Medical Assistance Programs Fee Schedule Legend

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Field Heading
Description
Prov Type
Provider Type: 2-digit code representing the type of provider that can bill for this service.
Prov Spclty Code
Provider Specialty Code: 3-digit code representing a particular provider specialty.
Proc Code
Procedure Code: Code that describes the procedure performed.
Pricing Modifier
If this field contains modifiers, then a two-digit modifier may be required for billing purposes. More information about the use of modifiers can be found in the Medical Assistance Bulletins section of the website. Please Note: ** is not a valid modifier.
Modifier 1
If this field contains modifiers, then a two-digit modifier may be required for billing purposes. More information about the use of modifiers can be found in the Medical Assistance Bulletins section of the website. Please Note: ** is not a valid modifier.
Modifier 2
If this field contains modifiers, then a two-digit modifier may be required for billing purposes. More information about the use of modifiers can be found in the Medical Assistance Bulletins section of the website. Please Note: ** is not a valid modifier.
Modifier 3
If this field contains modifiers, then a two-digit modifier may be required for billing purposes. More information about the use of modifiers can be found in the Medical Assistance Bulletins section of the website. Please Note: ** is not a valid modifier.
Modifier 4
If this field contains modifiers, then a two-digit modifier may be required for billing purposes. More information about the use of modifiers can be found in the Medical Assistance Bulletins section of the website. Please Note: ** is not a valid modifier.
Proc Price Amt
Procedure Price Amount: This field contains the established Medical Assistance (MA) Program fee for the service. For procedures which indicate $0 in the procedure price amount field, please contact the appropriate program office for specific fee information.
Place of Service
2-digit code(s) representing valid place of service for a procedure.
Procedure Description
This field lists the procedure name that describes the service performed.
Details
Specific details for valid modifiers.
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