Section 360-7.12 - Co-payments by recipients. | New York Codes, Rules and Regulations

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Average or typical MA payment	Co-payment
$10 or less	$.50
$10.01 to $25	$1.00
$25.01 to $50	$2.00
$50.01 or more	$3.00

Service	Co-payment
In-patient care	$25.00 per discharge
Out-patient hospital and clinic services	$3.00 per visit
Sickroom supplies	$1.00 per order
Enteral and parenteral formulae/supplies	$1.00 per claim
Brand name prescription drugs	$2.00 for each prescription dispensed
Generic prescription drugs	$ .50 for each prescription dispensed
Non-prescription drugs	$ .50 for each order dispensed
Clinical laboratory procedures	$ .50 for each procedure billed
Radiology procedures	$1.00 for each procedure code billed
Emergency room services provided for non-urgent or non-emergency care	$3.00 per visit