What the amounts mean
- Non-facility is the fee when the service is done in the office. Facility is the fee when it's done in a hospital or other facility that is paid separately.
- Professional component is the fee for the interpretation only (modifier 26) on codes that have one.
- By report (BR) means there is no set fee: send documentation with the claim and Medicaid prices it.
- Prior approval means the service needs approval before it's done. DVS codes need a Dispensing Validation System number.
- Follow-up days is the global period: visits for the same problem in those days are included in the surgery fee.
- Cost means the drug is paid at the practice's acquisition cost; keep the invoice.
This tool shows New York State Medicaid fee-for-service fees from the eMedNY physician fee schedules (Medicine, Drugs, Radiology, Surgery, Anesthesia and Enhanced Program). Medicaid managed care plans set their own rates. Fees are checked against eMedNY every month. CPT is a registered trademark of the American Medical Association; code descriptions aren't shown.