Pain

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PAIN

DATE: February 7, 1997

RE: Pain Management Services, Pain Care Institute

The Kentucky Department of Vocational Rehabilitation (DVR) will allow the following fees to Pain Care Institute for its Phase 2 Pain and Stress Treatment Program. This Program is located to 10597 Montgomery Road, Suite 100, Cincinnati, OH. DVR payment is considered to be full and final.

Service		DVR Allowable Fee
Evaluation
90899	Psychological Evaluation	$ 75.00
90830	Psychometric Testing MMPI	44.00
97750	Physical Therapy Evaluation	60.00
99205	Office Visit	75.00
Treatment
99199	Phase 2 Pain and Stress Treatment Program (P.A.S.T.) with Limit of Twenty (20) Outpatient Treatment Days	315.00 per diem

VENDOR NUMBER:	611274830
VENDOR NAME AND ADDRESS:	PAIN CARE INSTITUTE LTD 601 WASHINGTON, STE 390 NEWPORT KY 41071
SEND COPY OF AUTHORIZATION TO:	Ms. Pat Grote, Pain Care Institute 10597 Montgomery Road, Suite 100 Cincinnati, OH 45242 PHONE: 513-984-6300 FAX: 513-985-2600

SERVICE FEE MEMORANDUM

MS-89-90-22

DATE: May 7, 1990

RE: Pain Rehabilitation Program, University of Kentucky,

Department of Physical Medicine, Lexington

The Kentucky Office of Vocational Rehabilitation (OVR) has established the following fees for services through the Pain Rehabilitation Program at the University of Kentucky, Department of Physical Medicine.

CODE	PROCEDURE	ALLOWABLE FEE
By Report	Supplementary Evaluation to include Psychological Evaluation and Training	$150.00
TREATMENT
By Report	Office Visit to include Relaxation Therapy, Biofeedback Training, Point Stimulation, Exercise Instruction and Review, Education and Paravertebral Multiple Nerve Block; Two (2) per Week for Eight (8) Weeks	$202.00 Per Visit

Psychological counseling is recommended by program staff when essential to successful pain treatment; it is not a routine component of the program. When individual psychotherapy involves a 50 to 60 Minute Session, allow $50.00 and code 9007a; when involves a 25 to 30 Minute Session, allow $25.00 and code 9007a.

For the Supplementary Evaluation, pre-authorized to the Kentucky Medical Services Foundation (KMSF), invoice upon receipt of bill and written report of findings and treatment recommendations.

Authorizations for treatment should be issued monthly to KMSF and invoiced upon receipt of itemized bills and progress reports. Coverage for sixteen (16) treatment sessions must not be exceeded.

AUTHORIZATIONS:

VENDOR NUMBER:	V00414573
VENDOR NAME AND ADDRESS:	KY MED SVC FOUND INC P O BOX 1688 LEXINGTON KY 40592
CONTACT PERSON:	Deborah C. Bradley PHONE: 606-257-3573

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