|
TMJ EVALUATION & TREATMENT
Outpatient Programs at Cardinal Hill Rehabilitation Hospital, Lexington,
KY
(Oct. 1, 1993)
Cardinal Hill TMJ Evaluation and Treatment Program
(Nov. 22, 1989)
SERVICE FEE MEMORANDUM
MS-93-94-2
DATE: October 1, 1993
RE: Outpatient Programs at Cardinal Hill Rehabilitation Hospital, Lexington,
KY
Several fees have been increased for outpatient programs at Cardinal Hill
Rehabilitation Hospital to be effective October 1, 1993.
Please cross reference SERVICE FEE MEMORANDUMS for guidelines
and for other fees which have not been increased. SERVICE FEE MEMORANDUMS
will be updated in their entirety as quickly as possible.
|
CODE |
TREATMENT |
OVR ALLOWABLE FEE |
CRANIOMANDIBULAR DISORDER PROGRAM
SERVICE FEE MEMORANDUM
MS-89-90-4 Amended, Cardinal Hill TMJ
Evaluation and Treatment Program, November 22, 1989
CARDINAL HILL REHABILITATION HOSPITAL
|
By Report |
Sironathograph, Initial Evaluation |
$221.00 |
|
By Report |
Sironathogrph, Re-evaluation |
89.00 |
|
By Report |
Physical Therapy Evaluation |
Per Relative Value Schedule |
|
By Report |
Psychological Evaluation |
Per Psychological Fee Schedule |
(Do not authorize the Multidisciplinary TMJ Evaluation @ $175.00)
ASSOCIATED DENTAL SERVICES
|
00040 |
Other: Craniomandibular/Craniovertebral
Dental Consultation |
$58.00 |
SERVICE FEE MEMORANDUM
MS-89-90-4 AMENDED
DATE: November 22, 1989
RE: Cardinal Hill TMJ Evaluation and Treatment Program
Due to errors and omissions, please destroy SERVICE FEE MEMORANDUM,
MS-89-90-4 and replace with SERVICE FEE MEMORANDUM, MS-89-90-4 AMENDED.
Treatment codes have been added on the first page of this amended Memorandum.
On the second page, the Dental Consultation (original memo) has been
changed to Other: Craniomandibular/Craniovertebral Dental Consultation
(amended memo). This is not a routine dental examination.
SERVICE FEE MEMORANDUM
MS-89-90-4 AMENDED
The Kentucky Office of Vocational Rehabilitation (OVR) has established the
following fee schedule for services through the Cardinal Hill TMJ (Temporomandibular
Joint) Evaluation and Treatment Program.
|
CODE |
PROCEDURE |
OVR ALLOWABLE FEE |
|
Evaluation |
|
|
|
By Report |
Sironathograph, Initial Evaluation |
221.00 (10-1-93) |
|
By Report |
Sironathograph, Re-Evaluation or Discharge |
89.00 (10-1-93) |
|
By Report |
EMG, Cranial Nerve Supplied Muscles, Bilateral |
150.00 |
|
By Report |
Physical therapy Evaluation |
Per Relative Value Schedule |
|
By Report |
Psychological Evaluation |
Per Psychological Fee Schedule |
| |
|
|
|
Treatment |
|
|
|
Per RVS |
Phase I – Short Term Physical Therapy |
Per OVR Relative Value Schedule |
|
Per RVS/
Psychological
Fee Schedule |
Phase II – Short Term Physical Therapy and Psychological Intervention |
Per OVR Relative Value Schedule and Psychological Fee Schedule |
|
By Report |
Phase III – Comprehensive Pain Management Program |
$330.00 Per day (10-1-93)
$6,270.00 Total (10-1-93) |
| |
(or) |
|
|
Per RVS/
Psychological
Fee Schedule |
Phase III - Long Term Physical Therapy and Psychological Intervention |
Per OVR Relative Value Schedule and Psychological Fee Schedule |
|
VENDOR NUMBER |
V00045252 |
|
|
VENDOR NAME AND ADDRESS |
CARDINAL HILL HOSPITAL
2050 VERSAILLES RD
LEXINGTON KY 40504 |
|
|
PROGRAM CONTACT PERSON |
Kathy Bishop, Director
PHONE: 606-254-5701, Extension 210 |
|
|
ASSOCIATED DENTAL SERIVCES |
|
|
|
CODE |
PROCEDURE |
OVR ALLOWABLE FEE |
|
EVALUTION |
|
|
|
00040 |
Other: Craniomandibular/Craniovertebral Dental Consultation |
$58.00 |
|
TREATMENT |
|
|
| |
Dental Splints |
|
|
By Report |
Diagnostic Cast and Initial Plastic Craniomandibular Repositioning
Appliance |
$400.00 |
|
By Report |
Permanent Cast Metal Craniomandibular Repositioning Appliances |
$400.00 |
Even though Cardinal Hill Hospital does bill for dental services, the EP-8
should be issued to John Tarrant, D.M.D.
|
VENDOR NUMBER |
VOO897603 |
|
|
VENDOR NAME AND ADDRESS |
TARRANT JOHN D DMD
CARDINAL HILL
2050 VERSAILLES RD
LEXINGTON KY 40504 |
|
|
PROGRAM OCNTACT PERSON |
Kathy Bishop, Director
PHONE: 606-254-5701, Extension 210 |
|
|
