Common use of HCPCS Codes Clause in Contracts

HCPCS Codes. All covered services for HCPCS codes, with the exception of J codes, are fixed at [****] of fixed 2006 Medicare RBRVS schedule. • Drugs, Immunizations, Vaccines and Injectables: ChoiceCare’s (201-544) fee schedule will be utilized for reimbursement for drugs, immunizations or injectables. These drugs and/or immunizations will be reimbursed at [****] of ChoiceCare’s (201-544) Fee Schedule. ChoiceCare’s 201-544: ChoiceCare’s injectable fee schedule (201-544) uses a percentage of the CMS Average Sales Price (ASP) or another industry standard as the basis of the (201-544) fee schedule. Notwithstanding anything to the contrary in the Agreement, in the event the basis for the schedule is changed from a percentage of ASP to another basis, then ChoiceCare will provide ninety (90) days advance notice to Provider, of the new basis. The list of codes and associated fees are reviewed and updated quarterly to reflect market pricing, These quarterly updates, if any, as well as any change in the basis may result in fees being adjusted either upwardly or downwardly. These updates shall be [****] Certain information on this page has been omitted and filed separately with the Commission. Confidential treatment has been requested with respect to the omitted portions. incorporated in the ChoiceCare injectable fee schedule (201-544) without notice to Provider, but will be made available to Provider upon request.

HCPCS Codes. All covered services for HCPCS codes, with the exception of J codes, are fixed at [****] of fixed 2006 Medicare RBRVS schedule]. • Drugs, Immunizations, Vaccines and Injectables: ChoiceCare’s (201-544) fee schedule will be utilized for reimbursement for drugs, immunizations or injectables. These drugs and/or immunizations will be reimbursed at [****] of ChoiceCare’s (201-544) Fee Schedule]. ChoiceCare’s 201-544: ChoiceCare’s injectable fee schedule (201-544) uses a percentage of the CMS Average Sales Price (ASP) or another industry standard as the basis of the (201-544) fee schedule. Notwithstanding anything to the contrary in the Agreement, in the event the basis for the schedule is changed from a percentage of ASP to another basis, then ChoiceCare will provide ninety (90) days advance notice to Provider, of the new basis. The list of codes and associated fees are reviewed and updated quarterly to reflect market pricing, These quarterly updates, if any, as well as any change in the basis may result in fees being adjusted either upwardly or downwardly. These updates shall be [****] Certain information on this page has been omitted and filed separately with the Commission. Confidential treatment has been requested with respect to the omitted portions. incorporated in the ChoiceCare injectable fee schedule (201-544) without notice to Provider, but will be made available to Provider upon request.