Pediatric Physician Rate Increase

RI Medicaid has implemented a rate increase to allow physicians billing for recipients under the age of 21 years to receive rates equivalent to Medicare. This rate increase will be retro-actively effective for dates of service on or after July 1, 2022. Providers should update their billing systems to reflect the new rates in order to be reimbursed correctly.

Claims previously submitted and paid will be mass adjusted by Medicaid in January. Additional communication will be sent with a specific date.

CPT codes included in this initiative and the new rates can be seen in the table below.

*Proc* *Code*	*Short Description*	*New Rate*	*Age*
99202	99202 - Office o/p new sf 15-29 min	$76.53	0 - 20
99203	99203 - Office o/p new low 30-44 min	$117.43	0 - 20
99204	99204 - Office o/p new mod 45-59 min	$174.72	0 - 20
99205	99205 - Office o/p new hi 60-74 min	$231.00	0 - 20
99211	99211 - Office o/p est minimal prob	$24.47	0 - 20
99212	99212 - Office o/p est sf 10-19 min	$59.39	0 - 20
99213	99213 - Office o/p est low 20-29 min	$95.02	0 - 20
99214	99214 - Office o/p est mod 30-39 min	$133.93	0 - 20
99215	99215 - Office o/p est hi 40-54 min	$188.75	0 - 20
99381	99381 - Preventive visit new patient	$114.76	0 - 0
99382	99382 - Preventive visit new patient	$119.72	1 - 4
99383	99383 - Preventive visit new patient	$124.34	5 - 11
99384	99384 - Preventive visit new patient	$141.33	12 - 17
99385	99385 - Preventive visit new patient	$137.08	18 - 20
99391	99391 - Preventive visit est patient	$103.64	0 - 0
99392	99392 - Preventive visit est patient	$110.05	1 - 4
99393	99393 - Preventive visit est patient	$109.68	5 - 11
99394	99394 - Preventive visit est patient	$119.99	12 - 17
99395	99395 - Preventive visit est patient	$122.48	18 - 20

For questions, please contact Karen Murphy at karen.murphy3@gainwelltechnologies.com or (571) 348-5933.