AMOUNT AMOUNT AMOUNT AMOUNT AMOUNT Effective PROCEDURE Effective DESCRIPTION UNIT Effective 2/22/17 to Effective CODE 8/1/18 Effective 7/29/16 to 6/30/17 and 7/1/17 to to 7/1/19 2/21/17 7/1/18 to 6/30/18 6/30/19 7/31/18 Administration of oral, T1502 intramuscular and/or Per visit $6.32 $6.32 $6.32 $8.09 $7.42 subcutaneous medication Home Health Aide/ T1004 15 Certified Nursing $4.90 $4.90 $5.39 $5.55 $5.50 0571 minutes Assistant Services Home Health T1004 UN Aide/Certified Nursing 15 N/A $2.70 $2.97 $3.05 $3.03 0571 Assistant Services minutes – multiple patients (2) Home Health T1004 UP Aide/Certified Nursing 15 N/A $1.96 $2.16 $2.22 $2.20 0571 Assistant Services minutes – multiple patients (3) Personal Support T1019 15 $4.62 $4.62 $5.03 $5.18 $5.13 Services (PSS) minutes 0589 Personal Support 15 T1019 Services (PSS) (for $4.62 $4.62 $5.03 $5.18 $5.13 – minutes PCA Agencies only) Personal Support Services (PSS) (for 15 – T1019 UN N/A $2.54 $2.77 $2.85 $2.82 PCA Agencies only) minutes multiple patients (2)
PROCEDURE CODE DESCRIPTION UNIT AMOUNT Effective 7/29/16 to 2/21/17 AMOUNT Effective 2/22/17 to 6/30/17 and 7/1/18 to 7/31/18 AMOUNT Effective 7/1/17 to 6/30/18 AMOUNT Effective 8/1/18 to 6/30/19 AMOUNT Effective 7/1/19 T1502 Administration of oral, intramuscular and/or subcutaneous medication Per visit $6.32 $6.32 $6.32 $8.09 $7.42 T1004 0571 Home Health Aide/ Certified Nursing Assistant Services 15 minutes $4.90 $4.90 $5.39 $5.55 $5.50 T1004 UN 0571 Home Health Aide/Certified Nursing Assistant Services – multiple patients (2) 15 minutes N/A $2.70 $2.97 $3.05 $3.03 T1004 UP 0571 Home Health Aide/Certified Nursing Assistant Services – multiple patients (3) 15 minutes N/A $1.96 $2.16 $2.22 $2.20 T1019 0589 Personal Support Services (PSS) 15 minutes $4.62 $4.62 $5.03 $5.18 $5.13 T1019 Personal Support Services (PSS) – (for PCA Agencies only) 15 minutes $4.62 $4.62 $5.03 $5.18 $5.13 T1019 UN Personal Support Services (PSS) – (for PCA Agencies only) multiple patients (2) 15 minutes N/A $2.54 $2.77 $2.85 $2.82
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