Search
Hcpcs Mod Id | Hcpcs Cd | Mod 1 | Mod 2 | Mod 3 | Mod 4 | Unit Type Cd | Hcpcs Mod Desc | Hcpcs Mod Start Dt | Hcpcs Mod End Dt |
11 | T2028 | U2 | - | - | - | 09 | CDCS - Treatment and training | 10/01/2004 | - |
22 | T2028 | U3 | - | - | - | 09 | CDCS - Environmental modifications and provisions | 10/01/2004 | - |
33 | T2028 | U4 | - | - | - | 09 | CDCS - Self direction support activities | 10/01/2004 | - |
44 | T1019 | TT | UC | - | - | 16 | Extended shared personal care services 1:2 | 11/01/2004 | - |
55 | T1019 | HQ | UC | - | - | 16 | Extended shared personal care services 1:3 | 11/01/2004 | - |
66 | S5135 | U9 | - | - | - | 16 | Behavioral programming by aide | 11/01/2004 | 04/30/2013 |
77 | S5135 | UA | - | - | - | 16 | BI night supervision | 11/01/2004 | - |
88 | S5135 | UB | - | - | - | 16 | 24-hour emergency assistance (15 minutes) | 11/01/2004 | 12/31/2013 |
99 | S5136 | UB | - | - | - | 08 | 24-hour emergency assistance (day) | 11/01/2004 | 12/31/2013 |
100 | S5100 | TF | - | - | - | 16 | Adult day service bath | 11/01/2004 | - |
110 | T1002 | TT | UC | - | - | 16 | RN, regular, extended 1:2 | 11/01/2004 | - |
111 | T1003 | TT | UC | - | - | 16 | LPN, regular, extended 1:2 | 11/01/2004 | - |
112 | S9131 | TF | UC | - | - | 29 | Extended physical therapy assistant | 11/01/2004 | - |
113 | S9129 | TF | UC | - | - | 29 | Extended occupational therapy assistant | 11/01/2004 | - |
114 | T1002 | TG | UC | - | - | 16 | RN, complex, extended | 11/01/2004 | - |
115 | T1003 | TG | UC | - | - | 16 | LPN, complex, extended | 11/01/2004 | - |
116 | T1002 | TT | - | - | - | 16 | RN, regular 1:2 | 11/01/2004 | - |
117 | T1002 | UC | - | - | - | 16 | RN, regular, extended 1:1 | 11/01/2004 | - |
118 | T1002 | TG | - | - | - | 16 | RN, complex | 11/01/2004 | - |
119 | T1003 | UC | - | - | - | 16 | LPN, regular, extended 1:1 | 11/01/2004 | - |
120 | T1003 | TT | - | - | - | 16 | LPN, regular 1:2 | 11/01/2004 | - |
121 | T1003 | TG | - | - | - | 16 | LPN, complex | 11/01/2004 | - |
122 | T1019 | TT | - | - | - | 16 | Personal care services (PCA) 1:2 | 11/01/2004 | - |
123 | T1019 | - | - | - | - | 16 | Personal care services (PCA) 1:1 | 11/01/2004 | - |
124 | T1019 | HQ | - | - | - | 16 | Personal care services (PCA) 1:3 | 11/01/2004 | - |
125 | T2023 | HA | HE | - | - | 18 | MH-TCM, child, face-to-face | 01/01/2004 | - |
126 | T2023 | HE | U4 | - | - | 18 | MH-TCM, adult, telephone | 01/01/2004 | - |
127 | T2023 | HE | HW | - | - | 18 | MH-TCM, adult, face-to-face by state staff | 01/01/2004 | 12/31/2007 |
128 | T2023 | HE | HW | U4 | - | 18 | MH-TCM, adult, telephone by state staff | 01/01/2004 | 12/31/2007 |
129 | T2023 | U3 | - | - | - | 18 | CW-TCM, face-to-face | 01/01/2004 | - |
130 | T2023 | U3 | U4 | - | - | 18 | CW-TCM, telephone | 01/01/2004 | - |
131 | T2023 | U1 | - | - | - | 18 | VA/DD-TCM, face-to-face | 01/01/2004 | - |
132 | T2023 | U1 | U4 | - | - | 18 | VA/DD-TCM, telephone | 01/01/2004 | - |
135 | T1005 | TG | - | - | - | 16 | Crisis respite, specialized | 11/01/2004 | - |
140 | S5126 | TG | - | - | - | 08 | DD, in home family support (day) | 11/01/2004 | 12/31/2013 |
141 | H0040 | HW | - | - | - | 08 | Assertive Community Treatment (ACT) by state staff | 07/01/2004 | 12/31/2007 |
142 | H0019 | - | - | - | - | 08 | Children's residential treatment | 07/01/2004 | - |
143 | H0019 | HW | - | - | - | 08 | Intensive Residential Rehab. Treatment (IRT) by state staff | 07/01/2004 | 12/31/2007 |
145 | S9484 | HM | - | - | - | 11 | Crisis assessment, intervention and stabilization, non-residential, ind. by rehab. worker | 01/01/2004 | - |
146 | S9484 | HQ | - | - | - | 11 | Crisis assessment, intervention and stabilization, non-residential, group | 01/01/2004 | - |
91155306 | X5265 | - | - | - | - | 28 | Transportation | 01/01/1999 | 09/30/2006 |
91155312 | X5291 | - | - | - | - | 18 | Residential care services | 01/01/1999 | 09/30/2006 |
91155315 | X5294 | - | - | - | - | 28 | Extended transportation | 01/01/1999 | 09/30/2006 |
91155324 | X5363 | - | - | - | - | 18 | Foster care, corporate | 01/01/2000 | 09/30/2006 |
91155325 | X5400 | - | - | - | - | 26 | DD county screening, MA elig | 01/01/1999 | 09/30/2006 |
91155326 | X5410 | - | - | - | - | 17 | Day program, supported employment | 01/01/1999 | 09/30/2006 |
91155327 | X5411 | - | - | - | - | 22 | Day program, supported employment | 01/01/1999 | 09/30/2006 |
91155328 | X5412 | - | - | - | - | 08 | Day program, supported employment | 01/01/1999 | 09/30/2006 |
91155331 | X5415 | - | - | - | - | 17 | MR, adult supported living services | 01/01/1999 | 09/30/2006 |
91155332 | X5416 | - | - | - | - | 08 | MR, adult supported living services | 01/01/1999 | 09/30/2006 |
91155352 | X5467 | - | - | - | - | 12 | Extended home health medical supplies/equipment | 01/01/1999 | 09/30/2006 |
91155353 | X5476 | - | - | - | - | 16 | Case management | 01/01/1999 | 09/30/2006 |
91155358 | X5484 | - | - | - | - | 17 | Respite care, out of home | 01/01/1999 | 09/30/2006 |
91155362 | X5491 | - | - | - | - | 16 | Case management, paraprofessional | 01/01/1999 | 09/30/2006 |
91155364 | X5502 | - | - | - | - | 06 | Consumer education and training | 01/01/1999 | 09/30/2006 |
91155365 | X5503 | - | - | - | - | 11 | Consumer directed community support | 01/01/1999 | 06/30/2005 |
91155366 | X5504 | - | - | - | - | 08 | Consumer directed community support | 01/01/1999 | 06/30/2005 |
91155378 | X5590 | - | - | - | - | 17 | Independent Living Skills counseling | 01/01/1999 | 09/30/2006 |
91155381 | X5593 | - | - | - | - | 17 | Independent Living Skills group therapy | 01/01/1999 | 09/30/2006 |
91155386 | X5601 | - | - | - | - | 28 | Extended transportation | 01/01/1999 | 09/30/2006 |
91155387 | X5602 | - | - | - | - | 14 | Extended transportation | 01/01/1999 | 09/30/2006 |
91155388 | X5603 | - | - | - | - | 09 | Extended transportation - extra attendant | 01/01/1999 | 09/30/2006 |
91155396 | X5630 | - | - | - | - | 16 | MR Preadmission screening - 15 min | 01/01/1999 | 09/30/2006 |
91155398 | X5632 | - | - | - | - | 16 | MH preadmission screening | 01/01/1999 | - |
91155400 | X5639 | - | - | - | - | 17 | PASARR MH diag asses Masters | 01/01/1999 | - |
91155401 | X5640 | - | - | - | - | 17 | PASARR MH diag asses PhD | 01/01/1999 | - |
91155419 | X5671 | - | - | - | - | 12 | Assistive technology | 01/01/1999 | 09/30/2006 |
91155422 | X5674 | - | - | - | - | 11 | Specialist service | 01/01/1999 | 09/30/2006 |
91155425 | X5679 | - | - | - | - | 22 | DT&H, waiver, non-pilot | 01/01/1999 | 09/30/2006 |
91155438 | 99450 | - | - | - | - | 16 | Life/disability evaluation: Face-to-face LTCC assessment under age 65 | 07/01/2001 | 03/31/2008 |
91155439 | X5398 | - | - | - | - | 18 | MR, adult supported living services | 02/01/2000 | 09/30/2006 |
91155440 | T1016 | - | - | - | - | 16 | Relocation Service Coordination (RSC-TCM) | 07/01/2001 | 08/31/2008 |
91155443 | H0018 | - | - | - | - | 08 | Crisis stabilization, residential | 01/01/2004 | - |
91155445 | T2023 | HE | - | - | - | 18 | MH-TCM, adult, face-to-face | 01/01/2004 | - |
91155446 | S9484 | - | - | - | - | 11 | Crisis assessment, intervention and stabilization, non-residential, ind. by professional | 01/01/2004 | - |
91155447 | H0035 | - | - | - | - | 08 | Partial hospitalization | 01/01/2004 | - |
91155448 | S5165 | - | - | - | - | 12 | Environmental accessibility adaptations, home modifications/install and expenses | 11/01/2004 | - |
91155449 | T2028 | U1 | - | - | - | 09 | CDCS - Personal assistance | 10/01/2004 | - |
91155450 | T2040 | - | - | - | - | 16 | CDCS - Background check | 10/01/2004 | - |
91155451 | T2041 | - | - | - | - | 16 | CDCS - Mandatory case management | 10/01/2004 | - |
91155452 | S5100 | - | - | - | - | 16 | Adult day service (15 minutes) | 11/01/2004 | - |
91155453 | S5102 | - | - | - | - | 08 | Adult day service (day) | 11/01/2004 | - |
91155454 | S5110 | - | - | - | - | 16 | Family training | 11/01/2004 | - |
91155455 | S5116 | - | - | - | - | 27 | Caregiver training/education | 11/01/2004 | 06/30/2013 |
91155456 | S5120 | - | - | - | - | 16 | Chore services | 11/01/2004 | - |
91155457 | S5125 | - | - | - | - | 16 | DD, in home family support (15 minutes) | 11/01/2004 | - |
91155458 | S5126 | - | - | - | - | 08 | Caregiver living expenses | 11/01/2004 | - |
91155459 | S5130 | - | - | - | - | 16 | Homemaker service - cleaning only (15 minutes) | 11/01/2004 | - |
91155460 | S5131 | - | - | - | - | 08 | Homemaker services (day) | 11/01/2004 | - |
91155461 | S5140 | - | - | - | - | 08 | Foster care, adult (day) | 11/01/2004 | - |
91155462 | S5141 | - | - | - | - | 18 | Foster care, adult (month) | 11/01/2004 | 12/31/2013 |
91155463 | S5145 | - | - | - | - | 08 | Foster care, therapeutic, child, per diem | 11/01/2004 | - |
91155464 | S5146 | - | - | - | - | 18 | Foster care, child (month) | 11/01/2004 | 12/31/2013 |
91155465 | S5150 | - | - | - | - | 16 | Respite care, in home (15 minutes) | 11/01/2004 | 12/31/2013 |
91155466 | S5151 | - | - | - | - | 08 | Respite care, in home (day) | 11/01/2004 | - |
91155467 | S5170 | - | - | - | - | 13 | Home delivered meals | 11/01/2004 | - |
91155469 | S9125 | - | - | - | - | 08 | Crisis respite (day) | 11/01/2004 | - |
91155470 | S9128 | UC | - | - | - | 29 | Extended speech therapy | 11/01/2004 | - |
91155471 | S9129 | UC | - | - | - | 29 | Extended occupational therapy | 11/01/2004 | - |
91155472 | S9131 | UC | - | - | - | 29 | Extended physical therapy | 11/01/2004 | - |
91155473 | S9470 | - | - | - | - | 29 | Nutritional counseling, diet | 11/01/2004 | - |
91155474 | E1399 | - | - | - | - | 12 | Durable medical equipment | 11/01/2004 | 05/31/2013 |
91155475 | H0045 | - | - | - | - | 08 | Respite care services, not in home | 11/01/2004 | - |
91155476 | G0154 | - | - | - | - | 16 | Direct skilled nursing services - LPN or RN - home | 11/01/2004 | 12/31/2015 |
91155477 | G0156 | - | - | - | - | 16 | Home health aide/extended home health aide | 11/01/2004 | 06/30/2009 |
91155479 | T1005 | - | - | - | - | 16 | Crisis respite (15 minutes) | 11/01/2004 | - |
91155480 | T1002 | - | - | - | - | 16 | RN, regular | 11/01/2004 | - |
91155481 | T1003 | - | - | - | - | 16 | LPN, regular | 11/01/2004 | - |
91155482 | T1019 | UC | - | - | - | 16 | Extended personal care 1:1 | 11/01/2004 | - |
91155483 | T1021 | - | - | - | - | 29 | Home health aide visit | 11/01/2004 | - |
91155484 | T1020 | - | - | - | - | 08 | Personal care services | 11/01/2004 | 09/30/2011 |
91155485 | T2038 | - | - | - | - | 09 | Trans Serv Deposits/Moving Exp | 11/01/2004 | - |
91155487 | S5135 | - | - | - | - | 16 | Companion care, adult/Personal support | 11/01/2004 | - |
91155488 | S5136 | - | - | - | - | 08 | Personal support | 11/01/2004 | 12/31/2013 |
91155490 | H0040 | - | - | - | - | 08 | Assertive Community Treatment (ACT) | 07/01/2004 | - |
91172029 | H2017 | HM | UD | - | - | 16 | Transition to Community Living by a mental health rehabilitation worker | 01/01/2004 | 08/31/2016 |
91172031 | H2017 | HM | HW | UD | - | 16 | Psychosocial rehab., indiv., transitional by rehab worker/state employee | 01/01/2004 | 12/31/2007 |
91172033 | H2017 | HM | HW | - | - | 16 | Psychosocial rehab., indiv. by rehab worker/state employee | 01/01/2004 | 12/31/2007 |
91172035 | H2017 | HW | UD | - | - | 16 | Psychosocial rehab., indiv., transitional by state employee | 01/01/2004 | 12/31/2007 |
91172037 | H2017 | HQ | HW | - | - | 16 | Psychosocial rehab., group by state employee | 01/01/2004 | 12/31/2007 |
91172045 | T2028 | U8 | - | - | - | 09 | CDCS - Flexible case management | 10/01/2004 | - |
91176169 | H2017 | - | - | - | - | 16 | Basic Living and Social Skills - individual; mental health professional or practitioner | 01/01/2004 | - |
91176171 | H2017 | HM | - | - | - | 16 | Basic Living and Social Skills - individual; mental health rehabilitation worker | 01/01/2004 | - |
91176173 | H2017 | HW | - | - | - | 16 | Psychosocial rehab., indiv. by state employee | 01/01/2004 | 12/31/2007 |
91176175 | H2017 | HQ | - | - | - | 16 | Basic Living and Social Skills - group; mental health professional or practitioner, or rehab. worker | 01/01/2004 | - |
91176177 | H2017 | UD | - | - | - | 16 | Transition to Community Living | 01/01/2004 | 08/31/2016 |
91176200 | T2016 | U9 | - | - | - | 08 | Supported living services, adult, corporate AFC (day) | 10/01/2006 | - |
91176280 | H2017 | HQ | UD | - | - | 16 | Psychosocial rehab., group, transitional | 01/01/2004 | 01/01/2004 |
91176281 | H2017 | HM | HQ | UD | - | 16 | Psychosocial rehab., group, transitional by rehab worker | 01/01/2004 | 01/01/2004 |
91176282 | H2017 | HQ | HW | UD | - | 16 | Psychosocial rehab., group, transitional by state employee | 01/01/2004 | 12/31/2007 |
91176283 | H2017 | HM | HQ | HW | UD | 16 | Psychosocial rehab., group, transitional by rehab worker/state employee | 01/01/2004 | 12/31/2007 |
91176284 | H2017 | HM | HQ | - | - | 16 | Psychosocial rehab., group by rehab worker | 01/01/2004 | 01/01/2004 |
91176285 | H2017 | HM | HQ | HW | - | 16 | Psychosocial rehab., group by rehab worker/state employee | 01/01/2004 | 12/31/2007 |
91176286 | 90882 | - | - | - | - | 27 | Environmental or community intervention, mental health professional or practitioner | 01/01/2002 | - |
91176287 | 90882 | UD | - | - | - | 27 | Transition to Community Intervention | 01/01/2002 | 08/31/2016 |
91176288 | 90882 | HM | UD | - | - | 27 | Transition to Community Intervention by a mental health rehabilitation worker | 01/01/2002 | 08/31/2016 |
91176289 | 90882 | HW | UD | - | - | 16 | Community intervention, indiv., transitional by state employee | 01/01/2002 | 12/31/2007 |
91176290 | 90882 | HM | HW | UD | - | 16 | Community intervention, indiv., transitional by rehab worker/state employee | 01/01/2002 | 12/31/2007 |
91176291 | 90882 | HM | - | - | - | 27 | Environmental or community intervention, mental health rehabilitation worker | 01/01/2002 | - |
91176292 | 90882 | HW | - | - | - | 16 | Community intervention, indiv. by state employee | 01/01/2002 | 12/31/2007 |
91176293 | 90882 | HM | HW | - | - | 16 | Community intervention, indiv. by rehab worker/state employee | 01/01/2002 | 12/31/2007 |
91176294 | T2025 | - | - | - | - | 09 | Consumer Support Grant (CSG) | 06/01/2006 | - |
91178000 | H0025 | - | - | - | - | 16 | Behaviorial Support, by analyst | 10/01/2006 | - |
91178001 | H0025 | TF | - | - | - | 16 | Behaviorial Support, by specialist | 10/01/2006 | - |
91178002 | H0025 | TG | - | - | - | 16 | Behaviorial Support, by professional | 10/01/2006 | - |
91178003 | H2032 | - | - | - | - | 16 | Independent living skills, maintenance | 10/01/2006 | 12/31/2013 |
91178004 | H2032 | TG | - | - | - | 16 | Independent living skills, individual therapy | 10/01/2006 | - |
91178005 | H2032 | HQ | - | - | - | 16 | Independent living skills, group therapy | 10/01/2006 | - |
91178007 | T2020 | - | - | - | - | 08 | DT&H, non-pilot/Structured day program | 10/01/2006 | - |
91178008 | T2020 | U5 | - | - | - | 22 | DT&H, non-pilot | 10/01/2006 | 12/31/2013 |
91178009 | T2002 | - | - | - | - | 08 | DT&H, non-pilot, transportation | 10/01/2006 | 12/31/2013 |
91178010 | T2021 | TG | - | - | - | 16 | DT&H pilot, Rate A | 10/01/2006 | 12/31/2013 |
91178011 | T2021 | TF | - | - | - | 16 | DT&H pilot, Rate B | 10/01/2006 | 12/31/2013 |
91178012 | T2021 | UB | - | - | - | 16 | DT&H pilot, Rate C | 10/01/2006 | 12/31/2013 |
91178013 | T2021 | - | - | - | - | 16 | DT&H pilot, Rate D/Structured day program | 10/01/2006 | - |
91178014 | T2024 | - | - | - | - | 26 | DD screening (screen) | 10/01/2006 | 05/31/2007 |
91178015 | T2032 | - | - | - | - | 18 | Residential care services (month) | 10/01/2006 | 12/31/2013 |
91178016 | T2032 | U9 | - | - | - | 18 | Supported living services, adult, corporate AFC (month) | 10/01/2006 | 12/31/2013 |
91178017 | T2032 | HA | - | - | - | 18 | Supported living services, child (month) | 10/01/2006 | 12/31/2013 |
91178018 | T2018 | U5 | - | - | - | 22 | Supported employment (partial day) | 10/01/2006 | 12/31/2013 |
91178019 | S0215 | UC | - | - | - | 14 | Transportation, mileage (commercial vehicle) | 10/01/2006 | 12/31/2012 |
91178020 | T2038 | TF | - | - | - | 32 | Housing access coordination | 10/01/2006 | 12/31/2013 |
91178021 | T2029 | - | - | - | - | 12 | Assistive technology/Supplies and equip., extended | 10/01/2006 | - |
91178022 | T2013 | - | - | - | - | 11 | Specialist service | 10/01/2006 | - |
91178023 | T2017 | HA | - | - | - | 16 | Supported living services, child (15 minutes) | 10/01/2006 | - |
91178024 | T2016 | HA | - | - | - | 08 | Supported living services, child (day) | 10/01/2006 | - |
91178025 | T2017 | - | - | - | - | 16 | Supported living services, adult (15 minutes) | 10/01/2006 | - |
91178026 | T2017 | U9 | - | - | - | 16 | Supported living services, adult, corporate AFC (15 minutes) | 10/01/2006 | - |
91178027 | T2016 | - | - | - | - | 08 | Supported living services, adult (day) | 10/01/2006 | - |
91178028 | S5109 | - | - | - | - | 27 | Consumer training and education | 10/01/2006 | - |
91178029 | T1016 | UC | - | - | - | 16 | Waiver case management | 10/01/2006 | - |
91178030 | S5141 | HQ | - | - | - | 18 | Foster care, adult (month) | 10/01/2006 | - |
91178031 | T2003 | UC | - | - | - | 28 | Non-emergency transportation; encounter/trip (one way) | 10/01/2006 | - |
91178032 | T1019 | UA | - | - | - | 16 | Supervision of PCA | 10/01/2006 | - |
91178033 | T2003 | - | - | - | - | 28 | Non-emergency transportation; encounter/trip (one way) | 10/01/2006 | - |
91178034 | S5110 | TF | - | - | - | 16 | CAC Family training | 10/01/2006 | 04/30/2009 |
91178036 | T2030 | - | - | - | - | 18 | Customized living services (monthly) | 10/01/2006 | 12/31/2013 |
91178037 | T2030 | TG | - | - | - | 18 | 24-hour customized living (monthly) | 10/01/2006 | 12/31/2013 |
91178038 | T2030 | TG | U9 | - | - | 18 | 24-hour customized living (corporate) | 10/01/2006 | 12/31/2013 |
91178039 | T2019 | - | - | - | - | 16 | Supported employment (15 minutes) | 10/01/2006 | - |
91178040 | T2018 | - | - | - | - | 08 | Supported employment (day) | 10/01/2006 | 12/31/2013 |
91178042 | T1016 | TF | UC | - | - | 16 | Waiver case management by paraprofessional | 10/01/2006 | - |
91178043 | S5150 | UB | - | - | - | 16 | Respite care, out of home | 10/01/2006 | - |
91178045 | T2015 | - | - | - | - | 11 | Prevocational services (hour) | 10/01/2006 | - |
91178046 | T2014 | - | - | - | - | 08 | Prevocational services (day) | 10/01/2006 | - |
91178047 | H2032 | TF | - | - | - | 16 | Independent living skills, counseling | 10/01/2006 | - |
91178048 | T2001 | UC | - | - | - | 03 | Transportation, extra attendant | 10/01/2006 | - |
91178049 | T2031 | - | - | - | - | 08 | Customized living services (daily) | 10/01/2006 | - |
91178050 | T2033 | - | - | - | - | 08 | Residential care services (day) | 10/01/2006 | - |
91238006 | T1016 | - | - | - | - | 16 | AC Conversion | 07/01/2001 | - |
91238036 | T2003 | UC | - | - | - | 25 | Non-emergency transportation; round trip | 10/01/2006 | 09/30/2007 |
91238039 | T2032 | - | - | - | - | 34 | Supported living services, adult (semi-monthly) | 10/01/2006 | 12/31/2013 |
91238042 | S0215 | UC | - | - | - | 14 | Transportation, mileage | 10/01/2006 | - |
91238047 | T2032 | U9 | - | - | - | 34 | Supported living services, adult, corporate AFC (semi-monthly) | 10/01/2006 | 12/31/2013 |
91238050 | T2032 | HA | - | - | - | 34 | Supported living services, child (semi-monthly) | 10/01/2006 | 12/31/2013 |
91238313 | T2032 | - | - | - | - | 18 | Supported living services, adult (month) | 10/01/2006 | 12/31/2013 |
91238326 | X5527 | - | - | - | - | 09 | AC Discretionary service | 07/01/1999 | - |
91238333 | H0019 | - | - | - | - | 08 | Intensive Residential Rehab. Treatment (IRT) | 07/01/2004 | - |
91238364 | T2025 | UD | - | - | - | 09 | Family Support Grant (FSG) with CSG | 06/01/2006 | 07/31/2012 |
91238374 | S5140 | U9 | - | - | - | 08 | Foster care, adult, corporate (day) | 11/01/2004 | - |
91238376 | S5141 | U9 | - | - | - | 18 | Foster care, adult, corporate (month) | 11/01/2004 | 12/31/2013 |
91238380 | T2038 | U1 | - | - | - | 09 | Transitional services, furniture | 11/01/2004 | - |
91238383 | T2038 | U2 | - | - | - | 09 | Transitional services, supplies | 11/01/2004 | - |
91238594 | T2024 | - | - | - | - | 16 | DD Screening (15 minutes) | 06/01/2007 | - |
91261022 | T1030 | - | - | - | - | 29 | Home health skilled nurse | 11/01/2004 | - |
91261024 | T1030 | GT | - | - | - | 09 | Home health telehomecare | 11/01/2004 | - |
91299000 | H2019 | UA | - | - | - | 16 | Therapeutic behavioral services, Level I MHBA | 07/01/2004 | - |
91299002 | H2019 | HM | UA | - | - | 16 | Therapeutic behavioral services, Level II MHBA | 07/01/2004 | - |
91299004 | H2019 | HE | UA | - | - | 16 | Therapeutic behavioral services, direction of MHBA | 07/01/2004 | - |
91308964 | S5100 | U7 | - | - | - | 16 | Family adult day services (FADS) (15 minutes) | 01/01/2008 | - |
91308966 | S5102 | U7 | - | - | - | 08 | Family adult day services (FADS) (day) | 01/01/2008 | - |
91308974 | T1023 | - | - | - | - | 16 | Life/disability evaluation: Face-to-face LTCC assessment under age 65 | 04/01/2008 | - |
91309042 | T1017 | - | - | - | - | 16 | Relocation Service Coordination (RSC-TCM) | 09/01/2008 | - |
91413000 | T1004 | - | - | - | - | 16 | Home health aide/extended home health aide | 07/01/2009 | - |
91413001 | S5165 | U3 | - | - | - | 12 | Environmental accessibility adaptations, square footage | 08/01/2009 | - |
91413134 | H0001 | - | - | - | - | 26 | Alcohol and/or drug assessment | 07/01/2009 | - |
91413136 | H0002 | - | - | - | - | 26 | Behavioral health eligibility screening | 07/01/2009 | - |
91413239 | S9484 | HN | - | - | - | 11 | Crisis assessment, intervention and stabilization, non-residential, ind. by practitioner | 01/01/2010 | - |
91413243 | 90882 | HK | - | - | - | 27 | Community intervention, crisis response | 01/01/2010 | - |
91530002 | S5116 | TF | - | - | - | 32 | Caregiver assessment | 04/01/2010 | 06/30/2013 |
91534000 | S5160 | - | - | - | - | 12 | Emergency response system-installation and testing | 05/01/2010 | - |
91538000 | S5161 | - | - | - | - | 12 | Emergency response system-service fee, per month | 05/01/2010 | - |
91538002 | S5162 | - | - | - | - | 12 | Emergency response system-purchase | 05/01/2010 | - |
91807008 | H0040 | U6 | - | - | - | 08 | Assertive Community Treatment, MHM | 06/01/2013 | - |
91807049 | H2015 | U6 | - | - | - | 16 | Comprehensive community support services, MHM | 06/01/2013 | - |
91807073 | T1016 | U6 | - | - | - | 16 | Case management, MHM | 06/01/2013 | - |
91807099 | T2038 | U6 | - | - | - | 09 | Transition plan development, MHM | 06/01/2013 | - |
91807125 | T2038 | UD | U6 | - | - | 09 | Transition coordination, MHM | 06/01/2013 | 12/31/2015 |
91807151 | A0180 | U6 | - | - | - | 09 | Non-emergency transportation: ancillary lodging, recipient, MHM | 06/01/2013 | - |
91807161 | A0200 | U6 | - | - | - | 09 | Non-emergency transportation: lodging for caseworker, escort, parent, MHM | 06/01/2013 | - |
91807195 | S5135 | UA | U6 | - | - | 16 | Overnight Assistance, MHM | 06/01/2013 | - |
91807205 | S5160 | U6 | - | - | - | 12 | Emergency response system installation and testing, MHM | 06/01/2013 | - |
91807213 | S5161 | U6 | - | - | - | 12 | Emergency response system service fee per month, MHM | 06/01/2013 | - |
91807221 | S5162 | U6 | - | - | - | 12 | Emergency response system purchase, MHM | 06/01/2013 | - |
91807229 | S5165 | U6 | - | - | - | 12 | Environmental accessibility adaptations, MHM | 06/01/2013 | - |
91807237 | S9970 | U6 | - | - | - | 12 | Health club membership, annual, MHM | 06/01/2013 | 07/31/2014 |
91807243 | T1028 | U6 | - | - | - | 12 | Adaptations - home assessment, MHM | 06/01/2013 | - |
91807251 | T1999 | U6 | - | - | - | 12 | Tools, clothing and equipment for employment, MHM | 06/01/2013 | - |
91807259 | T2038 | U1 | U6 | - | - | 09 | Transitional services, furniture, MHM | 06/01/2013 | - |
91807265 | T2038 | U2 | U6 | - | - | 09 | Transitional services, supplies, MHM | 06/01/2013 | - |
91807271 | T2038 | UA | U6 | - | - | 09 | Transitional services, housing deposit, MHM | 06/01/2013 | - |
91817000 | S5115 | - | - | - | - | 16 | Caregiver training/education | 07/01/2013 | - |
91817010 | S5115 | TF | - | - | - | 16 | Caregiver Coaching and Counseling/Caregiver Assessment | 07/01/2013 | - |
91822024 | T2011 | - | - | - | - | 26 | PASRR Level II Screening | 09/01/2012 | - |
91836004 | S5150 | - | - | - | - | 16 | Respite care, in home (15 minutes) | 01/01/2014 | - |
91857000 | T2029 | U6 | - | - | - | 12 | Assistive technology/Supplies and equip., extended, MHM | 12/01/2013 | 12/31/2015 |
91876000 | S9970 | U5 | U6 | - | - | 18 | Health club membership, monthly, MHM | 08/01/2014 | - |
91904000 | H2015 | - | - | - | - | 16 | Community Living Assistance Services, in person | 01/01/2015 | - |
91907010 | H2016 | - | - | - | - | 08 | Community Living Assistance Services, remote | 01/01/2015 | - |
91915000 | S5115 | TG | - | - | - | 16 | Family Caregiver Coaching and Counseling/Family Memory Care | 07/01/2015 | - |
91918000 | E1399 | NU | - | - | - | 12 | Durable medical equipment, new | 06/01/2013 | - |
91918012 | E1399 | RB | - | - | - | 12 | Durable medical equipment, repair | 06/01/2013 | - |
91918020 | E1399 | RR | - | - | - | 12 | Durable medical equipment, rental | 06/01/2013 | - |
91946000 | T1017 | U6 | - | - | - | 16 | Transition coordination, MHM | 01/01/2016 | - |
91946030 | T2029 | U6 | NU | - | - | 12 | Durable medical equipment, new, MHM | 01/01/2016 | - |
91949000 | T2029 | U6 | RB | - | - | 12 | Durable medical equipment, repair, MHM | 01/01/2016 | - |
91949008 | T2029 | U6 | RR | - | - | 12 | Durable medical equipment, rental, MHM | 01/01/2016 | - |
91949016 | T2029 | U6 | UE | - | - | 12 | Durable medical equipment, used, MHM | 01/01/2016 | - |
91949026 | E1399 | UE | - | - | - | 12 | Durable medical equipment, used | 01/01/2016 | - |
91949034 | T2029 | NU | - | - | - | 12 | Durable medical equipment, new | 01/01/2016 | - |
91949042 | T2029 | RB | - | - | - | 12 | Durable medical equipment, repair | 01/01/2016 | - |
91949050 | T2029 | RR | - | - | - | 12 | Durable medical equipment, rental | 01/01/2016 | - |
91949058 | T2029 | UE | - | - | - | 12 | Durable medical equipment, used | 01/01/2016 | - |
91949059 | T2039 | - | - | - | - | 12 | Environmental Accessibility Adaptations / Vehicle Install | 12/07/2017 | - |
92020000 | H2017 | U3 | - | - | - | 16 | Basic living and social skills, transitioning to community living (TCL), mental health professional | 09/01/2016 | - |
92020006 | H2017 | HM | U3 | - | - | 16 | Basic skills, transitioning to community living (TCL) by a mental health rehabilitation worker, less | 09/01/2016 | - |
92020008 | 90882 | U3 | - | - | - | 27 | Environmental or community intervention; transition to community living (TCL) intervention | 09/01/2016 | - |
92020010 | 90882 | HM | U3 | - | - | 27 | Environmental or community intervention; transition to community living intervention, less than bach | 09/01/2016 | - |
92045008 | S5145 | HE | - | - | - | 08 | Intensive Treatment in Foster Care | 01/01/2018 | - |
201717525 | T2019 | U9 | - | - | - | 16 | Employment Exploration | 01/01/2022 | - |
201717526 | T2019 | U2 | - | - | - | 16 | Individual Employment Support | 01/01/2022 | - |
201717529 | T2021 | UC | - | - | - | 08 | DT&H pilot, Rate D/Structured day program | 01/01/2022 | - |
201719527 | T2019 | HQ | - | - | - | 16 | Group Employment Support | 01/01/2022 | - |
201721523 | T2024 | U8 | - | - | - | 27 | Service assessment/plan of care development, waiver | 07/20/2020 | - |
201734510 | T1016 | HX | - | - | - | 16 | Case management (15 minutes) | 10/01/2020 | - |
201734518 | T2019 | U3 | - | - | - | 16 | Employment Development | 01/01/2022 | - |
201748512 | T1016 | U8 | HN | - | - | 16 | Treatment Coordination | 10/01/2020 | - |
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