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 -multiple patients (2) | 15 minutes | $6.94 | $6.69 | $7.41 | $7.63 | $7.56 |
G0299 TD UP 0551 | RN Services - multiple patients (3) | 15 minutes | N/A | $4.87 | $5.39 | $5.55 | $5.50 |
G0300 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 |
T1000 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 |
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 |
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 | $23.51 per visit | $21.57 per visit |
S5125 TF UN 0589 | PCA Supervisit - multiple patients (2) | 15 minutes | N/A | $2.81 | $11.64 per visit | $12.93 per visit | $11.87 per visit |
S5125 TF UP 0589 | PCA Supervisit - multiple patients (3) | 15 minutes | N/A | $2.04 | $8.46 per visit | $9.40 per visit | $8.63 per visit |
S5125TF | PCA Supervisit (for PCA Agencies only) | 15 minutes | $5.10 | $5.10 | $21.14 per visit | $23.51 per 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 visit |
S5125 TF UP | PCA Supervisit (for PCA Agencies only) multiple patients (3) | 15 minutes | N/A | $2.04 | $8.46 per visit | $9.40 per visit | $8.63 per visit |
S5125 | Personal Support Services (FPSO) | 15 minutes | $3.72 | $3.72 | $3.72 | $3.73 | $3.73 |
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 | Chore Services | 15 minutes | $2.30 | $2.30 | $2.30 | $2.30 | $2.30 |
10-144 C.M.R. ch. 101, § III-96
2/11/2019 - filing 2019-032