PROCEDURE REVENUE Effective MODIFIER DESCRIPTION UNIT CODE CODE 7/1/18 $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* Respite Care Services, in the home-Participant $3.73 Cost Not T1005 U7 15 minutes Directed Option to Exceed Cap* Respite Care Services, in the home-Participant $2.05 Cost Not T1005 U7 UN 15 minutes Directed Option- 2 members served to Exceed Cap* Respite Care Services, in the home-Participant $1.49 Cost Not T1005 U7 UP 15 minutes Directed Option-3 members served to Exceed Cap* S5165 U7 Environmental Modifications Per Service By report Assistive Technology- (Monitoring feature/device, stand alone or integrated, any type, includes all A9279 U7 1 unit Per device accessories, components and electronics, not otherwise classified) A9279 U7 QC Assistive Technology-Remote Monitoring-Monthly fee Monthly Up to $ 500.00 T2035 U7 Assistive Technology-Transmission (Utility Services) Monthly Up to $ 50.00 T1005 U7 0669 Respite Care, in the home by CNA/Home Health Aide 15 minutes $5.50 Respite Care, in the home by CNA/Home Health Aide- T1005 U7 UN 0669 15 minutes $3.03* 2 members served Respite Care, in the home by CNA/Home Health T1005 U7 UP 0669 15 minutes $2.20* 3 members served 0551 Skilled Nursing Visit (RN) Per Visit $53.60 0551 Skilled Nursing Visit (RN)-2 members served Per $29.48 0551 Skilled Nursing Visit (RN)-3 members served Per Visit $21.44 0559 Nursing (LPN) Per $39.05
PROCEDURE CODE MODIFIER REVENUE CODE DESCRIPTION UNIT Effective 7/1/18 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* T1005 U7 Respite Care Services, in the home-Participant Directed Option 15 minutes $3.73 Cost Not to Exceed Cap* T1005 U7 UN Respite Care Services, in the home-Participant Directed Option- 2 members served 15 minutes $2.05 Cost Not to Exceed Cap* T1005 U7 UP Respite Care Services, in the home-Participant Directed Option-3 members served 15 minutes $1.49 Cost Not to Exceed Cap* S5165 U7 Environmental Modifications Per Service By report A9279 U7 Assistive Technology- (Monitoring feature/device, stand alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) 1 unit Per device A9279 U7 QC Assistive Technology-Remote Monitoring-Monthly fee Monthly Up to $ 500.00 T2035 U7 Assistive Technology-Transmission (Utility Services) Monthly Up to $ 50.00 T1005 U7 0669 Respite Care, in the home by CNA/Home Health Aide 15 minutes $5.50 T1005 U7 UN 0669 Respite Care, in the home by CNA/Home Health Aide- 2 members served 15 minutes $3.03* T1005 U7 UP 0669 Respite Care, in the home by CNA/Home Health members served 15 minutes $2.20* 0551 Skilled Nursing Visit (RN) Per Visit $53.60 0551 Skilled Nursing Visit (RN)-2 members served Per $29.48 0551 Skilled Nursing Visit (RN)-3 members served Per Visit $21.44 0559 Nursing (LPN) Per $39.05 3