| 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 |
16.84 |
| 4122 |
ADULT DAY CARE-TRANSPORTATION |
17 |
TRIP |
12.44 |
| 4139 |
BACKGROUND CHECK |
25-D |
UNIT |
30 |
| 4184 |
CASE MANAGEMENT |
50-D |
MO |
175.27 |
| 4187 |
CASE MANAGEMENT CONSULTATION |
50-D |
HOUR |
25 |
| 4185 |
CASE MANAGEMENT-ASSESSMENT |
50-D |
AS |
140.00 |
| 4186 |
CASE MANAGEMENT-REASSESSMENT |
50-D |
REAS |
70.10 |
| 4145 |
CCU FACE TO FACE W/TRANSLATION |
24-D |
UNIT |
168.26 |
| 4144 |
CCU PRE-SCREEN NON FACE TO FACE |
24-D |
UNIT |
65.43 |
| 4143 |
CCU PRE-SCREEN FACE TO FACE |
24-D |
UNIT |
132.26 |
| 4166 |
CM TRANSPORTATION SERVICES (TBI AND AIDS ONLY) |
50-D |
MILE |
0.54 |
| 4090 |
CNA TRAINING |
65 |
HOUR |
20.75 |
| 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 |
25.00 |
| 4175 |
HH AGENCY NURSING CARE (LPN) |
83 |
HOUR |
37.50 |
| 4176 |
HH AGENCY NURSING CARE (RN) |
83 |
HOUR |
45.00 |
| 4173 |
HH AGENCY NURSING RN/LPN (MULTIPLE CUSTOMERS) |
83 |
HOUR |
47.28 |
| 4179 |
HH AGENCY RN & LPN VISITS < 2HRS |
83 |
VST |
111.00 |
| 4180 |
HOME DELIVERED MEALS |
60 |
DAY |
16.00 |
| 4178 |
HOME HEALTH (OT, PT & SPEECH) |
65,83,99 |
VST |
111.00 |
| 4160 |
HOME MODIFICATION INSTALLATION |
25 |
- |
5000.00 |
| 4161 |
HOME MODIFICATION REPAIR |
25 |
- |
2000 |
| 4100 |
HOMEMAKER SERVICE |
63 |
HOUR |
28.07 |
| 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 |
27.75 |
| 4123 |
NEUROPSYCHOLOGICAL EVAL |
83-D |
EVAL |
475 |
| 4198 |
NON-AGENCY CNA |
65 |
HOUR |
20.75 |
| 4197 |
NON-AGENCY LPN |
65 |
HOUR |
27.75 |
| 4196 |
NON-AGENCY RN |
65 |
HOUR |
34.50 |
| 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 |
17.75 |
| 4150 |
PERSONAL ASSISTANT |
65 |
HOUR |
17.75 |
| 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 |
20.75 |
| 4182 |
RESPITE NON-AGENCY LPN |
65 |
HOUR |
27.75 |
| 4181 |
RESPITE NON-AGENCY RN |
65 |
HOUR |
34.50 |
| 4193 |
RESPITE-ADULT DAY CARE |
17 |
HOUR |
15.30 |
| 4194 |
RESPITE-ADULT DAY CARE TRANSPORTATION |
17 |
TRIP |
11.29 |
| 4174 |
RESPITE-HH AGENCY NURSING (CNA) |
83 |
HOUR |
25.00 |
| 4188 |
RESPITE-HH AGENCY NURSING (LPN) |
83 |
HOUR |
37.50 |
| 4192 |
RESPITE-HH AGENCY NURSING (RN) |
83 |
HOUR |
45.00 |
| 4103 |
RESPITE-HOMEMAKER |
63 |
HOUR |
28.07 |
| 4151 |
RESPITE-PERSONAL ASSISTANT |
65 |
HOUR |
17.75 |
| 4088 |
RN TRAINING |
65 |
HOUR |
34.50 |
| 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 |
76.74 |
| 4108 |
TBI PREVOCATIONAL SERVICES |
88 |
DAY |
76.74 |
| 4109 |
TBI SUPPORTED EMPLOYMENT (JOB COACHING) |
93 |
HOUR |
44 |
