HSP Rates & Fees

Last Reviewed: 8/11/2021, Updated 7/1/2021

Service
Description
Code
Service
Description
Text
Type
Service
Codes (D=diagnostic)

Units
Max
Unit
Price
4163 ADAPTIVE EQUIPMENT PURCHASES 25 0
4162 ADAPTIVE EQUIPMENT RENTAL 25 MO 250
4167 ADAPTIVE EQUIPMENT REPAIR 25 2000
4121 ADULT DAY CARE-HOURLY RATE 17 HOUR 14.30
4122 ADULT DAY CARE-TRANSPORTATION 17 TRIP 10.29
4139 BACKGROUND CHECK 25-D UNIT 30
4184 CASE MANAGEMENT 50-D MO 159.34
4187 CASE MANAGEMENT CONSULTATION 50-D HOUR 25
4185 CASE MANAGEMENT-ASSESSMENT 50-D AS 127.47
4186 CASE MANAGEMENT-REASSESSMENT 50-D REAS 63.73
4145 CCU FACE TO FACE W/TRANSLATION 24-D UNIT 114.95
4143 CCU PRE-SCREEN FACE TO FACE 24-D UNIT 89.53
4166 CM TRANSPORTATION SERVICES (TBI AND AIDS ONLY) 50-D MILE 0.54
4090 CNA TRAINING 65 HOUR 18.50
4165 DRIVER EVALUATION 25-D EVAL 650
4199 E H R INSTALLATION 26 SVC 40.00
4195 ELECTRONIC HOME RESPONSE 26 MO 28.00
4164 EVALUATION FOR ADAPTIVE EQUIPMENT REPAIR 25 EVAL 200
4159 EVALUATION FOR HOME MODIFICATION OR HOME MODIFICATION REPAIR 25-D ASSM 600
4140 HEALTH & SAFETY SERVICE 25 UNIT 300
4177 HH AGENCY AIDE (CNA) 83 HOUR 13.75
4175 HH AGENCY NURSING CARE (LPN) 83 HOUR 31.14
4176 HH AGENCY NURSING CARE (RN) 83 HOUR 35.03
4173 HH AGENCY NURSING RN/LPN (MULTIPLE CUSTOMERS) 83 HOUR 47.28
4179 HH AGENCY RN & LPN VISITS < 2HRS 83 VST 65.25
4180 HOME DELIVERED MEALS 60 DAY 15.00
4178 HOME HEALTH (OT, PT & SPEECH) 65,83,99 VST 65.25
4160 HOME MODIFICATION INSTALLATION 25 0
4161 HOME MODIFICATION REPAIR 25 2000
4100 HOMEMAKER SERVICE 63 HOUR 23.40
4125 HSP INTERPRETER SERVICES "FOREIGN LANGUAGES ONLY" 18-D HOUR 70
4170 HSP PHYSICIAN HOME VISIT 60-D VST 300
4141 INDEPENDENT LIVING ASSESSMENT 43-D AS 75
4142 INDEPENDENT LIVING SUPPORT SERVICES 43-D HOUR 31
4089 LPN TRAINING 65 HOUR 25.50
4123 NEUROPSYCHOLOGICAL EVAL 83-D EVAL 475
4198 NON-AGENCY CNA 65 HOUR 18.50
4197 NON-AGENCY LPN 65 HOUR 25.50
4196 NON-AGENCY RN 65 HOUR 32.25
4137 OCCUPATIONAL THERAPY (IN CLINIC) 83 HOUR 37
4168 OCCUPATIONAL THERAPY (IN HOME) 83 HOUR 37
4114 OCCUPATIONAL/PHYSICAL THERAPY EVAL, DIAGNOSTIC 83-D EVAL 95
4091 PA TRAINING 65 HOUR 15.50
4150 PERSONAL ASSISTANT 65 HOUR 15.50
4115 PHYSICAL THERAPY (IN CLINIC) 83 HOUR 37
4169 PHYSICAL THERAPY (IN HOME) 83 HOUR 37
4148 PHYSICIANS CERTIFICATIN FORM REPORT FEE 30-D REPT 25
1040 RELEASE OF INFORMATION 09-D,30-D,32-D,35-D,74-D,75 REPT 25
4149 RESIDUAL CAPACITY EXAM FORM REPORT FEE 30-D REPT 25
4183 RESPITE NON-AGENCY CNA 65 HOUR 18.50
4182 RESPITE NON-AGENCY LPN 65 HOUR 25.50
4181 RESPITE NON-AGENCY RN 65 HOUR 32.25
4193 RESPITE-ADULT DAY CARE 17 HOUR 14.30
4194 RESPITE-ADULT DAY CARE TRANSPORTATION 17 TRIP 10.29
4174 RESPITE-HH AGENCY NURSING (CNA) 83 HOUR 13.75
4188 RESPITE-HH AGENCY NURSING (LPN) 83 HOUR 25.47
4192 RESPITE-HH AGENCY NURSING (RN) 83 HOUR 29.55
4103 RESPITE-HOMEMAKER 63 HOUR 23.40
4151 RESPITE-PERSONAL ASSISTANT 65 HOUR 15.50
4088 RN TRAINING 65 HOUR 32.25
4190 SECURITY SERVICE 26-D HOUR 13
4112 SPEECH THERAPY (HOSPITAL) 83 VST 50
4110 SPEECH THERAPY EVAL (HOSPITAL) DIAGNOSTIC 83-D EVAL 150
4111 SPEECH THERAPY EVAL (NON-HOSPITAL) DIAGNOSTIC 83-D EVAL 120
4113 SPEECH THERAPY, NON-HOSPITAL 83 VST 37
4117 TBI BEHAVIORAL/COGNITIVE SERVICES-MASTER'S 89 VST 20
4116 TBI BEHAVIORAL/COGNITIVE SERVICES-PH.D. 89 VST 50
4107 TBI DAY HABILITATION 87 DAY 43.25
4108 TBI PREVOCATIONAL SERVICES 88 DAY 43.25
4109 TBI SUPPORTED EMPLOYMENT (JOB COACHING) 93 HOUR 44