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Section 4 / Part 3
Effective Date: May 1, 1998
Medical examinations
General Medical (GENM) up to a maximum of
$70 fee This includes a comprehensive history and physical exam with decision
making of average complexity and is to include functional physical limitations
and comprehensive report (all information completed on the general medical
exam, including range of motion for low back questions). The counselor
completes the Health Assessment Questionnaire as part of the referral
information. This fee will be paid for the average, traditional medical
examination and will be generally used for the payment of family practitioners
and internal medicine practitioners providing the general medical exam.
Primarily used by Disability Determination Service (DDS) staff, this exam
is also used for a basic mental status exam provided by a psychologist.
This exam is a clinical interview that provides a diagnosis and assesses
the following areas of psychological functioning: history, thought content,
affect, insight and judgment, intelligence, attention, concentration,
appearance and behavior.
Rehabilitation counselors should not use the GENM for purchase of psychological
testing for intelligence and personality assessment. Refer to the psychological
testing section.
Intermediate Examination (INTM) with payment
up to a maximum of $85 This examination is the same information as the general medical exam with
additional information for a specific functional limitation not provided
by a general medical exam. Also, this can be used in areas where the medical
exam reimbursement is not adequate. Primarily, this examination fee and
code are used for the following physicians specialties: internal medicine,
rheumatology, physical medicine, pulmonary, nephrology and pediatrics.
Specialist Examination (SPECM) up to a maximum
fee of $110 This examination includes a comprehensive specialty history and physical
with decision making of high complexity and to include functional physical
limitations and a comprehensive report.
CODES
Cardiology CARDI
Neurology NEURO
Orthopedic ORTHO
Otolayrngology OTOLA
Pediatric Subspecialty PEDIA
Physiatric PHYSI
Psychiatry PSYCH
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