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Michigan Department of Health and Human Services Medical ...

Michigan Department of Health and Human Services Medical Suppliers/Orthotists /Prosthetists/DME Dealers Fee Schedule October 2021. Code Short Description Modifier Age Range Rate Effective Date**. A4206 1 Cc Sterile Syringe&Needle $ A4207 2 Cc Sterile Syringe&Needle $ A4208 3 Cc Sterile Syringe&Needle $ A4209 5+ Cc Sterile Syringe&Needle $ A4210 Nonneedle Injection Device $ A4213 20+ Cc Syringe Only $ A4215 Sterile Needle $ A4220 Infusion Pump Refill Kit $ A4230 Infus Insulin Pump Non Needl $ A4231 Infusion Insulin Pump Needle $ A4232 Syringe W/Needle Insulin 3cc $ A4244 Alcohol Or Peroxide Per Pint $ A4245 Alcohol Wipes Per Box $ A4246 Betadine/Phisohex Solution $ A4247 Betadine/Iodine Swabs/Wipes $ A4250 Urine Reagent Strips/Tablets $ A4253 Blood Glucose/Reagent Strips $ A4256 Calibrator Solution/Chips $ A4259 Lancets Per Box $ A4265 Paraffin $ A4280 Brst Prsths Adhsv Attchmnt $ A4281 Replacement Breastpump Tube $ A4282 Replacement Breastpump Adpt $ A4283 Replacement Breastpump Cap $ A4284 Replcmnt Breast Pump Shield $ A4285 Replcmnt Breast Pump Bottle $ A4286 Replcmnt Breastpump Lok Ring $ A4305 Drug Delivery System >=50 Ml $ A4306

A4605 Trach Suction Cath Close Sys; $14.03 A4606; Oxygen Probe Used W Oximeter $113.94; A4614 Hand-Held Pefr Meter; $21.01 A4615; Cannula Nasal M; A4619 Face Tent; M A4620; Variable Concentration Mask $0.74; A4623 Tracheostomy Inner Cannula; $4.33 A4624; Tracheal Suction Tube $1.49; A4625 Trach Care Kit For New Trach; $5.09 A4626; Tracheostomy ...

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