Reimbursement basis and provider notification

Reimbursement will follow the CHP (Community Health Program) encounter rate, as established annually by the Office of Rate Review (ORR) and distributed to Tribal Health Organizations and participating CHA/BHA providers. The fee schedule is subject to change; providers who identify potential errors or claim adjudication issues should contact the Division of Health Care Services for resolution.

• CHP encounter rate established annually by ORR and sent to THOs and participating CHA/BHAs.
• Coverage and rates are subject to change; clerical/typographical errors may be corrected promptly or at the next quarterly update.

Fee schedule listing — no authorization rules in extract

This excerpt shows fee-schedule rows listing CPT/HCPCS procedure codes alongside CHA/CHP category indicator columns, but it does not contain any prior authorization, denial risk, or explicit documentation/prior‑auth rules in the visible lines.

• Rows list procedure codes with CHA I–IV and CHP columns marked (e.g., 'X') to indicate applicability.
• No prior authorization, denial risk, or documentation instructions are shown in this extract.

Fee schedule matrix — indicator-only (no authorization guidance)

The table segment displays procedure codes with matrix-style coverage indicators (CHA I–IV, CHP) only; the excerpt does not include provider authorization guidance, denial criteria, documentation requirements, or step‑therapy rules.

• Matrix shows per-code 'X' and '=' markers under CHA/CHP columns to indicate allowance/relationship.
• No explicit provider action instructions (e.g., prior authorization) are present in this excerpt.

Coverage markers present in excerpt only

Codes in this excerpt are marked with 'X' (and occasionally '=') to indicate payment/allowance or grouping, but the visible pages do not include explicit prior authorization, denial risk, documentation, or step‑therapy rules.

• 'X' is used as the coverage/allowance indicator in the fee schedule table.
• Legend defining 'X'/'=' meaning is not present in this excerpt.

Vaccine code list (partial)

The fee schedule includes multiple influenza and related vaccine CPT codes in the vaccine rows; this excerpt lists vaccine codes with coverage indicators but does not add authorization instructions.

• Examples shown: 90658, 90662, 90664, 90672, 90674, 90682 (influenza/related vaccine codes).
• Vaccine rows are repeated with CHA/CHP matrix markers (X / =) indicating allowance per column.

Procedure code list (partial)

Audiology and other procedure CPT codes are listed with per-column indicators in the fee schedule; the excerpt contains the code list but no authorization or special billing instructions in these lines.

• Examples shown: 92551, 92552, 92567, 92950, 93005, 94640.
• Each code row displays 'X' and '=' markers under CHA/CHP columns to indicate applicability.

Fee schedule excerpt — no authorization rules shown

This fee schedule excerpt lists procedure codes and grouping/bundling markers but does not include explicit prior authorization, denial-risk guidance, billing rules beyond indicator columns, or step‑therapy requirements in the visible lines.

• Rows show codes with 'X'/'=' markers (grouping/bundling) but no accompanying authorization or documentation rules.
• Providers should refer to the full fee schedule or program guidance for authorization and billing requirements not shown here.

May require physician or qualified health professional

Certain office/outpatient established visit codes may require a physician or qualified health professional; the listing shows the note 'OFF/OP EST MAY X REQ PHY/QHP'.

• Example: 99211 OFF/OP EST MAY X REQ PHY/QHP — indicates established visit may require physician/QHP involvement as marked.

Billing rule — use fee schedule codes and CHP encounter rate

Bill using the CPT/HCPCS codes listed and the fee‑schedule matrix indicators; the schedule notes rates are subject to change and that the CHP encounter rate governs reimbursement. Contact Division of Health Care Services for discrepancies.

• Use listed CPT/HCPCS codes as shown in the fee schedule rows when submitting claims.
• Reimbursement follows the CHP encounter rate established by ORR; coverage and rates are subject to change.

Fee schedule code entries — indicators and short descriptors

The fee schedule lists many individual code entries showing payment/availability indicators and short descriptors (for example, preventive counseling and digital E/M service lines), but the excerpted entries do not display dollar amounts or explicit claim submission instructions.

• Entries include codes such as 99421–99423 and descriptive labels (e.g., PREV MED CNSL INDIV APPRX 45 = OL DIG E/M SVC 11-20 MIN).
• Per-code 'X' indicators appear across CHA/CHP columns; fee amounts are not shown in this excerpt.

Preventive counseling codes (G-codes)

Preventive counseling and immunization counseling G-codes are listed with 'X' indicators (coverage/availability) in the fee schedule; the excerpt shows those codes but does not attach authorization conditions in the visible lines.

• Examples: G0312–G0315 (immunization counseling by a physician) and G0443 (brief alcohol misuse counseling) are listed with 'X' indicators.
• These G-codes are presented under the PREV MED CNSL INDIV APPRX 45 heading in the excerpt.

Drug and infusion supply codes (J‑codes)

J‑codes for injectable drugs and infusion supplies are listed with 'X' indicators in the preventive‑counseling rows; entries include many drug and infusion supply HCPCS codes but the excerpt does not include separate billing or prior‑authorization instructions.

• Examples shown: J0561, J0696, J0885, J1050, J1438, J1885, J2550, J3420, J7030, J7040, J7120, J7613.
• Some J‑code rows show '.' in certain columns while others show 'X' to indicate availability per CHA/CHP column.