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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

CODEDESCRIPTION
RATE
5CLINICAL ASSESSMENT
$286.88/HOUR
9INDIVIDUAL THERAPY
$286.88/HOUR
10MARITAL/COUPLES THERAPY$260.00/HOUR
11FAMILY THERAPY$260.00/HOUR
12FAMILY SUPPORT GROUP$25.00/EVENT
13FAMILY GROUP THERAPY$25.00/EVENT
14GROUP PSYCHOTHERAPY$136.40/EVENT
16PEER SUPPORT SERVICES$177.00/HOUR
171SUD GROUP$106.40/EVENT
175IOP GROUP$106.40/EVENT
18PSYCHOLOGICAL INTERVIEW/TESTING$120.00/HOUR
19ANGER MANAGEMENT GROUP$25.00/EVENT
20FAMILY W/O PATIENT PRESENT$260.00/HOUR
21EMERGENCY SERVICES/DAYTIME$100.00/HOUR
22EMERGENCY SERVICES/AFTER HOURS$200.00/HOUR
24DBT GROUP$136.40/EVENT
25COACHING DBTNO RATE
30SSA CHILD MSE$148.00/EVENT
31SSA ADULT MSE$148.00/EVENT
32SSA WAIS IV$125.00/EVENT
33SSA WISC IV$125.00/EVENT
34SSA BAYLEY$160.00/EVENT
35SSA STANFORD BINET V$140.00/EVENT
36SSA WPPSI$95.00/EVENT
37SSA WMS IV$200.00/EVENT
38SSA VINELAND ADAPT$160.00/EVENT
39AT RISK ASSESSMENT$65.00/HOUR
50HB FAM CENTERED THERAPY$98.40/HOUR
51DCS HOME BASED ASSESSMENT$80.00/HOUR
52DCS REPORT$78.76/HOUR
53PARENT EDUCATION GROUP$25.00/GROUP
54HOMEMAKER SERVICES$54.36/HOUR
55PARENT EDUCATION INDIVIDUAL$80.32/HOUR
56PARENTING/FAM FUNCT ASSESS$68.40/HOUR
57HB FAM CENTER CASEWK SUPER VISIT$79.32/HOUR
58VISIT FACILITAT P/C/S SUPERVISED VIS$54.36/HOUR
59COUNSELING SUPERVISED VISITATION$67.12/HOUR
60HOMEMAKER SUPERVISED VISITATION$54.36/HOUR
61HB FAM CASEWORK FACE TO FACE$79.32/HOUR
62HB FAM CEN THERAPY SUP VISITATION$98.36/HOUR
63CARE NETWORK$60.00/HOUR
64DCS COUNSELING TEAM MTG$64.00/HOUR
65DCS WRAPAROUND PER DIEM$965.49/EVENT
66COUNSELING THERAPY$68.40/HOUR
67RECOVERY COACH$80.00/HOUR
68PRESERVATION PER DIEM$113.47/EVENT
69PRESERVATION WEEKLY SAFETY CK$0.00
70PRESERVATION CONTACT TRACKING$0.00
71PRESERVATION CHILD PER DIEM$24.50/EVENT
72PRESERVATION MONTHLY MEETING$0.00
250WRAPAROUND FACILITATION$115.00/HOUR
251WRAPAROUND TECHNICIAN$104.56/HOUR
252HABILITATION$85.60/HOUR
253RESPITE CARE$16.00/HOUR
254CRISIS RESPITE$15.00/HOUR
255NON-MEDICAID TRANSPORATION$5.00/ONE WAY TRIP
256THERAPEUTIC SERVICES$90.00/HOUR
257TRAINING AND SUPPORT$60.00/HOUR
258FLEX FUNDS$ FOR $
331INITIAL HOSPITAL CONSULT$165.00/HOUR
336SUBSEQUENT HOSPITAL CONSULT$165.00/HOUR
361IPU PHYSICAL$125.00/EVENT
366IPU PHYSICAL FOLLOW UP$60.00/EVENT
381INITIAL IPU PHYSICIAN ROUND$85.00/EVENT
382INITIAL IPU PHYSICIAN ROUND$140.00/EVENT
383INITIAL IPU PHYSICIAN ROUND$190.00/EVENT
391SUBSEQUENT IPU PHYSICIAN ROUND$45.00/EVENT
392SUBSEQUENT IPU PHYSICIAN ROUND$75.00/EVENT
393SUBSEQUENT IPU PHYSICIAN ROUND$100.00/EVENT
41INPATIENT DAY OF CARE$1000.00/EVENT
42THERAPEUTIC LEAVE DAY$85.00/EVENT
43ISOLATION MONITORING$45.00/HOUR
490MEDICINAL SUPPLIESCOST*
491PHARMACY SERVICESCOST*
492LABORATORY SERVICESCOST*
493RADIOLOGY SERVICESCOST*
494ELECTROCARDIOLOGY SERVICESCOST*
495RESPIRATORY THERAPYCOST*
496PHYSICAL THERAPYCOST*
497NUCLEAR MEDICINE SERVICESCOST*
499OTHER HOSPITAL SERVICESCOST*
9500FACILITY CHG FOR SERVICE 05$146.88/EVENT
9501FACILITY CHG FOR SERVICE 09 1/2 HR$146.88/EVENT
9502FACILITY CHG FOR SERVICE 09 1 HR$146.88/EVENT
9503FACILITY CHG FOR SERVICE 09 1 1/2 HR$146.88/EVENT
9504FACILITY CHG FOR SERVICE 10$100.00/EVENT
9505FACILITY CHG FOR SERVICE 11$100.00/EVENT
9506FACILITY CHG FOR SERVICE 13$50.00/EVENT
9507FACILITY CHG FOR SERVICE 14$73.44/EVENT
9508FACILITY CHG FOR SERVICE 20$100.00/EVENT
9509FACILITY CHG FOR SERVICE 171/175$71.40/EVENT
9510FACILITY CHG FOR SERVICE 311$60.00/EVENT
9511FACILITY CHG FOR SERVICE 16$146.88/EVENT
9600FACILITY CHG FOR SERVICE 99201$146.88/EVENT
9601FACILITY CHG FOR SERVICE 99202$146.88/EVENT
9602FACILITY CHG FOR SERVICE 99203$146.88/EVENT
9603FACILITY CHG FOR SERVICE 99204$146.88/EVENT
9604FACILITY CHG FOR SERVIC E 99205$146.88/EVENT
9605FACILITY CHG FOR SERVICE 99211$146.88/EVENT
9606FACILITY CHG FOR SERVICE 99212$146.88/EVENT
9607FACILITY CHG FOR SERVICE 99213$146.88/EVENT
9608FACILITY CHG FOR SERVICE 99214$146.88/EVENT
9609FACILITY CHG FOR SERVICE 99215$146.88/EVENT
9610FACILITY CHG FOR SERVICE 99495$100.00/EVENT

 

 

* Actual charge for supplies/services received

 

 

CODEDESCRIPTIONRATE
100MRO LON DETERMINATION$77.72/EVENT
101MRO INDIVIDUAL COUNSELING$114.60/HOUR
102MRO GROUP COUNSELING$28.64/HOUR
103MRO FAMILY WITH CONSUMER$114.60/HOUR
104MRO FAMILY WITHOUT CONSUMER$114.60/HOUR
105MRO FAMILY GROUP WITH CONSUMER$28.64/HOUR
106MRO FAMILY GROUP W/O CONSUMER$28.64/HOUR
107MRO MED TRAINING AND SUPPORT$74.48/HOUR
108MRO MED TRAINING GROUP$13.40/HOUR
109MRO MED TRAINING FAMILY$74.48/HOUR
110MRO MED TRAIN FAM GRP W/O CON$13.40/HOUR
111MRO MED TRAIN FAM WITH CON$84.48/HOUR
112MRO MED TRAIN FAM GRP WITH CON$13.40/HOUR
113MRO SKILLS TRAINING AND DEV IND$104.56/HOUR
114MRO SKILLS TRAINING GROUP$18.84/HOUR
115MRO SKILLS TRAIN FAMILY W/O CON$104.56/HOUR
116MRO SKILLS TRAIN FAM GRP W/O CONS$18.84/HOUR
117MRO SKILLS TRAIN FAMILY WITH CON$104.56/HOUR
118MRO SKILLS TRAIN FAM GRP WITH CON$18.84/HOUR
119MRO CASE MANAGEMENT$58.12/HOUR
120MRO CRISIS INTERVENTION134.88/HOUR
121MRO PSYCH INTERVENT FACE TO FACE$122.48/HOUR
122MRO PSYCH INTERVENT NON FACE TO$73.48/HOUR
123MRO CAIRS$58.48/HOUR
124MRO AIRS$58.48/HOUR
125MRO INTENSIVE OUTPATIENT$174.96/3 HOUR
126MRO ADDICTION COUNSELING IND$58.32/HOUR
127MRO ADDICT FAMILY WITH CON$58.32/HOUR
128MRO ADDICT FAMILY W/O CON$14.58/HOUR
129MRO ADDICTION GROUP$14.58/HOUR
130MRO ADDICT FAM GROUP WITH CON$14.58/HOUR
131MRO ADDICT FAM GROUP W/O CON$14.58/HOUR
132MRO PEER RECOVERY SERVICES$34.20/HOUR
133MRO PSYCH INTERVENT – APN$122.48/HOUR
134MRO PSYCH INTERVENT – APN NON FTF$73.48/HOUR
135MRO SKILLS TRN SUPERVISED VISIT$104.56/HOUR
136BPHC Care Coordination$58.12/HOUR
142PRIME FOR LIFE260.00/EVENT
580SCREENING/PRE-VOCATIONAL REFERRAL$0.00
581DISCOVERY$42.00/HOUR
582WORK EXPERIENCE DEVELOPMENT$42.00/HOUR
583WORK EXPERIENCE A 1-5 HOURS/WEEK$200.00/WEEK
584WORK EXPERIENCE B 6-10 HOURS/WEEK$325.00/WEEK
585WORK EXPERIENCE C 11+ HOURS/WEEK$450.00/WEEK
586JOB READINESS TRAINING$42.00/HOUR
587JOB SEARCH AND PLACEMENT ASSISST$42.00/HOUR
588EMPLOYMENT MILESTONE 1$1300.00/EVENT
589EMPLOYMENT MILESTONE 2$1500.00/EVENT
590EMPLOYMENT MILESTONE 3$1300.00/EVENT
591ON THE JOB SUPPORTS SHORT TERM$42.00/HOUR
592SUPPORT EMPLOYMENT 1-5 HRS/MTH$176.00/MONTH
593SUPPORT EMPLOYMENT 6-10 HRS/MTH$352.00/MONTH
594SUPPORT EMPLOYMENT 11-15 HRS/MTH$528.00/MONTH
595SUPPORT EMPLOYMENT 16-20 HRS/MTH$720.00/MONTH
596SUPPORT EMPLOYMENT 21-25 HRS/MTH$920.00/MONTH
597SUPPORT EMPLOYMENT 26-30 HRS/MTH$1120.00/MTH
598SUPPORTED EMPLOYMENT HOURLY$42.00/HOUR
599BENEFITS ANALYSIS$500.00/EVENT
600LEVEL OF CARE CONSULTATION$100.00/HOUR
601COMPETENCY EVALUATION$100.00/HOUR
602ADHD EVALUATION$97.00/HOUR
603WALK IN CLINIC EVALUATION$240.00/HOUR
604BARIATRIC EVALUATION$100.00/HOUR
605MEDICAID DISABILITY EVALUATION$80.00/HOUR
606SOCIAL SECURITY DISABILITY EVAL$100.00/EVENT
607STERLING EVALUATION$93.48/HOUR
608PARENTING ASSESSMENT$97.00/HOUR
609JAIL CONSULTS$100.00/HOUR
610PASARR EVALUATION$100.00/HOUR
611DRUG AND ALCOHOL EVALUATION$100.00/EVENT
80TELEPHONE EMERGENCIES$0.00
83INTERN TRACKING$0.00
84TESTIMONY/DEPOSITION$200.00/EVENT
85BRIDGE DEVICE$800.00/EVENT
88INTERPRETER SERVICES$75.00/HOUR
89DRUG TESTING$15.00/EVENT
95INFORMATION/REFERRAL$0.00
96DOCUMENTATION ONLY$0.00
3410RN STAFF EDUCATION$0.00
3411RN MEDICATION AUDIT$0.00
3412RN CONSULTATION$0.00
3413RN TB TESTING$0.00
99201NEW PATIENT STRAIGHTFORWARD$178.88/EVENT
99202NEW PATIENT EXPANDED$200.88/EVENT
99203NEW PATIENT DETAILED$231.88/EVENT
99204NEW PATIENT COMPREHENSIVE$276.88/EVENT
99205NEW PATIENT HIGH COMPLEXITY$326.88/EVENT
99211ESTABLISHED PATIENT MINIMAL COMPLEX$162.88/EVENT
99212ESTABLISHED PATIENT STRAIGHTFORWARD$191.88/EVENT
99213ESTABLISHED PATIENT LOW COMPLEX$216.88/EVENT
99214ESTABLISHED PATIENT MODERATE$246.88/EVENT
99215ESTABLISHED PATIENT HIGH COMPLEX$286.88/EVENT
99216SMOKING CESSATION$15.00/EVENT
99495TRANSITIONAL CARE EVALUATION$262.80/EVENT
T9201TELEHEALTH NEW PT STRAIGHTFORWARD$178.88/EVENT
T9202TELEHEALTH NEW PT EXPANDED$200.88/EVENT
T9203TELEHEALTH NEW PT DETAILED$231.88/EVENT
T9204TELEHEALTH NEW PT COMPREHENSIVE$276.88/EVENT
T9205TELEHEALTH NEW PT HIGH COMPLEXITY$326.88/EVENT
T9211TELEHEALTH ESTAB PT MINIMAL COMPLEX$162.88/EVENT
T9212TELEHEALTH ESTAB PT STRAIGHTFORWARD$191.88/EVENT
T9213TELEHEALTH ESTAB PT LOW COMPLEX$216.88/EVENT
T9214TELEHEALTH ESTAB PT MODERATE$246.88/EVENT
T9215TELEHEALTH ESTAB PT HIGH COMPLEXITY$286.88/EVENT
T3014TELEHEALTH SPOKE SITE$35.00/EVENT
69290EAR IRRIGATION$15.00/EVENT
82948GLUCOSE$15.00/EVENT
96372IM INJECTION$25.00/EVENT
87804RAPID FLU SWAB$20.00/EVENT
87880RAPID STREP$20.00/EVENT
81025URINE PREGNANCY$10.00/EVENT
99364VENIPUNCTURE$10.00/EVENT