TEXAS HEALTH AND HUMAN SERVICES COMMISSION RATE …...Duty Nursing, and Therapy Services. The Texas Health and Human Services Commission (HHSC) intends to submit an amendment to the

Approved Rates Effective September 1, 2019 Page 1

TEXAS HEALTH AND HUMAN SERVICES

COMMISSION

RATE ANALYSIS DEPARTMENT

Notice of Approved Adjustments to Fees, Rates or

Charges for Personal Care Services, Private Duty

Nursing, and Therapy Services

Adjustments are approved to be effective

September 1, 2019

Approved Rates Effective September 1, 2019 Page 2

SUMMARY OF APPROVED ADJUSTMENTS

To Be Effective September 1, 2019

Included in this document is information relating to the approved adjustments to Medicaid payment rates for Personal Care Services, Private

Duty Nursing, and Therapy Services. The Texas Health and Human Services Commission (HHSC) intends to submit an amendment to the Texas State

Plan for Medical Assistance under Title XIX of the Social Security Act to update the fee schedules to reflect these approved adjustments. The rates

are approved to be effective September 1, 2019.

Hearing

The Health and Human Services Commission (HHSC) conducted a public

hearing to receive comments regarding the proposed adjustments to Medicaid rates detailed in this document on July 29, 2019, at 10:30 a.m. –

12:00 p.m. in the Public Hearing Room in the Winters Building at 701 West 51st St., Austin, Texas 78751. HHSC considered all concerns expressed at

the hearing prior to final rate approval. Should you have any questions regarding the information in this document, please contact:

Rate Analysis for Acute Care Services

Texas Health and Human Services Commission E-mail: [email protected]

Background

HHSC is responsible for the reimbursement determination functions for the

Texas Medicaid Program. The approved rates were calculated utilizing

established methodologies that conform to the Social Security Act and related federal regulations, the federally approved Texas Medicaid State

Plan, all applicable state statutes and rules, and other requirements. HHSC reviews the Medicaid reimbursement rates for all acute care services every

two years. These biennial reviews result in rates that are increased, decreased, or remain the same. The reviews are conducted to ensure that

rates continue to be based on established rate methodologies.

Methodology

The specific administrative rules that govern the establishment of the fees in this proposal include these rules in the TAC:

Public Rate Hearing July 29, 2019 Page 3

• §355.8021, which addresses the reimbursement methodology for

home health services;


durable medical equipment, prosthetics, orthotics, and supplies

(DMEPOS);


physicians and other practitioners; and§355.8097, which addresses

the reimbursement methodology for therapy services;


therapy services; and

• §355.8441, which addresses the reimbursement methodology for Early

and Periodic Screening, Diagnosis, and Treatment (EPSDT) services.

Legislative Direction for Proposed Rate Adjustments:

The 2019-20 General Appropriations Act, H.B. 1, 86th Legislature, Regular Session, 2019 [Article II, HHSC, Rider 45] directed the Health and Human

Services Commission (HHSC) to increase reimbursement rates for Personal Care Services to provide a base wage of personal attendants to $8.11

effective September 1, 2019.

The 2019-20 General Appropriations Act, H.B. 1, 86th Legislature, Regular Session, 2019 [Article II, HHSC, Rider 46] directed the Health and Human

Services Commission (HHSC) to increase reimbursement rates for Private Duty Nursing by 2.5 percent effective September 1, 2019.

The 2019-20 General Appropriations Act, H.B. 1, 86th Legislature, Regular

Session, 2019 [Article II, HHSC, Rider 47] directed the Health and Human

Services Commission (HHSC) to make the following increases to the reimbursement for physical, occupational, and speech therapies: (1)

increase the reimbursement for therapy assistants to 80 percent of the reimbursement paid to a licensed therapist; and (2) a 10 percent increase to

reimbursement for physical, occupational, and speech therapies provided in the home to children. Both of these rate increases will be effective

September 1, 2019.

Public Rate Hearing July 29, 2019 Page 4

Specific approved payment rate adjustments are listed in the attachments outlined below:

Att 1–Personal Care Services

Att 2–Private Duty Nursing Att 3–Therapy Services: Assistants

Att 4–Therapy Services: Children in the Home

TOS*

Procedure

Code Modifier**

Age

Range

Non-

Facility

(N)

Provider

Type (PT)

/Provider

Specialty

(PS)***

Current

Medicaid Fee

Percent

Reduction

Current

Adjusted

Medicaid Fee

Medicaid

Fee

Effective

9/1/2019

Percent

Reduction

Adjusted

Medicaid

Fee

Effective

9/1/2019

1 T1019 U3 0-20 N 59/CD $2.75 1% $2.72 $2.75 0% $2.75

1 T1019 U4 0-20 N 59/CD $3.26 1% $3.23 $3.26 0% $3.26

1 T1019 U5 0-20 N 59/CD $110.00 1% $108.90 $110.00 0% $110.00

1 T1019 U6 0-20 N $2.95 1% $2.92 $2.95 0% $2.95

1 T1019 U7 0-20 N $2.75 1% $2.72 $2.75 0% $2.75

1 T1019 U8 0-20 N 59/CD $110.00 1% $108.90 $110.00 0% $110.00

1 T1019 U9 0-20 N $3.46 1% $3.43 $3.46 0% $3.46

1 T1019 UA 0-20 N $3.46 1% $3.43 $3.46 0% $3.46

1 T1019 UB 0-20 N $3.26 1% $3.23 $3.26 0% $3.26

1 T1019 UD 0-20 N $2.95 1% $2.92 $2.95 0% $2.95

*Type of Service (TOS): 1 = Medical Services

**Modifier: U3 = CFC attendant care for PCS - CDS Option, each 15 minutes, U4 = CFC Habilitation for PCS - CDS Option, each 15 minutes, U5 =

Administrative fee for PCS - CFC only; CDSA Under CDS Option, per month, U6 = PCS each 15 minutes; All PCS Providers (except CDSA), U7 =

Attendant fee each 15 minutes; CDSA Under CDS Option, U8 = Administrative fee for PCS; CDSA Under CDS Option, per month U9 = CFC -

habilitation only, or attendant and habilitation, each 15 minutes, UA = PCS each 15 minutes, with behavioral health condition; All PCS Providers*

(except CDSA), UB = PCS each 15 minutes, with behavioral health condition; CDSA Under CDS Option* UD = CFC - attendant care only, each 15

minutes

Personal Care Services

***Provider Type/Provider Specialty: 59 = CCP - PCS, CD = Consumer Directed Services (CDS)

TOS*

Procedure

Code Modifier 1 Modifier 2

Age

Range

Non-Facility

(N)/Facility (F)

Current

Medicaid

Fee

Percent

Reduction

Current

Adjusted

Medicaid Fee

Medicaid Fee

Effective

9/1/2019

Percent

Reduction

Adjusted

Medicaid Fee

9/1/2019

1 T1000 TD 0-20 N $8.51 0% $8.51 $8.72 0% $8.72

1 T1000 TD UA 0-20 N $9.78 0% $9.78 $10.02 0% $10.02

1 T1000 TE 0-20 N $5.82 0% $5.82 $5.97 0% $5.97

1 T1000 TE UA 0-20 N $6.69 0% $6.69 $6.86 0% $6.86

C T1000 TD 0-20 N $11.05 0% $11.05 $11.33 0% $11.33

C T1000 TD UA 0-20 N $12.71 0% $12.71 $13.03 0% $13.03

C T1000 TE 0-20 N $8.09 0% $8.09 $8.29 0% $8.29

C T1000 TE UA 0-20 N $8.87 0% $8.87 $9.09 0% $9.09

Private Duty Nursing

*Type of Service (TOS): 1 = Medical Services, C = Home Health Procedure

**Modifier: TD = For home health services performed by an RN, TE = For Home health services performed by an LPN/LVN, UA = Services for clients with a

tracheostomy or clients who are ventilator dependent,

TOS*

Procedure

Code Modifier

Age

Range

Provider

Type (PT)

/Provider

Specialty

(PS)**

Current

Medicaid

Fee

Percent

Reduction

Current

Adjusted

Medicaid Fee

Medicaid Fee

Effective

9/1/2019

Percent

Reduction

Adjusted

Medicaid Fee

Effective

9/1/2019

1 92507 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $75.45 0% $75.45 $86.22 0% $86.22

1 92507 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $75.45 0% $75.45 $86.22 0% $86.22

1 92508 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $31.87 0% $31.87 $36.42 0% $36.42

1 92508 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $31.87 0% $31.87 $36.42 0% $36.42

1 92526 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $90.54 0% $90.54 $103.47 0% $103.47

1 92526 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $90.54 0% $90.54 $103.47 0% $103.47

1 97012 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $11.56 0% $11.56 $13.21 0% $13.21

1 97012 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $11.56 0% $11.56 $13.21 0% $13.21

C 97012 UB 0-20 HHA $11.56 0% $11.56 $13.21 0% $13.21

Therapy Assistants

C 97012 UB 21-999 HHA $11.56 0% $11.56 $13.21 0% $13.21

1 97014 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $11.31 0% $11.31 $12.92 0% $12.92

1 97014 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $11.31 0% $11.31 $12.92 0% $12.92

C 97014 UB 0-20 HHA $11.31 0% $11.31 $12.92 0% $12.92

C 97014 UB 21-999 HHA $11.31 0% $11.31 $12.92 0% $12.92

1 97016 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $13.82 0% $13.82 $15.79 0% $15.79

1 97016 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $13.82 0% $13.82 $15.79 0% $15.79

C 97016 UB 0-20 HHA $13.82 0% $13.82 $15.79 0% $15.79

C 97016 UB 21-999 HHA $13.82 0% $13.82 $15.79 0% $15.79

1 97018 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $7.79 0% $7.79 $8.90 0% $8.90

1 97018 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $7.79 0% $7.79 $8.90 0% $8.90

C 97018 UB 0-20 HHA $7.79 0% $7.79 $8.90 0% $8.90

C 97018 UB 21-999 HHA $7.79 0% $7.79 $8.90 0% $8.90

1 97022 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $16.84 0% $16.84 $19.24 0% $19.24

1 97022 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $16.84 0% $16.84 $19.24 0% $19.24

C 97022 UB 0-20 HHA $16.84 0% $16.84 $19.24 0% $19.24

C 97022 UB 21-999 HHA $16.84 0% $16.84 $19.24 0% $19.24

1 97024 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $4.77 0% $4.77 $5.46 0% $5.46

1 97024 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $4.77 0% $4.77 $5.46 0% $5.46

C 97024 UB 0-20 HHA $4.77 0% $4.77 $5.46 0% $5.46

C 97024 UB 21-999 HHA $4.77 0% $4.77 $5.46 0% $5.46

1 97026 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $4.27 0% $4.27 $4.88 0% $4.88

1 97026 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $4.27 0% $4.27 $4.88 0% $4.88

C 97026 UB 0-20 HHA $4.27 0% $4.27 $4.88 0% $4.88

C 97026 UB 21-999 HHA $4.27 0% $4.27 $4.88 0% $4.88

1 97028 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $5.28 0% $5.28 $6.03 0% $6.03

1 97028 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $5.28 0% $5.28 $6.03 0% $6.03

C 97028 UB 0-20 HHA $5.28 0% $5.28 $6.03 0% $6.03

C 97028 UB 21-999 HHA $5.28 0% $5.28 $6.03 0% $6.03

1 97032 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $25.95 0% $25.95 $29.66 0% $29.66

1 97032 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $25.95 0% $25.95 $29.66 0% $29.66

C 97032 UB 0-20 HHA $25.95 0% $25.95 $29.66 0% $29.66

C 97032 UB 21-999 HHA $25.95 0% $25.95 $29.66 0% $29.66

1 97033 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.70 0% $24.70 $28.23 0% $28.23

1 97033 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.70 0% $24.70 $28.23 0% $28.23

C 97033 UB 0-20 HHA $24.70 0% $24.70 $28.23 0% $28.23

C 97033 UB 21-999 HHA $24.70 0% $24.70 $28.23 0% $28.23

1 97034 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97034 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97035 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.35 0% $24.35 $27.82 0% $27.82

1 97035 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.35 0% $24.35 $27.82 0% $27.82

C 97035 UB 0-20 HHA $24.35 0% $24.35 $27.82 0% $27.82

C 97035 UB 21-999 HHA $24.35 0% $24.35 $27.82 0% $27.82

1 97036 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97036 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97110 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97110 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

C 97110 UB 0-20 HHA $23.63 0% $23.63 $27.00 0% $27.00

C 97110 UB 21-999 HHA $23.63 0% $23.63 $27.00 0% $27.00

1 97112 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97112 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

C 97112 UB 0-20 HHA $23.63 0% $23.63 $27.00 0% $27.00

C 97112 UB 21-999 HHA $23.63 0% $23.63 $27.00 0% $27.00

1 97113 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $27.13 0% $27.13 $31.00 0% $31.00

1 97113 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $27.13 0% $27.13 $31.00 0% $31.00

1 97116 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $21.85 0% $21.85 $24.98 0% $24.98

1 97116 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $21.85 0% $21.85 $24.98 0% $24.98

C 97116 UB 0-20 HHA $21.85 0% $21.85 $24.98 0% $24.98

C 97116 UB 21-999 HHA $21.85 0% $21.85 $24.98 0% $24.98

1 97124 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $19.71 0% $19.71 $22.53 0% $22.53

1 97124 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $19.71 0% $19.71 $22.53 0% $22.53

C 97124 UB 0-20 HHA $19.71 0% $19.71 $22.53 0% $22.53

C 97124 UB 21-999 HHA $19.71 0% $19.71 $22.53 0% $22.53

1 97140 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $22.26 0% $22.26 $25.44 0% $25.44

1 97140 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $22.26 0% $22.26 $25.44 0% $25.44

C 97140 UB 0-20 HHA $22.26 0% $22.26 $25.44 0% $25.44

C 97140 UB 21-999 HHA $22.26 0% $22.26 $25.44 0% $25.44

1 97150 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.02 0% $24.02 $27.45 0% $27.45

1 97150 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.02 0% $24.02 $27.45 0% $27.45

C 97150 UB 0-20 HHA $24.02 0% $24.02 $27.45 0% $27.45

C 97150 UB 21-999 HHA $24.02 0% $24.02 $27.45 0% $27.45

1 97530 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97530 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

C 97530 UB 0-20 HHA $23.63 0% $23.63 $27.00 0% $27.00

C 97530 UB 21-999 HHA $23.63 0% $23.63 $27.00 0% $27.00

1 97535 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97535 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

C 97535 UB 0-20 HHA $23.63 0% $23.63 $27.00 0% $27.00

C 97535 UB 21-999 HHA $23.63 0% $23.63 $27.00 0% $27.00

1 97537 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97537 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

C 97537 UB 0-20 HHA $23.63 0% $23.63 $27.00 0% $27.00

C 97537 UB 21-999 HHA $23.63 0% $23.63 $27.00 0% $27.00

1 97542 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97542 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

C 97542 UB 0-20 HHA $23.63 0% $23.63 $27.00 0% $27.00

C 97542 UB 21-999 HHA $23.63 0% $23.63 $27.00 0% $27.00

1 97750 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97750 UB 21-999

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97760 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.23 0% $24.23 $27.69 0% $27.69

1 97761 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $23.63 0% $23.63 $27.00 0% $27.00

1 97763 UB 0-20

CORF/ORF,

ECI, HHA,

and

Independent

Therapists $24.96 0% $24.96 $28.53 0% $28.53

1 97799 UB 0-20

CORF/ORF,

HHA, and

Independent

Therapists $25.06 0% $25.06 $28.64 0% $28.64

1 97799 UB 21-999

CORF/ORF,

HHA, and

Independent

Therapists $25.06 0% $25.06 $28.64 0% $28.64

C 97799 UB 0-20 HHA $25.06 0% $25.06 $28.64 0% $28.64

C 97799 UB 21-999 HHA $25.06 0% $25.06 $28.64 0% $28.64


**Modifier: UB = Services provided by therapy assistant

TOS*

Procedure

Code

Modifier*

*

Age

Range

Non-Facility

(N) POS***

Provider

Type (PT)

/Provider

Specialty

(PS)**

Current

Medicaid

Fee

Percent

Reduction

Current

Adjusted

Medicaid

Fee

Medicaid

Fee

Effective

9/1/2019

Percent

Reduction

Adjusted

Medicaid

Fee

Effective

9/1/2019

1 92507 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $107.78 0% $107.78 $118.56 0% $118.56

1 92507 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $75.45 0% $75.45 $94.85 0% $94.85

1 92508 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $45.53 0% $45.53 $50.08 0% $50.08

1 92508 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $31.87 0% $31.87 $40.06 0% $40.06

1 92521 0-20 N 2

ECI, HHA, and

Independent

Therapists $101.12 0% $101.12 $111.23 0% $111.23

1 92522 0-20 N 2

ECI, HHA, and

Independent

Therapists $127.36 0% $127.36 $140.10 0% $140.10

1 92523 0-20 N 2

ECI, HHA, and

Independent

Therapists $169.81 0% $169.81 $186.79 0% $186.79

1 92524 0-20 N 2

ECI, HHA, and

Independent

Therapists $86.82 0% $86.82 $95.50 0% $95.50

1 92526 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $129.34 0% $129.34 $142.27 0% $142.27

1 92526 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $90.54 0% $90.54 $113.82 0% $113.82

1 92610 0-20 N 2

ECI, HHA, and

Independent

Therapists $205.12 0% $205.12 $225.63 0% $225.63

1 97012 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $16.51 0% $16.51 $18.16 0% $18.16

C 97012 U5 0-20 N 2 HHA $16.51 0% $16.51 $18.16 0% $18.16

1 97012 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $11.56 0% $11.56 $14.53 0% $14.53

C 97012 UB 0-20 N 2 HHA $11.56 0% $11.56 $14.53 0% $14.53

1 97014 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $16.15 0% $16.15 $17.77 0% $17.77

C 97014 U5 0-20 N 2 HHA $16.15 0% $16.15 $17.77 0% $17.77

1 97014 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $11.31 0% $11.31 $14.22 0% $14.22

Therapies for Children in the Home

C 97014 UB 0-20 N 2 HHA $11.31 0% $11.31 $14.22 0% $14.22

1 97016 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $19.74 0% $19.74 $21.71 0% $21.71

C 97016 U5 0-20 N 2 HHA $19.74 0% $19.74 $21.71 0% $21.71

1 97016 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $13.82 0% $13.82 $17.37 0% $17.37

C 97016 UB 0-20 N 2 HHA $13.82 0% $13.82 $17.37 0% $17.37

1 97018 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $11.13 0% $11.13 $12.24 0% $12.24

C 97018 U5 0-20 N 2 HHA $11.13 0% $11.13 $12.24 0% $12.24

1 97018 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $7.79 0% $7.79 $9.79 0% $9.79

C 97018 UB 0-20 N 2 HHA $7.79 0% $7.79 $9.79 0% $9.79

1 97022 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $24.05 0% $24.05 $26.46 0% $26.46

C 97022 U5 0-20 N 2 HHA $24.05 0% $24.05 $26.46 0% $26.46

1 97022 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $16.84 0% $16.84 $21.17 0% $21.17

C 97022 UB 0-20 N 2 HHA $16.84 0% $16.84 $21.17 0% $21.17

1 97024 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $6.82 0% $6.82 $7.50 0% $7.50

C 97024 U5 0-20 N 2 HHA $6.82 0% $6.82 $7.50 0% $7.50

1 97024 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $4.77 0% $4.77 $6.00 0% $6.00

C 97024 UB 0-20 N 2 HHA $4.77 0% $4.77 $6.00 0% $6.00

1 97026 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $6.10 0% $6.10 $6.71 0% $6.71

C 97026 U5 0-20 N 2 HHA $6.10 0% $6.10 $6.71 0% $6.71

1 97026 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $4.27 0% $4.27 $5.37 0% $5.37

C 97026 UB 0-20 N 2 HHA $4.27 0% $4.27 $5.37 0% $5.37

1 97028 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $7.54 0% $7.54 $8.29 0% $8.29

C 97028 U5 0-20 N 2 HHA $7.54 0% $7.54 $8.29 0% $8.29

1 97028 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $5.28 0% $5.28 $6.63 0% $6.63

C 97028 UB 0-20 N 2 HHA $5.28 0% $5.28 $6.63 0% $6.63

1 97032 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $37.07 0% $37.07 $40.78 0% $40.78

C 97032 U5 0-20 N 2 HHA $37.07 0% $37.07 $40.78 0% $40.78

1 97032 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $25.95 0% $25.95 $32.62 0% $32.62

C 97032 UB 0-20 N 2 HHA $25.95 0% $25.95 $32.62 0% $32.62

1 97033 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $35.29 0% $35.29 $38.82 0% $38.82

C 97033 U5 0-20 N 2 HHA $35.29 0% $35.29 $38.82 0% $38.82

1 97033 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $24.70 0% $24.70 $31.06 0% $31.06

C 97033 UB 0-20 N 2 HHA $24.70 0% $24.70 $31.06 0% $31.06

1 97034 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

1 97034 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

1 97035 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $34.78 0% $34.78 $38.26 0% $38.26

C 97035 U5 0-20 N 2 HHA $34.78 0% $34.78 $38.26 0% $38.26

1 97035 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $24.35 0% $24.35 $30.61 0% $30.61

C 97035 UB 0-20 N 2 HHA $24.35 0% $24.35 $30.61 0% $30.61

1 97110 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

C 97110 U5 0-20 N 2 HHA $33.75 0% $33.75 $37.13 0% $37.13

1 97110 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

C 97110 UB 0-20 N 2 HHA $23.63 0% $23.63 $29.70 0% $29.70

1 97112 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

C 97112 U5 0-20 N 2 HHA $33.75 0% $33.75 $37.13 0% $37.13

1 97112 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

C 97112 UB 0-20 N 2 HHA $23.63 0% $23.63 $29.70 0% $29.70

1 97113 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $38.75 0% $38.75 $42.63 0% $42.63

1 97113 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $27.13 0% $27.13 $34.10 0% $34.10

1 97116 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $31.22 0% $31.22 $34.34 0% $34.34

C 97116 U5 0-20 N 2 HHA $31.22 0% $31.22 $34.34 0% $34.34

1 97116 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $21.85 0% $21.85 $27.47 0% $27.47

C 97116 UB 0-20 N 2 HHA $21.85 0% $21.85 $27.47 0% $27.47

1 97124 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $28.16 0% $28.16 $30.98 0% $30.98

C 97124 U5 0-20 N 2 HHA $28.16 0% $28.16 $30.98 0% $30.98

1 97124 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $19.71 0% $19.71 $24.78 0% $24.78

C 97124 UB 0-20 N 2 HHA $19.71 0% $19.71 $24.78 0% $24.78

1 97140 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $31.80 0% $31.80 $34.98 0% $34.98

C 97140 U5 0-20 N 2 HHA $31.80 0% $31.80 $34.98 0% $34.98

1 97140 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $22.26 0% $22.26 $27.98 0% $27.98

C 97140 UB 0-20 N 2 HHA $22.26 0% $22.26 $27.98 0% $27.98

1 97150 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $34.31 0% $34.31 $37.74 0% $37.74

C 97150 U5 0-20 N 2 HHA $34.31 0% $34.31 $37.74 0% $37.74

1 97150 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $24.02 0% $24.02 $30.19 0% $30.19

C 97150 UB 0-20 N 2 HHA $24.02 0% $24.02 $30.19 0% $30.19

1 97161 0-20 N 2

ECI, HHA, and

Independent

Therapists $116.19 0% $116.19 $127.81 0% $127.81

C 97161 0-20 N 2 HHA $116.19 0% $116.19 $127.81 0% $127.81

1 97162 0-20 N 2

ECI, HHA, and

Independent

Therapists $116.19 0% $116.19 $127.81 0% $127.81

C 97162 0-20 N 2 HHA $116.19 0% $116.19 $127.81 0% $127.81

1 97163 0-20 N 2

ECI, HHA, and

Independent

Therapists $116.19 0% $116.19 $127.81 0% $127.81

C 97163 0-20 N 2 HHA $116.19 0% $116.19 $127.81 0% $127.81

1 97164 0-20 N 2

ECI, HHA, and

Independent

Therapists $104.57 0% $104.57 $115.03 0% $115.03

C 97164 0-20 N 2 HHA $104.57 0% $104.57 $115.03 0% $115.03

1 97165 0-20 N 2

ECI, HHA, and

Independent

Therapists $116.19 0% $116.19 $127.81 0% $127.81

C 97165 0-20 N 2 HHA $116.19 0% $116.19 $127.81 0% $127.81

1 97166 0-20 N 2

ECI, HHA, and

Independent

Therapists $116.19 0% $116.19 $127.81 0% $127.81

C 97166 0-20 N 2 HHA $116.19 0% $116.19 $127.81 0% $127.81

1 97167 0-20 N 2

ECI, HHA, and

Independent

Therapists $116.19 0% $116.19 $127.81 0% $127.81

C 97167 0-20 N 2 HHA $116.19 0% $116.19 $127.81 0% $127.81

1 97168 0-20 N 2

ECI, HHA, and

Independent

Therapists $104.57 0% $104.57 $115.03 0% $115.03

C 97168 0-20 N 2 HHA $104.57 0% $104.57 $115.03 0% $115.03

1 97530 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

C 97530 U5 0-20 N 2 HHA $33.75 0% $33.75 $37.13 0% $37.13

1 97530 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

C 97530 UB 0-20 N 2 HHA $23.63 0% $23.63 $29.70 0% $29.70

1 97535 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

C 97535 U5 0-20 N 2 HHA $33.75 0% $33.75 $37.13 0% $37.13

1 97535 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

C 97535 UB 0-20 N 2 HHA $23.63 0% $23.63 $29.70 0% $29.70

1 97537 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

C 97537 U5 0-20 N 2 HHA $33.75 0% $33.75 $37.13 0% $37.13

1 97537 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

C 97537 UB 0-20 N 2 HHA $23.63 0% $23.63 $29.70 0% $29.70

1 97542 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

C 97542 U5 0-20 N 2 HHA $33.75 0% $33.75 $37.13 0% $37.13

1 97542 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

C 97542 UB 0-20 N 2 HHA $23.63 0% $23.63 $29.70 0% $29.70

1 97750 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

1 97750 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

1 97760 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $34.61 0% $34.61 $38.07 0% $38.07

1 97760 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $24.23 0% $24.23 $30.46 0% $30.46

1 97761 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $33.75 0% $33.75 $37.13 0% $37.13

1 97761 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $23.63 0% $23.63 $29.70 0% $29.70

1 97763 U5 0-20 N 2

ECI, HHA, and

Independent

Therapists $35.66 0% $35.66 $39.23 0% $39.23

1 97763 UB 0-20 N 2

ECI, HHA, and

Independent

Therapists $24.96 0% $24.96 $31.38 0% $31.38

1 97799 U5 0-20 N 2

HHA and

Independent

Therapists $35.80 0% $35.80 $39.38 0% $39.38

C 97799 U5 0-20 N 2 HHA $35.80 0% $35.80 $39.38 0% $39.38

1 97799 UB 0-20 N 2

HHA and

Independent

Therapists $25.06 0% $25.06 $31.50 0% $31.50

C 97799 UB 0-20 N 2 HHA $25.06 0% $25.06 $31.50 0% $31.50

1 S9152 0-20 N 2

ECI, HHA, and

Independent

Therapists $118.87 0% $118.87 $130.76 0% $130.76


**Modifier: UB = Services provided by therapy assistant

***Place of Service (POS): 2 = Home

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