Assistive $ 14.44 ¼ hour $14.44 per ¼ Modifiers Modifier Description hour CG Policy Criteria Applied SC Medical Add On Assistive Up to $50.00 Up to $50.00 HQ Group Setting per per Month T2035 QC Remote Only (Utility Services) GT Remote Support-Interactive Assistive Support UN Two Members Served UP Members Served feature/device, UQ Four Members Served stand alone or Per invoice up Per invoice up UR Five Members Served integrated, any A9279 to $6,000.00 per to $6,000.00 per US Six Members Served type, includes all year year accessories, components and electronics, not otherwise classified) S5150 Respite Services- ¼ $ 2.70 ¼ hour $2.99 ¼ hr hour S5151 Respite Services- $90.00 per diem $99.54 per diem Per Diem
Assistive $ 14.44 ¼ hour $14.44 per ¼ hour T2035 Assistive (Utility Services) Up to $50.00 per Up to $50.00 per Month A9279 Assistive feature/device, stand alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) Per invoice up to $6,000.00 per year Per invoice up to $6,000.00 per year S5150 Respite Services- ¼ hour $ 2.70 ¼ hour $2.99 ¼ hr S5151 Respite Services- Per Diem $90.00 per diem $99.54 per diem Modifiers Modifier Description CG Policy Criteria Applied SC Medical Add On HQ Group Setting QC Remote Only GT Remote Support-Interactive Support UN Two Members Served UP Members Served UQ Four Members Served UR Five Members Served US Six Members Served
Chapter%20III,%20Section%2029,%20Home%20and%20Community%20Based%20Services%20(Word).docx