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Resolution 2016-224 RESOLUTION NO.2016 - 2 2 4 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, SUPERSEDING RESOLUTION NO. 2013-20 AND ALL PRIOR RATE RESOLUTIONS AND SCHEDULES FOR THE DEPARTMENT OF HEALTH AND ETABLISHING THE FEES, RATES AND CHARGES FOR SERVICES RENDERED BY THE COUNTY HEALTH DEPARTMENT. WHEREAS, under the authority of Section 154.06 of the Florida Statutes, the Department of Health may establish fee schedules for public health services rendered through the Health Department. WHEREAS, said statutory authority grants the Department of Health the power to assess fees, co-payments, sliding fee scales, fee waivers and fee exemptions. WHEREAS, the funds collected under Section 154.06 of the Florida Statutes shall be expended solely for the purpose of providing health services and facilities within the county served by the county health department. Fees collected by the county health department pursuant to department rules shall be deposited with the Chief Financial Officer and credited to the County Health Department Trust Fund. WHEREAS, the fees collected by the county health department for public health services or personal health services shall be allocated to the state and the county based upon the pro rata share of funding for each service. WHEREAS, the Board of County Commissioners, shall provide for the transmittal of funds collected for its pro rate share of personal health services or primary care services rendered under the provisions of this section to the State Treasury for credit to the County Health Department Trust Fund, but in any events the proceeds from such fees may only be used to fund county health department services. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that: Section 1. Resolution No. 2013-20 is hereby superseded in its entirety. Section 2. The schedule of rates, changes and fees set forth are attached and made an integral component of this Resolution. Section 3. This Resolution shall become effective upon adoption. [16-HDP-00011/1290398/1] 1 THIS RESOLUTION ADOPTED after majority vote on the 2-S4k day of CiaoSc,czAr- , 2016. ATTEST: , ';> BOARD OF COUNTY COMMISSIONERS DWIGHT :`BROCI ,C4erk COLLIER COUNTY, FLORIDA e II a B1, � 1r B Y m-' y: Attest as to Ch.innaaep> ' Cler ` ' D NNA FIALA, CHAIRMAN signatur only > E Appro i6•k_r , ..r- • legality: kb A Jeffrey ' A ow, County Attorney , i f, 1 [16-1-IDP-00011/1290398/1] 2 COLLIER COUNTY HEALTH DEPARTMENT - FEE SCHEDULE This fee schedule is established as authorized by Florida Statutes Section 154.06. All funds collected shall be expended soley for the purpose of providing public health services within Collier County. Financial Eligibility: Shall be determined for all clients receiving personal health services for which a sliding fee is to be charged, and shall be re-determined a minimum of once a year or shorter if income or family size changes. Clients that waive the financial eligibility determination shall be assigned to the full fee category and attest to their decision by signing the HMS generated fact sheet. Clients will not be charged in the following circumstances: (1) Clients enrolled in Medicaid, however charges may apply for non-covered services. (2) Childhood immunizations required for school (pre-K- 12th). Third party payers shall be billed an administration (injection) fee. (3) Anonymous HIV testing if there is an inability to pay. (4) No charge to a minor's parent(s) if the minor is without parental consent, has no income and is receiving STD or HIV services. (5) Clients that are part of a contact or at-risk group related to the investigation of a communicable disease. Charges may apply for any subsequent clinical examination and treatment. Note: Patients may not be denied the following services due to their failure or inability to pay: communicable disease services, TB, STD, HIV/AIDS communicable disease control services. Fees are based on the enhanced Medicaid primary care rates published in 2014 IAW with Section 1202 of the Affordable Care Act. If unavailable, then 150%of the Medicaid fee schedule. CPT Code Description of Service Current Fee Proposed Fee 99201 New Prob Focused 50.00 50.00 99202 New Expanded Prob Focused 75.00 80.00 99203 New Detailed Low 120.00 120.00 99204 New Comp Moderate 175.00 180.00 99205 New Comp High 200.00 220.00 99211 Min Visit MD/Nurse Visit 40.00 40.00 99212 Est Prob Focused 50.00 50.00 99213 Est Expanded Prob Focused 75.00 80.00 99214 Est Detailed Visit 120.00 120.00 99215 Est Comp Visit 160.00 160.00 BUNDLED SERVICES IMMPE Immigration PE(Adult)with CXR, T-Spot, RPR, HIV 180.00 180.00 IMMPE Immigration PE(Child) 120.00 120.00 X-Ray fees are based on contracted cost. CPT Code Description of Service Current Fee Proposed Fee 36415 Venous Blood Draw 10.00 10.00 46924 TCA Anal(per treatment) 50.00 50.00 54065 TCA Male(per treatment) 50.00 50.00 56501 TCA Female(per treatment) 50.00 50.00 710XX Chest X-Rays -Single(1)View 30.00 30.00 -Two(2)View 40.00 40.00 86580 PPD Placement and reading 20.00 20.00 Page 1 86480 Quantiferon 40.00 40.00 86481 T-Spot 25.00 25.00 86703 HIV Testing 20.00 20.00 1693 MD Completion of 1-693 INS Immigration Form 30.00 50.00 Vaccine fees are based on cost plus an administration(injection)fee which is the Medicare rate. CPT Code Description of Service Current Fee Proposed Fee 90471 Immunization Administration 20.00 27.00 90472 Immunization Administration Each Additional Vaccine 5.50 13.00 90632 IM HEP A, Adult Intramuscular 30.00 30.00 90636 IM HEPA-HEPB Vaccine 56.00 56.00 90649 HPV4 Vaccine 132.00 132.00 90651 HPV9 Vaccine NEW 160.50 90656 IM Influenza Vaccine 10.00 10.00 90662 New-High Dose Influenza Vaccine 30.00 37.00 90686 New-Quadrivalent Influenza Vaccine 16.00 19.00 90732 New-Pneumococcal Vaccine 65.00 65.00 90675 Rabies Vaccine, Intramuscular Pre/Intramuscular Post 215.00 215.00 90707 IM MMR Vaccine 55.00 55.00 90716 Varicella Vaccine 92.00 92.00 90718 TDAP Vaccine 35.00 35.00 90718 IM TD or Tetnus Vaccine 25.00 25.00 90736 IM Zostavax Vaccine 161.00 161.00 90744 IM HEP B Vaccine 35.00 35.00 Fees are based on the local family planning contractor rates or the enhanced Medicaid family planning enhanced rates published in 2014 IAW with Section 1202 of the Affordable Care Act. If unavailable, then 150%of the Medicaid fee schedule. CPT Code Description of Service Current Fee Proposed Fee 99403 Minimal (Counseling/PT) NEW 130.00 99384 12-17 Yrs Initial Evaluation NEW 175.00 99385 18-39 Yrs Initial Evaluation NEW 175.00 99386 40-64 Yrs Initial Evaluation NEW 190.00 99387 65 and Over Initial Evaluation NEW 210.00 99394 12-17 Yrs Annual (Periodic) Evaluation NEW 155.00 99395 18-39 Yrs Annual (Periodic) Evaluation NEW 155.00 99396 40-64 Yrs Annual (Periodic) Evaluation NEW 155.00 99397 65 and Over Annual (Periodic)Evaluation NEW 175.00 PROCEDURES 11981 Nexplanon Insertion NEW 200.00 11982 Nexplanon Removal NEW 135.00 11983 Nexplanon Removal and Insertion NEW 185.00 58300 IUD Insertion NEW 200.00 58301 IUD Removal NEW 150.00 J1050 Depo-Provera + Injec Adm NEW 135.00 J7300 Paragard Device NEW 700.00 J7301 SKYLA 13.5 MG NEW 660.00 J7302 Mirena Device NEW 800.00 J7307 Nexplanon Device NEW 850.00 Page 2 LABS($10 draw fee total for all five) 81002 Urine, Dip Stick NEW 2.00 81025 Pregnancy Test(Urine) NEW 2.00 82948 Blood Sugar NEW 2.00 85018 HgB NEW 2.00 87210 Wet Mount NEW 2.00 LABS(Cost plus$10 draw fee) 80053 Comp Metab Panel (pre-op) NEW 1.51 80061 LIPID Panel NEW 1.75 80076 Hepatic Panel NEW 1.16 81003 MICRO UA NEW 1.50 82270 Occult Blood Screen NEW 11.70 83001 FSH+LH NEW 7.00 83036 Hemoglobin A1C NEW 2.00 83540 IRON, TOTAL NEW 17.85 84146 PROLACTIN NEW 7.00 84443 TSH NEW 2.00 84450 AST(SGOT) NEW 0.88 84460 ALT(SGPT) NEW 0.88 84479 T3, T4 NEW 1.10 84702 Pregnancy(Quant Serum)(pre-op) NEW 4.50 85025 CBC with diff(pre-op) NEW 1.10 86592 RPR NEW 2.00 86692 Chronic Hepatitis Screen NEW 25.00 86695 HSV TYPE 1&2 IGC NEW 15.00 86701 HIV Screening NEW 7.00 86780 FTA-ABS NEW 25.96 87070 Nose/Throat/Other(Culture) NEW 7.50 87086 Urine(Culture) NEW 3.00 87255 HERPES (Culture) NEW 53.60 87389 HIV 1/2 Antinge/Antibody Combo Immunoassay NEW 7.00 87490 DNA Probe Chlamydia/GC NEW 12.00 87491 Amplified GC/CT NEW 12.00 88142 Thin Prep(Pap) NEW 12.60 Dental fees are based on the average fee published in the 2013 Survey of Fees conducted by the American Dental Association (ADA)for the South Atlantic Region. CDT CODE Description of Service Current Fee Proposed Fee D0120 Periodic oral evaluation-established patient 35.00 43.00 D0140 Limited oral evaluation-problem focused 50.00 64.00 D0145 Oral evaluation for a patient under three years of age and counseling 40.00 55.00 D0150 Comprehensive oral evaluation-new or established patient 58.00 73.00 D0210 Intraoral-complete series(including bitewings) 93.00 121.00 D0220 Intraoral-periapical first film 20.00 26.00 D0230 Intraoral-periapical each additional film 16.00 22.00 D0240 Intraoral-occlusal film 29.00 35.00 D0270 Bitewing-single film 16.00 22.00 D0272 Bitewings-two films 32.00 41.00 D0273 Bitewings-three films 40.00 51.00 D0274 Bitewings-four films 45.00 58.00 D0277 Vertical bitewings-7 to 8 films 74.00 89.00 D0330 Panoramic film 82.00 103.00 D0350 Oral/facial photographic images 35.00 36.00 Page 3 D0460 Pulp vitality tests 20.00 30.00 D0470 Diagnostic casts 75.00 94.00 PREVENTIVE D1110 Prophylaxis-adult 64.00 83.00 D1120 Prophylaxis-child 48.00 62.00 D1206 Topical fluoride varnish; therapeutic application for moderate to high 30.00 35.00 D1208 Topical application of fluoride 27.00 33.00 D1330 Oral Hygiene Instructions 37.00 22.00 D1351 Sealant-per tooth 39.00 48.00 D1510 Space maintainer-fixed-unilateral 233.00 298.00 D1515 Space maintainer-fixed-bilateral 335.00 402.00 D1550 Re-cementation of space maintainer 59.00 83.00 D1555 Removal of fixed space maintainer 74.00 104.00 RESTORATIVE D2140 Amalgam-one surface, primary or permanent 91.00 127.00 D2150 Amalgam-two surfaces, primary or permanent 117.00 158.00 D2160 Amalgam-three surfaces, primary or permanent 140.00 189.00 D2161 Amalgam-four or more surfaces, primary or permanent 171.00 221.00 D2330 Resin-based composite-one surface, anterior 90.00 149.00 D2331 Resin-based composite-two surfaces, anterior 139.00 181.00 D2332 Resin-based composite-three surfaces, anterior 171.00 220.00 D2335 Resin-based composite-four or more surfaces or involving incisal 211.00 271.00 D2390 Resin-based composite crown, anterior 227.00 389.00 D2391 Resin-based composite-one surface, posterior 123.00 162.00 D2392 Resin-based composite-two surfaces, posterior 164.00 206.00 D2393 Resin-based composite-three surfaces, posterior 204.00 253.00 D2394 Resin-based composite-four or more surfaces, posterior 232.00 297.00 D2740 Crown-porcelain/ceramic substrate 800.00 1,112.00 D2750 Crown-porcelain fused to high noble metal 886.00 1,080.00 D2752 Crown-porcelain fused to noble metal 854.00 1,045.00 D2790 Crown-full cast high noble metal 900.00 1,100.00 D2792 Crown-full cast noble metal 890.00 1,086.00 D2799 Provisional crown 250.00 331.00 D2915 Recement cast or prefabricated post and core 99.00 121.00 D2920 Recement crown 77.00 94.00 D2930 Prefabricated stainless steel crown-primary tooth 197.00 270.00 D2931 Prefabricated stainless steel crown-permanent tooth 246.00 297.00 D2932 Prefabricated resin crown 246.00 297.00 D2940 Protective restoration 80.00 104.00 D2950 Core buildup, including any pins 180.00 245.00 D2952 Post and core in addition to crown, indirectly fabricated 290.00 355.00 D2954 Prefabricated post and core in addition to crown 230.00 299.00 D2962 Labial veneer(porcelain laminate)-laboratory 887.00 1,083.00 D2970 Temporary crown (fractured tooth) 250.00 294.00 ENDODONTICS D3110 Pulp cap-direct(excluding final restoration) 56.00 71.00 D3120 Pulp cap-indirect(excluding final restoration) 54.00 69.00 D3220 Therapeutic pulpotomy(excluding final restoration)-removal of pulp 138.00 172.00 application of medicament D3221 Pulpal debridement, primary and permanent teeth 146.00 173.00 D3230 Pulpal therapy(resorbable filling)-anterior, primary tooth(Excluding 185.00 250.00 D3240 Pulpal therapy(resorbable filling)-posterior, primary tooth 209.00 270.00 D3310 Endodontic therapy, anterior tooth(excluding final restoration) 571.00 702.00 D3320 Endodontic therapy, bicuspid tooth (excluding final restoration) 665.00 812.00 D3330 Endodontic therapy, molar(excluding final restoration) 807.00 983.00 D3346 Retreatment of previous root canal therapy-anterior 625.00 825.00 PERIODONTICS Page 4 D4211 Gingivectomy or gingivoplasty-one to three contiguous teeth or 160.00 245.00 D4249 Clinical crown lengthening-hard tissue 570.00 665.00 D4321 Provisional splinting-extracoronal 350.00 369.00 D4341 Periodontal scaling and root planing-four or more teeth per 187.00 233.00 D4342 Periodontal scaling and root planing-one to three teeth per 130.00 163.00 D4355 Full mouth debridement to enable comprehensive evaluation and 132.00 160.00 D4381 Localized delivery of antimicrobial agents via a controlled release 40.00 83.00 D4910 Periodontal maintenance 100.00 121.00 PROSTHODONTICS, REMOVABLE D5110 Complete denture-maxillary 1,200.00 1,482.00 D5120 Complete denture-mandibular 1,200.00 1,485.00 D5130 Immediate denture-maxillary 1,200.00 1,565.00 D5140 Immediate denture-mandibular 1,200.00 1,569.00 D5211 Maxillary partial denture-resin base(including any conventional 880.00 1,063.00 D5212 Mandibular partial denture-resin base(including any conventional 880.00 1,087.00 D5213 Maxillary partial denture-cast metal framework with resin denture 1,300.00 1,561.00 D5214 Mandibular partial denture-cast metal framework with resin denture 1,300.00 1,570.00 teeth) D5225 Maxillary partial denture-flexible base(including any clasps, rests 1,100.00 1,357.00 D5226 Mandibular partial denture-flexible base(including any clasps, rests 1,100.00 1,347.00 D5410 Adjust complete denture-maxillary 72.00 80.00 D5411 Adjust complete denture-mandibular 72.00 80.00 D5421 Adjust partial denture-maxillary 72.00 80.00 D5422 Adjust partial denture-mandibular 72.00 80.00 D5510 Repair broken complete denture base 167.00 186.00 D5520 Replace missing or broken teeth-complete denture(each tooth) 150.00 162.00 D5610 Repair resin denture base 150.00 182.00 D5620 Repair cast framework 238.00 265.00 D5630 Repair or replace broken clasp 194.00 215.00 D5640 Replace broken teeth-per tooth 125.00 170.00 PROSTHODONTICS, REMOVABLE D5650 Add tooth to existing partial denture 182.00 194.00 D5660 Add clasp to existing partial denture 175.00 223.00 D5730 Reline complete maxillary denture(chairside) 250.00 301.00 D5731 Reline complete mandibular denture(chairside) 250.00 298.00 D5740 Reline maxillary partial denture(chairside) 250.00 298.00 D5741 Reline mandibular partial denture(chairside) 250.00 298.00 D5750 Reline complete maxillary denture(laboratory) 339.00 400.00 D5751 Reline complete mandibular denture(laboratory) 339.00 397.00 D5760 Reline maxillary partial denture(laboratory) 339.00 397.00 D5761 Reline mandibular partial denture(laboratory) 339.00 397.00 D5850 Tissue conditioning, maxillary 145.00 170.00 D5851 Tissue conditioning, mandibular 145.00 170.00 PROSTHODONTICS, FIXED D6210 Pontic-cast high noble metal 886.00 1,102.00 D6212 Pontic-cast noble metal 860.00 1,102.00 D6240 Pontic-porcelain fused to high noble metal 874.00 1,075.00 D6242 Pontic-porcelain fused to noble metal 870.00 1,071.00 D6245 Pontic-porcelain/ceramic 907.00 1,098.00 D6740 Crown-porcelain/ceramic 907.00 1,008.00 D6750 Crown-porcelain fused to high noble metal 886.00 1,092.00 D6752 Crown-porcelain fused to noble metal 850.00 1,075.00 D6790 Crown-full cast high noble metal 890.00 1,075.00 D6930 Recement fixed partial denture 107.00 142.00 D6970 Post and core in addition to fixed partial denture retainer, indirectly 274.00 334.00 D6972 Prefabricated post and core in addition to fixed partial denture 217.00 265.00 D6973 Core build up for retainer, including any pins 180.00 220.00 Page 5 ORAL AND MAXILLOFACIAL SURGERY D7111 Extraction, coronal remnants-deciduous tooth 90.00 111.00 D7140 Extraction, erupted tooth or exposed root(elevation and/or forcepts 112.00 157.00 D7210 Surgical removal of erupted tooth requiring removal of bone and/or 197.00 251.00 mucoperiosteal flap if indicated D7220 Removal of impacted tooth-soft tissue 229.00 297.00 D7230 Removal of impacted tooth-partially bony 293.00 370.00 D7250 Surgical removal of residual tooth roots(cutting procedure) 208.00 260.00 D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or 374.00 400.00 D7310 Alveoloplasty in conjunction with extractions-four or more teeth or 293.00 268.00 D7311 Alveoloplasty in conjunction with extractions-one to three teeth or 229.00 230.00 D7410 Excision of benign lesion up to 1.25 cm 315.00 329.00 D7510 Incision and drainage of abscess-intraoral soft tissue 159.00 175.00 D7530 Removal of foreign body from mucosa, skin, or subcutaneous 246.00 250.00 D7880 Occlusal orthotic device, by report 860.00 788.00 D7960 Frenulectomy-Also known as frenectomy or frenotomy-separate 253.00 387.00 ADJUNCTIVE GENERAL SERVICES D9110 Palliative(emergency)treatment of dental pain-minor procedure 85.00 98.00 D9120 Fixed partial denture sectioning 75.00 143.00 D9210 Local anesthesia not in conjunction with operative or surgical 12.00 20.00 D9630 Other Drugs and Medicaments 20.00 28.00 D9910 Application of desensitizing medicament 27.00 48.00 D9920 Behavior management, by report 85.00 89.00 D9940 Occlusal guard, by report 420.00 493.00 D9974 Internal bleaching-per tooth 200.00 240.00 D9999 Unspecified adjunctive procedure, by Report 20.00 30.00 : : > '>':'ORMEM:»< '>IIIIIIII> «'<> .1fi1O>" ::>_>::::>:::»:::>:::::<::::<:>::::>::::>:<:>::»:>::>::::<: <:>:>:::::: : :.:LW �+tlE?N'�1��:f�E�tifTH<S Fees for environmental health services are based on the usual and customary fee for that service. Description of Service Current Fee Proposed Fee FOOD Plan Review(per hour) 50.00 50.00 GROUP Plan Review(per hour) 50.00 50.00 Reinspection (one-time fee) 50.00 50.00 Construction Inspection (one-time fee) 50.00 50.00 Adult Family Care(annual fee) 150.00 150.00 Assisted Living Facilities(annual fee) 250.00 250.00 Residential Facilities(annual fee) 250.00 250.00 Schools>200 persons(annual fee) 500.00 500.00 Schools<200 persons(annual fee) 150.00 150.00 Other Group Facilities(annual fee) 150.00 150.00 MOBILE HOME PARKS Plan Review(per hour) 50.00 50.00 Reinspection(one-time fee) 50.00 50.00 MIGRANT HOUSING Reinspection (one-time fee) NEW 50.00 TANNING Plan Review(per hour) 50.00 50.00 Reinspection(one-time fee) 50.00 50.00 SWIMMING POOLS Reinspection routine inspections(one-time fee) 75.00 75.00 Construction Inspection(one-time fee) 100.00 100.00 Bacteriological Fee(annual fee) 250.00 250.00 Rough Plumb Inspection (one-time fee) 50.00 50.00 Page 6 Renovation Inspection (one-time fee) 50.00 50.00 Exempt Pool (one-time fee) 100.00 100.00 Operator Certificate(one-time fee) 20.00 20.00 Operator Course(one-time fee) 75.00 75.00 WATER Water Letter(one-time fee) 30.00 30.00 Bacteriological Sample Non-Regulated (one-time fee) 25.00 25.00 Sample Collection Non-Regulated (one-time fee) 60.00 60.00 Nitrate Sample Non-Regulated (one-time fee) 60.00 60.00 Bacteriological Sample Regulated (one-time fee) 15.00 15.00 Sample Collection Regulated (one-time fee) 40.00 40.00 Nitrate Sample Regulated (one-time fee) 60.00 60.00 Lead Sample(one-time fee) 30.00 30.00 Sodium Sample(one-time fee) 25.00 25.00 Chloride Sample(one-time fee) 20.00 20.00 OSTDS Development Plan Review(one-time fee) 20.00 20.00 Incidental Plan Review(one-time fee) 10.00 10.00 Construction Permit Application (one-time fee) 160.00 160.00 Final Cover Inspection(one-time fee) 75.00 75.00 ATU Permit(annual fee) 150.00 150.00 PBT Permit(annual fee) 200.00 200.00 Reinspection(one-time fee) 75.00 75.00 Repair Permit(one-time fee) 200.00 200.00 Septic Letter(one-time fee) 30.00 30.00 Description of Service Current Fee Proposed Fee VITAL STATISTICS Birth Certificate(1st Copy) 10.00 12.00 Birth Certificate(each additional copy) 6.00 8.00 Death Certificate 8.00 10.00 MISC FEES Emergency Management Plan Review(CEMP)- Initial 48.00 48.00 Emergency Management Plan Review(CEMP)-Update/Renewal 24.00 24.00 Duplication*(.15 per page-charges under$5.00 will be waived) 0.15 0.15 Returned Check 25.00 25.00 *A special service charge will apply for requests that involve large volumes or require extensive personnel or IT resources. 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