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 G0299 TD 0551 RN Services 15 minutes $12.16 $12.16 $13.47 $13.88 $13.74 G0299 TD UN 0551 RN Services patients (2) 15 minutes $6.94 $6.69 $7.41 $7.63 $7.56 TD UP 0551 RN Services – multiple patients (3) 15 minutes N/A $4.87 $5.39 $5.55 $5.50 TE 0559 LPN Services 15 minutes $8.04 $8.04 $9.56 $9.90 $9.75 G0300 TE UN 0559 LPN Services – multiple patients (2) 15 minutes $4.74 $4.43 $5.27 $5.45 $5.37 G0300 TE UP 0559 LPN Services – multiple patients (3) 15 minutes N/A $3.21 $3.83 $3.96 $3.90 T1000 TD Independent RN 15 minutes $10.96 $10.96 $13.47 $13.88 $13.74 TD UN Independent RN – multiple patients (2) 15 minutes $6.13 $6.03 $7.41 $7.63 $7.56 T1000 TD UP Independent RN– multiple patients (3) 15 minutes N/A $4.39 $5.39 $5.55 $5.50
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
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
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 S5125 UN Personal Support Services (FPSO) multiple patients (2) 15 minutes N/A $2.04 $2.04 $2.05 $2.05 S5125 UP Personal Support Services (FPSO) multiple patients (3) 15 minutes N/A $1.49 $1.49 $1.49 $1.49 H2014 Skills Training (FPSO only) 15 minutes $14.03 $14.03 $14.03 $14.03 $14.03 G9001 Care Coordination Service (Initial Visit) 15 minutes $17.00 $17.00 $17.00 $17.00 $17.00 G9002 Care Coordination Service (Maintenance Visit) 15 minutes $17.00 $17.00 $17.00 $17.00 $17.00 S5120 Services 15 minutes $2.30 $2.30 $2.30 $2.30 $2.30