MHDO CompareMaine Updated: 9/17/2015
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1 Office Visits -- Adult Preventative Care Office Visit (or Wellness Office Visit) New patient preventive care visit for adult, ages 18 to New patient preventive care visit for adult, ages 40 to Preventive care visit for adult, ages 18 to Preventive care visit for adult, ages 40 to 64 Office Visits -- Pediatric or Adolescent Preventative Care Office Visit (or Wellness Office Visit) New patient preventative care visit for child under age New patient preventative care visit for child, ages 1 to New patient preventative care visit for child ages 5 to New patient preventative care visit for adolescent ages 12 to Preventive care visit for child under age Preventive care visit for child, ages 1 to Preventive care visit for child, ages 5 to Preventive care visit for adolescent, ages 12 to 17 Office Visits -- Office or Outpatient Visit New patient office visit (10 minutes) New patient office visit (20 minutes) New patient office visit (30 minutes) New patient office visit (45 minutes) New patient office visit (60 minutes) Office visit for an established patient (5 minutes) Office visit for an established patient (10 minutes) Office visit for an established patient (15 minutes) Office visit for an established patient (25 minutes) Office visit for an established patient (40 minutes) Office Visits -- Specialist Consultation Patient office consultation (15 minutes) Patient office consultation (30 minutes) Patient office consultation (45 minutes) Patient office consultation (60 minutes) Patient office consultation (80 minutes) Office Visits -- Wound Management Remove tissue from wounds (debridement, open wound 20 square centimeters or less) Negative or vacuum pressure wound therapy (total wound(s) surface area less than or equal to 50 square centimeters) Physical and Occupational Therapy -- Physical Therapy Physical therapy evaluation Physical therapy re-evaluation Application of hot or cold packs to 1 or more areas Application of mechanical traction to 1 or more areas Application of electrical stimulation to 1 or more areas, when physical therapist is not there Application of hot wax bath to 1 or more areas Application of whirlpool therapy to 1 or more areas Application of electrical stimulation to 1 or more areas Application of medication through skin using electrical current Application of ultrasound to 1 or more areas Therapeutic exercise to develop strength, endurance, range of motion, and flexibility Therapeutic procedure to re-educate brain-to-nerve-to-muscle function Water pool therapy for 1 or more areas Walking training to 1 or more areas Therapeutic massage to 1 or more areas Manual (physical) therapy techniques to 1 or more regions Therapeutic procedures in a group setting Therapeutic activities to improve function, with one-on-one contact between patient and provider Physical and Occupational Therapy -- Occupational Therapy Occupational therapy evaluation Self-care or home management training Orthotic management of arm or leg and/or trunk Evaluation of orthotic or prosthetic use Integrative Medicine -- Osteopathic Manipulative Treatment
2 98925 Manipulation of bones and muscles (osteopathic manipulative treatment), 1 to 2 areas of the body Manipulation of bones and muscles (osteopathic manipulative treatment), 3 to 4 areas of the body Manipulation of bones and muscles (osteopathic manipulative treatment), 5 to 6 areas of the body Manipulation of bones and muscles (osteopathic manipulative treatment), 7 to 8 areas of the body Manipulation of bones and muscles (osteopathic manipulative treatment), 9 to 10 areas of the body Integrative Medicine -- Nutrition Services Medical nutrition therapy, first appointment (15 minutes) Medical nutrition therapy, all individual visits after the first visit (15 minutes) Medical nutrition therapy in a group (30 minutes) Mental and Behavioral Health Services -- Diagnostic Evaluation Psychiatric diagnostic evaluation Psychiatric diagnostic evaluation with medical services Mental and Behavioral Health Services -- Therapy Psychotherapy, 30 minutes with patient and/or family member Psychotherapy with patient, or with patient and family member, with evaluation and case management Psychotherapy with patient, or with patient and family member, lasting 45 minutes Psychotherapy with patient, or with patient and family member, with evaluation and case management, lasting 45 minutes Psychotherapy with patient, or with patient and family member, lasting 60 minutes Psychotherapy with patient, or with patient and family member, with evaluation and case management, lasting 60 minutes Family psychotherapy without patient Family psychotherapy with patient Group psychotherapy Mental and Behavioral Health Services -- Procedures Shock treatment and monitoring Mental and Behavioral Health Services -- Health and behavior assessment Health and behavior assessment for 15 minute session Obstetric/Gynecological Procedures -- Delivery Vaginal delivery# 59400, 59409, 59410, 59610, 59612, C-section (Cesarean delivery)# 59510, 59514, 59515, 59618, 59620, Obstetric/Gynecological Procedures -- Laboratory Services Pregnancy test, urine Blood test for folic acid level 36415, 36416, Obstetric/Gynecological Procedures -- Ultrasounds Ultrasound re-evaluation of pregnant uterus, per fetus Transvaginal ultrasound Radiology and Imaging -- CT (Computed Tomography) Scans CT scan of head or brain CT scan of face CT scan of chest CT scan of chest, with contrast A ,Q9958-Q9967 or CT scan of pelvis CT scan of pelvis, with contrast A ,Q9958-Q9967 or CT scan of abdomen CT scan of abdomen, with contrast A ,Q9958-Q9967 or CT scan of abdomen, with and without contrast A ,Q9958-Q9967 or CT scan of abdomen and pelvis, without contrast CT scan of abdomen and pelvis, with contrast A ,Q9958-Q9967 or CT scan of abdomen and pelvis, with and without contrast A ,Q9958-Q9967 or Radiology and Imaging -- Mammograms Analog diagnostic mammogram (computer analysis of image data for lesion detection, with further review for interpretation) 77055, 77056
3 77052 Analog screening mammogram, imaging of breast done for routine check?up (computer analysis of image data for lesion detection, with further review for interpretation) Analog diagnostic mammogram of one breast Radiology and Imaging -- MRI (Magnetic Resonance Imaging) Scans MRI scan of brain MRI scan of brain, with and without contrast A ,Q9958-Q9967 or MRI scan of upper spinal canal MRI scan of lower spinal canal MRI scan of arm joint MRI scan of leg joint MRI scan of both breasts, with contrast A ,Q9958-Q9967 or Radiology and Imaging -- Ultrasounds Ultrasound of breast Ultrasound of abdomen (complete) Ultrasound of abdomen (limited area) Ultrasound of pelvis Radiology and Imaging -- X-Rays X-ray of chest, 2 views, front and side X-ray of lower and sacral spine, 2 or 3 views X-ray of shoulder, minimum of 2 views X-ray of wrist, minimum of 3 views X-ray of hand, 2 views X-ray of knee, 3 views X-ray of ankle, minimum of 3 views X-ray of foot, 2 views X-ray of foot, minimum of 3 views Radiology and Imaging -- Other Imaging Procedures Bone density test of spine or hips using dedicated X-ray machine Bone and joint imaging, whole body A ,Q9958-Q9967 or Nuclear medicine study with CT imaging, skull base to mid-thigh A ,Q9958-Q9967 or Laboratory Services -- Blood Test Blood test for electrolyte levels (sodium potassium, chloride, carbon dioxide) 36415, 36416, Blood test for lipids (cholesterol and triglycerides) 36415, 36416, Blood test for kidney functioning 36415, 36416, Blood test for acute hepatitis panel 36415, 36416, Blood test for liver functioning 36415, 36416, Blood test for albumin (protein) level 36415, 36416, Alpha-fetoprotein (AFP) level, serum 36415, 36416, Blood test for amylase (enzyme) level 36415, 36416, Blood test for calcium level 36415, 36416, Blood test to check for a protein associated with certain kinds of cancers 36415, 36416, (carcinoembryonic antigen protein or CEA level) Blood test for chloride level 36415, 36416, Blood test for cholesterol levels 36415, 36416, Blood test for cortisol hormone level 36415, 36416, Blood test for cardiac enzyme (creatine kinase) level 36415, 36416, Blood test for vitamin B-12 (cyanocobalamin) level 36415, 36416, Blood test for DHEA-S (dehydroepiandrosterone) level 36415, 36416, Blood test for ferritin level 36415, 36416, Blood test for IgE (immune system protein) level 36415, 36416, Blood test for blood glucose (sugar) level 36415, 36416, Blood test for glutamyltransferase (liver enzyme) level 36415, 36416, Blood test for blood glucose control (hemoglobin A1C) 36415, 36416, Blood test for insulin level 36415, 36416, Blood test for iron level 36415, 36416, Blood test for lactate dehydrogenase (enzyme) level 36415, 36416, Blood test for lipase (fat enzyme) level 36415, 36416, Blood test for LDL cholesterol level 36415, 36416, Blood test for magnesium level 36415, 36416, Blood test for opiates (drug) 36415, 36416, Blood test for parathormone (parathyroid hormone) level 36415, 36416, Blood test for phosphatase (enzyme) level 36415, 36416, Blood test for phosphate level 36415, 36416, 99000
4 84146 Blood test for prolactin (milk producing hormone) level 36415, 36416, Blood test for PSA (prostate specific antigen) level 36415, 36416, Blood test for total protein level 36415, 36416, Blood test for serum (protein) level 36415, 36416, Blood test for sodium level 36415, 36416, Blood test for testosterone level, free 36415, 36416, Blood test for testosterone level, total or assay 36415, 36416, Blood test for thyroxine (thyroid chemical) level, total or assay 36415, 36416, Blood test for thyroxine (thyroid chemical) level, free 36415, 36416, Blood test for TSH (thyroid stimulating hormone) level 36415, 36416, Blood test for SGOT (liver enzyme) level 36415, 36416, Blood test for SGPT (liver enzyme) level 36415, 36416, Blood test for triglycerides level 36415, 36416, Blood test to evaluate thyroid hormone 36415, 36416, Blood test for T3 (thyroid hormone) level, total or assay 36415, 36416, Blood test for T3 (thyroid hormone) level, free 36415, 36416, Blood test for urea nitrogen level (to assess kidney functioning) 36415, 36416, Blood test for uric acid level 36415, 36416, Blood test for gonadotropin (reproductive hormone) 36415, 36416, Blood test for complete blood cell count (red cells, white cells, platelets), 36415, 36416, automated test (complete blood count) Blood test for complete blood cell count (red cells, white cells, platelets), 36415, 36416, automated test (hemoglobin) Blood test for clotting time 36415, 36416, Blood test for red blood cell sedimentation rate (to detect inflammation) 36415, 36416, Blood test for antibody to allergic substance (IgE) 36415, 36416, Blood test to screen for autoimmune disorder 36415, 36416, Blood test for C-reactive protein (to detect infection or inflammation) 36415, 36416, Blood test for C-reactive protein (to detect infection or inflammation), high 36415, 36416, sensitivity Blood test for rheumatoid factor 36415, 36416, Blood test for tuberculosis 36415, 36416, Blood test for antibody to Herpes simplex virus, type , 36416, Blood test for antibody to Herpes simplex virus, type , 36416, Blood test for antibody to HIV-1 and HIV-2 virus 36415, 36416, Blood test for Hepatitis B surface antibody level 36415, 36416, Blood test for antibody to varicella-zoster virus (chicken pox) 36415, 36416, Blood test for thyroglobulin (thyroid protein) antibody level 36415, 36416, Blood test for hepatitis C antibody level 36415, 36416, Blood test to determine blood type (ABO) 36415, 36416, Blood test for Rh (D) antigen 36415, 36416, Blood test for Hepatitis B surface antigen 36415, 36416, Laboratory Services -- Fecal Test Stool test for blood (to screen for colon tumors) Stool test for bacterial culture Stool test for parasites Laboratory Services -- Swab Test Bacterial culture swab, other than urine, blood or stool Test for disease-causing (pathogenic) organisms, not limited to a specific condition Influenza test (virus A or B) Strep test (Streptococcus, group A) Chlamydia test Gonorrhoeae test (Neisseria gonorrhoeae bacteria) HPV test (human papillomavirus) Laboratory Services -- Urine Test Urinalysis test (automated) for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents Urine test for total protein level Urine test for bacterial culture: quantitative colony count Urine test for bacterial culture Inpatient/Outpatient Surgical Procedures -- Common Surgeries and Procedures Remove skin growth (premalignant/precancerous)# 17000, 17003, Remove up to 14 skin growths (benign/noncancerous)# 17110, 17111
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