PROCEDURE REVENUE Rates Effective MODIFIER DESCRIPTION UNIT CODE CODE 7/1/18 Skills Training and Development (Participant Directed H2014 U7 15 minutes $14.03 Option) Financial Management, self-directed, waiver T2040 U7 Monthly $85.09 (Participant Directed Option) Attendant Care Services (Personal Care Services, S5125 U7 15 minutes $3.73* Participant Directed Option) Attendant Care Services (Personal Care Services, S5125 U7 UN 15 minutes $2.05* Participant Directed Option)-2 members served Attendant Care Services (Personal Care Services, S5125 U7 UP 15 minutes $1.49* Participant Directed Option)-3 members served T1019 U7 0589 Personal Care Services (Agency PSS) 15 minutes $5.13* Personal Care Services (Agency PSS)- 2 members U7 UN 0589 15 minutes $2.82* served Personal Care Services (Agency PSS)-3 members T1019 U7 UP 0589 15 minutes $2.05* served U7 Care Coordination 15 minutes $17.00 Customary Personal Emergency Response System, Installation and S5160 U7 1 unit Charge, Not to Testing Exceed $45.00 Customary S5161 U7 Personal Emergency Response System, Service Fee Monthly Charge, Not To Exceed $35.00 H0045 U7 Respite Care Services, not in the home Per Diem $163.49 $5.13, Cost Not T1005 U7 Respite Care Services, in the home (PSS) 15 minutes to Exceed Cap Respite Care Services, in the home (PSS)- 2 members $2.82 Cost Not T1005 U7 UN 15 minutes served to Exceed Cap* Respite Care Services, in the home (PSS)-3 members $2.05 Cost Not T1005 U7 UP 15 minutes served to Exceed Cap*
PROCEDURE CODE MODIFIER REVENUE CODE DESCRIPTION UNIT Rates Effective 7/1/18 H2014 U7 Skills Training and Development (Participant Directed Option) 15 minutes $14.03 T2040 U7 Financial Management, self-directed, waiver (Participant Directed Option) Monthly $85.09 S5125 U7 Attendant Care Services (Personal Care Services, Participant Directed Option) 15 minutes $3.73* S5125 U7 UN Attendant Care Services (Personal Care Services, Participant Directed Option)-2 members served 15 minutes $2.05* S5125 U7 UP Attendant Care Services (Personal Care Services, Participant Directed Option)-3 members served 15 minutes $1.49* T1019 U7 0589 Personal Care Services (Agency PSS) 15 minutes $5.13* U7 UN 0589 Personal Care Services (Agency PSS)- 2 members served 15 minutes $2.82* T1019 U7 UP 0589 Personal Care Services (Agency PSS)-3 members served 15 minutes $2.05* U7 Care Coordination 15 minutes $17.00 S5160 U7 Personal Emergency Response System, Installation and Testing 1 unit Customary Charge, Not to Exceed $45.00 S5161 U7 Personal Emergency Response System, Service Fee Monthly Customary Charge, Not To Exceed $35.00 H0045 U7 Respite Care Services, not in the home Per Diem $163.49 T1005 U7 Respite Care Services, in the home (PSS) 15 minutes $5.13, Cost Not to Exceed Cap T1005 U7 UN Respite Care Services, in the home (PSS)- 2 members served 15 minutes $2.82 Cost Not to Exceed Cap* T1005 U7 UP Respite Care Services, in the home (PSS)-3 members served 15 minutes $2.05 Cost Not to Exceed Cap*