[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.]
[Adopted 11-5-1986 by Ord. No. 73-1986]
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.
[Amended 1-8-1992 by Ord. No. 106-1991]
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.
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.
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.
