Atlantic City, NJ
Atlantic County
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Table of Contents
Table of Contents
[HISTORY: Adopted by the City Council of the City of Atlantic City: Art. I, 11-5-1986 by Ord. No. 73-1986. Amendments noted where applicable.]
110a Clinical Fees Table
[Adopted 11-5-1986 by Ord. No. 73-1986]

§ 110-1 Fee schedule established.

The City of Atlantic City hereby establishes a schedule of fees and services for patients attending official City of Atlantic City clinical facilities and its physician-employed group performing various medical procedures within or outside of the City of Atlantic City.

§ 110-2 Sliding scale.

[Amended 1-8-1992 by Ord. No. 106-1991]
A. 
The sliding fee scale shall be as follows:
(1) 
Maximum annual income per family size.[1]
[1]
Editor's Note: The Sliding Scale Fees are included at the end of this chapter.
B. 
The word "family" shall be defined as a household or economic unit made up of a person or group of persons who usually, but not necessarily, live together and whose production of income and consumption of goods or services are related.
C. 
For purpose of the above schedule, income shall be determined as gross family income for the previous 12 months. No allowance shall be made for the use of a standard deduction or hardship deduction when calculating family income.
D. 
The Atlantic City Division of Health is hereby authorized to screen each patient and to establish a monetary charge for medical and ancillary services rendered in connection with the operation of its health centers.

§ 110-3 Third-party insurance.

All residents of the City of Atlantic City shall be charged for services rendered in accordance with the sliding fee scale in § 110-2 for medical and ancillary services as it relates to maximum annual income and family size. For any person presenting third-party insurance which covers said procedure, the resident's third-party insurance shall be billed for the visit at the full fee, regardless of the family income. Said insurance payment shall be regarded as payment in full for the specific service rendered. Any person not a resident that received medical or ancillary services within or outside a clinical facility of the City of Atlantic City by its physician-employed group shall be charged full fee regardless of income.

§ 110-4 Schedule of Fees.

A. 
The Schedule of Fees shall be as follows:
Procedures
Code
Fee
General Procedures, office service
Initial visit, sick care
90015
$24
Intermediate
90017
$40
Extended
90050
$16
Brief revisit
90060
$20
Intermediate revisit
90070
$24
Prolonged revisit
$8
Nurse-managed visit
93000
$40
Electrocardiogram
36415
$4
Blood drawing
N/C
N/C
Same day revisit
90750
$24
Initial visit (preventive)
Pediatrics
Initial visit (preventive)
Age 12 to 17
90751
$24
Age 5 to 11
90752
$24
Age 1 to 4
90753
$24
Age under 1 year
90754
$24
Annual pediatric exam same as above
$24
Pediatric well visit
90060
$16
EPSDT
W9820
$60
Established patient (well visit)
Age 12 to 17
90761
$16
Age 5 to 11
90762
$16
Age 1 to 4
90763
$16
Age under 1 year
90764
$16
Immunizations
DPT
90701
$8
DT
90702
$8
Polio
90712
$8
MMR
90707
$8
Hib
W9090
$8
Influenza
90724
$16
PPD
86580
$8
Tetanus
90703
$8
Unlisted injection
90799
$8
Family Planning
Intermediate, new patient
90015
$24
Brief, established patient
90040
$16
Intermediate, established patient
90060
$20
Extended, established patient
90070
$24
Insertion of IUD introduction
58300
$40
Removal of IUD, introduction
58301
$40
Female Genital System
Biopsy of penneum (separate procedure), Excision
56100
$150
Incision and drainage, abscess of vulva, extensive
56400
$300
Incision and drainage of Bartholin's gland abcess, unilateral
56420
$300
Marsupialization of Bartholin's gland or cyst
56440
$300
Destruction of condylomata, vulva multiple; simple, chemical
56500
$200
Cryosurgery of benign lesion, vulva; simple
56520
Minimum
$200
Maximum
$250
Hymenectomy, partial excision of hymen
56700
$150
Hymenotomy, simple incision
56720
$300
Excision of Bartholin's gland or cyst
56740
$400
Plastic repair of introitus
56800
$400
With drainage of pelvic abscess
57010
$400
Colpocentesis (separate procedure)
57020
$150
Cyrosurgery of vagina
57050
$300
Biopsy of vaginal mucosa; simple (separate procedure)
57100
$250
Coipectomy, obliteration of vagina; partial
57108
$1,200
Extensive, requiring suture (including cysts)
57105
$1,200
Excision of vaginal septum
57130
$500
Excision of vaginal cyst or tumor
57135
$500
Irrigation and/or application of medicament for treatment of bacterial parasitic or fungoid disease
57150
$200
Insertion of pessary
57160
$75
Diaphragm fitting with instructions
57107
$40
Colporrhaphy, suture of injury of vagina (nonobstetrical)
57200
$800
Plastic operation on urethral sphincter, vaginal approach (e.g., Kelly urethral plication), separate
57220
$800
Plastic repair of urethrocele
57230
$800
Anterior colporrhaphy, repair cystocele with or without repair or urethreocele (separate procedure)
57240
$800
Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy
57250
$800
Combined anteroposterior colporrhaphy
57260
$800
With enterocele repair
57265
$800
Repair of enterocele, vaginal approach (separate procedure)
57268
$800
Repair of enterocele, abdominal approach (separate procedure)
57270
$800
Sling operation for stress incontinence (e.g., fascia or synthetic)
57288
$1,200
Closure of rectovaginal approach
57300
$1,000
Closure of urethrovaginal fistula
57310
$1,000
Pelvic exam under anesthesia
57410
$250
Biopsy single or multiple or local excision of lesion, with or without fulguration (separate procedure)
57500
$250
Endocervical curettage (not done as part of a D and C)
57505
$200
Cauterization of cervix; electro or thermal
57510
$250
Cryocautery, initial or repeat
57511
$200
Biopsy of cervix, circumferential (cone), with or without D and C, with or without Sturmdorff type repair
57520
$500
Introduction of any hemostatic agent or pack for spontaneous hemorrage (separate procedure); initial
57600
$75
Cerclage of uterine cervix
57700
$500
Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach
57720
$500
Dilation of cervical canal, instrumental (separate procedure)
57800
$200
Endometrial biopsy, suction type (separate procedure)
58100
Minimum
$150
Maximum
$200
Office endometrial curettage
58102
Minimum
$150
Maximum
$200
D and C, diagnostic and/or therapeutic (nonobstetrical)
58120
1st trimester
$460
2nd trimester
$552
Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate procedure); abdominal approach
58140
$1,000
Total hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)
58150
$1,500
With colpo-urethrocystopexy (Marshall-Marchetti-Krantz type)
58152
$1,800
Total hysterectomy, extended corpus cancer, including partial vaginectomy
58200
$1,200
Vaginal hysterectomy
58260
$1,800
With plastic repair of vagina, anterior and/or posterior colporrhaphy
58265
$1,800
With colpo-urethrocystopexy (Marshall-Marchetti-Krantz type)
58267
$1,800
With repair of enterocele
58270
$1,800
Hysteroplasty, repair of uterine anomaly (Strassman type)
58540
$1,200
Ligation or transection of fallopian tube(s), abdominal or vaginal approach or bilateral
58600
$750
Ligation or transection of fallopian tube(s), abdominal approach, post-partum, unilateral or bilateral, during same hospitalization (separate procedure)
58605
$500
Ligation or transection of fallopian tube(s) when done at the time of C/S of intraabdominal surgery (not a separate procedure)
58611
Occlusion of fallopian tube(s) by device (e.g., band, clip, Falope ring) vaginal or suprapubic approach
58615
$750
Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
58700
$800
Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedures)
58720
$800
Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure), vaginal approach
58800
$800
Abdominal approach
58805
$800
Drainage of ovarian abcess, vaginal approach
58820
$800
Abdonimal approach
58822
$800
Wedge resection or bisection of ovary, unilateral or bilateral
58920
$800
Ovarian cystectomy, unilateral or bilateral
58925
$800
Oophorectomy partial or total, unilateral or bilateral
58940
$800
With total omentectomy
58945
$800
Laparoscopy for visualization of pelvic viscera
58980
$450
With fulgaration of oviducts (with or without transection)
58982
$500
With occlusion of oviducts by device (e.g., band, clip or falope ring)
58983
$500
With lysis of adhension
58985
$500
With aspiration (single or multiple)
58987
Maternity care and system
Amniocentesis for diagnosis, abdominal approach
59000
$200
Fetal nonstress test
59025
$40
Hysterotomy, abdominal, for removal of hydatidiform mole
59100
$1,000
With tubal ligation
59101
Hysterotomy, abdominal, for legal abortion
59105
With tubal ligation
59106
Surgical treatment of ectopic pregnancy; tubal requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach
59120
$800
Tubal, without salpinectomy and/or oophorectomy
59121
$800
Interstitial, uterine pregnancy requiring hysterectomy, total or subtotal
59135
$1,200
Total obstetric care ("global" all-inclusive care) includes antepartum care, vaginal delivery (with or without episiotomy and/or forceps or breech delivery) and postpartum care
59400
$1,080
Vaginal delivery only (with or without episiotomy, forceps or breech delivery, including in-hospital postpartum care (separate procedure)
59410
$552
Antepartum care only (separate procedure)
59420
$12
Postpartum care only (separate procedure)
59430
$24
C-section, low cervical, including in-hospital postpartum care (separate procedure)
59500
$912
Including antepartum care
59501
$1,200
C-section, classic, including in-hospital postpartum care (separate procedure)
59520
$912
Including antepartum and postpartum care
59561
$1,200
C-section with hysterectomy, total, including in-hospital postpartum care (separate procedure)
59580
$1,800
Including antepartum and postpartum care
58581
$1,800
Treatment of abortion, first trimester, completed medically
59800
$460
Surgically (separate procedure)
59801
$460
Treatment of abortion, second trimester
Medically
59810
$460
Surgically (separate procedure)
59811
$552
Legal (therapeutic) abortion by D and C and/or extraction
59840
$460
Legal (Therapeutic) abortion, by D and C and evacuation
59841
$552
Culdoscopy, diagnostic
57450
$460
Hospital services
Intermediate history and examination, initiation of diagnostic and treatment programs and preparation of hospital records
90215
Adults
$60
Peds
$30
Comprehensive history and examinaton, initiation of diagnostic and treatment programs and preparation of hospital records
90220
$80
Subsequent care
Brief visit
90240
  Adults
$40
  Peds
$20
Intermediate visit
90260
  Adults
$40
  Peds
$20
Extended visit
90270
$30
Newborn care in hospital, including physical examination of baby and conference(s) with parent(s)
90285
$15
Hospital discharge day management
90292
Adults
$40
Peds
$20
Circumcision
54150
$80
Emergency room visit
54150
$80
Mininal service (new patient)
90500
$40
Brief service (new patient)
90505
$50
Limited service (new patient)
90510
$60
Intermediate service (new patient)
90515
$80
Extended service (new patient)
90517
$80
Minimal service (established patient)
90530
$24
Brief service (established patient)
90540
$28
Limited service (established patient)
90550
$32
Intermediate service (established patient)
90560
$36
Extended service (established patient)
90570
$40
Initial consultation, limited
90600
$60
Intermediate
90605
$70
Extensive
90610
$80
Comprehensive
90620
$80
Complex
90630
$100
Follow-up consultation; brief
90640
$40
Limited visit
90641
$50
Intermediate visit, evaluation and/or treatment
90642
$60
Extended visit requiring reexamination or reevaluation and/or treatment, same or new illness
90643
$80
Confirmatory consultation, limited
90650
$40
Intermediate
90651
$50
Extensive
90652
$60
Comprehensive
90653
$80
Complex
90654
$100
Unlisted medical service, general
90699
$24
Administrative services
Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory
99000
$5
Handling and/or conveyance of specimen for transfer from the patient in other than a physician's office to a laboratory (distance may be indicated)
99001
$5
Handling, conveyance, and/or any other service in connection with the implementation of an order involving devices (e.g., designing, fitting, packaging, handling, delivery or mailing when devices such as orthotics or protectives are fabricated by an outside laboratory or shop but which items have been designed and are to be fitted and adjusted by attending physician)
99002
$5
Telephone call for consultation or medical management, simple or brief
99013
$10
Intermediate (e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone or to discuss results of tests in detail)
99014
$15
Lengthy or complex (e.g., lengthy counseling session with anxious or distraught patient or detailed or prolonged discussion with family member regarding seriously ill patient)
99015
$30
Initial (new patient) visit when surgical procedure constitutes major service at that visit
99025
$60
Service requested after office hours, in addition to basic service
99050
$30
Services requested between 10:00 p.m. and 8:00 a.m., in addition to basic service
99052
$45
Service requested on Sundays and holidays in addition to basic service
99054
$45
Services provided at request of patient in a location other than physician's office which are normally provided in the office
99056
$30
Office services provided on an emergency basis
99058
$30
Emergency-care facility services, when the non-hospital-based physician is in the hospital but is involved in patient care elsewhere and is called to the emergency facility to provide emergency services
99062
$30
Emergency-care facility services, when the non-hospital-based physician is called to the emergency facility from outside the hospital to provide emergency services not during regular office hours
99064
$45
During regular office hours
90065
$30
Educational supplies, such as books, tapes and pamphlets, provided by the physician for the patient's education at cost to physician
90071
$5
Medical testimony
90075
$480
Physician educational services to patients in a group setting (e.g., prenatal, obesity or diabetic instructions)
99078
$45
Special reports as insurance forms, or the review of medical data to clarify a patient's status, more than the information conveyed in the usual medical communications or standard reporting form
99080
$10
Unusual travel (e.g., transportation and escort of patient)
99082
$45
Analysis of information data stored in computors (e.g., EKG's, blood pressures, hematologic data)
99090
$45
Digestive system
Exploratory laparotomy, exploratory celiotomy (separate procedure)
49000
$750
Reopening of recent laparotomy incision for exploration, removal of hematoma, control of bleeding
49002
$750
Exploration, retroperitoneal area (separate procedure)
49010
$750
Miscellaneous services
Nutrition counseling
$8
Hearing test
$8
Glaucoma screening
$20
Social service counseling
$8
Intensive care unit
Admission
99160
$80
2nd to 9th day
99171
$60
OB, midwife
Antepartum visit, package
59400
$450
Initial visit, no package
59420
$12
Postpartum visit, no package
59430
N/C
OB/gynecological procedures, midwife
Destruction of condylomata, vulva multiple; simple, chemical
56500
$200
Cryosurgery of benign lesion, vulva; simple
56520
Minimum
$200
Maximum
$250
Hymenectomy, partial excision of hymen
56700
$150
Hymenectomy, simple excision
56720
$150
Excision of Bartholin's gland or cyst
56740
$400
Plastic repair or introitus
56800
$400
With/drainage of pelvic abscess, additional
57010
$150
Col pocentesis
57020
$150
Cryosurgery
57050
$300
Biopsy of vaginal mucosa; simple (separate procedure)
57100
$250
Colpectomy, obliteration of vagina; partial
57108
$1,200
Extensive, requiring suture (including cysts)
57105
$1,200
Excision of vaginal septum
57130
$500
Excision of vaginal cyst or tumor
57135
$500
Irrigation and/or treatment of bacterial parasitic or fungoid disease
57150
$200
Insertion of pessary
57160
$75
Colporrhaphy, suture of injury of vagina (non-OB)
57200
$800
Colpoperineorrhaphy, suture of injury of vagina and/or perineum (non-OB)
57210
$800
Plastic operation on urethral sphincter, vaginal approach (Kelly urethral plication), separate procedure
57220
$800
Plastic repair of urethrocele (separate procedure)
57230
$800
Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele (separate procedure)
57240
$800
Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy
57250
$800
Combined anteroposterior colporrhaphy
57260
$800
Sling operation for stress incontinence (e.g., fascia or synthetic)
57288
$1,200
Closure of rectovaginal fistula; vaginal approach
57300
$1,000
Closure of urethrovaginal fistula
57310
$1,000
Pelvic exam under anesthesia
57410
$250
Biopsy, single or multiple or local excision of lesion, with or without fulguration (separate procedure)
57500
$250
Endocervical curettage (not done as part of D and C)
57505
$200
Cauterization of cervix; electro or thermal
57510
$250
Cryocautery, initial or repeat
57511
$200
B. 
In the event that the physician-employed group performs a medical procedure, because of necessity and within the scope of their capabilities, not specifically listed in this Article, the Health Officer shall establish an interim charge that is customary and reasonable within the scope of medical services provided in the Greater Atlantic City Area.
C. 
The City of Atlantic City is hereby authorized to collect said charges at the time services are rendered or within 15 days after services are rendered. The Health Officer or treating physician may waive the charge for particular service when in his/her opinion the charge presents an extreme financial hardship.