The DOH administration fee cap is found on Page 8, #6 of the DOH Provider Agreement: Enrollment Packet. This applies a $23.44 cap to all patients/parents (federal and state eligible) who may be paying the administration/office visit portion of the service “out of pocket”.
If the patient has commercial insurance but is required to pay the administration/office visit portion of the service “out of pocket,” either because of a coverage cap, deductible, out of network, etc., then the DOH $23.44 administration fee cap applies.
However, if the commercial insurance is paying the administration/office visit portion, then the cap doesn’t apply and the charge and payment should align with the provider and payer’s contracted allowable amounts.