Charge Master
The CMHC, Inc. Charge Master outlines the standard billable costs charged for services provided. Charges are the same for all patients, but a patient’s responsibility and out-of-pocket expenses (i.e. deductible, co-insurance, copays, etc.) may vary based upon insurance coverage and/or qualification for financial assistance. Patients can contact our Billing Department at (812) 537 – 1302 to determine whether they qualify for discounts. Please understand that few patients will pay the full charge amount listed due to insurance coverage and/or financial assistance discounts in place.
To view a copy of the current Charge Master, click here
For a PDF version, click here
| CODE | DESCRIPTION | |
| 5 | CLINICAL ASSESSMENT | |
| 9 | INDIVIDUAL THERAPY | |
| 10 | MARITAL/COUPLES THERAPY | $260.00/HOUR |
| 11 | FAMILY THERAPY | $260.00/HOUR |
| 12 | FAMILY SUPPORT GROUP | $25.00/EVENT |
| 13 | FAMILY GROUP THERAPY | $25.00/EVENT |
| 14 | GROUP PSYCHOTHERAPY | $136.40/EVENT |
| 16 | PEER SUPPORT SERVICES | $177.00/HOUR |
| 171 | SUD GROUP | $106.40/EVENT |
| 175 | IOP GROUP | $106.40/EVENT |
| 18 | PSYCHOLOGICAL INTERVIEW/TESTING | $120.00/HOUR |
| 19 | ANGER MANAGEMENT GROUP | $25.00/EVENT |
| 20 | FAMILY W/O PATIENT PRESENT | $260.00/HOUR |
| 21 | EMERGENCY SERVICES/DAYTIME | $100.00/HOUR |
| 22 | EMERGENCY SERVICES/AFTER HOURS | $200.00/HOUR |
| 24 | DBT GROUP | $136.40/EVENT |
| 25 | COACHING DBT | NO RATE |
| 30 | SSA CHILD MSE | $148.00/EVENT |
| 31 | SSA ADULT MSE | $148.00/EVENT |
| 32 | SSA WAIS IV | $125.00/EVENT |
| 33 | SSA WISC IV | $125.00/EVENT |
| 34 | SSA BAYLEY | $160.00/EVENT |
| 35 | SSA STANFORD BINET V | $140.00/EVENT |
| 36 | SSA WPPSI | $95.00/EVENT |
| 37 | SSA WMS IV | $200.00/EVENT |
| 38 | SSA VINELAND ADAPT | $160.00/EVENT |
| 39 | AT RISK ASSESSMENT | $65.00/HOUR |
| 50 | HB FAM CENTERED THERAPY | $98.40/HOUR |
| 51 | DCS HOME BASED ASSESSMENT | $80.00/HOUR |
| 52 | DCS REPORT | $78.76/HOUR |
| 53 | PARENT EDUCATION GROUP | $25.00/GROUP |
| 54 | HOMEMAKER SERVICES | $54.36/HOUR |
| 55 | PARENT EDUCATION INDIVIDUAL | $80.32/HOUR |
| 56 | PARENTING/FAM FUNCT ASSESS | $68.40/HOUR |
| 57 | HB FAM CENTER CASEWK SUPER VISIT | $79.32/HOUR |
| 58 | VISIT FACILITAT P/C/S SUPERVISED VIS | $54.36/HOUR |
| 59 | COUNSELING SUPERVISED VISITATION | $67.12/HOUR |
| 60 | HOMEMAKER SUPERVISED VISITATION | $54.36/HOUR |
| 61 | HB FAM CASEWORK FACE TO FACE | $79.32/HOUR |
| 62 | HB FAM CEN THERAPY SUP VISITATION | $98.36/HOUR |
| 63 | CARE NETWORK | $60.00/HOUR |
| 64 | DCS COUNSELING TEAM MTG | $64.00/HOUR |
| 65 | DCS WRAPAROUND PER DIEM | $965.49/EVENT |
| 66 | COUNSELING THERAPY | $68.40/HOUR |
| 67 | RECOVERY COACH | $80.00/HOUR |
| 68 | PRESERVATION PER DIEM | $113.47/EVENT |
| 69 | PRESERVATION WEEKLY SAFETY CK | $0.00 |
| 70 | PRESERVATION CONTACT TRACKING | $0.00 |
| 71 | PRESERVATION CHILD PER DIEM | $24.50/EVENT |
| 72 | PRESERVATION MONTHLY MEETING | $0.00 |
| 250 | WRAPAROUND FACILITATION | $115.00/HOUR |
| 251 | WRAPAROUND TECHNICIAN | $104.56/HOUR |
| 252 | HABILITATION | $85.60/HOUR |
| 253 | RESPITE CARE | $16.00/HOUR |
| 254 | CRISIS RESPITE | $15.00/HOUR |
| 255 | NON-MEDICAID TRANSPORATION | $5.00/ONE WAY TRIP |
| 256 | THERAPEUTIC SERVICES | $90.00/HOUR |
| 257 | TRAINING AND SUPPORT | $60.00/HOUR |
| 258 | FLEX FUNDS | $ FOR $ |
| 331 | INITIAL HOSPITAL CONSULT | $165.00/HOUR |
| 336 | SUBSEQUENT HOSPITAL CONSULT | $165.00/HOUR |
| 361 | IPU PHYSICAL | $125.00/EVENT |
| 366 | IPU PHYSICAL FOLLOW UP | $60.00/EVENT |
| 381 | INITIAL IPU PHYSICIAN ROUND | $85.00/EVENT |
| 382 | INITIAL IPU PHYSICIAN ROUND | $140.00/EVENT |
| 383 | INITIAL IPU PHYSICIAN ROUND | $190.00/EVENT |
| 391 | SUBSEQUENT IPU PHYSICIAN ROUND | $45.00/EVENT |
| 392 | SUBSEQUENT IPU PHYSICIAN ROUND | $75.00/EVENT |
| 393 | SUBSEQUENT IPU PHYSICIAN ROUND | $100.00/EVENT |
| 41 | INPATIENT DAY OF CARE | $1000.00/EVENT |
| 42 | THERAPEUTIC LEAVE DAY | $85.00/EVENT |
| 43 | ISOLATION MONITORING | $45.00/HOUR |
| 490 | MEDICINAL SUPPLIES | COST* |
| 491 | PHARMACY SERVICES | COST* |
| 492 | LABORATORY SERVICES | COST* |
| 493 | RADIOLOGY SERVICES | COST* |
| 494 | ELECTROCARDIOLOGY SERVICES | COST* |
| 495 | RESPIRATORY THERAPY | COST* |
| 496 | PHYSICAL THERAPY | COST* |
| 497 | NUCLEAR MEDICINE SERVICES | COST* |
| 499 | OTHER HOSPITAL SERVICES | COST* |
| 9500 | FACILITY CHG FOR SERVICE 05 | $146.88/EVENT |
| 9501 | FACILITY CHG FOR SERVICE 09 1/2 HR | $146.88/EVENT |
| 9502 | FACILITY CHG FOR SERVICE 09 1 HR | $146.88/EVENT |
| 9503 | FACILITY CHG FOR SERVICE 09 1 1/2 HR | $146.88/EVENT |
| 9504 | FACILITY CHG FOR SERVICE 10 | $100.00/EVENT |
| 9505 | FACILITY CHG FOR SERVICE 11 | $100.00/EVENT |
| 9506 | FACILITY CHG FOR SERVICE 13 | $50.00/EVENT |
| 9507 | FACILITY CHG FOR SERVICE 14 | $73.44/EVENT |
| 9508 | FACILITY CHG FOR SERVICE 20 | $100.00/EVENT |
| 9509 | FACILITY CHG FOR SERVICE 171/175 | $71.40/EVENT |
| 9510 | FACILITY CHG FOR SERVICE 311 | $60.00/EVENT |
| 9511 | FACILITY CHG FOR SERVICE 16 | $146.88/EVENT |
| 9600 | FACILITY CHG FOR SERVICE 99201 | $146.88/EVENT |
| 9601 | FACILITY CHG FOR SERVICE 99202 | $146.88/EVENT |
| 9602 | FACILITY CHG FOR SERVICE 99203 | $146.88/EVENT |
| 9603 | FACILITY CHG FOR SERVICE 99204 | $146.88/EVENT |
| 9604 | FACILITY CHG FOR SERVIC E 99205 | $146.88/EVENT |
| 9605 | FACILITY CHG FOR SERVICE 99211 | $146.88/EVENT |
| 9606 | FACILITY CHG FOR SERVICE 99212 | $146.88/EVENT |
| 9607 | FACILITY CHG FOR SERVICE 99213 | $146.88/EVENT |
| 9608 | FACILITY CHG FOR SERVICE 99214 | $146.88/EVENT |
| 9609 | FACILITY CHG FOR SERVICE 99215 | $146.88/EVENT |
| 9610 | FACILITY CHG FOR SERVICE 99495 | $100.00/EVENT |
* Actual charge for supplies/services received
| CODE | DESCRIPTION | RATE |
| 100 | MRO LON DETERMINATION | $77.72/EVENT |
| 101 | MRO INDIVIDUAL COUNSELING | $114.60/HOUR |
| 102 | MRO GROUP COUNSELING | $28.64/HOUR |
| 103 | MRO FAMILY WITH CONSUMER | $114.60/HOUR |
| 104 | MRO FAMILY WITHOUT CONSUMER | $114.60/HOUR |
| 105 | MRO FAMILY GROUP WITH CONSUMER | $28.64/HOUR |
| 106 | MRO FAMILY GROUP W/O CONSUMER | $28.64/HOUR |
| 107 | MRO MED TRAINING AND SUPPORT | $74.48/HOUR |
| 108 | MRO MED TRAINING GROUP | $13.40/HOUR |
| 109 | MRO MED TRAINING FAMILY | $74.48/HOUR |
| 110 | MRO MED TRAIN FAM GRP W/O CON | $13.40/HOUR |
| 111 | MRO MED TRAIN FAM WITH CON | $84.48/HOUR |
| 112 | MRO MED TRAIN FAM GRP WITH CON | $13.40/HOUR |
| 113 | MRO SKILLS TRAINING AND DEV IND | $104.56/HOUR |
| 114 | MRO SKILLS TRAINING GROUP | $18.84/HOUR |
| 115 | MRO SKILLS TRAIN FAMILY W/O CON | $104.56/HOUR |
| 116 | MRO SKILLS TRAIN FAM GRP W/O CONS | $18.84/HOUR |
| 117 | MRO SKILLS TRAIN FAMILY WITH CON | $104.56/HOUR |
| 118 | MRO SKILLS TRAIN FAM GRP WITH CON | $18.84/HOUR |
| 119 | MRO CASE MANAGEMENT | $58.12/HOUR |
| 120 | MRO CRISIS INTERVENTION | 134.88/HOUR |
| 121 | MRO PSYCH INTERVENT FACE TO FACE | $122.48/HOUR |
| 122 | MRO PSYCH INTERVENT NON FACE TO | $73.48/HOUR |
| 123 | MRO CAIRS | $58.48/HOUR |
| 124 | MRO AIRS | $58.48/HOUR |
| 125 | MRO INTENSIVE OUTPATIENT | $174.96/3 HOUR |
| 126 | MRO ADDICTION COUNSELING IND | $58.32/HOUR |
| 127 | MRO ADDICT FAMILY WITH CON | $58.32/HOUR |
| 128 | MRO ADDICT FAMILY W/O CON | $14.58/HOUR |
| 129 | MRO ADDICTION GROUP | $14.58/HOUR |
| 130 | MRO ADDICT FAM GROUP WITH CON | $14.58/HOUR |
| 131 | MRO ADDICT FAM GROUP W/O CON | $14.58/HOUR |
| 132 | MRO PEER RECOVERY SERVICES | $34.20/HOUR |
| 133 | MRO PSYCH INTERVENT – APN | $122.48/HOUR |
| 134 | MRO PSYCH INTERVENT – APN NON FTF | $73.48/HOUR |
| 135 | MRO SKILLS TRN SUPERVISED VISIT | $104.56/HOUR |
| 136 | BPHC Care Coordination | $58.12/HOUR |
| 142 | PRIME FOR LIFE | 260.00/EVENT |
| 580 | SCREENING/PRE-VOCATIONAL REFERRAL | $0.00 |
| 581 | DISCOVERY | $42.00/HOUR |
| 582 | WORK EXPERIENCE DEVELOPMENT | $42.00/HOUR |
| 583 | WORK EXPERIENCE A 1-5 HOURS/WEEK | $200.00/WEEK |
| 584 | WORK EXPERIENCE B 6-10 HOURS/WEEK | $325.00/WEEK |
| 585 | WORK EXPERIENCE C 11+ HOURS/WEEK | $450.00/WEEK |
| 586 | JOB READINESS TRAINING | $42.00/HOUR |
| 587 | JOB SEARCH AND PLACEMENT ASSISST | $42.00/HOUR |
| 588 | EMPLOYMENT MILESTONE 1 | $1300.00/EVENT |
| 589 | EMPLOYMENT MILESTONE 2 | $1500.00/EVENT |
| 590 | EMPLOYMENT MILESTONE 3 | $1300.00/EVENT |
| 591 | ON THE JOB SUPPORTS SHORT TERM | $42.00/HOUR |
| 592 | SUPPORT EMPLOYMENT 1-5 HRS/MTH | $176.00/MONTH |
| 593 | SUPPORT EMPLOYMENT 6-10 HRS/MTH | $352.00/MONTH |
| 594 | SUPPORT EMPLOYMENT 11-15 HRS/MTH | $528.00/MONTH |
| 595 | SUPPORT EMPLOYMENT 16-20 HRS/MTH | $720.00/MONTH |
| 596 | SUPPORT EMPLOYMENT 21-25 HRS/MTH | $920.00/MONTH |
| 597 | SUPPORT EMPLOYMENT 26-30 HRS/MTH | $1120.00/MTH |
| 598 | SUPPORTED EMPLOYMENT HOURLY | $42.00/HOUR |
| 599 | BENEFITS ANALYSIS | $500.00/EVENT |
| 600 | LEVEL OF CARE CONSULTATION | $100.00/HOUR |
| 601 | COMPETENCY EVALUATION | $100.00/HOUR |
| 602 | ADHD EVALUATION | $97.00/HOUR |
| 603 | WALK IN CLINIC EVALUATION | $240.00/HOUR |
| 604 | BARIATRIC EVALUATION | $100.00/HOUR |
| 605 | MEDICAID DISABILITY EVALUATION | $80.00/HOUR |
| 606 | SOCIAL SECURITY DISABILITY EVAL | $100.00/EVENT |
| 607 | STERLING EVALUATION | $93.48/HOUR |
| 608 | PARENTING ASSESSMENT | $97.00/HOUR |
| 609 | JAIL CONSULTS | $100.00/HOUR |
| 610 | PASARR EVALUATION | $100.00/HOUR |
| 611 | DRUG AND ALCOHOL EVALUATION | $100.00/EVENT |
| 80 | TELEPHONE EMERGENCIES | $0.00 |
| 83 | INTERN TRACKING | $0.00 |
| 84 | TESTIMONY/DEPOSITION | $200.00/EVENT |
| 85 | BRIDGE DEVICE | $800.00/EVENT |
| 88 | INTERPRETER SERVICES | $75.00/HOUR |
| 89 | DRUG TESTING | $15.00/EVENT |
| 95 | INFORMATION/REFERRAL | $0.00 |
| 96 | DOCUMENTATION ONLY | $0.00 |
| 3410 | RN STAFF EDUCATION | $0.00 |
| 3411 | RN MEDICATION AUDIT | $0.00 |
| 3412 | RN CONSULTATION | $0.00 |
| 3413 | RN TB TESTING | $0.00 |
| 99201 | NEW PATIENT STRAIGHTFORWARD | $178.88/EVENT |
| 99202 | NEW PATIENT EXPANDED | $200.88/EVENT |
| 99203 | NEW PATIENT DETAILED | $231.88/EVENT |
| 99204 | NEW PATIENT COMPREHENSIVE | $276.88/EVENT |
| 99205 | NEW PATIENT HIGH COMPLEXITY | $326.88/EVENT |
| 99211 | ESTABLISHED PATIENT MINIMAL COMPLEX | $162.88/EVENT |
| 99212 | ESTABLISHED PATIENT STRAIGHTFORWARD | $191.88/EVENT |
| 99213 | ESTABLISHED PATIENT LOW COMPLEX | $216.88/EVENT |
| 99214 | ESTABLISHED PATIENT MODERATE | $246.88/EVENT |
| 99215 | ESTABLISHED PATIENT HIGH COMPLEX | $286.88/EVENT |
| 99216 | SMOKING CESSATION | $15.00/EVENT |
| 99495 | TRANSITIONAL CARE EVALUATION | $262.80/EVENT |
| T9201 | TELEHEALTH NEW PT STRAIGHTFORWARD | $178.88/EVENT |
| T9202 | TELEHEALTH NEW PT EXPANDED | $200.88/EVENT |
| T9203 | TELEHEALTH NEW PT DETAILED | $231.88/EVENT |
| T9204 | TELEHEALTH NEW PT COMPREHENSIVE | $276.88/EVENT |
| T9205 | TELEHEALTH NEW PT HIGH COMPLEXITY | $326.88/EVENT |
| T9211 | TELEHEALTH ESTAB PT MINIMAL COMPLEX | $162.88/EVENT |
| T9212 | TELEHEALTH ESTAB PT STRAIGHTFORWARD | $191.88/EVENT |
| T9213 | TELEHEALTH ESTAB PT LOW COMPLEX | $216.88/EVENT |
| T9214 | TELEHEALTH ESTAB PT MODERATE | $246.88/EVENT |
| T9215 | TELEHEALTH ESTAB PT HIGH COMPLEXITY | $286.88/EVENT |
| T3014 | TELEHEALTH SPOKE SITE | $35.00/EVENT |
| 69290 | EAR IRRIGATION | $15.00/EVENT |
| 82948 | GLUCOSE | $15.00/EVENT |
| 96372 | IM INJECTION | $25.00/EVENT |
| 87804 | RAPID FLU SWAB | $20.00/EVENT |
| 87880 | RAPID STREP | $20.00/EVENT |
| 81025 | URINE PREGNANCY | $10.00/EVENT |
| 99364 | VENIPUNCTURE | $10.00/EVENT |