3-6 Hours = 1 unit, Day Activities & Health Services (3-6 hours) over 6 Hours = 2 units. 15 minutes = 1 unit 15 minutes = 1 unit 15 minutes = 1 unit
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1 Service Procedure Code Qualifier PC Codes CPT4 Codes Rev Codes Units Service Description Comments Rates State Plan Services AA Code Adult Day Ca S Hours =, Day Activities & Health Services (3-6 hours) over 6 Hours = 2 units S Level1 $14.35 S Level 2 $14.40 S Level 3 $14.45 S Level 4 $14.50 S Level 5 $14.55 S Level 6 $14.60 S Level 7 $14.65 S Level 8 $14.70 S Level 9 $14.75 S Level 10 $14.80 S Level 11 $14.85 S Level 12 $14.90 S Level 13 $14.95 S Level 14 $15.00 S Level 15 $15.05 S Level 16 $15.10 S Level 17 $15.15 S Level 18 $15.20 S Level 19 $15.25 S Level 20 $15.30 S Level 21 $15.35 S Level 22 $15.40 S Level 23 $15.45 S Level 24 $15.50 S Level 25 $15.55 S Level 26 $15.60 S Level 27 $15.65 S Level 28 $15.70 S Level 29 $15.75 S Level 30 $15.80 S Level 31 $15.85 S Level 32 $15.90 S Level 33 $15.95 S Level 34 $16.00 S Level 35 $16.05 $14.30 CCP- Community First Choice for Children under 21 CFC Attendant Care Only (CFC-PCS) T1019 UD T1019 U1 T1019 U3 Attendant Care and Habilitation (CFC- HAB) T1019 U9 T1019 U2 CFC PCS Attendant care only- Agency el $2.92 CFC PCS Attendant care only- Service Responsibility Option el $2.92 CFC PCS Attendant care only- Consumer Directed Services el $2.72 CFC Attendant care and habilitation, HAB- Agency el $3.43 CFC Attendant care and habilitation, HAB- Service Responsibility Option el $3.43
2 T1019 U4 CFC Attendant care and habilitation, HAB- Consumer Directed Services el $3.23 Emergency Response S5161 U3 U3 S month = 1 unit per Emergency Response Services (Monthly) $29.76 Emergency Response Services (Installation and Testing) $45.00 Personal Care Services (PCS) T1019 U6 T1019 US T1019 UC PCS - Agency el $2.92 PCS - Service Responsibility Option el $2.92 PCS - Consumer Directed Services el $2.72 T1019 UA U6 T1019 UA US T1019 UA UC PCS, BH Condition - Agency el $3.43 PCS, BH COndition - Service Responsibility Option el $3.43 PCS, BH Condition - Consumer Directed Services el $3.23 Nurse Delegation and Supervision G0162 RN Assessment for delegation of PCS or CFC tasks $11.05 G0162 U1 RN training and ongoing supervision of delegated tasks $11.05 Private Duty Nursing T1000 U3 PDN, LVN $8.09 T1000 U3 UA PDN, Specialized LVN $8.87 T1000 PDN, RN $11.05 T1000 UA PDN, Specialized RN $12.71 T1000 U3 TE PDN, Independently Enrolled LVN $5.82 T1000 PDN1 U3 UA TE PDN, Independently Enrolled Specialized LVN $6.69 T1000 TD PDN, Independently Enrolled RN $8.51 T1000 UA TD PDN, Independently Enrolled Specialized RN $9.78 Prescribed Pediatric Extended Care
3 T hours or more = Prescribed Pediatric Extended Care, greater than 4 hours Currently no providers exist rate can be Negotiated rate negotiated till rate hearing T hour= 1 unit Prescribed Pediatric Extended Care, up to 4 hours Currently no providers exist rate can be Negotiated rate negotiated till rate hearing T day = 1 unit Non-emergency transportation rate comes from TMHP - Transport FS round trip $22.62 Financial Management Services T2040 U8 Monthly Fee Financial Management Service Fee, PCS $ T2040 U5 Monthly Fee Financial Management Service Fee, CFC, non- MDCP $ MDCP Services Out-of-Home Respite T1005 UA T1005 U9 T1005 U8 T1005 U7 T1005 U6 T1005 U5 T1005 U4 T1005 U3 T1005 U2 T1005 U1 Level 10: SE3 $1.80 Level 9: RAD & SE2 $1.53 Level 8: SSC, SE1, &RAC $1.33 Level 7: SSA, SSB, & RAB $1.25 Level 6: RAA $1.12 Level 5: CB2, CC1, & CC2 $1.03 Level 4: BB2, CA2, PE1, IB2, PD2, CB1, & PE2 $0.92 Level 3: PB2, BB1, PC1, PC2, IB1, CA1, & PD1 $0.84 Level 2: BA1, PA2, IA1, PB1, BA2, & IA2 $0.74 Level 1: PA1 $0.69 T1005 UA U3 T1005 U9 U3 T1005 U8 U3 T1005 U7 U3 T1005 U6 U3 T1005 U5 U3 T1005 U4 U3 T1005 U3 U3 T1005 U2 U3 T1005 U1 U3 Level 10: SE3 with partial vent $2.19 Level 9: RAD & SE2 with partial vent $1.92 Level 8: SE1, & RAC with partial vent $1.73 Level 7: SSA, SSB, RAB, & SSC with partial vent $1.62 Level 6: RAA with partial vent $1.51 Level 5: CC1, & CC2 with partial vent $1.44 Level 4: PE1, IB2, PD2, CB1,PE2, & CB2 with partial vent $1.33 Level 3: BB1, PC1, PC2, IB1, CA1, PD1, BB2, & CA2 with partial vent $1.25 Level 2: PA2, IA1, PB1, BA2, IA2, and PB2 with partial vent $1.15 Level 1: PA1 & BA1 with partial vent $1.08 T1005 UA U5 Level 10: SE3 with trach $2.40
4 T1005 U9 U5 T1005 U8 U5 T1005 U7 U5 T1005 U6 U5 T1005 U5 U5 T1005 U4 U5 T1005 U3 U5 T1005 U2 U5 T1005 U1 U5 Level 9: RAD & SE2 with trach $2.12 Level 8: SE1, & RAC with trach $1.93 Level 7: SSA, SSB, RAB, & SSC with trach $1.86 Level 6: RAA with trach $1.72 Level 5: CC1, & CC2 with trach $1.65 Level 4: PE1, IB2, PD2, CB1,PE2, & CB2 with trach $1.54 Level 3: BB1, PC1, PC2, IB1, CA1, PD1, BB2, & CA2 with trach $1.45 Level 2: PA2, IA1, PB1, BA2, IA2, and PB2 with trach $1.36 Level 1: PA1 & BA1 with trach $1.29 T1005 UA U7 T1005 U9 U7 T1005 U8 U7 T1005 U7 U7 T1005 U6 U7 T1005 U5 U7 T1005 U4 U7 T1005 U3 U7 T1005 U2 U7 T1005 U1 U7 Level 10: SE3 with full vent $2.77 Level 9: RAD & SE2 with full vent $2.50 Level 8: RAB, SSC, SE1, & RAC with full vent $2.29 Level 7: SSA & SSB with full vent $2.22 Level 6: CC2 & RAA with full vent $2.07 Level 5: CB1, PE2, CB2, & CC1 with full vent $1.96 Level 4: PD1, BB2, CA2, PE1, IB2, & PD2 with full vent $1.87 Level 3: BB1, PC1, PC2, IB1, & CA1 with full vent $1.81 Level 2: IA1, PB1, BA2, IA2, & PB2 with full vent $1.74 Level 1: PA1, BA1, & PA2 with full vent $1.68 Out-of-Home Respite T2027 Respite Care, Camp Setting $2.46 In Home Respite H2015 U1 Attendant, Agency el $2.99 H2015 U1 US Attendant, Service Reposibility Option $2.99 H2015 U1 UC Attendant, CDS Option $2.79 H2015 U1 UA Attendant with RN delegation, Agency el $3.24 H2015 RES1 U1 UA US Attendant with RN delegation, Service Reposibility Option $3.24 H2015 RES2 U1 UA UC Attendant with RN delegation, CDS Option $2.24 H2015 U3 LVN, Agency el $7.42 H2015 U3 US LVN, Service Reponsibility Option $7.42
5 H2015 U3 UC H2015 U3 UA H2015 RES3 U3 UA US H2015 RES4 U3 UA UC LVN, CDS Option $7.17 Specialized LVN, Agency el $8.54 Specialized LVN, Service Reposibility Option $8.54 Specialized LVN, CDS Option $8.29 H2015 U5 H2015 U5 US H2015 U5 UC H2015 U5 UA H2015 RES5 U5 UA US H2015 RES6 U5 UA UC RN, Agency el $10.85 RN, Service Reponsibility Option $10.60 RN, CDS Option $10.60 Specialized RN, Agency el $12.48 Specialized RN, Service Reposibility Option $12.48 Specialized RN, CDS Option $12.23 Fexible Family Support Services H U1 H2015 FF01 99 U1 US H2015 FF02 99 U1 UC H2015 FF03 99 U1 UA H2015 FF04 99 U1 UA US H2015 FF05 99 U1 UA UC Attendant, Agency el $2.99 Attendant, Service Reposibility Option $2.99 Attendant, CDS Option $2.79 Attendant with RN delegation, Agency el $3.24 Attendant with RN delegation, Service Reposibility Option $3.24 Attendant with RN delegation, CDS Option $2.79 H U3 H2015 FF06 99 U3 US H2015 FF07 99 U3 UC H2015 FF08 99 U3 UA H2015 FF09 99 U3 UA US LVN, Agency el $7.42 LVN, Service Reponsibility Option $7.42 LVN, CDS Option $7.17 Specialized LVN, Agency el $8.54 Specialized LVN, Service Reposibility Option $8.54 H2015 FF10 99 U3 UA UC Specialized LVN, CDS Option $8.29
6 H U5 H2015 FF11 99 U5 US H2015 FF12 99 U5 UC H2015 FF13 99 U5 UA H2015 FF14 99 U5 UA US H2015 FF15 99 U5 UA UC RN, Agency el $10.85 RN, Service Reponsibility Option $10.85 RN, CDS Option $10.60 Specialized RN, Agency el $12.48 Specialized RN, Service Reposibility Option $12.48 Specialized RN, CDS Option $12.23 Financial Management Services T2040 U8 Monthly Fee Financial Management Service Fee, PCS $ T2040 U5 Monthly Fee Financial Management Service Fee, CFC, non- MDCP $ T2040 U3 Monthly Fee Financial Management Service Fee, MDCP $ T2040 U4 Monthly Fee Financial Management Service Fee, CFC and MDCP $ Adaptive Aids (Waiver) T2028 T2029 T2039 per per per Adaptive Aid- NOS Adaptive Aid- Medical Equipment Adaptive Aid- Vehicle ification Negotiated rate Negotiated rate Negotiated rate Minor Homeifications S5165 per Minor Home ifications $7, Repairs $ Transition Assistance Services Inspection Fee $ Employment Services T2038 per Transition Assistance Services $2, T2038 $ H2023 Supported Employment, Agency el $6.28 H2023 US H2023 UC Supported Employment, Service Responsibility Option $6.28 Supported Employment, CDS Option $6.28 Employment Services H2025 Employment Assistance, Agency el $6.28
7 H2025 US H2025 UC Employment Assistance, Service Responsibility Option $6.28 Employment Assistance, CDS Option $6.28
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