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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
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Chapter 22-B30. CENTRAL REFERRAL BUREAU; HEALTH CARE FEES |
Section 22-B3018. NEIGHBORHOOD HEALTH CLINIC FEES
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3018.1 The following fees shall be for the services provided by the Neighborhood Health Centers, and shall have the sliding fee scale, set forth at §3018.2, for patients who are not covered by Medicaid, Medicare, or any other third party insurance and whose annual gross family incomes fall within the ranges of the sliding scale. These rates shall not apply to those persons who are receiving assistance under title VII of the D.C. Public Assistance Act of 1982, D.C. Code, 2001 Ed. §§4-207.01 to 4-207.04, and who do not receive assistance under Medicaid:
Service Category
Fee
Acrylic or Plastic Restoration
Acrylic or plastic restoration, Class III
$ 16.00
Acrylic or plastic restoration, Class V
12.00
Esthetic restoration, including angle
20.00
Alveoloplasty (surgical preparation of ridge for dentures)
Alveolectomy with extraction
$ 55.00
Alveolectomy without extraction
75.00
Cardiology
Follow-up visit
25.00
Initial visit
75.00
Crowns - Single Restoration Only
Acrylic jacket
72.00
Dowel crown
120.00
Gold full cast
94.00
Stainless steel crown
31.00
Temporary crown
17.00
Veneer crown
94.00
Dental - Diagnostic
Full mouth x-ray series
22.00
Occlusal x-ray
8.00
Periapical x-ray, one film
4.00
Periapical x-ray, two films
7.00
Periapical x-ray, three films
8.00
Endodontics
Pulp capping
8.00
Pulpotomy
16.00
Root Canal
One Canal; excludes final restoration
75.00
Two Canals; excludes final restoration
96.00
Three Canals; excludes final restoration
116.00
Family Planning
Follow-up visit
40.00
General Medicine
Follow-up /return/acute care visit
40.00
Initial visit (comprehensive medical evaluation
75.00
including complete history, review of medical
records, complete physical examination,
laboratory testing and appropriate prescriptions)
Nursing Home Visit
32.25
Obstetrics/Gynecology
Acute care visit
$ 40.00
Follow-up visit
40.00
Initial visit
60.00
Oral Surgery
Complicated extraction
Extraction of tooth, erupted
30.00
Extraction of tooth, soft tissue impaction
45.00
Extraction of tooth, partial bony impaction
59.00
Extraction of tooth, complete bony impaction
65.00
Root tips
25.00
Simple extraction (per tooth)
11.50
Surgical exposure of bony impaction
45.00
Other Restorative Services
10.00
Orthodontics
Appliances to control harmful habits
75.00
Pediatrics
Acute care visit
40.00
Adolescent or athletic exam
50.00
Follow-up visit
40.00
Periapical Services
Apicoectomy
52.00
Periapical curettage
34.00
Periodontics
Adjunctive services
Deep scaling
25.00/quad
Advanced periodontitis
Vincents treatment
50.00
Nonsurgical services
Subgingival curettage, root
50.00/quad
Surgical services
Gingivectomy or gingivoplasy
100.00/quad
Podiatry
Follow-up visit
20.00
Initial visit/comprehensive
40.00
Postpartum OB
Follow-up visit
40.00
Acute
40.00
Prenatal OB
Follow-up/Returns
$ 40.00
Acute
40.00
Preventive
Dental Prophylaxis
Prophylaxis, mouth exam, fluoride application,
bitewings, oral hygiene instruction
25.00
Prophylaxis, under age 15
7.00
Prophylaxis, age 15 and over
10.00
Florida treatment
8.00
Space maintainers
Fixed, band type
75.00
Lingual archwire
75.00
Space maintainer, removable
59.00
Prostodontics
Additional clasps for partial dentures
25.00
Adjustment denture
10.00
Complex denture repair
35.00
Full denture1
100.00
Partial denture1
150.00
Simple denture repair
12.00
1 This fee represents the maximum charge for this service regardless of the number of treatment sessions required to complete dentures plus two (2) visits for adjustments.
Prosthodontics, Fixed
Amalgam build-up
35.00
Reduction of Dislocation
60.00
Restorative
Amalgam restoration (including polishing)
Amalgam restorative pit, one surface
6.00
Amalgam restoration, two pits
9.00
Amalgam one surface, deciduous
10.00
Amalgam two surfaces, deciduous
14.00
Amalgam three surfaces
21.00
Amalgam four surfaces
27.00
Amalgam one surface, permanent
10.00
Amalgam two surfaces, permanent
14.00
Amalgam three surfaces, permanent
21.00
Amalgam four surfaces, permanent
$ 27.00
Pin reinforced
6.00
Specialized Clinics
Physician services - comprehensive
50.00
(comprehensive medical evaluation, diagnosis
and treatment for allergic, ophthalmologic
and dermatologic complaints)
Physician services - Limited
25.00
(Re-evaluation and treatment for a special
complaint as defined above)
Services performed by ancillary professionals
20.00
not under the supervision of the physician
such as nutritional and social work counseling services
Specialized Services
Allergy F-U
40.00
Chest F-U
40.00
Dermatology F-U
40.00
Hearing F-U
40.00
Occ. Therapy F-U
40.00
Ophthalmo F-U
40.00
Psych. F-U
40.00
Phys. Therapy F-U
40.00
Speech F-U
40.00
Surgical Incision
Curettage of fistulous tract
15.00
Incision/Drainage abscess intraoral
25.00
Incision/Drainage, extraoral
65.00
3018.2 The sliding fee schedule applicable to self-pay patients for the services described in §3018.1 and certain other services provided by the Department of Human Services shall be as follows:
Department of Human Services Sliding Fee Schedule
Category
A
B
C
D
E
F
Family
Size
Pay 0% of Full Charge
Pay 20% of Full Charge
Pay 40% of Full Charge
Pay 60% of Full Charge
Pay 80% of Full Charge
Pay 100% of Full Charge*
1
0 to 4,860
4,861 - 6,895
6,896 - 8,930
8,931 - 10,965
10,966 -13,000
13,000
2
0 to 6,540
6,541 - 9,811
9,812 - 11,282
11,283 - 13,653
13,654 - 16,024
16,024
3
0 to 8,220
8,221 -10,927
10,928 - 13,634
13,635 - 16,341
16,342 - 19,048
19,048
4
0 to 9,900
9,901 - 12,943
12,944 - 15,986
15,987 - 19,029
19,030 - 22,072
22,072
5
0 to 11,580
11,581 - 14,959
14,960 -18,338
18,339 - 21,717
21,718 - 25,096
25,096
6
0 to 13,260
13,261 - 16,975
16,976 - 20,690
20,691 - 24,405
24,406 - 28,120
28,120
7
0 to 14,940
14,941 - 18,991
18,992 - 23,042
23,043 - 27,093
27,094 - 31,144
31,144
8
0 to 16,620
16,621 - 21,007
21,008 - 25,394
25,395 - 29,781
29,782 - 34,168
34,168
9
0 to 18,300
18,301 - 23,023
23,024 - 27,746
27,747 - 32,469
32,470 - 37,192
37,192
10
0 to 19,980
19,981 - 25,039
25,040 - 30,098
30,099 - 35,157
35,158 - 40,216
40,216
11
0 to 21,660
21,661 - 27,055
27,056 - 32,450
32,451 - 37,845
37,846 - 43,240
43,240
12
0 to 23,340
23,341 - 29,071
29,072 - 34,802
34,803 - 40,533
40,534 - 46,264
46,264
* Pay 100% of full charge if income is greater than the amount indicated in this column.