South Dakota Urban Indian Health

Behavioral Health Fees and Sliding Fee Scale

Behavioral Health Fees and Sliding Fee Scale

 CPT TNAs   CAT 1  CAT 2  CAT 3/Full Pay

 H0001

 Treatment Needs Assessment/Updates

 $75

 $75

 $75

*TNAs must be paid up front or patient will not be seen  

**Division funding will not be used for TNAs     

    
 CPT Substance Abuse Services   CAT 1 (15 min units) CAT 2 (15 min units)  CAT 3/Full Pay(15 min units)

 H0004

 Local Individual Counseling

 $8/unit

 $12/unit

 $20/unit

 H0005

 Local Group Counseling

 $4/person/unit

 $5/person/unit

 $6/person/unit

 T1006

 Local Family/Couple Counseling

 $5/unit

 $10/unit

 $20/unit

 H2011

 Crisis Intervention Services

 $8/unit

 $12/unit

 $20/unit

 H2022

 Early Intervention Services

 $8/unit

 $12/unit

 $20/unit

                                                                                                         

 CPT  Mental Health Services  CAT 1  CAT 2  CAT 3/Full Pay

 90804

 Individual Therapy 20-30 minutes

 $10

 $20

 $85

 90806

 Individual Therapy 40-50 minutes

 $20

 $35

 $130

 90808

 Individual Therapy 75-80 minutes

 $30

 $55

 $190

 90847

 Family Therapy

 $35

 $55

 $170

 90853

 Group Therapy

 $10/person

 $15/person

 $45/person

 N/A

 Minnesota Multiphasic Personality Inventory (MMPI)

 $50

 $60

 $80

 

Family Size  Federal Poverty Guidelines   SA State Funding  CAT 1 150%

CAT 2 151-250%

CAT 3/Full Pay 251% & above 

 1

 $11,490

 under $21,257

 $0-17,235

$17,235-28,725

 $28,726

 2

 $15,510

 under $28,694

 $0-23,265

 $23,266-38,775

 $38,776

 3

 $19,530

 under $36,131

 $0-29,295

 $29,296-48,825

 $48,826

 4

 $23,550

 under $43,568

 $0-35,325

 $35,326-58,875

 $58,876

 5

 $27,570

 under $51,005

 $0-41,355

 $41,356-68,925

 $68,926

 6

 $31,590

 under $58,442

 $0-47,385

 $47,386-78,975

 $78,976

 7

 $35,610

 under $65,879

 $0-53,415

 $53,416-89,025

 $89,026

 8

 $39,630

 under $73,316

 $0-59,445

 $59,446-99,075

 $99,076

 9+

add $4,020/each additional person

 add $7,437/each additonal person