| limit | proc_cde | acttyp_des | |||
| 0 | 001 | Assmt - Intake | |||
| 1 | 002 | OBRA Assmt.-Psychosocial | |||
| 1 | 003 | Assmt.-Psychological | |||
| 1 | 004 | Assessment, Brief | |||
| 1 | 005 | Assmt.-Physical Therapy -Standard | |||
| 2 | 006 | Assmt.-Psychiatric | |||
| 1 | 007 | Assmt.-Occupational-Standard | |||
| 1 | 008 | Assmt.-Speech,Language,Hearing-PASARR | |||
| 1 | 009 | Nursing Assessment | |||
| 1 | 011 | Assmt.-Speech, Hearing, Language-Standard | |||
| 1 | 013 | Assmt.-Occupational-PASARR | |||
| 1 | 014 | OBRA Assmt.-Psychiatric (by psychologist) | |||
| 52 | 017 | Preadmission Screen, Inpatient | |||
| 52 | 018 | Preadmission Screen, Partial Hospital | |||
| 52 | 019 | Preadmission Screen, Crisis Residential | |||
| 52 | 020 | Preadmission Screen, Transfer | |||
| 1 | 026 | OBRA Level II Follow-up | |||
| 8 | 030 | Individual Therapy | |||
| 8 | 032 | Therapy-Family | |||
| 8 | 033 | Group Therapy | |||
| 8 | 034 | Therapy-Child Group | |||
| 30 | 035 | Therapy-Physical, Individual | |||
| 10 | 036 | OT-Therapy, Individual | |||
| 10 | 040 | Therapy-Speech,Hear.,Lan.,Ind. | |||
| 12 | 047 | Group Nutritional Service | |||
| 15 | 048 | Nursing Service RN | |||
| 52 | 054 | Nursing Service Med Administration | |||
| 1 | 056 | Psychological Assessment | |||
| 55 | 057 | DBT | |||
| 0 | 058 | Prescription Assistance | |||
| 5 | 059 | Laboratory Services | |||
| 6 | 060 | Behavioral Treatment Monitoring | |||
| 395 | 061 | Monitoring-Nursing Home M.H. | |||
| 0 | 070 | Case Management Service | |||
| 395 | 072 | Supports Coordination | |||
| 395 | 073 | Home Based Service | |||
| 395 | 075 | Wrap Contact | |||
| 12 | 076 | Guardianship | |||
| 12 | 077 | Rep Payee / Conservator | |||
| 395 | 079 | School Based Service | |||
| 10 | 080 | Crisis Intervention | |||
| 10 | 083 | Crisis Intervention, Follow up | |||
| 52 | 087 | Jail Service | |||
| 15 | 088 | Med Clinic Service | |||
| 12 | 090 | Person/Family-Centered Plan of Service | |||
| 10 | 100 | Medication Review | |||
| 0 | 101 | Medication Assistance (OTC) | |||
| 0 | 103 | ECT Physician | |||
| 0 | 104 | Physician Service (Inpatient) | |||
| 0 | 108 | Electro Convulsive Therapy | |||
| 0 | 114 | Physician Service (Partial Hospitalization) | |||
| 1 | 130 | OT-Adaptive Equipment Assessment-Standard | |||
| 1 | 131 | OT -Environmental Modification Assessment-Standard | |||
| 1 | 132 | OT-Adaptive Equipment Training | |||
| 1 | 133 | OT-Environmental Modification Training | |||
| 0 | 134 | OT-Equipment Developed by Professionals | |||
| 0 | 135 | OT-Environmental Mod. Developed by Professionals | |||
| 1 | 136 | PT-Adaptive Equipment Assessment -Standard | |||
| 1 | 137 | PT-Adaptive Equipment Training/Monitoring | |||
| 0 | 138 | PT-Equipment Developed by Professionals | |||
| 1 | 139 | PT-Environmental Modification Training | |||
| 1 | 140 | Lang/Hearing/Speech-Adapt. Equip. Assessment-Standard | |||
| 1 | 141 | Speech / Hearing / Language Equipment Training | |||
| 0 | 142 | Lang/Hearing/Speech-Adapt. Equip. Dev. by Professional | |||
| 1 | 143 | Speech, Hearing, Language-Standard | |||
| 1 | 144 | Speech, Hearing, Language -Environmental Modification Training/Monitoring | |||
| 0 | 146 | Speech, Hearing, Language - Equipment Developed by Professional | |||
| 1 | 147 | PT-Environmental Modification Assessment - Standard | |||
| 0 | 148 | PT-Equipment Developed by Professionals | |||
| 60 | 149 | Medication Clinic Nursing Service | |||
| 2500 | 159 | Nursing Service LPN | |||
| 2500 | 188 | CWP Community Living Support | |||
| 2500 | 190 | Health - Mental Health Aide (1:1) | |||
| 0 | 202 | CWP Psychological Visit | |||
| 2500 | 207 | CWP Respite LPN (1:1) | |||
| 2500 | 209 | Nursing Service - RN Private Duty | |||
| 2500 | 212 | Nursing Service - LPN Private Duty | |||
| 250 | 219 | CWP Respite RN (1:1) | |||
| 0 | 221 | Nursing Services - RN (1:2) Private Duty | |||
| 0 | 224 | Nursing Service - LPN (1:2) Private Duty | |||
| 0 | 227 | Health - Mental Health Aide (1:2) | |||
| 0 | 228 | CWP Respite RN (1:2) | |||
| 2000 | 234 | Respite MHA (1:1) | |||
| 0 | 236 | Respite MHA (1:2) | |||
| 0 | 242 | Specialized Residential - Level II | |||
| 0 | 243 | Specialized Residential - Level III | |||
| 0 | 244 | Unoccupied Day | |||
| 0 | 249 | Specialized Residential - Level I | |||
| 0 | 252 | Respite Level I | |||
| 0 | 254 | Respite Level II | |||
| 0 | 255 | Respite Foster Care | |||
| 0 | 258 | Crisis Residential Day | |||
| 0 | 260 | Inpatient Day | |||
| 0 | 263 | SPECIALIZED RESIDENTIAL ATYPICAL | |||
| 0 | 264 | Emergency Residential | |||
| 1560 | 265 | Skill Building, Group | |||
| 1560 | 267 | Community Support,group | |||
| 0 | 268 | Partial Hospitalization Day | |||
| 0 | 270 | Day Program | |||
| 0 | 275 | Community Training and Support | |||
| 0 | 278 | CWP Respite LPN (1:2) | |||
| 0 | 282 | CWP Mileage | |||
| 0 | 288 | Adolescent Partial Hospitalization Day | |||
| 0 | 289 | Transitional Support | |||
| 0 | 290 | Intensive Inpatient | |||
| 0 | 291 | Level 1 Transportation (Van) | |||
| 0 | 292 | Level 2 Transportation (Ambulance) | |||
| 0 | 293 | CWP Speech Assessment-Standard | |||
| 0 | 294 | CWP Speech Therapy | |||
| 25 | 295 | Respite, Group (High Intensity) | |||
| 0 | 296 | CWP PT Assessment -Standard | |||
| 0 | 297 | CWP PT Therapy | |||
| 0 | 298 | CWP OT Assessment-Standard | |||
| 0 | 299 | CWP OT Therapy | |||
| 12 | 320 | Case Consulation Family, Individual | |||
| 12 | 321 | Case Consultation Family, Group | |||
| 6 | 329 | Case Consultation Family, Nutritionist | |||
| 2 | 334 | Lang/Hearing/Speech - Case Consultation | |||
| 2 | 336 | Case Consultation - RN | |||
| 2 | 339 | Case Consultation - LPN | |||
| 2 | 341 | CWP Home Health RN Overtime Rate | |||
| 2 | 342 | CWP Home Health LPN Overtime Rate | |||
| 0 | 351 | Psychiatric Testimony | |||
| 100 | 352 | Respite, Individualized | |||
| 200 | 355 | Respite, Group (Low Intensity) | |||
| 0 | 361 | IST | |||
| 0 | 388 | Pre Scheduled Response (Ambulance) | |||
| 0 | 389 | Anesthesia | |||
| 0 | 402 | Travel OBRA-PASARR | |||
| 1 | 405 | Translation Service | |||
| 0 | 606 | Dental Other Unique Conditions | |||
| 0 | 610 | Consultation Exam | |||
| 0 | 611 | Root Canal | |||
| 0 | 612 | Extraction | |||
| 0 | 613 | Hospital Use Fee | |||
| 0 | 614 | Full Mouth X-ray | |||
| 0 | 615 | Periodic Exam | |||
| 0 | 616 | Prophylaxis | |||
| 0 | 631 | Injection: Haldol Decanoate (J1631) 50mg | |||
| 0 | 649 | Drawing Fee | |||
| 0 | 650 | LAB-TSH | |||
| 0 | 651 | LAB-Urea Nitrogen | |||
| 0 | 652 | LAB-Creatinine | |||
| 0 | 653 | LAB-CBC | |||
| 0 | 654 | LAB-T4 | |||
| 0 | 655 | LAB-Complete Metabolic Panel | |||
| 0 | 656 | LAB-T3 | |||
| 0 | 657 | LAB-UA | |||
| 0 | 658 | LAB-Valporic Acid | |||
| 0 | 659 | LAB-Lithium | |||
| 0 | 660 | LAB-Hepatic Panel | |||
| 0 | 661 | LAB-HCG | |||
| 0 | 662 | LAB-Liver Panel | |||
| 0 | 663 | LAB-Basic Metabolic Panel | |||
| 0 | 664 | LAB-Imipramine and Desipramine | |||
| 0 | 665 | LAB-Clozapine | |||
| 0 | 680 | Injection: Prolixin Decanoate 25mg (J2680) | |||
| 9999 | 700 | Discharge Planning | |||
| 0 | 701 | Psychological Testing - IQ | |||
| 0 | 702 | Psychological Testing - Personality | |||
| 0 | 703 | Psychological Testing - Neuro Screen | |||
| 0 | 704 | Psychological Testing - Neuro Test | |||
| 0 | 705 | Involuntary Cert. (psychologist) | |||
| 1 | 710 | Assessment - Nutritional | |||
| 12 | 711 | Nutritional Service | |||
| 0 | 712 | OBRA Assmt. Speech (peformed by psychologist) | |||
| 1 | 720 | Assessment Behavioral | |||
| 0 | 721 | Behavioral Treatment | |||
| 20 | 725 | Hearing Impaired Service | |||
| 0 | 729 | Assmt, Health | |||
| 0 | 730 | Assessment - Guardianship | |||
| 0 | 741 | Massage Therapy | |||
| 10 | 800 | Consumer Contact | |||
| 15 | 900 | Community Integration | |||
| 185 | 901 | Supported Employment (MIA) | |||
| 185 | 902 | Supported Employment (DDA) | |||
| 800 | 903 | Skill Building, Individual | |||
| 800 | 904 | Community Support, Individual | |||
| 12 | 90782 | Medication Adminstration | |||
| 0 | 90801 | Evaluation Psychiatric | |||
| 10 | 90804 | Therapy - Individual | |||
| 10 | 90806 | Therapy - Individual | |||
| 0 | 90812 | Individual psychotherapy, interactive, using play equipment | |||
| 10 | 90847 | Therapy - Family | |||
| 10 | 90853 | Group Therapy | |||
| 10 | 90857 | Interactive Group Psychotherapy | |||
| 0 | 90887 | Explanation of results of psychiatric / medical examinations & procedure | |||
| 1 | 92506 | Evaluation of speech, language, voice, communication, etc | |||
| 10 | 92507 | Therapy - Speech, language, voice, communication, etc | |||
| 10 | 92508 | Therapy - group Speech, language, voice, communication, etc | |||
| 0 | 96100 | Other testing | |||
| 0 | 96115 | Neurobehavorial status exam | |||
| 0 | 96117 | Neuropsychological testing | |||
| 1 | 97001 | PT Assessment | |||
| 1 | 97002 | PT Reassessment | |||
| 1 | 97003 | OT Assessment | |||
| 1 | 97004 | OT Re Assessment | |||
| 0 | 97110 | Therapeutic Procedure | |||
| 0 | 97112 | Neuromuscular Re-Education | |||
| 0 | 97150 | Therapeutic Procedures Group | |||
| 0 | 97530 | Therapeutic Activities | |||
| 0 | 97532 | Development of Cognitive Skills | |||
| 0 | 97533 | Sensory Integrative Techniques | |||
| 0 | 99205 | Office or other outpatient visit | |||
| 0 | 99213 | Office or other outpatient visit-Low Complexity | |||
| 0 | 99214 | Office or other outpatient visit-Moderate Complexity | |||
| 0 | 99215 | Office or other outpatient visit-High Complexity | |||
| 0 | 99221 | Initial Hospital Care, low complexity | |||
| 0 | 99222 | Initial Hospital Care, medium complexity | |||
| 0 | 99223 | Initial Hospital Care, high complexity | |||
| 0 | 99231 | Hospital Care, low complexity | |||
| 0 | 99232 | Hospital Care, medium complexity | |||
| 0 | 99233 | Hospital Care, high complexity | |||
| 0 | 99244 | Office consultation -Moderate Complexity | |||
| 0 | 99245 | Office consultation -High Complexity | |||
| 0 | 99251 | Initial Inpatient Consult, focused | |||
| 0 | 99252 | Initial Inpatient Consult, expanded focused | |||
| 0 | 99253 | Initial Inpatient Consult, low complexity | |||
| 0 | 99254 | Initial Inpatient Consult, medium complexity | |||
| 0 | 99255 | Initial Inpatient Consult, high complexity | |||
| 0 | 99261 | Followup Inpatient Consult, low complexity | |||
| 0 | 99262 | Followup Inpatient Consult, medium complexity | |||
| 0 | 99263 | Followup Inpatient Consult, high complexity | |||
| 0 | 99374 | Physician supervision | |||
| 0 | 99375 | Care Plan Oversight Services | |||
| 0 | h0002 | Assmt - Intake | |||
| h0018 | Crisis Residential Day | ||||
| 2 | h0032 | Person centered Planning | |||
| 12 | h0036 | Home Based | |||
| 12 | h0036:tf | Home Based high intensity | |||
| 9999 | h0039 | ACT Service | |||
| 100 | h2011 | Crisis (15min) | |||
| 6240 | h2014 | Skill Training and Development | |||
| 3200 | h2014:tf | Skill Training and Development: medium | |||
| 6240 | h2014:tf:tt | Skill Training and Development (Group-Medium) | |||
| 6240 | h2014:tt | Skill Training and Development Group | |||
| 0 | h2015 | CLS | |||
| 0 | h2015:tf:tt | CLS 15 min:medium | |||
| 0 | h2015:tg:tt | CLS 15 min:high | |||
| 0 | h2015:tt | CLS 15 min:low | |||
| 0 | h2016 | CLS PerDiem:low | |||
| 0 | h2016:tf | CLS PerDiem:medium | |||
| 0 | h2016:tg | CLS PerDiem:high | |||
| 0 | h2019 | Behavorial Treatment (DD) | |||
| 12 | h2023 | Supported Employment (15min) | |||
| 12 | h2023:tf | Supported Employment: Medium (15min) | |||
| 12 | h2023:tg | Supported Employment: High(15min) | |||
| 135 | h2030 | Mental Health Clubhouse | |||
| 0 | h2031 | Clubhouse per diem | |||
| 0 | j1631 | Injection: Haldol Decanoate (J1631) 50mg | |||
| 0 | j2680 | Injection: Prolixin Decanoate 25mg (J2680) | |||
| 10 | m0064 | Medication Review | |||
| 0 | RC100 | Inpatient Psychiatric Bed Day | |||
| 2 | s5111 | Family Training (DD) | |||
| s5150 | Respite Unskilled | ||||
| 10 | s8990 | OT / PT Service | |||
| 0 | s9123 | Private Duty Nursing-RN | |||
| 0 | s9123:tt | Private Duty Nursing-RN (1:2) | |||
| 0 | s9124 | Private Duty Nursing-LPN | |||
| 0 | s9124:tt | Private Duty Nursing-LPN (1:2) | |||
| 12 | t1001 | Nursing Assessment | |||
| 12 | t1002 | RN Service | |||
| 0 | t1005 | Respite Service | |||
| 0 | t1005:td | Respite-RN (1:1) | |||
| 0 | t1005:td:tt | Respite-RN (1:2) | |||
| 0 | t1005:te | Respite-LPN (1:1) | |||
| 0 | t1005:te:tt | Respite-LPN (1:2) | |||
| 0 | t1005:tf | Respite Service | |||
| 0 | t1005:tf:tt | Respite Service - Aide(1:2) | |||
| 0 | t1005:tg | Respite Service | |||
| 0 | t1005:tg:tt | Respite Service - Group(high) | |||
| 0 | t1005:tt | Respite Service - Group(low) | |||
| 0 | t1016:TG | Supports & Services Coordination | |||
| 12 | t1017 | Targeted Case Mgmt | |||
| 12 | t1017:52 | Nursing Home Monitoring | |||
| 12 | t1017:tf | Targeted Case Mgmt:medium | |||
| 12 | t1017:tg | Targeted Case Mgmt:high | |||
| 0 | t1020 | Personal Care | |||
| 0 | t1020:tf | Personal Care:mid level | |||
| 0 | t1020:tg | Personal Care:high level | |||
| 1 | t1023 | Assmt. - Behavorial | |||
| 0 | t2011:ah | PASARR Level2: Psychologist | |||
| 0 | t2011:aj | PASARR Level2: Social Work | |||
| 0 | t2011:gn | PASARR Level2: Speech | |||
| 0 | t2011:go | PASARR Level2: OT | |||
| 0 | t2011:td | PASARR Level2: Nursing | |||
| 12 | t2038 | Community transition, waiver, per service | |||
| 0 | zz415 | F.I. Cost | |||