AMOUNT AMOUNT AMOUNT AMOUNT AMOUNT Effective PROCEDURE DESCRIPTION UNIT Effective 2/22/17 to Effective Effective CODE Effective 7/29/16 to 6/30/17 and 7/1/17 to 8/1/18 7/1/19 2/21/17 7/1/18 to 6/30/18 to 6/30/19 7/31/18 Personal Support Services (PSS) (for 15 – T1019 UP N/A $1.84 $2.01 $2.07 $2.05 PCA Agencies only) minutes multiple patients (3) S5125 TF 15 $21.14 $23.51per $21.57 PCA Supervisit $5.10 $5.10 0589 minutes Per visit visit per visit S5125 TF UN PCA Supervisit 15 $11.64 $12.93per $11.87 – N/A $2.81 0589 multiple patients (2) minutes per visit visit per visit S5125 TF UP PCA Supervisit 15 $8.46 $9.40per $8.63 – N/A $2.04 0589 multiple patients (3) minutes per visit visit per visit PCA Supervisit (for PCA 15 $21.14 $23.51per $21.57 S5125 TF $5.10 $5.10 Agencies only) minutes per visit visit per visit PCA Supervisit (for PCA 15 $11.64 $12.93 $11.87 S5125 TF UN Agencies only) multiple N/A $2.81 minutes per visit per visit per patients (2) PCA Supervisit (for PCA 15 $8.46 $9.40per $8.63 S5125 TF UP Agencies only) multiple N/A $2.04 minutes per visit visit per visit patients (3) Personal Support 15 S5125 $3.72 $3.72 $3.72 $3.73 $3.73 Services (FPSO) minutes
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 T1019 UP Personal Support Services (PSS) – (for PCA Agencies only) multiple patients (3) 15 minutes N/A $1.84 $2.01 $2.07 $2.05 S5125 TF 0589 PCA Supervisit 15 minutes $5.10 $5.10 $21.14 Per visit $23.51per visit $21.57 per visit S5125 TF UN 0589 PCA Supervisit – multiple patients (2) 15 minutes N/A $2.81 $11.64 per visit $12.93per visit $11.87 per visit S5125 TF UP 0589 PCA Supervisit – multiple patients (3) 15 minutes N/A $2.04 $8.46 per visit $9.40per visit $8.63 per visit S5125 TF PCA Supervisit (for PCA Agencies only) 15 minutes $5.10 $5.10 $21.14 per visit $23.51per visit $21.57 per visit S5125 TF UN PCA Supervisit (for PCA Agencies only) multiple patients (2) 15 minutes N/A $2.81 $11.64 per visit $12.93 per visit $11.87 per S5125 TF UP PCA Supervisit (for PCA Agencies only) multiple patients (3) 15 minutes N/A $2.04 $8.46 per visit $9.40per visit $8.63 per visit S5125 Personal Support Services (FPSO) 15 minutes $3.72 $3.72 $3.72 $3.73 $3.73
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