00<br />
51865 $658.00<br />
52305 $203.00<br />
52700 $281.00<br />
53460 $330.00<br />
50920 $588.00<br />
51575 $1,243.00<br />
51880 $321.00<br />
52310 $238.00<br />
53000 $154.00<br />
53500 $552.00<br />
50930 $803.00<br />
51580 $1,229.00<br />
51900 $646.00<br />
52315 $391.00<br />
53010 $180.00<br />
53502 $412.00<br />
50940 $618.00<br />
51585 $1,417.00<br />
51920 $617.00<br />
52317 $967.00<br />
53020 $135.00<br />
53505 $318.00<br />
50945 $728.00<br />
51590 $1,369.00<br />
51925 $635.00<br />
52318 $420.00<br />
53025 $86.00<br />
53510 $430.00<br />
50947 $954.00<br />
51595 $1,574.00<br />
51940 $1,376.00<br />
52320 $216.00<br />
53040 $294.00<br />
53515 $618.00<br />
50948 $873.00<br />
51596 $1,839.00<br />
51960 $1,001.00<br />
52325 $268.00<br />
53060 $141.00<br />
53520 $360.00<br />
p. 18
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
53600 $77.00<br />
54164 $128.00<br />
54512 $383.00<br />
55500 $262.00<br />
56606 $35.00<br />
57150 $47.00<br />
53601 $70.00<br />
54200 $81.00<br />
54520 $272.00<br />
55520 $284.00<br />
56620 $417.00<br />
57155 $318.00<br />
53605 $57.00<br />
54205 $343.00<br />
54522 $397.00<br />
55530 $260.00<br />
56625 $441.00<br />
57160 $56.00<br />
53620 $111.00<br />
54220 $177.00<br />
54530 $385.00<br />
55535 $298.00<br />
56630 $607.00<br />
57170 $42.00<br />
53621 $102.00<br />
54231 $97.00<br />
54535 $534.00<br />
55540 $352.00<br />
56631 $755.00<br />
57180 $108.00<br />
53660 $61.00<br />
54235 $63.00<br />
54550 $348.00<br />
55550 $265.00<br />
56632 $1,029.00<br />
57200 $208.00<br />
53661 $62.00<br />
54240 $59.00<br />
54560 $491.00<br />
55600 $264.00<br />
56633 $746.00<br />
57210 $266.00<br />
53665 $31.00<br />
54250 $98.00<br />
54600 $356.00<br />
55605 $347.00<br />
56634 $915.00<br />
57220 $206.00<br />
53850 $402.00<br />
54300 $477.00<br />
54620 $220.00<br />
55650 $598.00<br />
56637 $977.00<br />
57230 $240.00<br />
53852 $397.00<br />
54304 $562.00<br />
54640 $360.00<br />
55680 $296.00<br />
56640 $963.00<br />
57240 $334.00<br />
53853 $1,273.00<br />
54308 $560.00<br />
54650 $513.00<br />
55700 $159.00<br />
56700 $131.00<br />
57250 $309.00<br />
54000 $125.00<br />
54312 $744.00<br />
54660 $218.00<br />
55705 $199.00<br />
56720 $40.00<br />
57260 $448.00<br />
54001 $153.00<br />
54316 $918.00<br />
54670 $264.00<br />
55720 $303.00<br />
56740 $223.00<br />
57265 $530.00<br />
54015 $232.00<br />
54318 $488.00<br />
54680 $663.00<br />
55725 $411.00<br />
56800 $168.00<br />
57267 $214.00<br />
54050 $83.00<br />
54322 $655.00<br />
54690 $483.00<br />
55801 $724.00<br />
56805 $737.00<br />
57268 $373.00<br />
54055 $90.00<br />
54324 $817.00<br />
54692 $561.00<br />
55810 $952.00<br />
56810 $195.00<br />
57270 $561.00<br />
54056 $83.00<br />
54326 $703.00<br />
54700 $180.00<br />
55812 $1,135.00<br />
56820 $84.00<br />
57280 $685.00<br />
54057 $97.00<br />
54328 $770.00<br />
54800 $146.00<br />
55815 $1,266.00<br />
56821 $113.00<br />
57282 $392.00<br />
54060 $142.00<br />
54330 $590.99<br />
54820 $206.00<br />
55821 $625.00<br />
57000 $129.00<br />
57283 $506.00<br />
54065 $149.00<br />
54332 $926.00<br />
54830 $250.00<br />
55831 $679.00<br />
57010 $297.00<br />
57284 $602.00<br />
54100 $133.00<br />
54336 $1,162.00<br />
54840 $238.00<br />
55840 $965.00<br />
57020 $64.00<br />
57287 $487.00<br />
54105 $223.00<br />
54340 $506.00<br />
54860 $287.00<br />
55842 $1,135.00<br />
57022 $107.00<br />
57288 $573.00<br />
54110 $421.00<br />
54344 $734.00<br />
54861 $378.00<br />
55845 $1,207.00<br />
57023 $107.00<br />
57289 $478.00<br />
54111 $563.00<br />
54348 $716.00<br />
55000 $99.00<br />
55859 $550.00<br />
57061 $85.00<br />
57291 $434.00<br />
54112 $721.00<br />
54352 $992.00<br />
55040 $255.00<br />
55860 $554.00<br />
57065 $164.00<br />
57292 $508.00<br />
54115 $324.00<br />
54360 $604.00<br />
55041 $382.00<br />
55862 $736.00<br />
57100 $68.00<br />
57295 $301.11<br />
54120 $422.00<br />
54380 $571.00<br />
55060 $257.00<br />
55865 $1,022.00<br />
57105 $102.00<br />
57300 $407.00<br />
54125 $591.00<br />
54385 $660.00<br />
55100 $164.00<br />
55866 $1,066.73<br />
57106 $225.00<br />
57305 $543.00<br />
54130 $887.00<br />
54390 $889.00<br />
55110 $263.00<br />
55873 $853.00<br />
57107 $808.00<br />
57307 $708.00<br />
54135 $1,075.00<br />
54420 $488.00<br />
55120 $239.00<br />
56405 $82.00<br />
57109 $981.00<br />
57308 $459.00<br />
54150 $172.00<br />
54430 $513.00<br />
55150 $331.00<br />
56420 $105.00<br />
57110 $554.00<br />
57310 $362.00<br />
54152 $106.00<br />
54435 $325.00<br />
55175 $296.00<br />
56440 $156.00<br />
57111 $984.00<br />
57311 $415.00<br />
54160 $187.00<br />
54440 $680.00<br />
55180 $484.00<br />
56441 $111.00<br />
57112 $1,048.00<br />
57320 $445.00<br />
54161 $161.00<br />
54450 $60.00<br />
55250 $225.00<br />
56501 $97.00<br />
57120 $390.00<br />
57330 $641.00<br />
54162 $217.00<br />
54500 $100.00<br />
55300 $139.00<br />
56515 $157.00<br />
57130 $152.00<br />
57400 $103.00<br />
54163 $148.00<br />
54505 $160.00<br />
55450 $229.00<br />
56605 $64.00<br />
57135 $160.00<br />
57410 $109.00<br />
p. 19
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
57415 $108.00<br />
58180 $743.00<br />
58559 $277.00<br />
59000 $64.00<br />
59610 $1,300.00<br />
60500 $774.00<br />
57420 $88.00<br />
58200 $852.00<br />
58560 $311.00<br />
59012 $139.00<br />
59612 $950.00<br />
60502 $805.00<br />
57421 $120.00<br />
58210 $1,292.00<br />
58561 $441.00<br />
59020 $50.00<br />
59614 $1,000.00<br />
60505 $887.00<br />
57425 $689.00<br />
58240 $1,577.00<br />
58562 $233.00<br />
59025 $31.00<br />
59618 $1,300.00<br />
60512 $189.00<br />
57452 $83.00<br />
58260 $648.00<br />
58563 $340.00<br />
59030 $81.00<br />
59620 $1,000.00<br />
60520 $759.00<br />
57454 $120.00<br />
58262 $719.00<br />
58600 $514.00<br />
59070 $259.08<br />
59622 $1,000.00<br />
60521 $882.00<br />
57455 $111.00<br />
58263 $735.00<br />
58605 $480.00<br />
59072 $319.98<br />
59812 $209.00<br />
60522 $1,065.00<br />
57456 $104.00<br />
58267 $672.00<br />
58611 $240.00<br />
59074 $247.48<br />
59820 $258.00<br />
60540 $753.00<br />
57460 $245.00<br />
58270 $654.00<br />
58615 $461.00<br />
59076 $319.98<br />
59821 $270.00<br />
60545 $819.00<br />
57461 $272.00<br />
58275 $610.00<br />
58660 $510.00<br />
59100 $608.00<br />
59830 $240.00<br />
60600 $799.00<br />
57500 $98.00<br />
58280 $617.00<br />
58661 $498.00<br />
59120 $571.00<br />
59840 $167.00<br />
60605 $880.00<br />
57505 $76.00<br />
58285 $741.00<br />
58662 $540.00<br />
59121 $580.00<br />
59841 $277.00<br />
60650 $865.00<br />
57510 $103.00<br />
58290 $864.00<br />
58670 $616.00<br />
59130 $539.00<br />
59850 $268.77<br />
61000 $76.00<br />
57511 $110.00<br />
58291 $943.00<br />
58671 $678.00<br />
59135 $576.00<br />
59851 $306.00<br />
61001 $68.00<br />
57513 $121.00<br />
58292 $831.33<br />
58673 $509.00<br />
59136 $642.00<br />
59852 $446.20<br />
61020 $87.00<br />
57520 $235.00<br />
58293 $864.14<br />
58700 $554.00<br />
59140 $244.00<br />
59855 $310.00<br />
61026 $105.00<br />
57522 $196.00<br />
58294 $765.45<br />
58720 $563.00<br />
59150 $572.00<br />
59856 $372.00<br />
61050 $88.00<br />
57530 $246.00<br />
58300 $97.00<br />
58740 $647.00<br />
59151 $567.00<br />
59857 $398.00<br />
61055 $105.00<br />
57531 $1,110.00<br />
58301 $55.00<br />
58800 $229.00<br />
59160 $186.00<br />
59866 $181.00<br />
61070 $64.00<br />
57540 $545.00<br />
58340 $125.00<br />
58805 $320.00<br />
59200 $59.00<br />
59870 $331.00<br />
61105 $335.00<br />
57545 $545.00<br />
58346 $266.00<br />
58820 $177.00<br />
59300 $143.00<br />
60000 $77.00<br />
61107 $276.00<br />
57550 $317.00<br />
58350 $72.00<br />
58822 $468.00<br />
59320 $132.00<br />
60001 $68.00<br />
61108 $662.00<br />
57555 $491.00<br />
58353 $1,045.00<br />
58823 $662.00<br />
59325 $166.00<br />
60100 $86.00<br />
61120 $396.00<br />
57556 $457.00<br />
58356 $340.77<br />
58825 $328.00<br />
59350 $252.00<br />
60200 $468.00<br />
61140 $830.00<br />
57700 $197.00<br />
58400 $351.00<br />
58900 $326.00<br />
59400 $1,300.00<br />
60210 $534.00<br />
61150 $899.00<br />
57720 $216.00<br />
58410 $479.00<br />
58920 $521.00<br />
59409 $950.00<br />
60212 $729.00<br />
61151 $486.00<br />
57800 $45.00<br />
58520 $440.00<br />
58925 $523.00<br />
59410 $1,000.00<br />
60220 $593.00<br />
61154 $892.00<br />
57820 $105.00<br />
58540 $534.00<br />
58940 $391.00<br />
59412 $122.00<br />
60225 $659.00<br />
61156 $793.00<br />
58100 $85.00<br />
58545 $571.66<br />
58943 $745.00<br />
59414 $83.00<br />
60240 $726.00<br />
61210 $321.00<br />
58110 $33.00<br />
58546 $722.56<br />
58950 $818.00<br />
59425 $281.00<br />
60252 $938.00<br />
61215 $328.00<br />
58120 $189.00<br />
58550 $658.00<br />
58951 $1,189.00<br />
59426 $491.00<br />
60254 $1,036.00<br />
61250 $480.00<br />
58140 $667.00<br />
58552 $732.00<br />
58952 $1,065.00<br />
59430 $108.00<br />
60260 $561.00<br />
61253 $587.00<br />
58145 $390.00<br />
58553 $859.00<br />
58953 $1,432.00<br />
59510 $1,300.00<br />
60270 $795.00<br />
61304 $1,117.00<br />
58146 $861.00<br />
58554 $987.00<br />
58954 $1,307.00<br />
59514 $950.00<br />
60271 $773.00<br />
61305 $1,336.00<br />
58150 $745.00<br />
58555 $182.00<br />
58956 $865.33<br />
59515 $1,000.00<br />
60280 $350.00<br />
61312 $1,350.00<br />
58152 $935.00<br />
58558 $213.00<br />
58960 $692.00<br />
59525 $437.00<br />
60281 $433.00<br />
61313 $1,350.00<br />
p. 20
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
61314 $1,212.00<br />
61531 $748.00<br />
61586 $1,446.00<br />
61703 $781.00<br />
62140 $699.00<br />
62282 $292.00<br />
61315 $1,412.00<br />
61533 $1,187.00<br />
61590 $1,789.00<br />
61705 $1,645.00<br />
62141 $766.00<br />
62284 $179.00<br />
61316 $56.71<br />
61534 $960.00<br />
61591 $1,892.00<br />
61708 $1,390.00<br />
62142 $698.00<br />
62290 $282.00<br />
61320 $1,301.00<br />
61535 $665.00<br />
61592 $1,757.00<br />
61710 $1,162.00<br />
62143 $677.00<br />
62291 $248.00<br />
61321 $1,252.00<br />
61536 $1,551.00<br />
61595 $1,275.00<br />
61711 $1,699.00<br />
62145 $960.00<br />
62294 $449.00<br />
61322 $1,157.55<br />
61537 $1,113.07<br />
61596 $1,533.00<br />
61720 $932.00<br />
62146 $923.00<br />
62310 $186.00<br />
61323 $1,199.81<br />
61538 $1,326.00<br />
61597 $1,651.00<br />
61735 $1,097.00<br />
62147 $1,091.00<br />
62311 $177.00<br />
61330 $993.00<br />
61539 $1,439.00<br />
61598 $1,459.00<br />
61750 $1,057.00<br />
62148 $77.67<br />
62318 $214.00<br />
61332 $1,247.00<br />
61540 $1,342.99<br />
61600 $1,106.00<br />
61751 $1,029.00<br />
62160 $112.34<br />
62319 $189.00<br />
61333 $1,209.00<br />
61541 $1,645.00<br />
61601 $1,234.00<br />
61760 $1,055.00<br />
62161 $798.08<br />
62350 $333.00<br />
61334 $1,060.00<br />
61542 $1,452.00<br />
61605 $1,248.00<br />
61770 $1,179.00<br />
62162 $1,022.15<br />
62351 $538.00<br />
61340 $855.00<br />
61543 $1,398.00<br />
61606 $1,720.00<br />
61790 $513.00<br />
62163 $645.78<br />
62355 $264.00<br />
61343 $1,695.00<br />
61544 $1,223.00<br />
61607 $1,603.00<br />
61791 $816.00<br />
62164 $1,106.36<br />
62360 $157.00<br />
61345 $1,222.00<br />
61545 $2,257.00<br />
61608 $1,871.00<br />
61793 $882.00<br />
62165 $868.73<br />
62361 $284.00<br />
61440 $1,472.00<br />
61546 $1,455.00<br />
61609 $432.00<br />
61795 $217.00<br />
62180 $940.00<br />
62362 $353.00<br />
61450 $1,175.00<br />
61548 $1,060.00<br />
61610 $1,277.00<br />
61850 $587.00<br />
62190 $715.00<br />
62365 $276.00<br />
61458 $1,380.00<br />
61550 $619.00<br />
61611 $317.00<br />
61860 $863.00<br />
62192 $672.00<br />
62367 $21.00<br />
61460 $1,310.00<br />
61552 $901.00<br />
61612 $1,203.00<br />
61863 $803.00<br />
62194 $182.00<br />
62368 $33.00<br />
61470 $1,236.00<br />
61556 $955.00<br />
61613 $1,826.00<br />
61864 $192.43<br />
62200 $940.00<br />
63001 $911.00<br />
61480 $1,164.00<br />
61557 $979.00<br />
61615 $1,396.00<br />
61867 $1,229.35<br />
62201 $650.00<br />
63003 $925.00<br />
61490 $1,058.00<br />
61558 $1,129.00<br />
61616 $1,914.00<br />
61868 $323.01<br />
62220 $839.00<br />
63005 $787.00<br />
61500 $913.00<br />
61559 $1,750.00<br />
61618 $868.00<br />
61870 $591.00<br />
62223 $757.00<br />
63011 $803.00<br />
61501 $936.00<br />
61563 $1,178.00<br />
61619 $911.00<br />
61875 $625.00<br />
62225 $300.00<br />
63012 $908.00<br />
61510 $1,639.00<br />
61564 $1,412.00<br />
61623 $355.98<br />
61880 $301.00<br />
62230 $545.00<br />
63015 $1,000.00<br />
61512 $1,774.00<br />
61566 $1,554.00<br />
61624 $833.00<br />
61885 $347.00<br />
62252 $65.00<br />
63016 $1,053.00<br />
61514 $1,443.00<br />
61567 $1,530.03<br />
61626 $675.00<br />
61886 $366.00<br />
62256 $359.00<br />
63017 $938.00<br />
61516 $1,212.00<br />
61570 $1,070.00<br />
61680 $1,556.00<br />
61888 $277.00<br />
62258 $841.00<br />
63020 $787.00<br />
61517 $48.96<br />
61571 $1,346.00<br />
61682 $3,055.00<br />
62000 $529.00<br />
62263 $526.00<br />
63030 $730.00<br />
61518 $1,890.00<br />
61575 $1,613.00<br />
61684 $2,010.00<br />
62005 $705.00<br />
62264 $373.00<br />
63035 $173.00<br />
61519 $1,866.00<br />
61576 $2,167.00<br />
61686 $2,746.00<br />
62010 $1,014.00<br />
62268 $453.00<br />
63040 $1,031.00<br />
61520 $2,693.00<br />
61580 $1,293.00<br />
61690 $1,380.00<br />
62100 $1,057.00<br />
62269 $543.00<br />
63042 $1,031.00<br />
61521 $1,984.00<br />
61581 $1,452.00<br />
61692 $2,177.00<br />
62115 $916.00<br />
62270 $114.00<br />
63043 $173.00<br />
61522 $1,674.00<br />
61582 $1,385.00<br />
61697 $2,541.00<br />
62116 $1,044.00<br />
62272 $139.00<br />
63044 $173.00<br />
61524 $1,720.00<br />
61583 $1,609.00<br />
61698 $2,104.00<br />
62117 $1,196.00<br />
62273 $139.00<br />
63045 $858.00<br />
61526 $2,211.00<br />
61584 $1,532.00<br />
61700 $2,700.00<br />
62120 $1,255.00<br />
62280 $267.00<br />
63046 $823.00<br />
61530 $1,954.00<br />
61585 $1,701.00<br />
61702 $2,174.00<br />
62121 $1,266.00<br />
62281 $232.00<br />
63047 $823.00<br />
p. 21
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
63048 $178.00<br />
63250 $1,728.00<br />
63650 $336.00<br />
64450 $74.00<br />
64650 $37.51 Yes<br />
64782 $306.00<br />
63050 $912.52<br />
63251 $1,742.00<br />
63655 $513.00<br />
64470 $247.00<br />
64653 $43.52 Yes<br />
64783 $193.00<br />
63051 $1,042.47<br />
63252 $1,799.00<br />
63660 $298.00<br />
64472 $108.00<br />
64680 $258.00<br />
64784 $501.00<br />
63055 $1,124.00<br />
63265 $1,045.00<br />
63685 $344.00<br />
64475 $224.00<br />
64681 $294.24<br />
64786 $781.00<br />
63056 $1,047.00<br />
63266 $1,104.00<br />
63688 $275.00<br />
64476 $97.00<br />
64702 $242.00<br />
64787 $202.00<br />
63057 $272.00<br />
63267 $928.00<br />
63700 $846.00<br />
64479 $265.00<br />
64704 $238.00<br />
64788 $245.00<br />
63064 $1,244.00<br />
63268 $1,025.00<br />
63702 $819.00<br />
64480 $126.00<br />
64708 $366.00<br />
64790 $480.00<br />
63066 $183.00<br />
63270 $1,189.00<br />
63704 $1,081.00<br />
64483 $266.00<br />
64712 $420.00<br />
64792 $624.00<br />
63075 $1,022.00<br />
63271 $1,293.00<br />
63706 $1,017.00<br />
64484 $128.00<br />
64713 $591.00<br />
64795 $161.00<br />
63076 $222.00<br />
63272 $1,190.00<br />
63707 $671.00<br />
64505 $76.00<br />
64714 $392.00<br />
64802 $441.00<br />
63077 $1,066.00<br />
63273 $1,088.00<br />
63709 $747.00<br />
64508 $63.00<br />
64716 $363.00<br />
64804 $650.00<br />
63078 $153.00<br />
63275 $1,165.00<br />
63710 $810.00<br />
64510 $128.00<br />
64718 $361.00<br />
64809 $618.00<br />
63081 $1,365.00<br />
63276 $1,193.00<br />
63740 $733.00<br />
64517 $140.00<br />
64719 $282.00<br />
64818 $539.00<br />
63082 $239.00<br />
63277 $1,200.00<br />
63741 $461.00<br />
64520 $176.00<br />
64721 $302.00<br />
64820 $454.00<br />
63085 $1,301.00<br />
63278 $1,010.00<br />
63744 $397.00<br />
64530 $166.00<br />
64722 $243.00<br />
64821 $393.00<br />
63086 $196.00<br />
63280 $1,442.00<br />
63746 $327.00<br />
64573 $398.00<br />
64726 $212.00<br />
64831 $502.00<br />
63087 $2,038.00<br />
63281 $1,345.00<br />
64400 $85.00<br />
64575 $174.00<br />
64727 $162.00<br />
64832 $267.00<br />
63088 $208.00<br />
63282 $1,243.00<br />
64402 $84.00<br />
64577 $196.00<br />
64732 $218.00<br />
64834 $527.00<br />
63090 $1,362.00<br />
63283 $1,105.00<br />
64405 $80.00<br />
64580 $186.15<br />
64734 $233.00<br />
64835 $569.00<br />
63091 $158.00<br />
63285 $1,589.00<br />
64408 $77.00<br />
64581 $572.00<br />
64736 $215.00<br />
64836 $598.00<br />
63101 $1,390.66<br />
63286 $1,623.00<br />
64410 $73.00<br />
64585 $113.00<br />
64738 $306.00<br />
64837 $295.00<br />
63102 $1,390.66<br />
63287 $1,630.00<br />
64412 $107.00<br />
64590 $263.00<br />
64740 $249.00<br />
64840 $573.00<br />
63103 $162.85<br />
63290 $1,870.00<br />
64415 $120.00<br />
64595 $106.00<br />
64742 $359.00<br />
64856 $704.00<br />
63170 $1,236.00<br />
63295 $208.53<br />
64416 $133.00<br />
64600 $148.00<br />
64744 $303.00<br />
64857 $740.00<br />
63172 $1,025.00<br />
63300 $1,393.00<br />
64417 $125.00<br />
64605 $208.00<br />
64746 $267.00<br />
64858 $721.00<br />
63173 $1,286.00<br />
63301 $1,539.00<br />
64418 $110.00<br />
64610 $481.00<br />
64752 $391.00<br />
64859 $185.00<br />
63180 $1,035.00<br />
63302 $1,239.00<br />
64420 $139.00<br />
64612 $127.00<br />
64755 $728.00<br />
64861 $981.00<br />
63182 $1,190.00<br />
63303 $1,646.00<br />
64421 $212.00<br />
64613 $138.00<br />
64760 $402.00<br />
64862 $967.00<br />
63185 $725.00<br />
63304 $1,359.00<br />
64425 $99.00<br />
64614 $153.00<br />
64761 $298.00<br />
64864 $600.00<br />
63190 $973.00<br />
63305 $1,395.00<br />
64430 $112.00<br />
64620 $120.00<br />
64763 $304.00<br />
64865 $677.00<br />
63191 $1,004.00<br />
63306 $1,407.00<br />
64435 $113.00<br />
64622 $298.00<br />
64766 $386.00<br />
64866 $672.00<br />
63194 $968.00<br />
63307 $1,367.00<br />
64445 $117.00<br />
64623 $109.00<br />
64771 $341.00<br />
64868 $780.00<br />
63195 $968.00<br />
63308 $230.00<br />
64446 $109.27<br />
64626 $307.00<br />
64772 $441.00<br />
64870 $711.00<br />
63196 $980.00<br />
63600 $578.00<br />
64447 $59.00<br />
64627 $155.00<br />
64774 $213.00<br />
64872 $86.00<br />
63197 $968.00<br />
63610 $345.00<br />
64448 $100.51<br />
64630 $131.00<br />
64776 $267.00<br />
64874 $161.00<br />
63200 $1,092.00<br />
63615 $729.00<br />
64449 $102.50<br />
64640 $199.00<br />
64778 $135.00<br />
64876 $138.00<br />
p. 22
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
64885 $750.00<br />
65270 $196.00<br />
65855 $262.00<br />
66740 $253.00<br />
67112 $808.00<br />
67420 $1,087.00<br />
64886 $890.00<br />
65272 $176.00<br />
65860 $234.00<br />
66761 $273.00<br />
67115 $289.00<br />
67430 $648.00<br />
64890 $673.00<br />
65273 $203.00<br />
65865 $360.00<br />
66762 $291.00<br />
67120 $411.00<br />
67440 $674.00<br />
64891 $676.00<br />
65275 $332.00<br />
65870 $364.00<br />
66770 $259.00<br />
67121 $518.00<br />
67445 $684.00<br />
64892 $641.00<br />
65280 $453.00<br />
65875 $382.00<br />
66820 $273.00<br />
67141 $355.00<br />
67450 $697.00<br />
64893 $714.00<br />
65285 $645.00<br />
65880 $345.00<br />
66821 $180.00<br />
67145 $354.00<br />
67500 $48.00<br />
64895 $1,047.00<br />
65286 $291.00<br />
65900 $510.00<br />
66825 $494.00<br />
67208 $416.00<br />
67505 $49.00<br />
64896 $914.00<br />
65290 $278.00<br />
65920 $476.00<br />
66830 $438.00<br />
67210 $504.00<br />
67515 $39.00<br />
64897 $771.00<br />
65400 $407.00<br />
65930 $376.00<br />
66840 $480.00<br />
67218 $655.00<br />
67550 $619.00<br />
64898 $840.00<br />
65410 $76.00<br />
66020 $131.00<br />
66850 $545.00<br />
67220 $683.00<br />
67560 $630.00<br />
64901 $467.00<br />
65420 $361.00<br />
66030 $62.00<br />
66852 $589.00<br />
67221 $238.00<br />
67570 $620.00<br />
64902 $531.00<br />
65426 $429.00<br />
66130 $492.00<br />
66920 $544.00<br />
67225 $24.00<br />
67700 $199.00<br />
64905 $690.00<br />
65430 $90.00<br />
66150 $428.00<br />
66930 $628.00<br />
67227 $430.00<br />
67710 $172.00<br />
64907 $799.00<br />
65435 $55.00<br />
66155 $426.00<br />
66940 $538.00<br />
67228 $699.00<br />
67715 $178.00<br />
65091 $420.00<br />
65436 $238.00<br />
66160 $584.00<br />
66982 $679.00<br />
67250 $548.00<br />
67800 $96.00<br />
65093 $443.00<br />
65450 $209.00<br />
66165 $412.00<br />
66983 $491.00<br />
67255 $600.00<br />
67801 $124.00<br />
65101 $388.00<br />
65600 $174.00 Yes<br />
66170 $699.00<br />
66984 $576.00<br />
67311 $412.00<br />
67805 $146.00<br />
65103 $491.00<br />
65710 $777.00<br />
66172 $868.00<br />
66985 $457.00<br />
67312 $500.00<br />
67808 $218.00<br />
65105 $539.00<br />
65730 $855.00<br />
66180 $737.00<br />
66986 $624.00<br />
67314 $458.00<br />
67810 $133.00<br />
65110 $701.00<br />
65750 $880.00<br />
66185 $504.00<br />
66990 $54.96<br />
67316 $508.00<br />
67820 $45.00<br />
65112 $815.00<br />
65755 $874.00<br />
66220 $473.00<br />
67005 $329.00<br />
67318 $460.00<br />
67825 $99.00<br />
65114 $787.00<br />
65760 $913.91<br />
66225 $696.00<br />
67010 $397.00<br />
67320 $210.00<br />
67830 $197.00<br />
65125 $175.00<br />
65765 $913.91<br />
66250 $492.00<br />
67015 $385.00<br />
67331 $197.00<br />
67835 $346.00<br />
65130 $390.00<br />
65767 $822.52<br />
66500 $237.00<br />
67025 $455.00<br />
67332 $218.00<br />
67840 $206.00<br />
65135 $364.00<br />
65770 $968.00<br />
66505 $193.00<br />
67028 $168.00<br />
67334 $193.00<br />
67850 $141.00<br />
65140 $413.00<br />
65772 $308.00<br />
66600 $443.00<br />
67030 $334.00<br />
67335 $121.00<br />
67875 $145.00<br />
65150 $402.00<br />
65775 $409.00<br />
66605 $612.00<br />
67031 $241.00<br />
67340 $239.00<br />
67880 $291.00<br />
65155 $468.00<br />
65780 $588.00<br />
66625 $300.00<br />
67036 $687.00<br />
67343 $339.00<br />
67882 $358.00<br />
65175 $349.00<br />
65781 $770.82<br />
66630 $333.00<br />
67038 $1,203.00<br />
67345 $148.00<br />
67900 $430.00 Yes<br />
65205 $44.00<br />
65782 $663.78<br />
66635 $319.00<br />
67039 $773.00<br />
67350 $130.00<br />
67901 $409.00 Yes<br />
65210 $53.00<br />
65800 $107.00<br />
66680 $346.00<br />
67040 $1,009.00<br />
67400 $602.00<br />
67902 $411.00 Yes<br />
65220 $44.00<br />
65805 $116.00<br />
66682 $400.00<br />
67101 $527.00<br />
67405 $427.00<br />
67903 $452.00 Yes<br />
65222 $59.00<br />
65810 $275.00<br />
66700 $337.00<br />
67105 $497.00<br />
67412 $584.00<br />
67904 $492.00 Yes<br />
65235 $413.00<br />
65815 $419.00<br />
66710 $320.00<br />
67107 $855.00<br />
67413 $595.00<br />
67906 $340.00 Yes<br />
65260 $515.00<br />
65820 $435.00<br />
66711 $328.34<br />
67108 $1,029.00<br />
67414 $580.00<br />
67908 $360.00 Yes<br />
65265 $595.00<br />
65850 $645.00<br />
66720 $301.00<br />
67110 $552.00<br />
67415 $85.00<br />
67909 $308.00 Yes<br />
p. 23
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
67911 $327.00<br />
68362 $371.00<br />
69150 $601.00<br />
69611 $72.00<br />
69820 $625.00<br />
70350 $15.00<br />
67912 $617.30 Yes<br />
68371 $237.13<br />
69155 $910.00<br />
69620 $478.00<br />
69840 $470.00<br />
70355 $26.00<br />
67914 $289.00<br />
68400 $152.00<br />
69200 $87.00<br />
69631 $627.00<br />
69905 $700.00<br />
70360 $18.00<br />
67915 $197.00<br />
68420 $173.00<br />
69205 $76.00<br />
69632 $806.00<br />
69910 $850.00<br />
70370 $42.00<br />
67916 $377.00<br />
68440 $94.00<br />
69210 $36.00<br />
69633 $767.00<br />
69915 $1,220.00<br />
70373 $58.00<br />
67917 $410.00<br />
68500 $478.00<br />
69220 $88.00<br />
69635 $864.00<br />
69930 $923.00 Yes<br />
70380 $22.00<br />
67921 $268.00<br />
68505 $498.00<br />
69222 $145.00<br />
69636 $991.00<br />
69950 $1,255.00<br />
70390 $56.00<br />
67922 $193.00<br />
68510 $282.00<br />
69300 $294.00 Yes<br />
69637 $986.00<br />
69955 $1,183.00<br />
70450 $158.00<br />
67923 $396.00<br />
68520 $400.00<br />
69310 $770.00<br />
69641 $798.00<br />
69960 $1,148.00<br />
70460 $174.00<br />
67924 $415.00<br />
68525 $185.00<br />
69320 $1,113.00<br />
69642 $964.00<br />
69970 $1,253.00<br />
70470 $212.00<br />
67930 $262.00<br />
68530 $328.00<br />
69400 $42.00<br />
69643 $941.00<br />
69990 $170.00<br />
70480 $161.00<br />
67935 $419.00<br />
68540 $473.00<br />
69401 $52.00<br />
69644 $1,075.00<br />
70015 $80.00<br />
70481 $182.00<br />
67938 $182.00<br />
68550 $746.00<br />
69405 $176.00<br />
69645 $1,047.00<br />
70030 $16.00<br />
70482 $218.00<br />
67950 $409.00 Yes<br />
68700 $363.00<br />
69420 $125.00<br />
69646 $1,118.00<br />
70100 $23.00<br />
70486 $195.00<br />
67961 $406.00<br />
68705 $138.00<br />
69421 $112.00<br />
69650 $568.00<br />
70110 $23.00<br />
70487 $179.00<br />
67966 $445.00<br />
68720 $500.00<br />
69424 $84.00<br />
69660 $723.00<br />
70120 $27.00<br />
70488 $217.00<br />
67971 $471.00<br />
68745 $452.00<br />
69433 $129.00<br />
69661 $819.00<br />
70130 $30.00<br />
70490 $201.00<br />
67973 $649.00<br />
68750 $488.00<br />
69436 $123.00<br />
69662 $835.00<br />
70134 $32.00<br />
70491 $182.00<br />
67974 $614.00<br />
68760 $147.00<br />
69440 $471.00<br />
69666 $613.00<br />
70140 $27.00<br />
70492 $218.00<br />
67975 $469.00<br />
68761 $111.00<br />
69450 $363.00<br />
69667 $614.00<br />
70150 $28.00<br />
70496 $238.00<br />
68020 $90.00<br />
68770 $341.00<br />
69501 $526.00<br />
69670 $674.00<br />
70160 $23.00<br />
70498 $238.00<br />
68040 $91.00<br />
68801 $90.00<br />
69502 $699.00<br />
69676 $586.00<br />
70170 $33.00<br />
70540 $409.00<br />
68100 $127.00<br />
68810 $155.00<br />
69505 $865.00<br />
69700 $505.00<br />
70190 $22.00<br />
70542 $372.00<br />
68110 $162.00<br />
68811 $137.00<br />
69511 $889.00<br />
69710 $700.00<br />
70200 $28.00<br />
70543 $648.00<br />
68115 $229.00<br />
68815 $315.00<br />
69530 $882.00<br />
69714 $779.00<br />
70210 $21.00<br />
70544 $314.00<br />
68130 $381.00<br />
68840 $91.00<br />
69535 $1,750.00<br />
69715 $751.00<br />
70220 $28.00<br />
70545 $314.00<br />
68135 $126.00<br />
68850 $170.00<br />
69540 $136.00<br />
69717 $611.00<br />
70240 $17.00<br />
70546 $594.00<br />
68200 $33.00<br />
69000 $122.00<br />
69550 $740.00<br />
69718 $760.00<br />
70250 $25.00<br />
70547 $314.00<br />
68320 $462.00<br />
69005 $144.00<br />
69552 $876.00<br />
69720 $703.00<br />
70260 $33.00<br />
70548 $314.00<br />
68325 $411.00<br />
69020 $151.00<br />
69554 $1,411.00<br />
69725 $1,050.00<br />
70300 $10.00<br />
70549 $594.00<br />
68326 $441.00<br />
69100 $70.00<br />
69601 $754.00<br />
69740 $882.00<br />
70310 $16.00<br />
70551 $318.00<br />
68328 $513.00 Yes<br />
69105 $88.00<br />
69602 $726.00<br />
69745 $1,003.00<br />
70320 $27.00<br />
70552 $381.00<br />
68330 $397.00<br />
69110 $286.00<br />
69603 $928.00<br />
69801 $543.00<br />
70328 $18.00<br />
70553 $674.00<br />
68335 $343.00<br />
69120 $292.00<br />
69604 $680.00<br />
69802 $774.00<br />
70330 $29.00<br />
71010 $20.00<br />
68340 $362.00<br />
69140 $602.00<br />
69605 $1,139.00<br />
69805 $824.00<br />
70332 $69.00<br />
71015 $20.00<br />
68360 $240.00<br />
69145 $235.00<br />
69610 $287.00<br />
69806 $604.00<br />
70336 $315.00 Yes<br />
71020 $23.00<br />
p. 24
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
71021 $27.00<br />
72114 $41.00<br />
72270 $191.00<br />
73530 $29.00<br />
74175 $248.00<br />
74400 $59.00<br />
71022 $28.00<br />
72120 $29.00<br />
72275 $69.00<br />
73540 $21.00<br />
74181 $407.00<br />
74410 $66.00<br />
71023 $34.00<br />
72125 $181.00<br />
72285 $238.00<br />
73542 $67.00<br />
74182 $367.00<br />
74415 $67.00<br />
71030 $29.00<br />
72126 $264.00<br />
72295 $216.00<br />
73550 $25.00<br />
74183 $654.00<br />
74420 $75.00<br />
71034 $51.00<br />
72127 $254.00<br />
73000 $18.00<br />
73560 $23.00<br />
74185 $330.00<br />
74425 $43.00<br />
71035 $22.00<br />
72128 $233.00<br />
73010 $23.00<br />
73562 $26.00<br />
74190 $47.00<br />
74430 $36.00<br />
71040 $55.00<br />
72129 $210.00<br />
73020 $22.00<br />
73564 $28.00<br />
74210 $46.00<br />
74440 $40.00<br />
71060 $78.00<br />
72130 $254.00<br />
73030 $21.00<br />
73565 $23.00<br />
74220 $44.00<br />
74445 $67.00<br />
71090 $60.00<br />
72131 $181.00<br />
73040 $69.00<br />
73580 $81.00<br />
74230 $49.00<br />
74450 $46.00<br />
71100 $23.00<br />
72132 $210.00<br />
73050 $23.00<br />
73590 $22.00<br />
74235 $133.00<br />
74455 $49.00<br />
71101 $28.00<br />
72133 $308.00<br />
73060 $25.00<br />
73592 $18.00<br />
74240 $59.00<br />
74470 $48.00<br />
71110 $28.00<br />
72141 $322.00<br />
73070 $18.00<br />
73600 $19.00<br />
74241 $60.00<br />
74475 $116.00<br />
71111 $36.00<br />
72142 $386.00<br />
73080 $24.00<br />
73610 $23.00<br />
74245 $88.00<br />
74480 $116.00<br />
71120 $28.00<br />
72146 $351.00<br />
73085 $69.00<br />
73615 $69.00<br />
74246 $63.00<br />
74485 $87.00<br />
71130 $27.00<br />
72147 $386.00<br />
73090 $20.00<br />
73620 $19.00<br />
74247 $64.00<br />
74710 $37.00<br />
71250 $181.00<br />
72148 $347.00<br />
73092 $17.00<br />
73630 $23.00<br />
74249 $93.00<br />
74740 $54.00<br />
71260 $211.00<br />
72149 $381.00<br />
73100 $19.00<br />
73650 $22.00<br />
74250 $47.00<br />
74775 $73.00<br />
71270 $258.00<br />
72156 $681.00<br />
73110 $23.00<br />
73660 $17.00<br />
74251 $54.00<br />
75552 $386.00<br />
71275 $256.00<br />
72157 $681.00<br />
73115 $57.00<br />
73700 $155.00<br />
74260 $53.00<br />
75553 $337.00<br />
71550 $386.00<br />
72158 $674.00<br />
73120 $18.00<br />
73701 $193.00<br />
74270 $65.00<br />
75554 $329.00<br />
71551 $367.00<br />
72170 $23.00<br />
73130 $19.00<br />
73702 $219.00<br />
74280 $88.00<br />
75555 $329.00<br />
71552 $649.00<br />
72190 $27.00<br />
73140 $18.00<br />
73706 $223.00<br />
74283 $131.00<br />
75600 $317.00<br />
71555 $331.00<br />
72191 $248.00<br />
73200 $161.00<br />
73718 $302.00<br />
74290 $29.00<br />
75605 $340.00<br />
72010 $52.00<br />
72192 $178.00<br />
73201 $194.00<br />
73719 $361.00<br />
74291 $22.00<br />
75625 $339.00<br />
72020 $20.00<br />
72193 $203.00<br />
73202 $261.00<br />
73720 $387.00<br />
74300 $32.00<br />
75630 $372.00<br />
72040 $27.00<br />
72194 $244.00<br />
73206 $223.00<br />
73721 $315.00<br />
74301 $134.99<br />
75635 $272.00<br />
72050 $32.00<br />
72195 $307.00<br />
73218 $302.00<br />
73722 $361.00<br />
74305 $33.00<br />
75650 $351.00<br />
72052 $39.00<br />
72196 $389.00<br />
73219 $361.00<br />
73723 $648.00<br />
74320 $94.00<br />
75658 $346.00<br />
72069 $25.00<br />
72197 $654.00<br />
73220 $407.00<br />
73725 $331.00<br />
74327 $67.00<br />
75660 $345.00<br />
72070 $29.00<br />
72198 $332.00<br />
73221 $315.00<br />
74000 $19.00<br />
74328 $99.00<br />
75662 $358.00<br />
72072 $25.00<br />
72200 $18.00<br />
73222 $361.00<br />
74010 $22.00<br />
74329 $99.00<br />
75665 $345.00<br />
72074 $30.00<br />
72202 $24.00<br />
73223 $648.00<br />
74020 $24.00<br />
74330 $105.00<br />
75671 $357.00<br />
72080 $28.00<br />
72220 $20.00<br />
73500 $22.00<br />
74022 $37.00<br />
74340 $81.00<br />
75676 $345.00<br />
72090 $26.00<br />
72240 $144.00<br />
73510 $27.00<br />
74150 $176.00<br />
74350 $102.00<br />
75680 $357.00<br />
72100 $30.00<br />
72255 $134.00<br />
73520 $32.00<br />
74160 $207.00<br />
74360 $94.00<br />
75685 $345.00<br />
72110 $38.00<br />
72265 $126.00<br />
73525 $69.00<br />
74170 $250.00<br />
74363 $176.00<br />
75705 $375.00<br />
p. 25
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
75710 $340.00<br />
75894 $619.00<br />
76066 $38.00<br />
76400 $323.00<br />
76830 $71.00<br />
77305 $69.00<br />
75716 $345.00<br />
75896 $545.00<br />
76070 $80.52<br />
76506 $56.00<br />
76831 $62.00<br />
77310 $92.00<br />
75722 $340.00<br />
75898 $106.00<br />
76071 $74.01<br />
76510 $108.21<br />
76856 $76.00<br />
77315 $118.00<br />
75724 $353.00<br />
75900 $473.00<br />
76075 $84.00<br />
76511 $62.00<br />
76857 $40.00<br />
77321 $130.00<br />
75726 $339.00<br />
75901 $60.03<br />
76076 $33.00<br />
76512 $78.00<br />
76870 $76.00<br />
77326 $89.00<br />
75731 $339.00<br />
75902 $56.61<br />
76077 $24.14<br />
76513 $61.00<br />
76872 $78.00<br />
77327 $131.00<br />
75733 $345.00<br />
75940 $318.00<br />
76078 $25.00<br />
76514 $8.00<br />
76873 $96.00<br />
77328 $191.00<br />
75736 $339.00<br />
75945 $124.00<br />
76080 $44.00<br />
76516 $64.00<br />
76880 $70.00<br />
77331 $54.00<br />
75741 $345.00<br />
75946 $70.00<br />
76082 $12.00<br />
76519 $50.00<br />
76885 $62.00<br />
77332 $54.00<br />
75743 $357.00<br />
75952 $157.00<br />
76083 $12.00<br />
76529 $68.00<br />
76886 $55.00<br />
77333 $74.00<br />
75746 $339.00<br />
75953 $64.00<br />
76086 $75.00<br />
76536 $69.00<br />
76900 $31.95<br />
77334 $120.00<br />
75756 $341.00<br />
75961 $396.00<br />
76088 $103.00<br />
76604 $64.00<br />
76910 $22.50<br />
77336 $71.00<br />
75773 $279.99<br />
75962 $450.00<br />
76090 $50.00<br />
76645 $56.00<br />
76920 $27.00<br />
77370 $83.00<br />
75774 $312.00<br />
75964 $212.00<br />
76091 $63.00<br />
76700 $81.00<br />
76930 $78.00<br />
77401 $42.00<br />
75790 $124.00<br />
75966 $421.00<br />
76093 $475.00<br />
76705 $57.00<br />
76932 $61.00<br />
77402 $42.00<br />
75801 $157.00<br />
75968 $212.00<br />
76094 $625.00<br />
76770 $73.00<br />
76936 $224.00<br />
77403 $55.00<br />
75803 $169.00<br />
75970 $309.00<br />
76095 $226.00<br />
76775 $54.00<br />
76937 $22.00<br />
77404 $55.00<br />
75805 $173.00<br />
75978 $396.00<br />
76096 $63.00<br />
76778 $73.00<br />
76940 $110.17<br />
77406 $55.00<br />
75807 $186.00<br />
75980 $178.00<br />
76098 $20.00<br />
76800 $73.00<br />
76941 $84.00<br />
77407 $64.00<br />
75810 $339.00<br />
75982 $195.00<br />
76100 $50.00<br />
76801 $59.21<br />
76942 $77.00<br />
77408 $50.00<br />
75820 $47.00<br />
75984 $71.00<br />
76101 $70.00<br />
76802 $46.44<br />
76945 $64.00<br />
77409 $50.00<br />
75822 $72.00<br />
75989 $116.00<br />
76102 $62.00<br />
76805 $85.00<br />
76946 $50.00<br />
77411 $64.00<br />
75825 $339.00<br />
75998 $46.00<br />
76120 $39.00<br />
76810 $168.00<br />
76950 $66.00<br />
77412 $56.00<br />
75827 $339.00<br />
76000 $37.00<br />
76125 $28.00<br />
76811 $152.31<br />
76965 $191.00<br />
77413 $56.00<br />
75831 $339.00<br />
76001 $86.00<br />
76140 $19.80<br />
76812 $92.25<br />
76975 $65.00<br />
77414 $56.00<br />
75833 $351.00<br />
76003 $64.00<br />
76150 $13.00<br />
76815 $57.00<br />
76977 $25.00<br />
77416 $56.00<br />
75840 $339.00<br />
76005 $50.00<br />
76350 $40.80<br />
76816 $47.00<br />
76986 $105.00<br />
77417 $14.00<br />
75842 $351.00<br />
76006 $13.00<br />
76355 $238.00<br />
76817 $60.45<br />
77261 $49.00<br />
77418 $357.00<br />
75860 $339.00<br />
76010 $20.00<br />
76360 $236.00<br />
76818 $66.00<br />
77262 $96.00<br />
77421 $86.93<br />
75870 $339.00<br />
76012 $71.00<br />
76362 $331.00<br />
76819 $62.00<br />
77263 $143.00<br />
77422 $39.11<br />
75872 $339.00<br />
76013 $59.00<br />
76370 $100.00<br />
76820 $57.23<br />
77280 $113.00<br />
77423 $50.90<br />
75880 $60.00<br />
76020 $23.00<br />
76376 $81.96<br />
76821 $64.35<br />
77285 $169.00<br />
77427 $110.00<br />
75885 $349.00<br />
76040 $34.00<br />
76377 $106.70<br />
76825 $101.00<br />
77290 $210.00<br />
77431 $80.00<br />
75887 $349.00<br />
76061 $39.00<br />
76380 $117.00<br />
76826 $50.00<br />
77295 $824.00<br />
77432 $384.00<br />
75891 $339.00<br />
76062 $53.00<br />
76393 $323.00<br />
76827 $67.00<br />
77300 $54.00<br />
77470 $339.00<br />
75893 $318.00<br />
76065 $27.00<br />
76394 $402.00<br />
76828 $47.00<br />
77301 $882.00<br />
77600 $163.00<br />
p. 26
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
77750 $250.00<br />
78135 $138.00<br />
78445 $79.00<br />
78607 $199.00<br />
78815 $1,494.00<br />
80174 $18.00<br />
77761 $225.00<br />
78140 $115.00<br />
78456 $128.00<br />
78608 $1,392.00<br />
78816 $1,496.00<br />
80176 $14.00<br />
77762 $350.00<br />
78185 $70.00<br />
78457 $116.00<br />
78609 $1,392.00<br />
78890 $26.29<br />
80178 $8.00<br />
77763 $404.00<br />
78191 $195.00<br />
78458 $127.00<br />
78610 $48.00<br />
78891 $44.99<br />
80182 $17.00<br />
77776 $270.00<br />
78195 $136.00<br />
78459 $112.00<br />
78615 $107.00<br />
79005 $125.43<br />
80184 $11.00<br />
77777 $361.00<br />
78201 $72.00<br />
78460 $111.00<br />
78630 $144.00<br />
79101 $131.27<br />
80185 $16.00<br />
77778 $510.00<br />
78202 $86.00<br />
78461 $200.00<br />
78635 $106.00<br />
79403 $181.71<br />
80186 $17.00<br />
77781 $541.00<br />
78205 $166.00<br />
78464 $206.00<br />
78645 $114.00<br />
79440 $132.00<br />
80188 $20.00<br />
77782 $570.00<br />
78206 $166.00<br />
78465 $332.00<br />
78647 $172.00<br />
79445 $147.55<br />
80190 $17.00<br />
77783 $612.00<br />
78215 $87.00<br />
78466 $95.00<br />
78650 $132.00<br />
80048 $11.00<br />
80192 $21.00<br />
77784 $677.00<br />
78216 $102.00<br />
78468 $115.00<br />
78660 $89.00<br />
80050 $48.74<br />
80194 $16.00<br />
77785 $34.99<br />
78220 $105.00<br />
78469 $157.00<br />
78700 $88.00<br />
80051 $8.00<br />
80195 $11.00<br />
77789 $64.00<br />
78223 $116.00<br />
78472 $166.00<br />
78701 $101.00<br />
80053 $12.00<br />
80196 $8.00<br />
77790 $63.00<br />
78231 $94.00<br />
78473 $247.00<br />
78704 $120.00<br />
80055 $70.80<br />
80197 $11.00<br />
78000 $30.00<br />
78232 $101.00<br />
78478 $59.00<br />
78707 $140.00<br />
80061 $14.00<br />
80198 $17.00<br />
78001 $40.00<br />
78261 $122.00<br />
78480 $59.00<br />
78708 $147.00<br />
80069 $8.00<br />
80200 $16.00<br />
78003 $35.00<br />
78262 $125.00<br />
78481 $190.00<br />
78709 $152.00<br />
80074 $45.00<br />
80201 $12.00<br />
78006 $74.00<br />
78264 $126.00<br />
78483 $244.00<br />
78710 $164.00<br />
80076 $8.00<br />
80202 $17.00<br />
78007 $79.00<br />
78267 $7.17<br />
78491 $734.00<br />
78715 $57.00<br />
80100 $14.00<br />
80299 $13.00<br />
78010 $57.00<br />
78268 $61.44<br />
78492 $1,040.00<br />
78725 $56.00<br />
80101 $15.00<br />
80400 $41.00<br />
78011 $94.00<br />
78270 $44.00<br />
78494 $204.00<br />
78730 $48.00<br />
80102 $15.00<br />
80402 $106.00<br />
78015 $85.00<br />
78271 $57.00<br />
78496 $58.00<br />
78740 $70.00<br />
80103 $30.90<br />
80406 $97.00<br />
78016 $111.00<br />
78272 $65.00<br />
78580 $107.00<br />
78760 $112.00<br />
80150 $15.00<br />
80408 $156.00<br />
78018 $159.00<br />
78278 $150.00<br />
78584 $110.00<br />
78761 $130.00<br />
80152 $17.00<br />
80410 $100.00<br />
78020 $24.00<br />
78282 $33.99<br />
78585 $192.00<br />
78800 $104.00<br />
80154 $18.00<br />
80412 $410.00<br />
78070 $70.00<br />
78290 $96.00<br />
78586 $76.00<br />
78801 $128.00<br />
80156 $18.00<br />
80414 $64.00<br />
78075 $155.00<br />
78291 $103.00<br />
78587 $84.00<br />
78802 $162.00<br />
80157 $10.00<br />
80415 $70.00<br />
78102 $87.00<br />
78300 $81.00<br />
78588 $165.00<br />
78803 $194.00<br />
80158 $22.00<br />
80416 $164.00<br />
78103 $102.00<br />
78305 $116.00<br />
78591 $82.00<br />
78804 $140.85<br />
80160 $17.00<br />
80417 $55.00<br />
78104 $125.00<br />
78306 $133.00<br />
78593 $99.00<br />
78805 $106.00<br />
80162 $17.00<br />
80418 $721.00<br />
78110 $30.00<br />
78315 $149.00<br />
78594 $137.00<br />
78806 $183.00<br />
80164 $17.00<br />
80420 $90.00<br />
78111 $69.00<br />
78320 $177.00<br />
78596 $212.00<br />
78807 $194.00<br />
80166 $19.00<br />
80422 $56.00<br />
78120 $50.00<br />
78350 $33.00<br />
78600 $84.00<br />
78811 $1,394.00<br />
80168 $17.00<br />
80424 $63.00<br />
78121 $80.00<br />
78351 $80.00<br />
78601 $99.00<br />
78812 $1,407.00<br />
80170 $16.00<br />
80426 $185.00<br />
78122 $125.00<br />
78414 $100.79<br />
78605 $100.00<br />
78813 $1,410.00<br />
80172 $20.00<br />
80428 $81.00<br />
78130 $89.00<br />
78428 $82.00<br />
78606 $114.00<br />
78814 $1,486.00<br />
80173 $14.00<br />
80432 $100.00<br />
p. 27
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
80434 $126.00<br />
82101 $30.00<br />
82272 $3.00<br />
82485 $20.00<br />
82638 $12.00<br />
82785 $15.00<br />
80435 $126.00<br />
82103 $13.00<br />
82274 $17.00<br />
82486 $18.00<br />
82649 $25.00<br />
82787 $5.00<br />
80436 $113.00<br />
82104 $14.00<br />
82286 $7.00<br />
82487 $20.00<br />
82651 $30.00<br />
82800 $11.00<br />
80438 $63.00<br />
82105 $20.00<br />
82300 $25.00<br />
82488 $21.00<br />
82652 $48.00<br />
82803 $24.00<br />
80439 $84.00<br />
82106 $18.00<br />
82306 $29.00<br />
82489 $23.00<br />
82654 $14.00<br />
82805 $35.00<br />
80440 $72.00<br />
82108 $32.00<br />
82307 $40.00<br />
82491 $22.00<br />
82656 $11.00<br />
82810 $11.00<br />
80500 $18.00<br />
82120 $4.00<br />
82308 $26.00<br />
82495 $5.00<br />
82657 $17.00<br />
82820 $12.00<br />
80502 $45.00<br />
82127 $17.00<br />
82310 $5.00<br />
82507 $27.00<br />
82658 $17.00<br />
82926 $7.00<br />
81000 $4.00<br />
82128 $13.00<br />
82330 $7.00<br />
82520 $15.00<br />
82664 $33.00<br />
82928 $6.00<br />
81001 $4.00<br />
82131 $19.00<br />
82331 $5.00<br />
82523 $9.00<br />
82666 $21.00<br />
82938 $22.00<br />
81002 $3.00<br />
82135 $16.00<br />
82340 $6.00<br />
82525 $12.00<br />
82668 $18.00<br />
82941 $17.00<br />
81003 $3.00<br />
82136 $16.00<br />
82355 $11.00<br />
82528 $23.00<br />
82670 $27.00<br />
82943 $18.00<br />
81005 $2.00<br />
82139 $16.00<br />
82360 $12.00<br />
82530 $21.00<br />
82671 $30.00<br />
82945 $4.00<br />
81007 $2.00<br />
82140 $15.00<br />
82365 $12.00<br />
82533 $17.00<br />
82672 $25.00<br />
82946 $5.00<br />
81015 $3.00<br />
82143 $9.00<br />
82370 $12.00<br />
82540 $6.00<br />
82677 $27.00<br />
82947 $4.00<br />
81020 $5.00<br />
82145 $15.00<br />
82373 $3.00<br />
82541 $17.00<br />
82679 $27.00<br />
82948 $4.00<br />
81025 $3.00<br />
82150 $7.00<br />
82374 $4.00<br />
82542 $17.00<br />
82690 $17.00<br />
82950 $6.00<br />
81050 $4.00<br />
82154 $36.00<br />
82375 $12.00<br />
82543 $17.00<br />
82693 $10.00<br />
82951 $9.00<br />
82000 $4.00<br />
82157 $32.00<br />
82376 $6.00<br />
82544 $22.00<br />
82696 $29.00<br />
82952 $4.00<br />
82003 $20.00<br />
82160 $24.00<br />
82378 $24.00<br />
82550 $8.00<br />
82705 $5.00<br />
82953 $15.00<br />
82009 $4.00<br />
82163 $20.00<br />
82379 $16.00<br />
82552 $17.00<br />
82710 $6.00<br />
82955 $12.00<br />
82010 $7.00<br />
82164 $18.00<br />
82380 $10.00<br />
82553 $14.00<br />
82715 $20.00<br />
82960 $6.00<br />
82013 $14.00<br />
82172 $19.00<br />
82382 $18.00<br />
82554 $15.00<br />
82725 $13.00<br />
82962 $3.00<br />
82016 $13.00<br />
82175 $18.00<br />
82383 $25.00<br />
82565 $6.00<br />
82726 $17.00<br />
82963 $27.00<br />
82017 $21.00<br />
82180 $10.00<br />
82384 $25.00<br />
82570 $6.00<br />
82728 $13.00<br />
82965 $7.00<br />
82024 $37.00<br />
82190 $15.00<br />
82387 $22.00<br />
82575 $10.00<br />
82731 $63.00<br />
82975 $20.00<br />
82030 $25.00<br />
82205 $14.00<br />
82390 $10.00<br />
82585 $10.00<br />
82735 $18.00<br />
82977 $7.00<br />
82040 $5.00<br />
82232 $18.00<br />
82397 $7.00<br />
82595 $6.00<br />
82742 $19.00<br />
82978 $15.00<br />
82042 $2.00<br />
82239 $20.00<br />
82415 $12.00<br />
82600 $19.00<br />
82746 $13.00<br />
82979 $7.00<br />
82043 $6.00<br />
82240 $26.00<br />
82435 $5.00<br />
82607 $17.00<br />
82747 $16.00<br />
82980 $18.00<br />
82044 $3.00<br />
82247 $5.00<br />
82436 $5.00<br />
82608 $18.00<br />
82757 $17.00<br />
82985 $15.00<br />
82045 $33.00<br />
82248 $5.00<br />
82438 $5.00<br />
82615 $8.00<br />
82759 $27.00<br />
83001 $22.00<br />
82055 $10.00<br />
82252 $4.00<br />
82441 $6.00<br />
82626 $29.00<br />
82760 $11.00<br />
83002 $21.00<br />
82075 $15.00<br />
82261 $16.00<br />
82465 $5.00<br />
82627 $28.00<br />
82775 $29.11<br />
83003 $17.00<br />
82085 $12.00<br />
82270 $3.00<br />
82480 $8.00<br />
82633 $39.00<br />
82776 $8.00<br />
83008 $17.00<br />
82088 $42.00<br />
82271 $3.00<br />
82482 $8.00<br />
82634 $28.00<br />
82784 $12.00<br />
83009 $66.00<br />
p. 28
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
83010 $12.00<br />
83527 $14.00<br />
83825 $17.00<br />
83918 $16.00<br />
84143 $28.00<br />
84302 $5.00<br />
83012 $17.00<br />
83528 $20.00<br />
83835 $19.00<br />
83919 $16.00<br />
84144 $20.00<br />
84305 $15.00<br />
83013 $66.00<br />
83540 $7.00<br />
83840 $20.00<br />
83921 $16.00<br />
84146 $24.00<br />
84307 $15.00<br />
83014 $8.00<br />
83550 $10.00<br />
83857 $10.00<br />
83925 $24.00<br />
84150 $24.00<br />
84311 $7.00<br />
83015 $18.00<br />
83570 $9.00<br />
83858 $14.00<br />
83930 $8.00<br />
84152 $18.00<br />
84315 $2.00<br />
83018 $23.00<br />
83582 $14.00<br />
83864 $23.00<br />
83935 $7.00<br />
84153 $20.00<br />
84375 $19.00<br />
83020 $16.91<br />
83586 $12.00<br />
83866 $10.00<br />
83937 $23.00<br />
84154 $18.00<br />
84376 $7.00<br />
83021 $17.00<br />
83593 $25.00<br />
83872 $6.00<br />
83945 $12.00<br />
84155 $5.00<br />
84377 $5.00<br />
83026 $3.00<br />
83605 $10.00<br />
83873 $21.00<br />
83970 $51.00<br />
84156 $4.00<br />
84378 $11.00<br />
83030 $8.00<br />
83615 $6.00<br />
83874 $12.00<br />
83986 $3.00<br />
84157 $4.00<br />
84379 $11.00<br />
83033 $6.00<br />
83625 $12.00<br />
83880 $33.00<br />
83992 $14.00<br />
84160 $5.00<br />
84392 $6.00<br />
83036 $12.00<br />
83630 $11.00<br />
83883 $17.00<br />
84022 $15.00<br />
84163 $10.00<br />
84402 $32.00<br />
83045 $5.00<br />
83631 $19.00<br />
83885 $25.00<br />
84035 $4.00<br />
84165 $13.00<br />
84403 $31.00<br />
83050 $7.00<br />
83632 $20.00<br />
83887 $23.00<br />
84060 $7.00<br />
84166 $17.00<br />
84425 $21.00<br />
83051 $7.00<br />
83633 $7.00<br />
83890 $5.00<br />
84061 $6.00<br />
84181 $21.00<br />
84430 $11.00<br />
83055 $5.00<br />
83634 $11.00<br />
83891 $4.00<br />
84066 $12.00<br />
84182 $22.00<br />
84432 $17.00<br />
83060 $8.00<br />
83655 $15.00<br />
83892 $5.00<br />
84075 $6.00<br />
84202 $14.00<br />
84436 $7.00<br />
83065 $7.00<br />
83661 $24.00<br />
83893 $4.00<br />
84078 $7.00<br />
84203 $8.00<br />
84437 $8.95<br />
83068 $8.00<br />
83662 $24.00<br />
83894 $5.00<br />
84080 $14.00<br />
84206 $17.00<br />
84439 $9.00<br />
83069 $4.00<br />
83663 $9.00<br />
83896 $5.00<br />
84081 $21.00<br />
84207 $27.00<br />
84442 $14.00<br />
83070 $5.00<br />
83664 $5.00<br />
83897 $4.00<br />
84085 $7.00<br />
84210 $11.00<br />
84443 $23.21<br />
83071 $9.00<br />
83670 $11.00<br />
83898 $7.00<br />
84087 $10.00<br />
84220 $9.00<br />
84445 $49.00<br />
83080 $16.00<br />
83690 $7.00<br />
83900 $13.00<br />
84100 $4.00<br />
84228 $14.00<br />
84446 $14.00<br />
83088 $29.00<br />
83695 $13.00<br />
83901 $6.00<br />
84105 $5.00<br />
84233 $62.00<br />
84449 $22.00<br />
83090 $19.00<br />
83700 $11.00<br />
83902 $4.00<br />
84106 $4.00<br />
84234 $67.00<br />
84450 $6.00<br />
83150 $19.00<br />
83701 $24.00<br />
83903 $8.00<br />
84110 $8.00<br />
84235 $51.00<br />
84460 $7.00<br />
83491 $17.00<br />
83704 $31.00<br />
83904 $7.00<br />
84119 $9.00<br />
84238 $45.00<br />
84466 $16.00<br />
83497 $2.00<br />
83718 $8.00<br />
83905 $7.00<br />
84120 $18.00<br />
84244 $25.00<br />
84478 $7.00<br />
83498 $37.54<br />
83719 $11.00<br />
83906 $7.00<br />
84126 $25.00<br />
84252 $20.00<br />
84479 $5.00<br />
83500 $25.00<br />
83721 $8.00<br />
83907 $13.00<br />
84127 $14.00<br />
84255 $25.00<br />
84480 $17.00<br />
83505 $24.00<br />
83727 $18.00<br />
83908 $7.00<br />
84132 $6.00<br />
84260 $10.00<br />
84481 $16.00<br />
83516 $14.00<br />
83735 $8.00<br />
83909 $7.00<br />
84133 $5.00<br />
84270 $27.00<br />
84482 $20.00<br />
83518 $9.00<br />
83775 $7.00<br />
83912 $5.00<br />
84134 $14.00<br />
84275 $13.00<br />
84484 $10.00<br />
83519 $13.00<br />
83785 $24.00<br />
83914 $7.00<br />
84135 $19.00<br />
84285 $23.00<br />
84485 $7.00<br />
83520 $16.00<br />
83788 $17.00<br />
83915 $11.00<br />
84138 $23.00<br />
84295 $6.00<br />
84488 $7.00<br />
83525 $11.00<br />
83805 $17.00<br />
83916 $19.00<br />
84140 $26.00<br />
84300 $6.00<br />
84490 $7.00<br />
p. 29
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
84510 $10.00<br />
85045 $5.00<br />
85348 $4.00<br />
85613 $9.00<br />
86215 $16.00<br />
86357 $37.00<br />
84520 $5.00<br />
85046 $5.00<br />
85360 $10.00<br />
85635 $11.00<br />
86225 $15.00<br />
86359 $47.00<br />
84525 $5.00<br />
85048 $3.00<br />
85362 $7.00<br />
85651 $4.00<br />
86226 $7.00<br />
86360 $58.00<br />
84540 $5.00<br />
85049 $4.00<br />
85366 $8.00<br />
85652 $3.00<br />
86235 $17.00<br />
86367 $37.00<br />
84545 $6.00<br />
85055 $26.00<br />
85370 $10.00<br />
85660 $5.00<br />
86243 $20.00<br />
86376 $15.00<br />
84550 $6.00<br />
85097 $35.00<br />
85378 $9.00<br />
85670 $6.00<br />
86255 $14.00<br />
86378 $19.00<br />
84560 $5.00<br />
85130 $15.00<br />
85379 $10.00<br />
85705 $9.00<br />
86256 $12.00<br />
86382 $16.00<br />
84577 $12.00<br />
85170 $3.00<br />
85380 $8.00<br />
85730 $6.00<br />
86277 $15.00<br />
86384 $14.00<br />
84578 $3.00<br />
85175 $6.00<br />
85384 $10.00<br />
85732 $5.00<br />
86280 $7.00<br />
86403 $10.00<br />
84580 $7.00<br />
85210 $6.00<br />
85385 $11.00<br />
85810 $11.00<br />
86294 $14.00<br />
86406 $13.00<br />
84583 $5.00<br />
85220 $17.00<br />
85390 $5.00<br />
86000 $5.00<br />
86300 $14.00<br />
86430 $7.00<br />
84585 $17.00<br />
85230 $17.00<br />
85396 $14.35<br />
86001 $5.00<br />
86301 $14.00<br />
86431 $5.00<br />
84586 $13.00<br />
85240 $17.00<br />
85400 $9.00<br />
86003 $6.00<br />
86304 $5.00<br />
86480 $61.00<br />
84588 $42.00<br />
85244 $20.00<br />
85410 $7.00<br />
86005 $9.00<br />
86308 $6.00<br />
86485 $11.00<br />
84590 $11.00<br />
85245 $29.00<br />
85415 $17.00<br />
86021 $15.00<br />
86309 $7.00<br />
86490 $7.00<br />
84597 $13.00<br />
85246 $29.00<br />
85420 $6.00<br />
86022 $18.00<br />
86310 $7.00<br />
86510 $8.00<br />
84600 $16.00<br />
85247 $29.00<br />
85421 $10.00<br />
86023 $14.00<br />
86316 $17.00<br />
86580 $6.00<br />
84620 $11.00<br />
85250 $18.00<br />
85441 $4.00<br />
86038 $15.00<br />
86317 $15.00<br />
86586 $9.00<br />
84630 $14.00<br />
85260 $17.00<br />
85445 $7.00<br />
86039 $14.00<br />
86318 $13.00<br />
86590 $11.00<br />
84681 $12.00<br />
85270 $17.00<br />
85460 $7.00<br />
86060 $8.00<br />
86320 $24.00<br />
86592 $5.00<br />
84702 $12.00<br />
85280 $19.00<br />
85461 $8.00<br />
86063 $7.00<br />
86325 $25.00<br />
86593 $5.00<br />
84703 $6.00<br />
85290 $16.00<br />
85475 $9.00<br />
86077 $34.00<br />
86327 $22.00<br />
86602 $7.00<br />
84830 $3.00<br />
85291 $10.00<br />
85520 $15.00<br />
86078 $44.00<br />
86329 $16.00<br />
86603 $16.00<br />
85002 $4.00<br />
85292 $19.00<br />
85525 $15.00<br />
86079 $34.00<br />
86331 $12.00<br />
86606 $19.00<br />
85004 $5.00<br />
85293 $24.00<br />
85530 $15.00<br />
86140 $5.00<br />
86332 $21.00<br />
86609 $16.00<br />
85007 $4.00<br />
85300 $11.00<br />
85536 $6.00<br />
86146 $25.00<br />
86333 $18.13<br />
86611 $6.00<br />
85008 $3.00<br />
85301 $11.00<br />
85540 $7.00<br />
86147 $32.00<br />
86334 $21.00<br />
86612 $16.00<br />
85009 $5.00<br />
85302 $12.00<br />
85547 $10.00<br />
86155 $16.00<br />
86335 $29.00<br />
86615 $15.00<br />
85013 $3.00<br />
85303 $17.00<br />
85549 $18.00<br />
86156 $6.00<br />
86336 $17.00<br />
86617 $19.00<br />
85014 $3.00<br />
85305 $14.00<br />
85555 $8.00<br />
86157 $10.00<br />
86337 $27.00<br />
86618 $16.00<br />
85018 $3.00<br />
85306 $19.00<br />
85557 $17.00<br />
86160 $15.00<br />
86340 $19.00<br />
86619 $15.00<br />
85025 $10.00<br />
85307 $15.00<br />
85576 $27.00<br />
86161 $15.00<br />
86341 $17.00<br />
86622 $11.00<br />
85027 $5.00<br />
85335 $12.00<br />
85597 $15.00<br />
86162 $20.00<br />
86343 $15.00<br />
86625 $16.00<br />
85032 $4.00<br />
85337 $13.00<br />
85610 $5.00<br />
86171 $12.00<br />
86344 $10.00<br />
86628 $15.00<br />
85041 $4.00<br />
85345 $5.00<br />
85611 $5.00<br />
86185 $9.00<br />
86353 $47.00<br />
86631 $15.00<br />
85044 $5.00<br />
85347 $4.00<br />
85612 $9.00<br />
86200 $13.00<br />
86355 $37.00<br />
86632 $16.00<br />
p. 30
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
86635 $14.00<br />
86708 $15.00<br />
86806 $59.00<br />
86970 $17.00<br />
87149 $19.00<br />
87272 $14.00<br />
86638 $15.00<br />
86709 $14.00<br />
86807 $40.00<br />
86971 $17.00<br />
87152 $5.00<br />
87273 $11.00<br />
86641 $18.00<br />
86710 $16.00<br />
86808 $37.00<br />
86972 $4.00<br />
87158 $5.00<br />
87274 $14.00<br />
86644 $18.00<br />
86713 $16.00<br />
86812 $32.00<br />
86975 $21.00<br />
87164 $6.00<br />
87275 $11.00<br />
86645 $20.00<br />
86717 $14.00<br />
86813 $72.00<br />
86976 $26.00<br />
87166 $11.00<br />
87276 $14.00<br />
86648 $17.00<br />
86720 $14.00<br />
86816 $27.00<br />
86977 $17.00<br />
87168 $4.00<br />
87277 $11.00<br />
86651 $16.00<br />
86723 $16.00<br />
86817 $62.00<br />
86978 $21.00<br />
87169 $4.00<br />
87278 $14.00<br />
86652 $16.00<br />
86727 $16.00<br />
86821 $70.00<br />
86985 $5.00<br />
87172 $4.00<br />
87279 $11.00<br />
86653 $16.00<br />
86729 $15.00<br />
86822 $35.00<br />
87001 $13.00<br />
87176 $6.00<br />
87280 $14.00<br />
86654 $16.00<br />
86732 $16.00<br />
86850 $8.00<br />
87003 $16.00<br />
87177 $8.00<br />
87281 $11.00<br />
86658 $16.00<br />
86735 $16.00<br />
86860 $30.00<br />
87015 $6.00<br />
87181 $6.00<br />
87283 $11.00<br />
86663 $16.00<br />
86738 $16.00<br />
86870 $23.00<br />
87040 $10.00<br />
87184 $7.00<br />
87285 $14.00<br />
86664 $18.00<br />
86741 $16.00<br />
86880 $4.00<br />
87045 $11.00<br />
87185 $6.00<br />
87290 $14.00<br />
86665 $22.00<br />
86744 $16.00<br />
86885 $7.00<br />
87046 $2.00<br />
87186 $9.00<br />
87300 $5.00<br />
86666 $6.00<br />
86747 $19.00<br />
86886 $6.00<br />
87070 $11.00<br />
87187 $8.00<br />
87301 $14.00<br />
86668 $11.00<br />
86750 $8.00<br />
86890 $52.00<br />
87071 $5.00<br />
87188 $8.00<br />
87320 $14.00<br />
86671 $12.00<br />
86753 $15.00<br />
86891 $45.00<br />
87073 $5.00<br />
87190 $7.00<br />
87324 $14.00<br />
86674 $14.00<br />
86756 $16.00<br />
86900 $4.00<br />
87075 $9.00<br />
87197 $6.00<br />
87327 $11.00<br />
86677 $18.00<br />
86757 $19.00<br />
86901 $5.40<br />
87076 $10.00<br />
87205 $5.00<br />
87328 $14.00<br />
86682 $16.00<br />
86759 $16.00<br />
86903 $4.00<br />
87077 $8.00<br />
87206 $5.00<br />
87329 $11.00<br />
86684 $20.00<br />
86762 $18.00<br />
86904 $4.00<br />
87081 $8.00<br />
87207 $7.00<br />
87332 $14.00<br />
86687 $10.00<br />
86765 $16.00<br />
86905 $4.00<br />
87084 $11.00<br />
87209 $18.00<br />
87335 $14.00<br />
86688 $17.00<br />
86768 $16.00<br />
86906 $10.00<br />
87086 $10.00<br />
87210 $5.00<br />
87336 $11.00<br />
86689 $24.00<br />
86771 $13.00<br />
86911 $7.23<br />
87088 $10.00<br />
87220 $3.00<br />
87337 $11.00<br />
86692 $18.00<br />
86774 $18.00<br />
86920 $29.00<br />
87101 $9.00<br />
87230 $13.00<br />
87338 $14.29<br />
86694 $18.00<br />
86777 $18.00<br />
86921 $59.00<br />
87102 $8.00<br />
87250 $19.00<br />
87339 $11.00<br />
86695 $16.00<br />
86778 $18.00<br />
86922 $25.00<br />
87103 $9.00<br />
87252 $21.00<br />
87340 $13.00<br />
86696 $19.00<br />
86781 $16.00<br />
86927 $40.00<br />
87106 $10.00<br />
87253 $17.00<br />
87341 $10.00<br />
86698 $16.00<br />
86784 $13.00<br />
86930 $40.00<br />
87107 $10.00<br />
87254 $5.00<br />
87350 $14.00<br />
86701 $11.00<br />
86787 $16.00<br />
86931 $40.00<br />
87109 $15.00<br />
87255 $4.00<br />
87380 $16.00<br />
86702 $17.00<br />
86790 $16.00<br />
86932 $32.00<br />
87110 $12.00<br />
87260 $14.00<br />
87385 $14.00<br />
86703 $17.00<br />
86793 $16.00<br />
86940 $10.00<br />
87116 $10.00<br />
87265 $14.00<br />
87390 $14.00<br />
86704 $11.00<br />
86800 $15.00<br />
86941 $12.00<br />
87118 $11.00<br />
87267 $11.00<br />
87391 $14.00<br />
86705 $15.00<br />
86803 $16.00<br />
86945 $20.00<br />
87140 $7.00<br />
87269 $11.00<br />
87400 $5.00<br />
86706 $12.00<br />
86804 $19.00<br />
86950 $49.21<br />
87143 $12.00<br />
87270 $14.00<br />
87420 $14.00<br />
86707 $14.00<br />
86805 $65.00<br />
86965 $13.00<br />
87147 $5.00<br />
87271 $11.00<br />
87425 $14.00<br />
p. 31
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
87427 $11.00<br />
87535 $28.00<br />
87901 $101.00<br />
88187 $47.00<br />
88312 $32.00<br />
89125 $5.00<br />
87430 $14.00<br />
87536 $47.00<br />
87902 $103.00<br />
88188 $58.00<br />
88313 $32.00<br />
89130 $36.00<br />
87449 $14.00<br />
87537 $25.00<br />
87903 $317.00<br />
88189 $76.00<br />
88314 $81.00<br />
89132 $27.00<br />
87450 $9.00<br />
87538 $28.00<br />
87904 $21.00<br />
88230 $145.00<br />
88318 $34.00<br />
89135 $49.00<br />
87451 $7.00<br />
87539 $41.00<br />
88104 $30.00<br />
88233 $148.00<br />
88319 $62.00<br />
89136 $28.00<br />
87470 $25.00<br />
87540 $25.00<br />
88106 $27.00<br />
88235 $145.00<br />
88321 $50.00<br />
89140 $55.00<br />
87471 $28.00<br />
87541 $28.00<br />
88107 $38.00<br />
88237 $157.00<br />
88323 $46.00<br />
89141 $72.00<br />
87475 $25.00<br />
87550 $25.00<br />
88108 $34.00<br />
88239 $148.00<br />
88325 $123.21<br />
89160 $4.00<br />
87476 $28.00<br />
87551 $28.00<br />
88112 $77.49<br />
88240 $9.00<br />
88329 $35.00<br />
89190 $6.00<br />
87480 $25.00<br />
87555 $25.00<br />
88125 $14.00<br />
88241 $9.00<br />
88331 $67.00<br />
89220 $10.00<br />
87481 $28.00<br />
87556 $28.00<br />
88130 $17.00<br />
88245 $145.00<br />
88332 $36.00<br />
89225 $1.00<br />
87482 $55.00<br />
87560 $25.00<br />
88140 $8.00<br />
88248 $168.00<br />
88333 $55.05<br />
89230 $12.00<br />
87485 $25.00<br />
87561 $28.00<br />
88141 $17.00<br />
88249 $215.00<br />
88334 $28.56<br />
89235 $5.00<br />
87486 $28.00<br />
87580 $25.00<br />
88142 $24.00<br />
88261 $171.00<br />
88342 $58.00<br />
89300 $1.00<br />
87490 $25.00<br />
87581 $28.00<br />
88143 $20.00<br />
88262 $155.00<br />
88346 $52.00<br />
89310 $9.00<br />
87491 $28.00<br />
87590 $25.00<br />
88147 $10.00<br />
88263 $187.00<br />
88347 $43.00<br />
89320 $14.00<br />
87495 $25.00<br />
87591 $28.00<br />
88148 $10.00<br />
88264 $155.00<br />
88348 $216.00<br />
89321 $11.00<br />
87496 $28.00<br />
87592 $56.00<br />
88150 $5.99<br />
88267 $200.00<br />
88349 $109.00<br />
89325 $10.00<br />
87497 $42.00<br />
87620 $25.00<br />
88152 $10.00<br />
88269 $207.00<br />
88355 $99.00<br />
89329 $20.00<br />
87510 $25.00<br />
87621 $28.00<br />
88153 $10.00<br />
88271 $21.00<br />
88356 $152.00<br />
89330 $12.00<br />
87511 $28.00<br />
87622 $55.00<br />
88154 $10.00<br />
88272 $33.00<br />
88358 $132.00<br />
90371 $119.74<br />
87512 $55.00<br />
87650 $25.00<br />
88155 $7.00<br />
88273 $40.00<br />
88360 $70.15<br />
90375 $64.59<br />
87515 $25.00<br />
87651 $28.00<br />
88160 $32.00<br />
88274 $43.00<br />
88361 $87.00<br />
90376 $69.23<br />
87516 $28.00<br />
87660 $19.00<br />
88161 $25.00<br />
88275 $50.00<br />
88365 $65.00<br />
90378 $679.34 Yes<br />
87520 $25.00<br />
87797 $25.00<br />
88162 $53.00<br />
88280 $25.00<br />
88367 $130.43<br />
90585 $116.56<br />
87521 $28.00<br />
87798 $28.00<br />
88164 $10.00<br />
88283 $34.00<br />
88368 $119.20<br />
90586 $111.54<br />
87522 $42.00<br />
87800 $19.00<br />
88165 $10.00<br />
88285 $18.00<br />
88371 $28.00<br />
90675 $156.73<br />
87525 $25.00<br />
87801 $22.00<br />
88166 $10.00<br />
88289 $33.00<br />
88372 $28.00<br />
90676 $129.91<br />
87526 $28.00<br />
87802 $11.00<br />
88167 $10.00<br />
88291 $18.00<br />
88400 $2.00<br />
90703 $18.34<br />
87528 $25.00<br />
87803 $11.00<br />
88172 $39.00<br />
88300 $12.00<br />
89049 $112.87<br />
90704 $19.14 Yes<br />
87529 $28.00<br />
87804 $11.00<br />
88173 $65.00<br />
88302 $25.00<br />
89050 $5.00<br />
90705 $14.52 Yes<br />
87530 $56.00<br />
87807 $11.00<br />
88174 $21.00<br />
88304 $25.00<br />
89051 $6.00<br />
90706 $16.16 Yes<br />
87531 $25.00<br />
87810 $14.00<br />
88175 $25.00<br />
88305 $49.00<br />
89055 $4.00<br />
90717 $54.44<br />
87532 $28.00<br />
87850 $14.00<br />
88182 $60.00<br />
88307 $98.00<br />
89060 $8.00<br />
90719 $18.67 Yes<br />
87533 $55.00<br />
87880 $14.00<br />
88184 $30.00<br />
88309 $139.00<br />
89100 $38.00<br />
90727 $24.67<br />
87534 $25.00<br />
87900 $108.00<br />
88185 $15.00<br />
88311 $12.00<br />
89105 $53.00<br />
90735 $100.10<br />
p. 32
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
90740 $113.91<br />
90865 $116.00<br />
92012 $42.00<br />
92315 $28.00 Yes<br />
92556 $15.00<br />
92609 $36.02 Yes<br />
90746 $56.96<br />
90870 $102.00<br />
92014 $62.00<br />
92317 $34.00 Yes<br />
92557 $35.00<br />
92610 $26.00<br />
90747 $113.91<br />
90880 $74.00<br />
92015 $9.00<br />
92326 $31.00 Yes<br />
92559 $35.00<br />
92611 $28.00<br />
90760 $39.00<br />
90887 $36.00<br />
92018 $92.00<br />
92340 $18.00<br />
92560 $11.25<br />
92612 $109.00<br />
90761 $13.00<br />
90922 $12.00<br />
92019 $48.00<br />
92341 $18.00<br />
92561 $19.00<br />
92613 $31.00<br />
90765 $48.00<br />
90923 $10.00<br />
92020 $21.00<br />
92342 $14.40<br />
92562 $13.00<br />
92614 $98.00<br />
90766 $17.00<br />
90924 $8.00<br />
92060 $37.00<br />
92352 $18.00<br />
92563 $10.00<br />
92615 $26.00<br />
90767 $27.00<br />
90925 $6.00<br />
92065 $29.00 Yes<br />
92353 $18.00<br />
92564 $13.00<br />
92616 $116.00<br />
90768 $16.00<br />
90935 $58.00<br />
92070 $56.00<br />
92354 $18.00<br />
92565 $11.00<br />
92617 $32.00<br />
90772 $10.00<br />
90937 $117.00<br />
92081 $31.00<br />
92358 $31.50<br />
92567 $14.00<br />
92625 $26.69<br />
90773 $10.00<br />
90945 $54.00<br />
92082 $40.00<br />
92370 $5.26<br />
92568 $10.00<br />
92626 $12.93<br />
90774 $36.00<br />
90947 $116.00<br />
92083 $46.00<br />
92371 $64.79<br />
92569 $13.00<br />
92627 $12.93<br />
90775 $17.00<br />
90997 $71.00<br />
92100 $56.00<br />
92499 $50.00 Yes<br />
92571 $12.00<br />
92630 $42.00<br />
90801 $110.00<br />
91000 $31.00<br />
92120 $46.00<br />
92502 $85.00<br />
92572 $3.00<br />
92633 $42.00<br />
90802 $117.00<br />
91010 $146.00<br />
92135 $36.00<br />
92504 $18.00<br />
92573 $11.00<br />
92950 $216.00<br />
90804 $47.00<br />
91011 $89.00<br />
92136 $53.00<br />
92511 $105.00<br />
92575 $9.00<br />
92953 $10.00<br />
90805 $52.00<br />
91012 $135.00<br />
92140 $36.00<br />
92512 $33.00<br />
92576 $14.00<br />
92960 $220.00<br />
90806 $71.00<br />
91020 $154.00<br />
92225 $20.00<br />
92516 $42.00<br />
92577 $19.00<br />
92961 $157.00<br />
90807 $76.00<br />
91022 $133.42<br />
92226 $18.00<br />
92520 $31.00<br />
92579 $19.00<br />
92970 $150.00<br />
90810 $51.00<br />
91030 $86.00<br />
92230 $51.00<br />
92526 $33.00<br />
92582 $23.00<br />
92971 $87.00<br />
90811 $57.00<br />
91034 $147.00<br />
92235 $82.00<br />
92531 $11.99<br />
92583 $23.00<br />
92973 $130.00<br />
90812 $76.00<br />
91035 $311.00<br />
92240 $83.00<br />
92532 $11.99<br />
92584 $65.00<br />
92974 $126.00<br />
90813 $71.00<br />
91037 $95.00<br />
92250 $47.00<br />
92533 $13.79<br />
92585 $82.00<br />
92975 $290.00<br />
90816 $47.00<br />
91038 $82.00<br />
92260 $15.00<br />
92534 $27.49<br />
92586 $48.00<br />
92977 $192.00<br />
90817 $52.00<br />
91040 $302.00<br />
92270 $57.00<br />
92541 $37.00<br />
92587 $40.00<br />
92978 $149.00<br />
90818 $72.00<br />
91052 $74.99<br />
92275 $50.00<br />
92542 $38.00<br />
92588 $53.00<br />
92979 $92.00<br />
90819 $75.00<br />
91055 $100.00<br />
92283 $24.00<br />
92543 $17.00<br />
92590 $20.24<br />
92980 $686.00<br />
90823 $50.00<br />
91060 $24.99<br />
92284 $22.00<br />
92544 $30.00<br />
92591 $31.50<br />
92981 $193.00<br />
90824 $56.00<br />
91065 $42.00<br />
92285 $31.00<br />
92545 $27.00<br />
92592 $13.49<br />
92982 $515.00<br />
90826 $69.00<br />
91100 $33.49<br />
92286 $88.00<br />
92546 $57.00<br />
92593 $31.50<br />
92984 $138.00<br />
90827 $79.00<br />
91105 $62.00<br />
92287 $66.00<br />
92547 $4.00<br />
92594 $12.50<br />
92986 $658.27<br />
90847 $84.00<br />
91110 $648.00<br />
92310 $49.20 Yes<br />
92548 $72.00<br />
92595 $14.50<br />
92987 $722.00<br />
90849 $27.00<br />
91120 $278.00<br />
92311 $54.00 Yes<br />
92551 $15.75<br />
92596 $16.00<br />
92990 $816.00<br />
90853 $23.00<br />
91122 $84.00<br />
92312 $59.00 Yes<br />
92552 $14.00<br />
92597 $80.00 Yes<br />
92992 $430.07<br />
90857 $25.00<br />
92002 $46.00<br />
92313 $58.00 Yes<br />
92553 $17.00<br />
92607 $76.00 Yes<br />
92993 $1,308.55<br />
90862 $37.00<br />
92004 $84.00<br />
92314 $300.00 Yes<br />
92555 $11.00<br />
92608 $13.15 Yes<br />
92995 $567.00<br />
p. 33
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
92996 $151.00<br />
93308 $70.00<br />
93561 $45.00<br />
93733 $26.00<br />
93980 $134.00<br />
94760 $2.00<br />
92997 $561.00<br />
93312 $182.00<br />
93562 $18.00<br />
93734 $24.00<br />
93981 $98.00<br />
94761 $4.00<br />
92998 $240.00<br />
93313 $40.00<br />
93571 $185.00<br />
93735 $40.00<br />
93990 $110.00<br />
94762 $16.00<br />
93000 $21.00<br />
93314 $146.00<br />
93572 $15.00<br />
93736 $23.00<br />
94010 $24.00<br />
94770 $14.00<br />
93005 $13.00<br />
93315 $192.00<br />
93580 $641.42<br />
93741 $48.00<br />
94060 $36.00<br />
94772 $67.50<br />
93010 $8.00<br />
93316 $41.00<br />
93581 $859.36<br />
93742 $54.00<br />
94070 $48.00<br />
95004 $2.48<br />
93012 $150.00<br />
93317 $164.00<br />
93600 $161.00<br />
93743 $59.00<br />
94150 $12.10<br />
95010 $11.46<br />
93014 $24.00<br />
93320 $71.00<br />
93602 $113.00<br />
93744 $63.00<br />
94200 $14.00<br />
95015 $9.47<br />
93015 $87.00<br />
93321 $38.00<br />
93603 $132.00<br />
93784 $49.00<br />
94240 $27.00<br />
95024 $4.00<br />
93016 $18.00<br />
93325 $88.00<br />
93609 $419.00<br />
93786 $21.00<br />
94250 $19.00<br />
95027 $4.00<br />
93017 $43.00<br />
93350 $103.00<br />
93610 $155.00<br />
93788 $12.00<br />
94260 $19.00<br />
95028 $6.00<br />
93018 $14.00<br />
93501 $553.00<br />
93612 $160.00<br />
93790 $6.00<br />
94350 $27.00<br />
95044 $5.00<br />
93024 $89.00<br />
93503 $120.00<br />
93615 $44.00<br />
93797 $14.00<br />
94360 $31.00<br />
95052 $6.00<br />
93025 $209.00<br />
93505 $227.00<br />
93616 $87.00<br />
93798 $18.00<br />
94370 $26.00<br />
95056 $5.00<br />
93040 $12.00<br />
93508 $494.00<br />
93618 $282.00<br />
93875 $66.00<br />
94375 $24.00<br />
95060 $8.00<br />
93041 $4.00<br />
93510 $1,132.00<br />
93619 $591.00<br />
93880 $161.00<br />
94400 $27.00<br />
95065 $6.00<br />
93042 $6.00<br />
93511 $1,052.00<br />
93620 $721.00<br />
93882 $102.00<br />
94450 $24.00<br />
95070 $53.00<br />
93224 $130.00<br />
93514 $1,141.00<br />
93624 $231.00<br />
93886 $201.00<br />
94452 $32.24<br />
95071 $67.00<br />
93225 $38.00<br />
93524 $1,402.00<br />
93631 $588.00<br />
93888 $128.00<br />
94453 $45.78<br />
95075 $57.17<br />
93226 $66.00<br />
93526 $1,489.00<br />
93640 $347.00<br />
93890 $147.04<br />
94620 $82.00<br />
95078 $7.00<br />
93227 $24.00<br />
93527 $1,443.00<br />
93641 $431.00<br />
93892 $156.93<br />
94621 $84.00<br />
95115 $9.28<br />
93230 $116.00<br />
93528 $1,468.00<br />
93642 $385.00<br />
93893 $153.97<br />
94640 $9.00<br />
95117 $11.78<br />
93231 $47.00<br />
93529 $1,308.00<br />
93650 $506.00<br />
93922 $76.00<br />
94642 $139.00<br />
95120 $15.00<br />
93232 $56.00<br />
93530 $583.00<br />
93651 $717.00<br />
93923 $117.00<br />
94656 $64.00<br />
95125 $15.00<br />
93233 $24.00<br />
93531 $1,579.00<br />
93652 $755.00<br />
93924 $137.00<br />
94657 $48.00<br />
95130 $18.00<br />
93235 $101.00<br />
93532 $1,530.00<br />
93660 $137.00<br />
93925 $190.00<br />
94660 $45.00<br />
95131 $34.00<br />
93236 $77.00<br />
93533 $1,368.00<br />
93662 $199.00<br />
93926 $116.00<br />
94662 $32.00<br />
95132 $42.00<br />
93237 $21.00<br />
93539 $19.00<br />
93701 $29.00<br />
93930 $152.00<br />
94664 $10.00<br />
95133 $43.00<br />
93268 $202.00<br />
93540 $20.00<br />
93710 $29.99<br />
93931 $99.00<br />
94667 $16.00<br />
95134 $44.00<br />
93270 $32.00<br />
93541 $13.00<br />
93720 $25.00<br />
93965 $81.00<br />
94668 $12.00<br />
95144 $7.32<br />
93271 $150.00<br />
93542 $13.00<br />
93721 $17.00<br />
93970 $157.00<br />
94680 $54.00<br />
95145 $11.66<br />
93272 $20.00<br />
93543 $13.00<br />
93722 $8.00<br />
93971 $107.00<br />
94681 $70.00<br />
95146 $15.18<br />
93278 $43.00<br />
93544 $12.00<br />
93724 $279.00<br />
93975 $249.00<br />
94690 $52.00<br />
95147 $20.31<br />
93303 $149.00<br />
93545 $19.00<br />
93727 $20.00<br />
93976 $148.00<br />
94720 $35.00<br />
95148 $19.28<br />
93304 $79.00<br />
93555 $192.00<br />
93731 $30.00<br />
93978 $138.00<br />
94725 $52.00<br />
95149 $24.57<br />
93307 $134.00<br />
93556 $284.00<br />
93732 $49.00<br />
93979 $97.00<br />
94750 $40.00<br />
95165 $6.20<br />
p. 34
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
95170 $7.55<br />
95874 $18.06<br />
95979 $64.90<br />
96570 $50.00<br />
99221 $49.00<br />
99306 $68.68<br />
95180 $100.53<br />
95875 $54.00<br />
95990 $38.00<br />
96571 $27.00<br />
99222 $81.00<br />
99307 $21.55<br />
95805 $484.00<br />
95900 $44.00<br />
95991 $59.00<br />
96900 $10.00<br />
99223 $113.00<br />
99308 $35.73<br />
95806 $164.00<br />
95903 $47.00<br />
96015 $4.12<br />
96910 $25.00<br />
99231 $24.00<br />
99309 $50.39<br />
95807 $226.00<br />
95904 $37.00<br />
96101 $61.98<br />
96912 $32.00<br />
99232 $40.00<br />
99310 $63.06<br />
95808 $283.00<br />
95920 $120.00<br />
96102 $26.99<br />
96920 $95.00<br />
99233 $57.00<br />
99315 $44.00<br />
95810 $539.00<br />
95921 $44.00<br />
96103 $17.79<br />
96921 $98.00<br />
99234 $97.00<br />
99316 $59.00<br />
95811 $589.00<br />
95922 $48.00<br />
96105 $47.00<br />
96922 $135.96<br />
99235 $128.00<br />
99318 $41.84<br />
95812 $133.00<br />
95923 $74.00<br />
96110 $10.00<br />
97075 $65.00<br />
99236 $160.00<br />
99324 $37.03<br />
95813 $176.00<br />
95925 $54.00<br />
96111 $103.00<br />
97597 $34.00<br />
99238 $51.00<br />
99325 $54.40<br />
95816 $125.00<br />
95926 $46.00<br />
96116 $68.31<br />
97598 $43.00<br />
99239 $69.00<br />
99326 $79.10<br />
95819 $107.00<br />
95927 $47.00<br />
96118 $80.31<br />
97602 $25.00<br />
99241 $41.00<br />
99327 $104.27<br />
95822 $147.00<br />
95928 $110.33<br />
96119 $39.21<br />
99082 $25.56<br />
99242 $64.00<br />
99328 $129.19<br />
95824 $46.00<br />
95929 $115.00<br />
96120 $29.15<br />
99170 $94.00<br />
99243 $86.00<br />
99334 $28.58<br />
95827 $98.00<br />
95930 $65.00<br />
96401 $33.00<br />
99175 $36.00<br />
99244 $121.00<br />
99335 $45.48<br />
95829 $243.00<br />
95933 $44.00<br />
96402 $23.00<br />
99183 $149.00<br />
99245 $157.00<br />
99336 $70.43<br />
95830 $86.00<br />
95934 $26.00<br />
96405 $67.00<br />
99185 $20.00<br />
99251 $31.00<br />
99337 $103.85<br />
95831 $19.00<br />
95936 $28.00<br />
96406 $90.00<br />
99186 $49.00<br />
99252 $60.00<br />
99341 $47.00<br />
95832 $19.00<br />
95937 $35.00<br />
96409 $76.00<br />
99190 $56.67<br />
99253 $74.00<br />
99342 $61.00<br />
95833 $28.00<br />
95950 $180.00<br />
96411 $44.00<br />
99191 $42.50<br />
99254 $102.00<br />
99343 $90.00<br />
95834 $37.00<br />
95951 $1,162.00<br />
96413 $108.00<br />
99192 $28.33<br />
99255 $140.00<br />
99344 $118.00<br />
95851 $14.00<br />
95953 $286.00<br />
96415 $25.00<br />
99195 $11.00<br />
99281 $13.00<br />
99345 $146.00<br />
95852 $11.00<br />
95954 $177.00<br />
96416 $115.00<br />
99201 $30.00<br />
99282 $21.00<br />
99347 $32.00<br />
95857 $34.00<br />
95955 $100.00<br />
96417 $53.00<br />
99202 $53.00<br />
99283 $42.00<br />
99348 $51.00<br />
95860 $63.00<br />
95956 $451.00<br />
96420 $68.00<br />
99203 $78.00<br />
99284 $66.00<br />
99349 $80.00<br />
95861 $81.00<br />
95957 $123.00<br />
96422 $120.00<br />
99204 $111.00<br />
99285 $104.00<br />
99350 $118.00<br />
95863 $107.00<br />
95958 $210.00<br />
96423 $49.00<br />
99205 $142.00<br />
99291 $126.00<br />
99354 $71.00<br />
95864 $126.00<br />
95961 $140.00<br />
96425 $111.00<br />
99211 $17.00<br />
99292 $63.00<br />
99355 $70.00<br />
95865 $72.92<br />
95962 $147.00<br />
96440 $247.00<br />
99212 $31.00<br />
99293 $196.00<br />
99356 $65.00<br />
95866 $49.84<br />
95970 $34.00<br />
96445 $244.00<br />
99213 $42.00<br />
99294 $131.00<br />
99357 $66.00<br />
95867 $47.00<br />
95971 $40.00<br />
96450 $210.00<br />
99214 $67.00<br />
99295 $225.00<br />
99360 $81.00<br />
95868 $71.00<br />
95972 $75.00<br />
96521 $95.00<br />
99215 $98.00<br />
99296 $132.00<br />
99374 $26.00<br />
95869 $24.00<br />
95973 $43.00<br />
96522 $69.00<br />
99217 $51.00<br />
99298 $125.00<br />
99377 $50.00<br />
95870 $21.00<br />
95974 $130.00<br />
96523 $17.00<br />
99218 $48.00<br />
99299 $89.00<br />
99391 $27.00<br />
95872 $69.00<br />
95975 $58.00<br />
96542 $135.00<br />
99219 $81.00<br />
99300 $124.48<br />
99392 $27.00<br />
95873 $17.84<br />
95978 $140.37<br />
96567 $29.00<br />
99220 $113.00<br />
99305 $55.60<br />
99393 $27.00<br />
p. 35
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
99394 $27.00<br />
99395 $27.00<br />
99401 $13.00<br />
99402 $13.00<br />
99431 $50.00<br />
99432 $60.00<br />
99433 $28.00<br />
99435 $68.00<br />
99436 $66.00<br />
99440 $123.00<br />
p. 36
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
Technical Component (modifier=TC)<br />
21172 $593.80 Yes<br />
70460 $96.75<br />
71110 $15.90<br />
72146 $227.51<br />
73092 $6.48<br />
73660 $10.26<br />
24332 $297.21<br />
70470 $103.14<br />
71111 $21.90<br />
72147 $205.49<br />
73100 $12.50<br />
73700 $37.79<br />
49323 $365.56<br />
70480 $105.76<br />
71120 $16.20<br />
72148 $224.44<br />
73110 $13.50<br />
73701 $120.49<br />
61770 $258.57<br />
70481 $102.16<br />
71130 $20.78<br />
72149 $246.81<br />
73115 $14.40<br />
73702 $84.48<br />
70010 $61.05<br />
70482 $124.65<br />
71250 $136.51<br />
72156 $476.59<br />
73120 $9.80<br />
73706 $179.00<br />
70015 $52.40<br />
70486 $59.39<br />
71260 $141.50<br />
72157 $476.59<br />
73130 $11.35<br />
73718 $267.00<br />
70030 $10.00<br />
70487 $59.39<br />
71270 $169.19<br />
72158 $471.00<br />
73140 $11.06<br />
73719 $320.00<br />
70100 $13.50<br />
70488 $121.08<br />
71275 $212.00<br />
72170 $13.70<br />
73200 $124.96<br />
73720 $416.00<br />
70110 $12.60<br />
70490 $159.01<br />
71550 $385.50<br />
72190 $15.30<br />
73201 $125.10<br />
73721 $252.95<br />
70120 $16.20<br />
70491 $110.00<br />
71551 $321.00<br />
72191 $204.00<br />
73202 $43.20<br />
73722 $320.00<br />
70130 $10.80<br />
70496 $174.00<br />
71552 $589.00<br />
72192 $41.57<br />
73206 $179.00<br />
73723 $592.00<br />
70134 $25.20<br />
70498 $174.00<br />
71555 $268.00<br />
72193 $53.99<br />
73218 $267.00<br />
73725 $268.00<br />
70140 $15.70<br />
70540 $421.00<br />
72010 $28.80<br />
72194 $123.83<br />
73219 $320.00<br />
74000 $9.60<br />
70150 $15.00<br />
70542 $320.00<br />
72020 $20.70<br />
72195 $268.00<br />
73220 $215.00<br />
74010 $10.80<br />
70160 $13.50<br />
70543 $592.00<br />
72040 $14.60<br />
72196 $416.00<br />
73221 $211.99<br />
74020 $12.60<br />
70170 $16.30<br />
70544 $271.00<br />
72050 $16.80<br />
72197 $594.00<br />
73222 $320.00<br />
74022 $22.59<br />
70190 $12.06<br />
70545 $217.00<br />
72052 $22.00<br />
72198 $268.00<br />
73223 $592.16<br />
74150 $96.75<br />
70200 $12.00<br />
70546 $530.00<br />
72069 $12.44<br />
72200 $6.00<br />
73500 $18.90<br />
74160 $94.42<br />
70210 $11.90<br />
70547 $271.00<br />
72070 $17.40<br />
72202 $13.40<br />
73510 $15.30<br />
74170 $119.69<br />
70220 $15.12<br />
70548 $271.00<br />
72072 $14.41<br />
72220 $8.96<br />
73520 $19.04<br />
74175 $204.00<br />
70240 $5.94<br />
70549 $523.00<br />
72074 $14.41<br />
72240 $36.00<br />
73525 $32.00<br />
74181 $215.00<br />
70250 $15.12<br />
70551 $205.72<br />
72080 $20.20<br />
72255 $20.48<br />
73530 $17.46<br />
74182 $321.00<br />
70260 $17.40<br />
70552 $246.81<br />
72090 $13.80<br />
72265 $33.12<br />
73540 $16.74<br />
74183 $594.00<br />
70300 $3.29<br />
70553 $470.00<br />
72100 $17.75<br />
72270 $46.08<br />
73542 $46.58<br />
74185 $268.00<br />
70310 $8.10<br />
71010 $11.88<br />
72110 $20.25<br />
72275 $48.49<br />
73550 $14.74<br />
74210 $33.41<br />
70320 $18.00<br />
71015 $14.40<br />
72114 $11.50<br />
72285 $63.45<br />
73560 $15.20<br />
74220 $15.30<br />
70328 $10.80<br />
71020 $13.80<br />
72120 $21.64<br />
72295 $54.35<br />
73562 $24.01<br />
74230 $15.66<br />
70330 $15.67<br />
71021 $21.60<br />
72125 $99.90<br />
73000 $10.90<br />
73564 $16.74<br />
74235 $130.22<br />
70332 $40.00<br />
71022 $11.91<br />
72126 $56.34<br />
73010 $11.07<br />
73565 $14.50<br />
74240 $21.60<br />
70336 $193.18 Yes<br />
71023 $3.60<br />
72127 $196.24<br />
73020 $14.40<br />
73580 $53.00<br />
74241 $18.90<br />
70350 $11.00<br />
71030 $13.50<br />
72128 $146.09<br />
73030 $12.42<br />
73590 $13.20<br />
74245 $22.14<br />
70355 $16.61<br />
71034 $18.00<br />
72129 $52.80<br />
73040 $14.40<br />
73592 $6.12<br />
74246 $22.27<br />
70360 $9.80<br />
71035 $12.96<br />
72130 $164.00<br />
73050 $8.10<br />
73600 $12.50<br />
74247 $33.30<br />
70370 $9.79<br />
71040 $23.76<br />
72131 $99.00<br />
73060 $14.74<br />
73610 $13.50<br />
74249 $45.89<br />
70373 $28.31<br />
71060 $30.51<br />
72132 $96.39<br />
73070 $11.90<br />
73615 $14.40<br />
74250 $15.12<br />
70380 $15.59<br />
71090 $40.50<br />
72133 $208.09<br />
73080 $14.58<br />
73620 $12.50<br />
74260 $36.66<br />
70390 $13.58<br />
71100 $9.72<br />
72141 $208.78<br />
73085 $18.00<br />
73630 $13.50<br />
74270 $24.00<br />
70450 $99.00<br />
71101 $18.60<br />
72142 $250.49<br />
73090 $12.28<br />
73650 $13.50<br />
74280 $44.00<br />
p. 1
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
74283 $45.59<br />
75635 $204.00<br />
75870 $59.60<br />
76078 $17.00<br />
76529 $33.77<br />
76940 $40.00<br />
74290 $15.66<br />
75650 $119.99<br />
75872 $234.85<br />
76080 $15.90<br />
76536 $19.20<br />
76941 $36.00<br />
74291 $14.70<br />
75658 $171.00<br />
75880 $47.46<br />
76082 $10.00<br />
76604 $48.01<br />
76942 $126.00<br />
74300 $10.80<br />
75660 $204.10<br />
75885 $70.19<br />
76083 $10.00<br />
76645 $36.09<br />
76945 $33.00<br />
74301 $80.99<br />
75662 $159.56<br />
75889 $206.98<br />
76086 $15.00<br />
76700 $65.00<br />
76946 $21.60<br />
74305 $18.90<br />
75665 $72.90<br />
75891 $57.72<br />
76088 $21.60<br />
76705 $33.74<br />
76950 $81.00<br />
74320 $21.44<br />
75671 $49.50<br />
75893 $21.71<br />
76090 $31.50<br />
76770 $38.00<br />
76965 $119.00<br />
74327 $22.95<br />
75676 $27.61<br />
75894 $33.20<br />
76091 $32.00<br />
76775 $18.00<br />
76975 $29.88<br />
74328 $7.20<br />
75680 $158.61<br />
75896 $84.84<br />
76092 $31.64<br />
76778 $39.93<br />
76977 $17.99<br />
74329 $36.00<br />
75685 $132.40<br />
75898 $9.88<br />
76093 $421.00<br />
76800 $29.29<br />
76986 $39.60<br />
74330 $38.40<br />
75705 $124.10<br />
75900 $423.00<br />
76094 $571.00<br />
76801 $24.00<br />
77280 $98.00<br />
74340 $59.99<br />
75710 $40.50<br />
75940 $94.26<br />
76095 $139.76<br />
76802 $17.00<br />
77285 $101.00<br />
74350 $57.75<br />
75716 $95.76<br />
75960 $27.00<br />
76096 $22.50<br />
76805 $25.50<br />
77290 $157.78<br />
74360 $41.25<br />
75722 $114.25<br />
75961 $45.44<br />
76098 $16.88<br />
76810 $79.23<br />
77295 $667.00<br />
74363 $118.80<br />
75724 $108.00<br />
75962 $280.00<br />
76100 $28.80<br />
76811 $81.00<br />
77300 $16.88<br />
74400 $33.30<br />
75726 $193.18<br />
75964 $97.44<br />
76101 $18.60<br />
76815 $25.00<br />
77301 $610.00<br />
74410 $38.70<br />
75731 $72.00<br />
75966 $70.00<br />
76102 $32.41<br />
76816 $32.00<br />
77305 $20.21<br />
74415 $20.52<br />
75733 $108.00<br />
75968 $97.44<br />
76120 $7.68<br />
76817 $34.87<br />
77310 $44.02<br />
74420 $10.80<br />
75736 $54.00<br />
75970 $246.80<br />
76125 $14.39<br />
76818 $48.00<br />
77315 $51.50<br />
74425 $32.40<br />
75741 $78.81<br />
75978 $280.00<br />
76140 $15.84<br />
76819 $39.00<br />
77321 $36.00<br />
74430 $18.00<br />
75743 $108.00<br />
75980 $89.09<br />
76150 $15.00<br />
76820 $39.04<br />
77326 $29.95<br />
74440 $22.80<br />
75746 $52.41<br />
75982 $47.00<br />
76350 $27.53<br />
76821 $39.04<br />
77327 $44.99<br />
74445 $18.25<br />
75756 $89.86<br />
75984 $36.53<br />
76355 $84.90<br />
76825 $80.00<br />
77328 $53.99<br />
74450 $11.70<br />
75774 $91.20<br />
75989 $58.34<br />
76360 $19.19<br />
76826 $14.00<br />
77331 $143.00<br />
74455 $25.42<br />
75790 $37.65<br />
75998 $32.00<br />
76362 $198.00<br />
76827 $42.06<br />
77332 $40.50<br />
74470 $32.40<br />
75801 $63.46<br />
76000 $5.76<br />
76370 $50.41<br />
76828 $24.00<br />
77333 $50.62<br />
74475 $20.87<br />
75803 $95.76<br />
76003 $26.67<br />
76376 $75.01<br />
76830 $28.74<br />
77334 $72.01<br />
74480 $28.80<br />
75805 $57.90<br />
76005 $28.88<br />
76377 $79.39<br />
76831 $33.00<br />
77336 $36.01<br />
74485 $63.47<br />
75807 $72.00<br />
76010 $12.05<br />
76380 $66.29<br />
76856 $48.00<br />
77370 $50.41<br />
74710 $10.80<br />
75809 $57.00<br />
76020 $12.20<br />
76393 $270.00<br />
76857 $32.00<br />
77401 $25.10<br />
74740 $36.90<br />
75810 $47.46<br />
76040 $18.10<br />
76394 $261.00<br />
76870 $14.45<br />
77402 $32.19<br />
74775 $29.00<br />
75820 $33.48<br />
76061 $19.45<br />
76400 $268.00<br />
76872 $34.24<br />
77403 $44.00<br />
75552 $385.00<br />
75822 $30.00<br />
76062 $28.00<br />
76506 $27.00<br />
76873 $47.22<br />
77404 $33.51<br />
75553 $268.00<br />
75825 $40.49<br />
76065 $12.00<br />
76510 $51.02<br />
76880 $62.22<br />
77406 $11.50<br />
75554 $268.00<br />
75827 $40.49<br />
76066 $25.20<br />
76511 $15.00<br />
76885 $33.00<br />
77407 $60.00<br />
75555 $268.00<br />
75831 $103.15<br />
76070 $99.00<br />
76512 $72.00<br />
76886 $31.00<br />
77408 $39.80<br />
75600 $137.91<br />
75833 $79.78<br />
76071 $68.00<br />
76513 $37.00<br />
76930 $151.19<br />
77409 $28.26<br />
75605 $13.01<br />
75840 $103.15<br />
76075 $31.22<br />
76514 $2.00<br />
76932 $29.23<br />
77411 $38.94<br />
75625 $126.91<br />
75842 $115.20<br />
76076 $33.00<br />
76516 $79.20<br />
76936 $125.00<br />
77412 $31.29<br />
75630 $80.99<br />
75860 $59.60<br />
76077 $18.07<br />
76519 $2.54<br />
76937 $10.00<br />
77413 $64.00<br />
p. 2
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
77414 $30.84<br />
78122 $86.00<br />
78456 $89.59<br />
78645 $85.50<br />
93231 $38.00<br />
95867 $13.62<br />
77416 $44.36<br />
78130 $58.99<br />
78457 $41.57<br />
78650 $59.99<br />
93268 $95.00<br />
95868 $16.51<br />
77417 $18.75<br />
78135 $26.99<br />
78458 $51.59<br />
78660 $45.00<br />
93271 $49.00<br />
95870 $5.00<br />
77418 $365.56<br />
78140 $38.60<br />
78459 $59.00<br />
78700 $17.82<br />
93303 $77.00<br />
95874 $4.67<br />
77421 $73.89<br />
78185 $18.90<br />
78460 $72.61<br />
78701 $28.71<br />
93317 $51.00<br />
95920 $31.00<br />
77470 $54.00<br />
78195 $74.19<br />
78461 $153.00<br />
78704 $30.95<br />
93350 $55.00<br />
95933 $19.00<br />
77600 $101.25<br />
78201 $23.22<br />
78464 $124.66<br />
78707 $78.24<br />
93701 $16.00<br />
97012 $9.99<br />
77610 $66.82<br />
78202 $33.60<br />
78465 $229.81<br />
78708 $96.00<br />
93724 $95.00<br />
97024 $9.00<br />
77750 $187.50<br />
78205 $61.74<br />
78466 $81.90<br />
78709 $96.00<br />
93731 $12.00<br />
97026 $6.70<br />
77761 $200.00<br />
78206 $124.34<br />
78468 $81.90<br />
78715 $45.61<br />
93732 $12.00<br />
97028 $4.00<br />
77762 $250.00<br />
78215 $24.84<br />
78469 $81.90<br />
78725 $4.32<br />
93733 $18.00<br />
97150 $13.00<br />
77763 $287.00<br />
78216 $45.06<br />
78472 $28.08<br />
78730 $23.81<br />
93734 $9.00<br />
99195 $45.00<br />
77776 $215.20<br />
78220 $30.00<br />
78473 $72.01<br />
78740 $34.20<br />
93735 $11.00<br />
99218 $10.00<br />
77777 $247.48<br />
78223 $28.80<br />
78478 $29.29<br />
78760 $21.87<br />
93736 $15.00<br />
99219 $15.00<br />
77778 $272.23<br />
78230 $5.13<br />
78480 $29.77<br />
78761 $81.60<br />
93741 $22.00<br />
77781 $283.79<br />
78231 $42.84<br />
78481 $50.75<br />
78800 $72.00<br />
93742 $29.00<br />
77782 $451.00<br />
78232 $76.00<br />
78483 $127.60<br />
78801 $24.00<br />
93743 $22.00<br />
77783 $381.00<br />
78258 $128.82<br />
78491 $680.00<br />
78802 $21.60<br />
93744 $29.00<br />
77784 $384.21<br />
78261 $82.76<br />
78492 $990.00<br />
78804 $104.00<br />
93797 $7.62<br />
77789 $14.00<br />
78262 $21.59<br />
78494 $119.56<br />
78805 $48.97<br />
93798 $12.97<br />
77790 $11.24<br />
78264 $35.09<br />
78496 $37.60<br />
78806 $48.96<br />
93875 $36.50<br />
78000 $8.10<br />
78267 $7.17<br />
78580 $30.78<br />
78807 $127.76<br />
93922 $45.00<br />
78001 $14.80<br />
78268 $17.00<br />
78584 $37.79<br />
78890 $5.39<br />
93923 $55.00<br />
78003 $9.00<br />
78270 $22.50<br />
78585 $24.00<br />
78891 $36.01<br />
93924 $65.00<br />
78006 $18.90<br />
78271 $42.75<br />
78586 $22.14<br />
79005 $62.43<br />
93965 $34.20<br />
78007 $21.60<br />
78272 $14.15<br />
78587 $54.00<br />
79101 $62.43<br />
94010 $12.00<br />
78010 $13.50<br />
78278 $16.19<br />
78588 $74.37<br />
79200 $53.00<br />
94060 $18.00<br />
78011 $105.85<br />
78282 $25.49<br />
78591 $51.21<br />
79440 $49.62<br />
94200 $7.11<br />
78015 $26.39<br />
78290 $20.52<br />
78593 $28.03<br />
79445 $62.83<br />
95810 $249.00<br />
78016 $18.01<br />
78291 $61.67<br />
78594 $61.81<br />
88240 $9.54<br />
95816 $39.00<br />
78018 $81.57<br />
78300 $32.94<br />
78596 $62.94<br />
88241 $9.54<br />
95819 $193.18<br />
78070 $37.00<br />
78305 $44.40<br />
78600 $40.50<br />
88346 $6.20<br />
95832 $9.60<br />
78075 $7.56<br />
78306 $72.28<br />
78601 $46.40<br />
90989 $158.00<br />
95833 $15.64<br />
78102 $72.00<br />
78315 $83.83<br />
78605 $51.30<br />
90993 $12.00<br />
95851 $6.33<br />
78103 $14.39<br />
78320 $96.98<br />
78606 $40.50<br />
92135 $15.00<br />
95860 $7.16<br />
78104 $32.99<br />
78350 $111.68<br />
78607 $118.00<br />
92136 $33.00<br />
95861 $14.33<br />
78110 $18.40<br />
78351 $35.00<br />
78610 $9.72<br />
93005 $13.00<br />
95863 $18.10<br />
78111 $30.80<br />
78414 $15.07<br />
78615 $26.99<br />
93014 $29.50<br />
95864 $34.41<br />
78120 $20.19<br />
78428 $18.89<br />
78630 $15.00<br />
93017 $24.99<br />
95865 $15.14<br />
78121 $37.60<br />
78445 $92.62<br />
78635 $68.39<br />
93041 $4.00<br />
95866 $4.86<br />
p. 3
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
Professional Component (modifier=26)<br />
51725 $53.00<br />
70350 $8.00<br />
71023 $17.00<br />
72127 $56.00<br />
73020 $7.00<br />
73580 $19.00<br />
51726 $69.00<br />
70355 $9.00<br />
71030 $14.00<br />
72128 $51.00<br />
73030 $8.00<br />
73590 $8.00<br />
51736 $22.00<br />
70360 $7.00<br />
71034 $18.00<br />
72129 $54.00<br />
73040 $19.00<br />
73592 $7.00<br />
51741 $46.00<br />
70370 $12.00<br />
71035 $8.00<br />
72130 $56.00<br />
73050 $9.00<br />
73600 $7.00<br />
51772 $66.00<br />
70373 $20.00<br />
71040 $20.00<br />
72131 $51.00<br />
73060 $8.00<br />
73610 $8.00<br />
51784 $62.00<br />
70380 $6.00<br />
71060 $26.00<br />
72132 $54.00<br />
73070 $7.00<br />
73615 $19.00<br />
51785 $62.00<br />
70390 $13.00<br />
71090 $20.00<br />
72133 $56.00<br />
73080 $8.00<br />
73620 $6.00<br />
51792 $41.00<br />
70450 $37.00<br />
71100 $10.00<br />
72141 $55.00<br />
73085 $19.00<br />
73630 $8.00<br />
51795 $62.00<br />
70460 $50.00<br />
71101 $11.00<br />
72142 $66.00<br />
73090 $7.00<br />
73650 $7.00<br />
51797 $65.00<br />
70470 $56.00<br />
71110 $12.00<br />
72146 $57.00<br />
73092 $7.00<br />
73660 $6.00<br />
59025 $24.00<br />
70480 $55.00<br />
71111 $14.00<br />
72147 $66.00<br />
73100 $7.00<br />
73700 $48.00<br />
62368 $29.00<br />
70481 $61.00<br />
71120 $9.00<br />
72148 $56.00<br />
73110 $8.00<br />
73701 $51.00<br />
70010 $41.00<br />
70482 $50.00<br />
71130 $10.00<br />
72149 $62.00<br />
73115 $19.00<br />
73702 $54.00<br />
70015 $41.00<br />
70486 $51.00<br />
71250 $42.00<br />
72156 $89.00<br />
73120 $6.00<br />
73706 $44.00<br />
70030 $8.00<br />
70487 $57.00<br />
71260 $52.00<br />
72157 $89.00<br />
73130 $8.00<br />
73718 $35.00<br />
70100 $8.00<br />
70488 $63.00<br />
71270 $61.00<br />
72158 $82.00<br />
73140 $6.00<br />
73719 $41.00<br />
70110 $9.00<br />
70490 $57.00<br />
71275 $44.00<br />
72170 $8.00<br />
73200 $37.00<br />
73720 $66.00<br />
70120 $8.00<br />
70491 $61.00<br />
71550 $71.00<br />
72190 $10.00<br />
73201 $51.00<br />
73721 $48.00<br />
70130 $15.00<br />
70492 $59.00<br />
71551 $46.00<br />
72191 $44.00<br />
73202 $54.00<br />
73722 $41.00<br />
70134 $12.00<br />
70496 $64.00<br />
71552 $60.00<br />
72192 $48.00<br />
73206 $44.00<br />
73723 $56.00<br />
70140 $9.00<br />
70498 $64.00<br />
71555 $63.00<br />
72193 $51.00<br />
73218 $35.00<br />
73725 $63.00<br />
70150 $10.00<br />
70540 $66.00<br />
72010 $20.00<br />
72194 $54.00<br />
73219 $56.00<br />
74000 $6.00<br />
70160 $8.00<br />
70542 $41.00<br />
72020 $6.00<br />
72195 $39.00<br />
73220 $66.00<br />
74010 $10.00<br />
70170 $10.00<br />
70543 $56.00<br />
72040 $10.00<br />
72196 $71.00<br />
73221 $48.00<br />
74020 $9.00<br />
70190 $10.00<br />
70544 $43.00<br />
72050 $11.00<br />
72197 $61.00<br />
73222 $41.00<br />
74022 $14.00<br />
70200 $12.00<br />
70545 $43.00<br />
72052 $16.00<br />
72198 $65.00<br />
73223 $56.00<br />
74150 $53.00<br />
70210 $8.00<br />
70546 $64.00<br />
72069 $10.00<br />
72200 $6.00<br />
73500 $8.00<br />
74160 $56.00<br />
70220 $11.00<br />
70547 $43.00<br />
72070 $10.00<br />
72202 $9.00<br />
73510 $10.00<br />
74170 $62.00<br />
70240 $9.00<br />
70548 $43.00<br />
72072 $8.00<br />
72220 $8.00<br />
73520 $12.00<br />
74175 $44.00<br />
70250 $11.00<br />
70549 $64.00<br />
72074 $10.00<br />
72240 $40.00<br />
73525 $21.00<br />
74181 $71.00<br />
70260 $12.00<br />
70551 $51.00<br />
72080 $10.00<br />
72255 $31.00<br />
73530 $13.00<br />
74182 $46.00<br />
70300 $5.00<br />
70552 $62.00<br />
72090 $10.00<br />
72265 $37.00<br />
73540 $7.00<br />
74183 $61.00<br />
70310 $6.00<br />
70553 $82.00<br />
72100 $10.00<br />
72270 $59.00<br />
73542 $18.00<br />
74185 $62.00<br />
70320 $8.00<br />
71010 $8.00<br />
72110 $14.00<br />
72275 $18.00<br />
73550 $8.00<br />
74210 $16.00<br />
70328 $7.00<br />
71015 $7.00<br />
72114 $16.00<br />
72285 $38.00<br />
73560 $7.00<br />
74220 $19.00<br />
70330 $11.00<br />
71020 $9.00<br />
72120 $9.00<br />
72295 $29.00<br />
73562 $8.00<br />
74230 $19.00<br />
70332 $19.00<br />
71021 $9.00<br />
72125 $45.00<br />
73000 $7.00<br />
73564 $10.00<br />
74235 $53.00<br />
70336 $51.00 Yes<br />
71022 $11.00<br />
72126 $54.00<br />
73010 $8.00<br />
73565 $8.00<br />
74240 $28.00<br />
p. 1
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
74241 $25.00<br />
74740 $17.00<br />
75809 $16.00<br />
75989 $41.00<br />
76120 $14.00<br />
76821 $25.31<br />
74245 $36.00<br />
74742 $21.00<br />
75810 $39.00<br />
75992 $19.00<br />
76125 $12.00<br />
76825 $54.00<br />
74246 $31.00<br />
74775 $28.00<br />
75820 $24.00<br />
75993 $13.00<br />
76355 $42.00<br />
76826 $33.00<br />
74247 $24.00<br />
75552 $71.00<br />
75822 $36.00<br />
75994 $46.00<br />
76360 $43.00<br />
76827 $31.00<br />
74249 $41.00<br />
75553 $69.00<br />
75825 $39.00<br />
75996 $13.00<br />
76362 $133.00<br />
76828 $20.00<br />
74250 $20.00<br />
75554 $64.00<br />
75827 $39.00<br />
75998 $14.00<br />
76376 $6.94<br />
76830 $24.00<br />
74260 $17.00<br />
75555 $62.00<br />
75831 $39.00<br />
76000 $8.00<br />
76377 $27.31<br />
76831 $25.00<br />
74270 $25.00<br />
75600 $23.00<br />
75833 $51.00<br />
76001 $23.00<br />
76380 $34.00<br />
76856 $28.00<br />
74280 $34.00<br />
75605 $40.00<br />
75840 $39.00<br />
76003 $24.00<br />
76393 $53.00<br />
76857 $13.00<br />
74283 $70.00<br />
75625 $40.00<br />
75842 $51.00<br />
76005 $20.00<br />
76394 $141.00<br />
76870 $28.00<br />
74290 $14.00<br />
75630 $60.00<br />
75860 $40.00<br />
76010 $8.00<br />
76400 $71.00<br />
76872 $24.00<br />
74291 $9.00<br />
75635 $68.00<br />
75870 $39.00<br />
76013 $59.00<br />
76506 $22.00<br />
76873 $46.00<br />
74300 $15.00<br />
75650 $51.00<br />
75872 $39.00<br />
76020 $9.00<br />
76510 $57.20<br />
76880 $26.00<br />
74301 $10.00<br />
75658 $59.00<br />
75880 $24.00<br />
76040 $12.00<br />
76511 $32.00<br />
76885 $25.00<br />
74305 $19.00<br />
75660 $45.00<br />
75885 $50.00<br />
76061 $16.00<br />
76512 $24.00<br />
76886 $21.00<br />
74320 $19.00<br />
75662 $58.00<br />
75887 $50.00<br />
76062 $19.00<br />
76513 $25.00<br />
76930 $31.00<br />
74327 $24.00<br />
75665 $46.00<br />
75889 $39.00<br />
76065 $12.00<br />
76514 $6.00<br />
76932 $24.00<br />
74328 $24.00<br />
75671 $57.00<br />
75891 $40.00<br />
76066 $13.00<br />
76516 $23.00<br />
76936 $74.00<br />
74329 $24.00<br />
75676 $46.00<br />
75893 $24.00<br />
76070 $9.00<br />
76519 $26.00<br />
76937 $11.00<br />
74330 $30.00<br />
75680 $57.00<br />
75894 $45.00<br />
76071 $8.00<br />
76529 $21.00<br />
76940 $70.00<br />
74340 $20.00<br />
75685 $45.00<br />
75896 $46.00<br />
76075 $10.00<br />
76536 $25.00<br />
76941 $48.00<br />
74350 $26.00<br />
75705 $75.00<br />
75898 $57.00<br />
76076 $8.00<br />
76604 $19.00<br />
76942 $30.00<br />
74355 $26.00<br />
75710 $40.00<br />
75900 $16.00<br />
76077 $6.08<br />
76645 $23.00<br />
76945 $27.00<br />
74360 $21.00<br />
75716 $57.00<br />
75940 $24.00<br />
76078 $7.00<br />
76700 $36.00<br />
76946 $13.00<br />
74363 $39.00<br />
75722 $40.00<br />
75953 $60.00<br />
76080 $19.00<br />
76705 $24.00<br />
76950 $26.00<br />
74400 $22.00<br />
75724 $53.00<br />
75956 $248.47<br />
76082 $2.00<br />
76770 $33.00<br />
76965 $58.00<br />
74410 $22.00<br />
75726 $39.00<br />
75957 $212.88<br />
76083 $2.00<br />
76775 $20.00<br />
76975 $28.00<br />
74415 $22.00<br />
75731 $39.00<br />
75958 $141.93<br />
76086 $16.00<br />
76778 $26.00<br />
76977 $2.00<br />
74420 $16.00<br />
75733 $45.00<br />
75959 $124.24<br />
76088 $16.00<br />
76800 $39.00<br />
76986 $42.00<br />
74425 $12.00<br />
75736 $39.00<br />
75960 $29.00<br />
76090 $18.00<br />
76801 $32.00<br />
77280 $25.00<br />
74430 $14.00<br />
75741 $45.00<br />
75961 $165.00<br />
76091 $22.00<br />
76802 $27.00<br />
77285 $37.00<br />
74440 $13.00<br />
75743 $57.00<br />
75962 $24.00<br />
76092 $16.00<br />
76805 $36.00<br />
77290 $55.00<br />
74445 $40.00<br />
75746 $39.00<br />
75964 $16.00<br />
76093 $56.00<br />
76810 $68.00<br />
77295 $157.00<br />
74450 $14.00<br />
75756 $41.00<br />
75966 $46.00<br />
76094 $56.00<br />
76811 $62.00<br />
77300 $27.00<br />
74455 $15.00<br />
75774 $16.00<br />
75968 $16.00<br />
76095 $56.00<br />
76815 $23.00<br />
77301 $272.00<br />
74470 $19.00<br />
75790 $82.00<br />
75970 $37.00<br />
76096 $25.00<br />
76816 $20.00<br />
77305 $25.00<br />
74475 $24.00<br />
75801 $28.00<br />
75978 $28.00<br />
76098 $7.00<br />
76817 $25.58<br />
77310 $37.00<br />
74480 $24.00<br />
75803 $40.00<br />
75980 $64.00<br />
76100 $26.00<br />
76818 $27.00<br />
77315 $55.00<br />
74485 $24.00<br />
75805 $28.00<br />
75982 $50.00<br />
76101 $26.00<br />
76819 $23.00<br />
77321 $43.00<br />
74710 $15.00<br />
75807 $40.00<br />
75984 $32.00<br />
76102 $20.00<br />
76820 $18.19<br />
77326 $33.00<br />
p. 2
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
77327 $49.00<br />
78122 $20.00<br />
78457 $34.00<br />
78645 $25.00<br />
86320 $14.00<br />
88361 $36.00<br />
77328 $94.00<br />
78130 $21.00<br />
78458 $40.00<br />
78650 $21.00<br />
86325 $14.00<br />
88362 $79.00<br />
77331 $39.00<br />
78135 $28.00<br />
78459 $51.82<br />
78660 $24.00<br />
87164 $14.00<br />
88365 $33.00<br />
77332 $19.00<br />
78140 $21.00<br />
78460 $38.00<br />
78700 $20.00<br />
87207 $14.00<br />
88367 $47.98<br />
77333 $29.00<br />
78185 $18.00<br />
78461 $51.00<br />
78701 $22.00<br />
88104 $20.00<br />
88368 $52.00<br />
77334 $43.00<br />
78191 $27.00<br />
78464 $49.00<br />
78704 $33.00<br />
88106 $23.00<br />
88371 $14.00<br />
77421 $13.04<br />
78195 $39.00<br />
78465 $51.00<br />
78707 $37.00<br />
88107 $26.00<br />
88385 $53.05<br />
77470 $73.00<br />
78201 $20.00<br />
78466 $24.00<br />
78708 $40.00<br />
88108 $26.00<br />
88386 $66.70<br />
77600 $70.00<br />
78202 $23.00<br />
78468 $28.00<br />
78709 $46.00<br />
88112 $44.00<br />
91000 $29.00<br />
77750 $170.00<br />
78205 $32.00<br />
78469 $32.00<br />
78710 $28.00<br />
88125 $10.00<br />
91010 $54.00<br />
77761 $168.00<br />
78206 $31.00<br />
78472 $44.00<br />
78715 $11.00<br />
88160 $18.00<br />
91011 $60.00<br />
77762 $199.00<br />
78215 $22.00<br />
78473 $66.00<br />
78725 $13.00<br />
88161 $18.00<br />
91012 $63.00<br />
77763 $300.00<br />
78216 $25.00<br />
78478 $22.00<br />
78730 $13.00<br />
88162 $28.00<br />
91020 $62.00<br />
77776 $205.00<br />
78220 $17.00<br />
78480 $22.00<br />
78740 $25.00<br />
88172 $23.00<br />
91030 $31.00<br />
77777 $261.00<br />
78223 $37.00<br />
78481 $44.00<br />
78760 $30.00<br />
88173 $48.00<br />
91034 $37.00<br />
77778 $393.00<br />
78230 $16.00<br />
78483 $67.00<br />
78761 $32.00<br />
88182 $29.00<br />
91035 $60.00<br />
77781 $74.00<br />
78231 $18.00<br />
78491 $54.00<br />
78800 $24.00<br />
88300 $5.00<br />
91037 $34.67<br />
77782 $87.00<br />
78232 $16.00<br />
78492 $68.00<br />
78801 $35.00<br />
88302 $8.00<br />
91038 $39.26<br />
77783 $129.00<br />
78261 $24.00<br />
78494 $39.00<br />
78802 $38.00<br />
88304 $13.00<br />
91040 $34.67<br />
77784 $194.00<br />
78262 $30.00<br />
78496 $17.00<br />
78803 $41.00<br />
88305 $31.00<br />
91052 $30.00<br />
77789 $48.00<br />
78264 $35.00<br />
78580 $33.00<br />
78804 $37.00<br />
88307 $58.00<br />
91055 $34.00<br />
77790 $37.00<br />
78267 $7.17<br />
78584 $44.00<br />
78805 $25.00<br />
88309 $84.00<br />
91060 $20.00<br />
78000 $9.00<br />
78268 $17.00<br />
78585 $37.00<br />
78806 $30.00<br />
88311 $11.00<br />
91065 $9.00<br />
78001 $9.00<br />
78270 $7.00<br />
78586 $18.00<br />
78807 $38.00<br />
88312 $21.00<br />
91110 $137.00<br />
78003 $11.00<br />
78271 $9.00<br />
78587 $18.00<br />
78811 $55.00<br />
88313 $9.00<br />
91120 $34.87<br />
78006 $22.00<br />
78272 $9.00<br />
78588 $35.00<br />
78812 $68.00<br />
88314 $18.00<br />
91122 $68.00<br />
78007 $22.00<br />
78278 $34.00<br />
78591 $14.00<br />
78813 $71.00<br />
88318 $14.00<br />
92135 $13.00<br />
78010 $17.00<br />
78282 $13.00<br />
78593 $17.00<br />
78814 $78.00<br />
88319 $19.00<br />
92136 $20.00<br />
78011 $20.00<br />
78290 $24.00<br />
78594 $19.00<br />
78815 $86.00<br />
88323 $46.00<br />
92235 $36.00<br />
78016 $29.00<br />
78291 $32.00<br />
78596 $44.00<br />
78816 $88.00<br />
88331 $53.00<br />
92240 $42.00<br />
78018 $39.00<br />
78300 $27.00<br />
78600 $20.00<br />
79005 $63.01<br />
88332 $28.00<br />
92548 $21.00<br />
78070 $27.00<br />
78305 $37.00<br />
78601 $23.00<br />
79101 $68.84<br />
88333 $42.50<br />
92585 $24.00<br />
78075 $26.00<br />
78306 $38.00<br />
78605 $24.00<br />
79440 $70.00<br />
88334 $20.90<br />
92978 $70.00<br />
78102 $24.00<br />
78315 $35.00<br />
78606 $28.00<br />
79445 $84.73<br />
88342 $30.00<br />
92979 $56.00<br />
78103 $26.00<br />
78320 $36.00<br />
78607 $43.00<br />
83020 $14.00<br />
88346 $39.00<br />
93303 $51.00<br />
78104 $36.00<br />
78350 $10.00<br />
78608 $53.00<br />
84165 $14.00<br />
88347 $28.00<br />
93304 $31.00<br />
78110 $7.00<br />
78414 $21.00<br />
78609 $53.00<br />
84166 $13.20<br />
88348 $61.00<br />
93307 $42.00<br />
78111 $9.00<br />
78428 $33.00<br />
78610 $13.00<br />
85390 $13.00<br />
88349 $42.00<br />
93308 $23.00<br />
78120 $11.00<br />
78445 $22.00<br />
78615 $16.00<br />
86255 $14.00<br />
88358 $101.00<br />
93312 $84.00<br />
78121 $14.00<br />
78456 $33.00<br />
78630 $24.00<br />
86256 $14.00<br />
88360 $41.08<br />
93314 $48.00<br />
p. 3
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Agency</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.? Code <strong>Fee</strong> P.A.?<br />
93315 $106.00<br />
93623 $121.00<br />
93979 $17.00<br />
95867 $32.00<br />
93317 $70.00<br />
93624 $193.00<br />
93980 $48.00<br />
95868 $57.00<br />
93318 $69.00<br />
93631 $392.00<br />
93990 $10.00<br />
95870 $16.00<br />
93320 $18.00<br />
93640 $198.00<br />
94010 $8.00<br />
95874 $13.39<br />
93321 $7.00<br />
93641 $260.00<br />
94060 $13.00<br />
95900 $20.00<br />
93325 $4.00<br />
93642 $232.00<br />
94070 $22.00<br />
95903 $24.00<br />
93350 $57.00<br />
93660 $75.00<br />
94200 $5.00<br />
95904 $15.00<br />
93501 $142.00<br />
93701 $7.00<br />
94240 $11.00<br />
95920 $86.00<br />
93505 $180.00<br />
93724 $184.00<br />
94260 $6.00<br />
95921 $34.00<br />
93508 $173.00<br />
93731 $18.00<br />
94350 $10.00<br />
95922 $33.00<br />
93510 $182.00<br />
93732 $35.00<br />
94360 $10.00<br />
95923 $36.00<br />
93511 $197.00<br />
93733 $8.00<br />
94370 $11.00<br />
95925 $24.00<br />
93514 $286.00<br />
93734 $15.00<br />
94375 $12.00<br />
95926 $26.00<br />
93524 $284.00<br />
93735 $29.00<br />
94452 $10.67<br />
95927 $25.00<br />
93526 $262.00<br />
93736 $7.00<br />
94453 $13.74<br />
95928 $55.78<br />
93527 $325.00<br />
93741 $31.00<br />
94620 $28.00<br />
95929 $56.00<br />
93528 $350.00<br />
93742 $35.00<br />
94621 $52.00<br />
95930 $17.00<br />
93529 $190.00<br />
93743 $40.00<br />
94680 $11.00<br />
95934 $20.00<br />
93530 $181.00<br />
93744 $46.00<br />
94681 $9.00<br />
95936 $21.00<br />
93531 $339.00<br />
93875 $10.00<br />
94690 $3.00<br />
95937 $27.00<br />
93532 $413.00<br />
93880 $27.00<br />
94720 $11.00<br />
95950 $61.00<br />
93533 $268.00<br />
93882 $16.00<br />
95805 $71.00<br />
95951 $239.00<br />
93555 $36.00<br />
93886 $37.00<br />
95806 $74.00<br />
95953 $123.00<br />
93556 $32.00<br />
93888 $24.00<br />
95807 $62.00<br />
95955 $43.00<br />
93561 $28.00<br />
93890 $36.83<br />
95808 $113.00<br />
95956 $112.00<br />
93562 $9.00<br />
93892 $42.18<br />
95810 $134.00<br />
95957 $79.00<br />
93600 $120.00<br />
93893 $42.00<br />
95811 $143.00<br />
93602 $87.00<br />
93922 $11.00<br />
95812 $43.00<br />
93603 $92.00<br />
93923 $21.00<br />
95813 $68.00<br />
93609 $236.00<br />
93924 $23.00<br />
95816 $43.00<br />
93610 $121.00<br />
93925 $23.00<br />
95819 $43.00<br />
93612 $121.00<br />
93926 $18.00<br />
95822 $43.00<br />
93613 $246.00<br />
93930 $21.00<br />
95824 $30.00<br />
93615 $34.00<br />
93931 $14.00<br />
95827 $43.00<br />
93616 $77.00<br />
93965 $16.00<br />
95860 $41.00<br />
93618 $195.00<br />
93970 $26.00<br />
95861 $63.00<br />
93619 $349.00<br />
93971 $17.00<br />
95863 $75.00<br />
93620 $537.00<br />
93975 $69.00<br />
95864 $92.00<br />
93621 $97.00<br />
93976 $45.00<br />
95865 $57.78<br />
93622 $125.00<br />
93978 $25.00<br />
95866 $44.98<br />
p. 4
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