Microsoft word - fee schedule 2011 - effective 1-1-2011.doc

TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010
$12 Administration Fee and Vaccine Costs + 10% (unless covered by VFC/VRP) $12 Administration Fee and Vaccine Costs + 10% (unless covered by VFC/VRP) Injectable Polio Vaccine/ Oral Polio Vaccine – Children, $12 Administration Fee and Vaccine Costs + 10% Students, Susceptible Adults, Adults for Foreign Travel Measles/Mumps/Rubella- Children, Students, Required College $12 Administration Fee and Vaccine Costs + 10% Booster,Adults for Foreign Travel, Susceptible Adults $12 Administration Fee and Vaccine Costs +10% $12 Administration Fee and Vaccine Costs + 10% (unless covered by VFC/VRP) Tuberculin Tests- Children, Requirement of Volunteer, Paid or Unpaid position HIB Vaccine – Children $12 Administration Fee and Vaccine Costs + 10% (unless covered by VFC/VRP) Hepatitis B Vaccine – Children through 18 years $12 Administration Fee and Vaccine Costs + 10% (unless covered by VFC/VRP) $12 Administration Fee and Vaccine Costs +10% Hepatitis B Vaccine – age 20 years and older $12 Administration Fee and Vaccine Costs + 10% $12 Administration Fee and Vaccine Costs +10% $12 Administration Fee and Vaccine Costs + 10% (unless covered by VFC/VRP) Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are delineated in a contract which is approved by the Tuscola County Board of Health/Board of Commissioners. To establish fees to be charged for services rendered. 01/01/2011
12/09/2010
12/09/2010
12/17/2010
12/29/2010
Varicella – Age 12 months through age 18 $12 Administration Fee and Vaccine Cost + 10% (unless covered by VFC/VRP) $12 Administration Fee and Vaccine Cost + 10% (unless covered by VFC/VRP) $12 Administration Fee and Vaccine Cost + 10% $12 Administration Fee and Vaccine Cost + 10% $12 Administration Fee and Vaccine Cost + 10% $12 Administration Fee and Vaccine Cost + 10% $12 Administration Fee and Vaccine Cost + 10% (unless covered by MDCH) $12 Administration Fee and Vaccine Cost + 10% $12 Administration Fee and Vaccine Cost + 10% $12 Administration Fee and Vaccine Cost + 10% Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are delineated in a contract which is approved by the Tuscola County Board of Health/Board of Commissioners. Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are
delineated in a contract which is approved by the Tuscola County Board of Health and the Tuscola Board of Commissioners.
TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
2 (Part 1)
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010
Established Exam (ages 5 – 11) [99393] Established Exam (ages 12 – 17) [99394] Established Exam (ages 18 – 39) [99395] Established Exam (ages 40 – 64) [99396] Initial Office Visit – Problem Focused [99201] Initial Office Visit – Expanded Problem Focused [99202] Initial Office Visit – Detailed [99203] Initial Office Visit – Comprehensive Moderate Complexity [99204] Initial Office Visit – Comprehensive High Complexity [99205] Established Office Visit – RN [99211] Established Office Visit – MLP-Problem Focused[99212] Established Office Visit – MLP-Expanded Problem Focused [99213] Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are delineated in a contract which is approved by the Tuscola County Board of Health and the Tuscola Board of Commissioners. TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
2 (Part 2)
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011
LAST REVIEW
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010

Wet Mount [87210]

GC - Probetec [87850] High Risk
Actual Cost of Test, unless free from MDCH
Chlamydia - Probetec [86631] High Risk
Actual Cost of Test, unless free from MDCH
VDRL [84703QW]
Actual Cost of Test, unless free from MDCH
Terazol [Z8005]
Actual Cost of Drug, unless free from MDCH Actual Cost of Drug, unless free from MDCH
Doxycycline [Z8068]
Actual Cost of Drug, unless free from MDCH
Zithromax Suspension 1 gm. [ Q0144]
Actual Cost of Drug, unless free from MDCH Actual Cost of Drug, unless free from MDCH Actual Cost of Drug, unless free from MDCH
Depo Provera [J1055]
Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are delineated in a contract which is approved by the Tuscola County Board of Health and the Tuscola Board of Commissioners. TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
2 (Part3)
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010

Diaphragm [A4266]

Male Condom [A4267]

Female Condom [A4268]

Jelly [A4269]
Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are delineated in a contract which is
approved by the Tuscola County Board of Health and the Tuscola Board of Commissioners

TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
Maternal Infant Support Program (Maternal Infant Health Program) To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010

MSS Office Enrollment
Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are
delineated in a contract which is approved by the Tuscola County Board of Health and the Tuscola Board of Commissioners.


TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010

Immune Status Titers:
Actual Cost of Lab Tests/Kits (when test FB146 – Medical/Nursing Student – Measles, Mumps, Rubella, Anti-HBs, Varicella Zoster
FB147- Health Care Worker – Measles, Mumps, Rubella, Varicella Zoster

Lead Nursing Home Visit – First Visit

Lead Nursing Home Visit – Second Visit

Lead Environmental Health Home Visit – First Visit

Lead Environmental Health Home Visit –Second Visit

Public Health Nurse/Health Educator Presentation

Disinterment/Reinterment Permit

Record Copy Cost (per page)
Breast and Cervical Cancer Control Program (BCCCP); FP/BCCCP TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
5 (Part 1) SUBJECT
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
01/26/1999 plus BOC BOC RATIFICATION DATE
12/29/2010
Food Service – Profit and Non Profit effective 10/1/08
STFU Inspection fee for each requested inspection Operation Prior to License Application - Fixed/Temporary/Vending Food Service License Late Fee - Fixed/Mobile/Transitory Construction/Alteration Prior to Plan Approval Change of Ownership Inspection Late Fee Second Follow-up Inspection Same Violation Additional Follow-up Inspections - Same Violations TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
5 (Part 2) SUBJECT
To establish fees to be charged for services rendered. EFFECTIVE DATE
01/01/2011 LAST
12/09/2010
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATIFICATION DATE
12/29/2010
Application $300 Relocation $160 Permit Transfer TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
PURPOSE To establish fees to be charged for services rendered.
12/09/2010
EFFECTIVE DATE
01/01/2011 LAST
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC RATAIFICATION
12/29/2010
DHS/MDCIS – effective 10/1/08
Land Division/Subdivision/Site Condominiums/Proposed Mobile Home Parks/ Proposed Campgrounds/Proposed Cemeteries Raw Land Evaluations (Applied toward preliminary plat if submitted) $113 +State Fee (51-75 sites) $124 +State Fee (76-100 sites) $138 +State Fee (101-500 sites) $173 +State Fee (500 + sites) Raw Land Evaluation for single residential usage Requested Evaluation (Water/Soil/Other) TUSCOLA COUNTY HEALTH DEPARTMENT
FEE SCHEDULE
To establish fees to be charged for services rendered. 12/09/2010
EFFECTIVE DATE
01/01/2011 LAST
DATE ESTABLISHED
LAST REVISION DATE
12/09/2010
BOH ADOPTED DATE
BOH ADOPTED DATE
12/17/2010
BOC ADOPTED DATE
BOC ADOPTED DATE
12/29/2010
New Client – Office Visit – Problem Focused New Client – Office Visit – Expanded Problem Established Client – Office Visit – Nursing Intervention Established Client – Office Visit – Problem Focused Laboratory – Pregnancy Test Laboratory - Serology/VDRL Actual cost of test unless free from MDCH Actual cost of test unless free from MDCH Actual cost of test unless free from MDCH Actual cost of drug unless free from MDCH Actual cost of drug unless free from MDCH Actual cost of drug unless free from MDCH Actual cost of drug unless free from MDCH Actual cost of drug unless free from MDCH Actual cost of drug unless free from MDCH Note: Different Fees may be negotiated with Qualified Health Plans and other Health Insurance Provider as long as they are delineated in a contract which is approved by the Tuscola County Board of Health/Board of Commissioners.

Source: http://mail.tchd.us/PDF%20Files/Fee%20Schedule%202011%20-%20effective%201-1-2011.pdf