Personal Attendant Service Rates Effective 9/1/14 1 unit= 1 HOUR
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1 PARTICIPANT LEVEL HCPCS MODIFIER Personal Attendant Service Rates Effective 9/1/14 = 1 HOUR WAIVER PAYMENT RATE (includes enhanced rate) MODIFIER BLENDED PAYMENT NON WAIVER/ PROTECTIVE SERVICES (includes enhanced rate) Nonparticipant S5125 U3U3 $11.33 U7U5 $11.10 Level 1 S5125 U3U3 $11.38 U7U5 $11.15 Level 2 S5125 U3U3 $11.43 U7U5 $11.20 Level 3 S5125 U3U3 $11.48 U7U5 $11.25 Level 4 S5125 U3U3 $11.53 U7U5 $11.30 Level 5 S5125 U3U3 $11.58 U7U5 $11.35 Level 6 S5125 U3U3 $11.63 U7U5 $11.40 Level 7 S5125 U3U3 $11.68 U7U5 $11.45 Level 8 S5125 U3U3 $11.73 U7U5 $11.50 Level 9 S5125 U3U3 $11.78 U7U5 $11.55 Level 10 S5125 U3U3 $11.83 U7U5 $11.60 Level 11 S5125 U3U3 $11.88 U7U5 $11.65 Level 12 S5125 U3U3 $11.93 U7U5 $11.70 Level 13 S5125 U3U3 $11.98 U7U5 $11.75 Level 14 S5125 U3U3 $12.03 U7U5 $11.80 Level 15 S5125 U3U3 $12.08 U7U5 $11.85 Level 16 S5125 U3U3 $12.13 U7U5 $11.90 Level 17 S5125 U3U3 $12.18 U7U5 $11.95 Level 18 S5125 U3U3 $12.23 U7U5 $12.00 Level 19 S5125 U3U3 $12.28 U7U5 $12.05 Level 20 S5125 U3U3 $12.33 U7U5 $12.10 Level 21 S5125 U3U3 $12.38 U7U5 $12.15 Level 22 S5125 U3U3 $12.43 U7U5 $12.20 Level 23 S5125 U3U3 $12.48 U7U5 $12.25 Level 24 S5125 U3U3 $12.53 U7U5 $12.30
2 PARTICIPANT LEVEL HCPCS MODIFIER Personal Attendant Service Rates Effective 9/1/14 = 1 HOUR WAIVER PAYMENT RATE (includes enhanced rate) MODIFIER BLENDED PAYMENT NON WAIVER/ PROTECTIVE SERVICES (includes enhanced rate) Level 25 S5125 U3U3 $12.58 U7U5 $12.35 Level 26 S5125 U3U3 $12.63 U7U5 $12.40 Level 27 S5125 U3U3 $12.68 U7U5 $12.45 Level 28 S5125 U3U3 $12.73 U7U5 $12.50 Level 29 S5125 U3U3 $12.78 U7U5 $12.55 Level 30 S5125 U3U3 $12.83 U7U5 $12.60 Level 31 S5125 U3U3 $12.88 U7U5 $12.65 Level 32 S5125 U3U3 $12.88 U7U5 $12.65 Level 33 S5125 U3U3 $12.88 U7U5 $12.65 Level 34 S5125 U3U3 $12.88 U7U5 $12.65 Level 35 S5125 U3U3 $12.88 U7U5 $12.65 HCPCS MODIFIER RATE EFFECTIVE DATE Protective Supervision S5125 U3U /1/14
3 Day Activity & Health Services PARTICIPANT LEVEL HCPC Code PAYMENT RATE Eff 9/1/14 Nonparticipant S Level 1 S Level 2 S Level 3 S Level 4 S Level 5 S Level 6 S Level 7 S Level 8 S Level 9 S Level 10 S Level 11 S Level 12 S Level 13 S Level 14 S Level 15 S Level 16 S Level 17 S Level 18 S Level 19 S Level 20 S Level 21 S Level 22 S Level 23 S Level 24 S Level 25 S
4 Day Activity & Health Services PARTICIPANT LEVEL HCPC Code PAYMENT RATE Eff 9/1/14 Level 26 S Level 27 S Level 28 S Level 29 S Level 30 S Level 31 S Level 32 S Level 33 S Level 34 S Level 35 S = 3-6 hours; 2 units= over 6 hours
5 CDS Rates Code WAIVER/NON-WAIVER MODIFIER RATE Admin Fee S5125 WAIVER U39999UC $10.99 T2040 WAIVER U3 $1.00 S5125 Protective Supervision U3U599UC $10.99 T2040 PROTECTIVE SUPERVISION U3 $1.00 S5125 NON-WAIVER UC $10.28 T2040 NON-WAIVER U7 $1.00 S5151 RESPITE U39999UC $10.99 T2040 RESPITE U3 $1.00 S9131 PT U39999UC $77.43 T2040 WAIVER U3 $1.00 S9128 SP U39999UC $76.29 T2040 WAIVER U3 $1.00 S9129 OT U39999UC $72.95 T2040 WAIVER U3 $ COGNITIVE REHABILITATION THERAPY U39999UC T2040 WAIVER U3 $1.00 H2025 SUPPORTIVE EMPLOYMENT U39999UC 32.1 T2040 WAIVER U3 $1.00 H2023 EMPLOYMENT ASSISTANCE U39999UC 32.1 T2040 WAIVER U3 $1.00 BOTH HCPCS codes MUST be on the claim for claims to pay appropriately
6 Code WAIVER/ NON-WAIVER THERAPIES DESCRIPTION MODIFIER RATE EFFECTIVE DATE S9131 WAIVER PHYSICAL THERAPY U3U3 $ /1/2014 S9128 WAIVER SPEECH THERAPY U3U3 $ /1/2014 S9129 WAIVER OCCUPATIONAL THERAPY U3U3 $ /1/ WAIVER COGNITIVE REHABILITATION THERAPY U3U3 $ /1/2014
7 Assisted Living Facility Pay Rates Assisted Living- Apartment- Single Occupancy CODE MODIFIER MODIFIER MODIFIER MODIFIER UNITS LEVEL RUG LEVEL T U8 U1 U1 PA1, BA1, PA2, 6 BA2, IA1, & IA2 T U7 U1 U1 PB1, CA1, 5 & PB2 T U6 U1 U1 SSA, PC2, BB2, 4 IB2, & PD1 T U5 U1 U1 CA2, PC1, BB1, 3 & IB1 T U4 U1 U1 RAA, RAB, CB1, 2 RAC, CB2, SE2, PD2, PE1, & SSB T U3 U1 U1 1 SSC, CC1, RAD, CC2, PE2, SE3, & SE1 TILE LEVEL 211 RESPITE RATE DAILY RATE EFF 1/1/14 $ $ $ $61.67 $ , 206, & , 203, 204, & 205 $60.78 $65.74
8 Assisted Living Facility Pay Rates Assisted Living- Apartment- Double Occupancy CODE MODIFIER MODIFIER MODIFIER MODIFIER UNITS LEVEL RUG LEVEL T U8 U2 U1 PA1, BA1, PA2, 6 BA2, IA1, & IA2 T U7 U2 U1 PB1, CA1, 5 & PB2 T U6 U2 U1 SSA, PC2, BB2, 4 IB2, & PD1 T U5 U2 U1 CA2, PC1, BB1, 3 & IB1 T U4 U2 U1 RAA, RAB, CB1, 2 RAC, CB2, SE2, PD2, PE1, & SSB T U3 U2 U1 1 SSC, CC1, RAD, CC2, PE2, SE3, & SE1 TILE LEVEL 211 RESPITE RATE DAILY RATE EFF 1/1/14 $ $ $ $52.55 $ , 206, & , 203, 204, & 205 $53.79 $58.74
9 Assisted Living Facility Pay Rates Residential Care- Non-Apartment CODE MODIFIER MODIFIER MODIFIER MODIFIER UNITS LEVEL RUG LEVEL T U8 U2 U2 PA1, BA1, PA2, 6 BA2, IA1, & IA2 T U7 U2 U2 PB1, CA1, & 5 PB2 T U6 U2 U2 SSA, PC2, BB2, 4 IB2, & PD1 T U5 U2 U2 CA2, PC1, BB1, 3 & IB1 T U4 U2 U2 RAA, RAB, CB1, 2 RAC, CB2, SE2, PD2, PE1, & SSB T U3 U2 U2 1 SSC, CC1, RAD, CC2, PE2, SE3, & SE1 TILE LEVEL 211 RESPITE RATE DAILY RATE EFF 1/1/14 $ $ $ $43.24 $ , 206, & , 203, 204, & 205 $35.23 $40.19
10 Assisted Living Facility Addendum Pay Rates PARTICIPANT LEVEL PAYMENT RATE Level 1 $0.05 Level 2 $0.10 Level 3 $0.15 Level 4 $0.20 Level 5 $0.25 Level 6 $0.30 Level 7 $0.35 Level 8 $0.40 Level 9 $0.45 Level 10 $0.50 Level 11 $0.55 Level 12 $0.60 Level 13 $0.65 Level 14 $0.70 Level 15 $0.75 Level 16 $0.80 Level 17 $0.85 Level 18 $0.90 Level 19 $0.95 Level 20 $1.00 Level 21 $1.05 Level 22 $1.10 Level 23 $1.15 Level 24 $1.20 Level 25 $1.25 Level 26 $1.30
11 Assisted Living Facility Addendum Pay Rates PARTICIPANT LEVEL PAYMENT RATE Level 27 $1.35 Level 28 $1.40 Level 29 $1.45 Level 30 $1.50 Level 31 $1.55
12 Adult Foster Care Pay Rates Service HCPCS Modifier Modifier Payment Rate Adult Foster Care (AFC) - Per day Level I S U3 $19.19 Level II S U4 $33.10 Level III S U5 $67.20 Adult Foster Care (AFC) - Out of Home Respite Level I S U3 $33.28 Level II S U4 $47.19 Level III S U5 $81.30
13 PAS NURSING FACILITY Respite Rates Code WAIVER MODIFIER RATE S5151 WAIVER U3U3 $9.94 Respite Rates-Out-of-Home Nursing Facility Code RUG LEVEL MODIFIER RATE PER DAY S5151 RAD U3 $ S5151 RAC U3 $ S5151 RAB U3 $ S5151 RAA U3 $ S5151 SE3 U3 $ S5151 SE2 U3 $ S5151 SE1 U3 $ S5151 SSC U3 $ S5151 SSB U3 $ S5151 SSA U3 $ S5151 CC2 U3 $ S5151 CC1 U3 $ S5151 CB2 U3 $ S5151 CB1 U3 $ S5151 CA2 U3 $ S5151 CA1 U3 $ S5151 IB2 U3 $ S5151 IB1 U3 $ S5151 IA2 U3 $92.67 S5151 IA1 U3 $87.88 S5151 BB2 U3 $ S5151 BB1 U3 $96.72 S5151 BA2 U3 $90.94
14 NURSING FACILITY Respite Rates-Out-of-Home Nursing Facility Code RUG LEVEL MODIFIER RATE PER DAY S5151 BA1 U3 $82.08 S5151 PE2 U3 $ S5151 PE1 U3 $ S5151 PD2 U3 $ S5151 PD1 U3 $ S5151 PC2 U3 $ S5151 PC1 U3 $96.92 S5151 PB2 U3 $94.36 S5151 PB1 U3 $89.79 S5151 PA2 U3 $84.20 S5151 PA1 U3 $79.45
15 Skilled Nursing Rates-LVN SKILL LEVEL CODE MODIFIER 1 MODIFIER 2 MODIFIER 3 MODIFIER 4 UNITS SERVICE OPTION RATE LVN S9124 U3U3 1 hour = AGENCY OPTION (AO) $29.69 LVN S9124 U UC 1 hour = Add for Admin Fee CONSUMER DIRECTED SERVICES OPTION (CDS) T2040 U US SR $1.00 $29.69
16 Skilled Nursing Rates-RN SKILL LEVEL CODE MODIFIER 1 MODIFIER 2 MODIFIER 3 MODIFIER 4 UNITS SERVICE OPTION RATE RN S9123 U3U3 1 hour = RN S9123 U UC 1 hour = Add for Admin Fee T2040 U3 AGENCY OPTION (AO) CONSUMER DIRECTED SERVICES OPTION (CDS) CONSUMER DIRECTED SERVICES OPTION (CDS) $43.39 $43.39 $1.00
17 HDM/MOW Rates Code WAIVER/NON-WAIVER MODIFIER RATE S5170 WAIVER U3 $6.12 S5170 NON WAIVER U7 $6.12
18 ERS Rates Code WAIVER MODIFIER RATE S5161 WAIVER U3 $29.76 S5161 NON WAIVER U7 $29.76 S5160 Installation $45.00
19 Minor Home Modifications Service HCPCS Payment Rate under $500 S % of cost $500 to $ S5165 $80.04 $1,000 to $1, S5165 $ $1,500 to $1, S5165 $ $2,000 to $2, S5165 $ $2,500 to $2, S5165 $ $3,000 to $3, S5165 $ $3,500 to $3, S5165 $ $4,000 to $4, S5165 $ $4,500 to $4, S5165 $ $5,000 to $5, S5165 $ $5,500 to $5, S5165 $ $6,000 to $6, S5165 $ $6,500 and over S5165 $428.76
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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