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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes V2301 thru Z9727)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Proc Type Proc Code Procedure Description Unit Value Basic Rate Child Rate ER Rate Conv Ind ER Ind Cut-back Ind Prof % Rental Rate Non-Physn. Med.Prac. Ind
3 V2301 LENS SPHERE TRIFOCAL 4.127. 22.07 $22.07 --- -- 009 0 0 0.00 $0.00 Y
1 V2301 LENS SPHERE TRIFOCAL 4.127. 46.42 $46.42 --- -- 009 0 0 0.00 $0.00 Y
N V2301 LENS SPHERE TRIFOCAL 4.127. 46.42 $46.42 --- -- 009 0 0 0.00 $0.00 Y
N V2302 LENS SPHERE TRIFOCAL 7.1220 54.33 $54.33 --- -- 009 0 0 0.00 $0.00 Y
1 V2302 LENS SPHERE TRIFOCAL 7.1220 54.33 $54.33 --- -- 009 0 0 0.00 $0.00 Y
3 V2302 LENS SPHERE TRIFOCAL 7.1220 32.18 $32.18 --- -- 009 0 0 0.00 $0.00 Y
3 V2303 LENS SPHCY TRIFOCAL 4.0/.12- 19.61 $19.61 --- -- 009 0 0 0.00 $0.00 N
1 V2303 LENS SPHCY TRIFOCAL 4.0/.12 42.59 $42.59 --- -- 009 0 0 0.00 $0.00 Y
N V2303 LENS SPHCY TRIFOCAL 4.0/.12 42.59 $42.59 --- -- 009 0 0 0.00 $0.00 Y
N V2304 LENS SPHCY TRIFOCAL 4.0/2.25 50.21 $50.21 --- -- 009 0 0 0.00 $0.00 Y
1 V2304 LENS SPHCY TRIFOCAL 4.0/2.25 50.21 $50.21 --- -- 009 0 0 0.00 $0.00 Y
3 V2304 LENS SPHCY TRIFOCAL 4.0/2.25 19.61 $19.61 --- -- 009 0 0 0.00 $0.00 N
3 V2305 LENS SPHCY TRIFOCAL 4.0/4.25 19.61 $19.61 --- -- 009 0 0 0.00 $0.00 N
1 V2305 LENS SPHCY TRIFOCAL 4.0/4.25 55.10 $55.10 --- -- 009 0 0 0.00 $0.00 Y
N V2305 LENS SPHCY TRIFOCAL 4.0/4.25 55.10 $55.10 --- -- 009 0 0 0.00 $0.00 Y
N V2306 LENS SPHCYL TRIFOCAL 4.00/>6 55.36 $55.36 --- -- 009 0 0 0.00 $0.00 Y
1 V2306 LENS SPHCYL TRIFOCAL 4.00/>6 55.36 $55.36 --- -- 009 0 0 0.00 $0.00 Y
3 V2306 LENS SPHCYL TRIFOCAL 4.00/>6 19.61 $19.61 --- -- 009 0 0 0.00 $0.00 N
3 V2307 LENS SPHCY TRIFOCAL 4.25-7/. 22.07 $22.07 --- -- 009 0 0 0.00 $0.00 N
1 V2307 LENS SPHCY TRIFOCAL 4.257/. 47.60 $47.60 --- -- 009 0 0 0.00 $0.00 Y
N V2307 LENS SPHCY TRIFOCAL 4.257/. 47.60 $47.60 --- -- 009 0 0 0.00 $0.00 Y
N V2308 LENS SPHC TRIFOCAL 4.257/2. 47.60 $47.60 --- -- 009 0 0 0.00 $0.00 Y
1 V2308 LENS SPHC TRIFOCAL 4.257/2. 47.60 $47.60 --- -- 009 0 0 0.00 $0.00 Y
3 V2308 LENS SPHC TRIFOCAL 4.25-7/2. 22.07 $22.07 --- -- 009 0 0 0.00 $0.00 N
3 V2309 LENS SPHC TRIFOCAL 4.25-7/4. 22.07 $22.07 --- -- 009 0 0 0.00 $0.00 N
1 V2309 LENS SPHC TRIFOCAL 4.257/4. 61.83 $61.83 --- -- 009 0 0 0.00 $0.00 Y
N V2309 LENS SPHC TRIFOCAL 4.257/4. 61.83 $61.83 --- -- 009 0 0 0.00 $0.00 Y
N V2310 LENS SPHC TRIFOCAL 4.257/>6 62.09 $62.09 --- -- 009 0 0 0.00 $0.00 Y
1 V2310 LENS SPHC TRIFOCAL 4.257/>6 62.09 $62.09 --- -- 009 0 0 0.00 $0.00 Y
3 V2310 LENS SPHC TRIFOCAL 4.25-7/>6 22.07 $22.07 --- -- 009 0 0 0.00 $0.00 N
3 V2311 LENS SPHC TRIFO 7.25-12/.25- 32.18 $32.18 --- -- 009 0 0 0.00 $0.00 N
1 V2311 LENS SPHC TRIFO 7.2512/.25 54.33 $54.33 --- -- 009 0 0 0.00 $0.00 Y
N V2311 LENS SPHC TRIFO 7.2512/.25 54.33 $54.33 --- -- 009 0 0 0.00 $0.00 Y
N V2312 LENS SPHC TRIFO 7.2512/2.25 54.59 $54.59 --- -- 009 0 0 0.00 $0.00 Y
1 V2312 LENS SPHC TRIFO 7.2512/2.25 54.59 $54.59 --- -- 009 0 0 0.00 $0.00 Y
3 V2312 LENS SPHC TRIFO 7.25-12/2.25 32.18 $32.18 --- -- 009 0 0 0.00 $0.00 N
3 V2313 LENS SPHC TRIFO 7.25-12/4.25 32.18 $32.18 --- -- 009 0 0 0.00 $0.00 N
1 V2313 LENS SPHC TRIFO 7.2512/4.25 62.09 $62.09 --- -- 009 0 0 0.00 $0.00 Y
N V2313 LENS SPHC TRIFO 7.2512/4.25 62.09 $62.09 --- -- 009 0 0 0.00 $0.00 Y
N V2314 LENS SPHCYL TRIFOCAL OVER 12 54.33 $54.33 --- -- 009 0 0 0.00 $0.00 Y
1 V2314 LENS SPHCYL TRIFOCAL OVER 12 54.33 $54.33 --- -- 009 0 0 0.00 $0.00 Y
3 V2314 LENS SPHCYL TRIFOCAL OVER 12 32.18 $32.18 --- -- 009 0 0 0.00 $0.00 N
1 V2320 LENS TRIFOCAL ADD OVER 3.25D 14.31 $14.31 --- -- 009 0 0 0.00 $0.00 Y
N V2320 LENS TRIFOCAL ADD OVER 3.25D 14.31 $14.31 --- -- 009 0 0 0.00 $0.00 Y
N V2321 LENTICULAR LENS, TRIFOCAL 93.54 $93.54 --- -- 009 0 0 0.00 $0.00 Y
1 V2321 LENTICULAR LENS, TRIFOCAL 93.54 $93.54 --- -- 009 0 0 0.00 $0.00 Y
1 V2399 SPECIALTY TRIFOCAL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2399 SPECIALTY TRIFOCAL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2410 LENS VARIAB ASPHERICITY SING 57.05 $57.05 --- -- 009 0 0 0.00 $0.00 Y
1 V2410 LENS VARIAB ASPHERICITY SING 57.05 $57.05 --- -- 009 0 0 0.00 $0.00 Y
1 V2430 LENS VARIABLE ASPHERICITY BI 97.71 $97.71 --- -- 009 0 0 0.00 $0.00 Y
N V2430 LENS VARIABLE ASPHERICITY BI 97.71 $97.71 --- -- 009 0 0 0.00 $0.00 Y
N V2499 VARIABLE SPHERICITY LENS, OTHER TYPE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2499 VARIABLE ASPHERICITY LENS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2500 CONTACT LENS PMMA SPHERICAL 65.94 $65.94 --- -- 009 0 0 0.00 $0.00 Y
N V2500 CONTACT LENS PMMA SPHERICAL 65.94 $65.94 --- -- 009 0 0 0.00 $0.00 Y
N V2501 CNTCT LENS PMMATORIC/PRISM 103.69 $103.69 --- -- 009 0 0 0.00 $0.00 Y
1 V2501 CNTCT LENS PMMATORIC/PRISM 103.69 $103.69 --- -- 009 0 0 0.00 $0.00 Y
1 V2510 CNTCT GAS PERMEABLE SPHERICL 88.64 $88.64 --- -- 009 0 0 0.00 $0.00 Y
N V2510 CNTCT GAS PERMEABLE SPHERICL 88.64 $88.64 --- -- 009 0 0 0.00 $0.00 Y
N V2511 CNTCT TORIC PRISM BALLAST 143.27 $143.27 --- -- 009 0 0 0.00 $0.00 Y
1 V2511 CNTCT TORIC PRISM BALLAST 143.27 $143.27 --- -- 009 0 0 0.00 $0.00 Y
1 V2513 CONTACT LENS EXTENDED WEAR 152.59 $152.59 --- -- 009 0 0 0.00 $0.00 Y
N V2513 CONTACT LENS EXTENDED WEAR 152.59 $152.59 --- -- 009 0 0 0.00 $0.00 Y
N V2520 CONTACT LENS HYDROPHILIC 78.21 $78.21 --- -- 009 0 0 0.00 $0.00 Y
1 V2520 CONTACT LENS HYDROPHILIC 78.21 $78.21 --- -- 009 0 0 0.00 $0.00 Y
1 V2521 CNTCT LENS HYDROPHILIC TORIC 136.15 $136.15 --- -- 009 0 0 0.00 $0.00 Y
N V2521 CNTCT LENS HYDROPHILIC TORIC 136.15 $136.15 --- -- 009 0 0 0.00 $0.00 Y
N V2523 CNTCT LENS HYDROPHIL EXTEND 112.92 $112.92 --- -- 009 0 0 0.00 $0.00 Y
1 V2523 CNTCT LENS HYDROPHIL EXTEND 112.92 $112.92 --- -- 009 0 0 0.00 $0.00 Y
1 V2531 CONTACT LENS SCLERAL GAS PERMEABLE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
N V2531 CONTACT LENS SCLERAL GAS PERMEABLE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
N V2599 CONTACT LENS, OTHER TYPE 56.77 $56.77 --- -- 009 0 0 0.00 $0.00 Y
1 V2599 CONTACT LENS, OTHER TYPE 56.77 $56.77 --- -- 009 0 0 0.00 $0.00 Y
1 V2600 HAND HELD LOW VISION AIDS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2600 HAND HELD LOW VISION AIDS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2610 SINGLE LENS SPECTACLE MOUNT 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2610 SINGLE LENS SPECTACLE MOUNT 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2615 TELESCOP/OTHR COMPOUND LENS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2615 TELESCOP/OTHR COMPOUND LENS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2623 PLASTIC EYE PROSTH CUSTOM 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2623 PLASTIC EYE PROSTH CUSTOM 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2624 POLISHING ARTIFICAL EYE 31.96 $31.96 --- -- 009 0 0 0.00 $0.00 Y
N V2624 POLISHING ARTIFICAL EYE 31.96 $31.96 --- -- 009 0 0 0.00 $0.00 Y
N V2625 ENLARGEMNT OF EYE PROSTHESIS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2625 ENLARGEMNT OF EYE PROSTHESIS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2626 REDUCTION OF EYE PROSTHESIS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2626 REDUCTION OF EYE PROSTHESIS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2627 SCLERAL COVER SHELL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2627 SCLERAL COVER SHELL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2628 FABRICATION & FITTING 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2628 FABRICATION & FITTING 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2629 PROSTHETIC EYE OTHER TYPE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2629 PROSTHETIC EYE OTHER TYPE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2630 ANTER CHAMBER INTRAOCUL LENS 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N V2631 IRIS SUPPORT INTRAOCLR LENS 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N V2632 POST CHMBR INTRAOCULAR LENS 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N V2702 DELUXE LENS FEATURE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2702 DELUXE LENS FEATURE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2710 GLASS/PLASTIC SLAB OFF PRISM 40.00 $40.00 --- -- 009 0 0 0.00 $0.00 Y
3 V2710 GLASS/PLASTIC SLAB OFF PRISM 26.00 $26.00 --- -- 009 0 0 0.00 $0.00 Y
N V2710 GLASS/PLASTIC SLAB OFF PRISM 40.00 $40.00 --- -- 009 0 0 0.00 $0.00 Y
N V2715 PRISM LENS/ES 8.17 $8.17 --- -- 009 0 0 0.00 $0.00 Y
3 V2715 PRISM LENS/ES 4.22 $4.22 --- -- 009 0 0 0.00 $0.00 Y
1 V2715 PRISM LENS/ES 8.17 $8.17 --- -- 009 0 0 0.00 $0.00 Y
1 V2718 FRESNELL PRISM PRESSON LENS 15.78 $15.78 --- -- 009 0 0 0.00 $0.00 Y
3 V2718 FRESNELL PRISM PRESSON LENS 11.05 $11.05 --- -- 009 0 0 0.00 $0.00 Y
N V2718 FRESNELL PRISM PRESSON LENS 15.78 $15.78 --- -- 009 0 0 0.00 $0.00 Y
N V2744 TINT PHOTOCHROMATIC LENS/ES 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
3 V2744 TINT PHOTOCHROMATIC LENS/ES 17.19 $17.19 --- -- 009 0 0 0.00 $0.00 Y
1 V2744 TINT PHOTOCHROMATIC LENS/ES 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2745 TINT, ANY COLOR/SOLID/GRAD 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
3 V2745 TINT, ANY COLOR/SOLID/GRAD 3.54 $3.54 --- -- 009 0 0 0.00 $0.00 Y
N V2745 TINT, ANY COLOR/SOLID/GRAD 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2750 ANTI-REFLECTIVE COATING 15.33 $15.33 --- -- 009 0 0 0.00 $0.00 Y
1 V2750 ANTI-REFLECTIVE COATING 15.33 $15.33 --- -- 009 0 0 0.00 $0.00 Y
1 V2755 UV LENS/ES 9.37 $9.37 --- -- 009 0 0 0.00 $0.00 Y
3 V2755 UV LENS/ES 3.54 $3.54 --- -- 009 0 0 0.00 $0.00 Y
N V2755 UV LENS/ES 9.37 $9.37 --- -- 009 0 0 0.00 $0.00 Y
N V2760 SCRATCH RESISTANT COATING PER LENS 13.70 $13.70 --- -- 009 0 0 0.00 $0.00 Y
1 V2760 SCRATCH RESISTANT COATING 13.70 $13.70 --- -- 009 0 0 0.00 $0.00 Y
1 V2761 MIRROR COATING, ANY TYPE SOLID 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2761 MIRROR COATING, ANY TYPE SOLID 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2762 POLARIZATION, ANY LENS MATERIAL PER LENS 37.54 $37.54 --- -- 009 0 0 0.00 $0.00 Y
1 V2762 POLARIZATION, ANY LENS MATRIAL PER LENS 37.54 $37.54 --- -- 009 0 0 0.00 $0.00 Y
1 V2770 OCCLUDER LENS/ES 7.68 $7.68 --- -- 009 0 0 0.00 $0.00 Y
N V2770 OCCLUDER LENS/ES 7.68 $7.68 --- -- 009 0 0 0.00 $0.00 Y
N V2781 PROGRESSIVE LENS, PER LENS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2781 PROGRESSIVE LENS PER LENS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2782 LENS,IND 1.54-1.65 PLASTIC/1.60-1.79 GL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2782 LENS,IND 1.54-1.65 PLASTIC/1.60-1.79 GL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2783 LENS INDEX >=1.66 PLASTIC/>=1.80 GLASS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2783 LENS INDEX >= 1.66 PLASTIC/>=1.80 GLASS 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2784 LENS POLYCARB OR EQUAL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
3 V2784 LENS POLYCARB OR EQUAL 4.00 $4.00 --- -- 009 0 0 0.00 $0.00 Y
N V2784 LENS POLYCARB OR EQUAL 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V2785 CORNEAL TISSUE PROCESSING 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 V2799 MISCELLANEOUS VISION SERVICE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N V2799 MISCELLANEOUS VISION SERVICE 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
1 V5008 HEARING SCREENING 18.07 $18.07 --- -- 009 0 0 0.00 $0.00 Y
1 V5010 ASSESSMENT FOR HEARING AID 52.70 $52.70 --- -- 009 0 0 0.00 $0.00 Y
E V5011 FIT/ORIENT/CHK HEARING AID 32.42 $32.42 --- -- 009 0 0 0.00 $0.00 N
1 V5014 REPAIR/MODIFICATION OF HEARING AID 25.00 $25.00 --- -- 009 0 0 0.00 $0.00 Y
1 V5030 MONAURAL HEARING AID,BODY WORN,AIR CONDU 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5040 MONAURAL HEARING AID,BODY WORN,BONE COND 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5050 HEARING AID MONAURAL IN EAR 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5060 MONAURAL HEARING AID, BEHIND THE EAR 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5070 GLASSES; AIR CONDUCTION 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5080 GLASSES; BONE CONDUCTION 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5120 BINAURAL; BODY 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5130 BINAURAL; IN THE EAR 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5140 BINAURAL, BEHIND THE EAR 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5150 BINAURAL; GLASSES 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5171 HEARING AID MONAURAL ITE 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5172 HEARING AID MONAURAL ITC 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5181 HEARING AID MONAURAL BTE 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5190 CROS HEARING AID, GLASSES 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5211 HEARING AID BINAURAL ITE/ITE 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5212 HEARING AID BINAURAL ITE/ITC 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5213 HEARING AID BINAURAL ITE/BTE 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5214 HEARING AID BINAURAL ITC/ITC 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5215 HEARING AID BINAURAL ITC/BTE 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5221 HEARING AID BINAURAL BTE/BTE 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5230 BICROS HEARING AID; GLASSES 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 V5264 EAR MOLD/INSERT 27.52 $27.52 --- -- 009 0 0 0.00 $0.00 Y
1 V5265 EAR MOLD/INSERT, DISP 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5267 HEARING AID SUPPLY/ACCESSORY 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 Y
1 V5298 HEARING AID NOC 0.01 $0.01 --- -- 009 0 0 0.00 $1.53 Y
1 X3900 PHY THER SGL MODALITY ONE AREAINT 30 MI 17.04 $17.04 --- -- 009 0 0 0.00 $0.00 Y
P X3900 PHY THER SGL MODALITY ONE AREAINT 30 MI 17.04 $17.04 --- -- 009 0 0 0.00 $0.00 Y
P X3902 PHY THER SGL MODALITY ONE AREAEA ADD 15 3.63 $3.63 --- -- 009 0 0 0.00 $0.00 Y
1 X3902 PHY THER SGL MODALITY ONE AREAEA ADD 15 3.63 $3.63 --- -- 009 0 0 0.00 $0.00 Y
1 X3904 PHY THER SGL PROC ONE AREA INI 30 MIN 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
P X3904 PHY THER PROC ONE AREA INT 30 MIN 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X3906 PHY THER SGL PROC ONE AREA EA ADD 15 MIN 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X3908 PHY THER TREAT INC MOD PROC INIT 30 MIN 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X3910 PHY THER TREAT INC MOD PROC EA ADD 15 MI 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X3912 PHY THER HUBBARD TANK INIT 30 MIN 34.84 $34.84 --- -- 009 0 0 0.00 $0.00 Y
1 X3914 PHY THER HUBBARD TANK EA ADD 15 MIN 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X3916 PHY THER HUBBARD TANK POOL EXER INI 30 M 41.69 $41.69 --- -- 009 0 0 0.00 $0.00 Y
1 X3918 PHY THER HUBB TANK POOL EXER EA ADD 15 M 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X3920 PHY THER ANY TEST MEAS INI 30 MIN 34.84 $34.84 --- -- 009 0 0 0.00 $0.00 Y
1 X3922 PHY THER ANY TEST MEAS EA ADD 15 MIN,PLU 17.04 $17.04 --- -- 009 0 0 0.00 $0.00 Y
1 X3924 PHYS THERAPY PRELIM EVAL REHAB SNF ICF 34.84 $34.84 --- -- 009 0 0 0.00 $0.00 Y
1 X3926 PHY THER CASE CONFER A REPORT INT 30 MIN 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X3928 PHY THER CASE CONSUL AND RPT 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X3930 CASE CONFERENCE AND REPORT EACH ADD 15 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X3932 PHY THER HME OR LONG TERM CARE FAC-ADD 6.57 $6.57 --- -- 009 0 0 0.00 $0.00 Y
1 X3934 PHY THER MILAGE 1.77 $1.77 --- -- 009 0 0 0.00 $0.00 Y
1 X3936 PHY THER UNLISTED 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 X4100 OCC THER EVAL INT 30 MIN,PLUS REPORT 34.84 $34.84 --- -- 009 0 0 0.00 $0.00 Y
1 X4102 OCC THER EVAL EA ADD 15 MIN,PLUS REPORT 17.04 $17.04 --- -- 009 0 0 0.00 $0.00 Y
1 X4104 OCC THER CSE CONF INI 30 MIN 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X4106 OCC THER CSE CONF EA ADD 15 MIN 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X4108 OCC THERAPY PRELIM EVAL REHAB SNF ICF 34.84 $34.84 --- -- 009 0 0 0.00 $0.00 Y
1 X4110 OCC THER TREAT INI 30 MIN 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X4112 OCC THER TREAT EA ADD 15 MIN 6.86 $6.86 --- -- 009 0 0 0.00 $0.00 Y
1 X4114 OCC THER HME OR LONGTERM FAC VISITADD 6.57 $6.57 --- -- 009 0 0 0.00 $0.00 Y
1 X4116 OCC THER | MILEAGE 1.77 $1.77 --- -- 009 0 0 0.00 $0.00 Y
1 X4118 OCC THER | UNLISTED 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 X4120 OCC THERAPY CASE CONSULTATION AND REPT 21.19 $21.19 --- -- 009 0 0 0.00 $0.00 Y
1 X4300 SP THER LANGUAGE EVAL 66.05 $66.05 --- -- 009 0 0 0.00 $0.00 Y
1 X4301 SP THERSPEECH EVALUATION 66.05 $66.05 --- -- 009 0 0 0.00 $0.00 Y
1 X4302 SPEECHLANGUAGE THER GROUP EA PAT OVER O 26.57 $26.57 --- -- 009 0 0 0.00 $0.00 Y
1 X4303 SPEECHLANGUAGE THER INDIVID PER HR 45.24 $45.24 --- -- 009 0 0 0.00 $0.00 Y
1 X4304 SPEECHLANGUAGE THERAPY INDIVIDUAL 1/2HR 22.63 $22.63 --- -- 009 0 0 0.00 $0.00 Y
1 X4306 SPEECH THER OUT OF OFFICE CALL VIS 1ST P 8.27 $8.27 --- -- 009 0 0 0.00 $0.00 Y
1 X4308 SPCH THERAPY PRELIM EVAL REHAB SNF ICF 33.03 $33.03 --- -- 009 0 0 0.00 $0.00 Y
1 X4310 SGD-REL BUNDLED SPCH THERAPY, PER VISIT 45.24 $45.24 --- -- 009 0 0 0.00 $0.00 N
1 X4312 SGD-RECIPIENT ASSESSMENT 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 X4320 UNLISTED SPEECH THERAPY SERVICES 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 X4500 SP HR HR DIAG AUDIOLOG EVALUATION 66.05 $66.05 --- -- 009 0 0 0.00 $0.00 Y
1 X4501 SP HR HR PURE TONE AUDIOMETRY 35.79 $35.79 --- -- 009 0 0 0.00 $0.00 Y
1 X4502 AUDIOL PRELIM EVALUATION REHAB SNF ICF 33.03 $33.03 --- -- 009 0 0 0.00 $0.00 Y
1 X4504 SP HR O HR S AUDIOMETRY DURING SURGERY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 X4522 EVOKED RESP AUDIOMET TEST PHYSICIAN EVAL 160.10 $160.10 --- -- 009 0 0 0.00 $0.00 Y
1 X4526 HEARING THER INDIVID PER HOUR 45.40 $45.40 --- -- 009 0 0 0.00 $0.00 Y
1 X4530 IMPED AUD (BILAT) PRT COMP AUD EVAL AUDI 33.14 $33.14 --- -- 009 0 0 0.00 $0.00 Y
1 X4532 ELECTROACOUSTIC ANALYSIS OF HEARING AID 23.32 $23.32 --- -- 009 0 0 0.00 $0.00 Y
1 X4535 UNLISTED AUDIOLOGICAL SERVICES 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 X4540 TY (IMP TST) PRT COMP AUD EVAL AUDIOLOGI 22.94 $22.94 --- -- 009 0 0 0.00 $0.00 Y
1 X4542 ELECTROACOUSTIC ANALYSIS OF HEARING AID 42.81 $42.81 --- -- 009 0 0 0.00 $0.00 Y
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K Z1032 INITIAL ANTEPARTUM OFFICE VISIT 154.04 $126.31 --- -- 007 0 1 0.00 $0.00 Y
K Z1034 ANTEPARTUM FOLLOW-UP OFFICE VISIT 60.48 $60.48 --- -- 009 0 1 0.00 $0.00 Y
K Z1038 POSTPARTUM FOLLOW-UP OFFICE VISIT 60.48 $60.48 --- -- 009 0 1 0.00 $0.00 Y
1 Z4300 CENTER COORDINATOR 72.00 $72.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z4301 ASSESSMENT, NURSE-PER HALF HOUR 16.80 $16.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z4302 CASE CONF-ALLIED HEALTH-PER QT HR 8.40 $8.40 --- -- 009 0 0 0.00 $0.00 Y
1 Z4303 EPSDT: CCS PATIENT RPT-COMPLEX/PERIODIC 30.00 $30.00 --- -- 009 0 0 0.00 $0.00 Y
N Z4303 PATIENT REPORT-COMPLEX/PERIODIC 30.00 $30.00 --- -- 009 0 0 0.00 $0.00 Y
N Z4304 PATIENT REPORT-COMPLEX/COMPREHENSIVE 54.00 $54.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z4304 EPSDT: CCS PATIENT RPT-COMPLEX/COMPREHEN 54.00 $54.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z4305 EPSDT SVS:CNTR COORD,PHYSICAN-PER CASE 72.00 $72.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z4306 EPSDT: CASE CONF, PHYS/DENTIST-PER CASE 36.00 $36.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z4307 EVAL/INTERVEN, SOC WK-PER HALF HOUR 16.80 $16.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z4308 ASSESS/INTERVEN, DIETITIAN PER HALF HR 16.80 $16.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z4309 ASSESS/INTERVEN, ALLD PROF-PER HALF HOUR 16.80 $16.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z4310 MEDICAL CASE CONF, NURSE-PER 1/4 HR 8.40 $8.40 --- -- 009 0 0 0.00 $0.00 Y
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1 Z4312 MEDICAL CASE CONF, DIETITIAN-PER 1/4 HR 8.40 $8.40 --- -- 009 0 0 0.00 $0.00 Y
1 Z4313 GROUP COUNSELING, PHSY-PER PERSON 28.80 $28.80 --- -- 009 0 0 0.00 $0.00 Y
N Z4313 GROUP COUNSELING, PHSY-PER PERSON 28.80 $28.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z4314 GROUP COUNSELING, ALLD PROF-PER PERSON 13.37 $13.37 --- -- 009 0 0 0.00 $0.00 Y
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1 Z5406 ALLIED PROF. NECTELEP CONSULT 15 MIN 8.40 $8.40 --- -- 009 0 0 0.00 $0.00 Y
1 Z5408 ALLIED PROF. NEC-PROG/CL CONSULT-HR 38.00 $38.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5410 ALLIED PROFESSIONAL NEC -TRAVEL TIME HR 22.80 $22.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z5412 ALLIED PROF NEC -TRAVEL MILEAGE-ONEWAY 1.70 $1.70 --- -- 009 0 0 0.00 $0.00 Y
1 Z5414 TRAVEL EXPENSES 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5416 TECHNICIAN SERVICES 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
N Z5422 PROGRAM CONSULTATION/CLINIC (MED),HOUR 125.00 $125.00 --- -- 009 0 0 0.00 $0.00 N
N Z5424 TRAVEL MILEAGE/ MEDICAL (MILE) 2.00 $2.00 --- -- 009 0 0 0.00 $0.00 N
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1 Z5814 EPSDT SVSMARRIAGE/FAMILY/CHILD COUNSEL 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5816 EPSDT SERVICESSOCIAL WORKER 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5820 EPSDT SERVICES CASE MANAGEMENT 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5822 EPSDT SERVICES HEARING AID BATTERIES 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5850 EPSDT SUPPL INDIVIDUAL AOD COUN-1/2 HOUR 14.60 $14.60 --- -- 009 0 0 0.00 $0.00 Y
1 Z5900 EPSDTAUDIO EVAL LESS THAN 2 YRS 71.50 $71.50 --- -- 009 0 0 0.00 $0.00 Y
1 Z5902 EPSDTAUDIO EVAL 25 YRS 65.00 $65.00 --- -- 009 0 0 0.00 $0.00 Y
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1 Z5906 EPSDTSUBSEQUENT AUDIO EVAL UNDER 2 YRS 39.00 $39.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5908 EPSDTSUBSEQUENT AUDIO EVAL 25 YRS 36.40 $36.40 --- -- 009 0 0 0.00 $0.00 Y
1 Z5910 EPSDTSUBSEQUENT AUDIO EVAL 620 YRS 32.50 $32.50 --- -- 009 0 0 0.00 $0.00 Y
1 Z5912 EPSDTEVAL DIFFICULT TEST PT UNDER 7 YRS 84.75 $84.75 --- -- 009 0 0 0.00 $0.00 Y
1 Z5914 EPSDTAUDITORY BRAINSTEM RESPONSE (ABR) 160.10 $160.10 --- -- 009 0 0 0.00 $0.00 Y
1 Z5916 AUDIOMETRY/BEHAVIORAL OBSERVATIONAUDIO 36.05 $36.05 --- -- 009 0 0 0.00 $0.00 Y
1 Z5918 EPSDTSPEECH THRESHOLD TEST 15.13 $15.13 --- -- 009 0 0 0.00 $0.00 Y
1 Z5920 SPEECH DISCRIMINATION/WORD RECOGNI TEST 15.13 $15.13 --- -- 009 0 0 0.00 $0.00 Y
1 Z5922 EPSDTACOUSTIC IMMITANCE TST, MONAURAL 32.96 $32.96 --- -- 009 0 0 0.00 $0.00 Y
1 Z5924 EPSDT ACOUSTIC IMMITANCE TST, BINAURAL 48.56 $48.56 --- -- 009 0 0 0.00 $0.00 Y
1 Z5928 EPSDTFUNCTIONAL GAIN TESTING 33.02 $33.02 --- -- 009 0 0 0.00 $0.00 Y
1 Z5930 EPSDTREAL EAR MEASUREMENTS, MONAURAL 23.32 $23.32 --- -- 009 0 0 0.00 $0.00 Y
1 Z5932 EPSDTREAL EAR MEASUREMENTS, BINAURAL 33.80 $33.80 --- -- 009 0 0 0.00 $0.00 Y
1 Z5934 EPSDTEVOKED OTOACOUSTIC EMISSION, LTD 47.05 $47.05 --- -- 009 0 0 0.00 $0.00 Y
1 Z5936 EVOKED OTOACOUSTIC EMISSION CMPHSV/DGNTC 58.84 $58.84 --- -- 009 0 0 0.00 $0.00 Y
1 Z5940 AURAL REHAB CONVEN HEARING AID 30 MIN 56.16 $56.16 --- -- 009 0 0 0.00 $0.00 Y
1 Z5942 AURAL REHAB COCHLEAR IMPLANTATION 30 MIN 56.16 $56.16 --- -- 009 0 0 0.00 $0.00 Y
1 Z5944 AURAL REHAB ALTERN HEARING DEVICE 30 MIN 56.16 $56.16 --- -- 009 0 0 0.00 $0.00 Y
1 Z5946 EPSDT SUPPLEMENTAL SERVICEHEARING AID 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z5950 COUNSELING BY AUDIOLOGIST, PER HOUR 112.32 $112.32 --- -- 009 0 0 0.00 $0.00 Y
1 Z5952 ASST PRECOCHLEAR EVAL BY 2ND AUDIOLOGIS 33.02 $33.02 --- -- 009 0 0 0.00 $0.00 Y
1 Z5954 EVAL BY AUDIOLOGISTSPEECH PATHOLOGIST 21.32 $21.32 --- -- 009 0 0 0.00 $0.00 Y
1 Z5956 SPEECH PERCEPTION TESTING PREOR POST 21.32 $21.32 --- -- 009 0 0 0.00 $0.00 Y
1 Z5958 COCHLEAR IMPLANT BY AUDIOLOGIST, PER HR 112.32 $112.32 --- -- 009 0 0 0.00 $0.00 Y
1 Z5964 COCHLEAR IMPLAN RECHECK/TROUBLE SHOOTING 56.16 $56.16 --- -- 009 0 0 0.00 $0.00 Y
1 Z5966 PT/CAREGIVER ORIENTATION, PER HOUR 112.32 $112.32 --- -- 009 0 0 0.00 $0.00 Y
1 Z5968 POSTCOCHLEAR IMPLANT TESTING PER 30 MIN 33.02 $33.02 --- -- 009 0 0 0.00 $0.00 Y
1 Z5999 EPSDT SERVICES-UNLISTED/SUPPLEMENTAL SVS 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
1 Z6004 CTR OR HOSP DIALYSISXCL PROF CHG-INCL.LA 141.31 $141.31 --- -- 009 0 0 0.00 $0.00 N
1 Z6006 CTR OR HOSP DIALYSIS-XCL PROF CHG AND LA 136.19 $136.19 --- -- 009 0 0 0.00 $0.00 N
1 Z6012 ALL DIALYSIS W TRAIN.HOME CARE/SCL PROF 161.79 $161.79 --- -- 009 0 0 0.00 $0.00 N
1 Z6014 ALL DIALYSIS W TRAIN.HOME CARE/XCL PROF 156.67 $156.67 --- -- 009 0 0 0.00 $0.00 N
1 Z6020 CTR OR HOSP DIALYSIS XCL PROF CHG-INCL.L 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z6030 HOME DIALYSIS 1837.06 $1837.06 --- -- 009 0 0 0.00 $0.00 N
1 Z6042 ALL DIALYSIS W TRAIN HOME CARE XCL PROF 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
K Z6200 INITIAL NUTRIT ASSESSMENT/DEVELOP 30 MIN 16.83 $16.83 --- -- 009 0 0 0.00 $0.00 Y
K Z6202 SUB NUTRITION ASSESS/DEVELOP EA SUB 15MN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6204 FOLLOW-UP ANTEPARTUM INDIVIDUAL EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6206 FOLLOW-UP ANTEPARTUM PER PATIENT EA 15M 2.81 $2.81 --- -- 009 0 0 0.00 $0.00 Y
K Z6208 POSTPARTUM NUTR ASSE/TREAT/INTER IND 15M 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6300 INIT PSYCHOSOCIAL ASSESS/DEVEL FIRST 30 16.83 $16.83 --- -- 009 0 0 0.00 $0.00 Y
K Z6302 SUB PSYCHOSOCIAL ASSESS/DEVELOP EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6304 FOLLOW-UP ANTEPARTUM PSYCHOSOCIAL EA 15M 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6306 FOLLOW-UP ANTEPARTUM PSYCHSOCIAL EA 15MI 2.81 $2.81 --- -- 009 0 0 0.00 $0.00 Y
K Z6308 POSTPARTUM PSYCHOSOCIAL ASSESS EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6400 NEW CLIENT ORIENTATION EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6402 INITIAL HEALTH ED ASSESS/DEVELOP 30 MIN 16.83 $16.83 --- -- 009 0 0 0.00 $0.00 Y
K Z6404 3UB HEALTH EDUCATION ASSESS/DEVELOP 15MI 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6406 FOLLOW-UP ANTEPARTUM HEALTH/ED EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6408 FOLLOW-UP ANTEPARTUM HEALTH ED EA 15MIN 2.81 $2.81 --- -- 009 0 0 0.00 $0.00 Y
K Z6410 PERINATAL EDUCATION INDIVIDUAL EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6412 PERINATAL EDUCATION GROUP PER PAT EA 15M 2.81 $2.81 --- -- 009 0 0 0.00 $0.00 Y
K Z6414 POSTPARTUM HEALTH ED ASSESS IND EA 15MIN 8.41 $8.41 --- -- 009 0 0 0.00 $0.00 Y
K Z6500 INITIAL COMP FIRST 30 MIN/INC CASE COORD 135.83 $135.83 --- -- 009 0 0 0.00 $0.00 Y
1 Z7500 USE OF HOSP,EXAM.OR TREAT.RM. 23.77 $23.77 --- -- 009 0 0 0.00 $0.00 N
1 Z7502 USE OF EMERGENCY ROOM 34.58 $34.58 --- -- 009 0 0 0.00 $0.00 N
1 Z7504 USE OF CAST ROOM 34.58 $34.58 --- -- 009 0 0 0.00 $0.00 N
1 Z7506 USE OF OPER ROOM OR CYST ROOM-FIRST HOUR 101.90 $101.90 --- -- 009 0 0 0.00 $0.00 N
1 Z7508 USE OF OP OR CYSTO RM 1ST SUBSEQ HALF HR 40.76 $40.76 --- -- 009 0 0 0.00 $0.00 N
1 Z7510 USE OP OR CYSTO RM SEC SUBS HALF HOUR 40.76 $40.76 --- -- 009 0 0 0.00 $0.00 N
1 Z7512 USE OF RECOVERY ROOM 18.22 $18.22 --- -- 009 0 0 0.00 $0.00 N
1 Z7514 PAY FOR RM AND BOARD AND GEN NURSING CAR 40.76 $40.76 --- -- 009 0 0 0.00 $0.00 N
1 Z7516 USE OF FACILITY - BIRTHING ROOM 1975.74 $1975.74 --- -- 009 0 0 0.00 $0.00 N
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1 Z7606 HYPERBARIC OXY CHMBR 1ST 15MIN ATMOS ABS 19.73 $19.73 --- -- 009 0 0 0.00 $0.00 Y
1 Z7608 HYPERBARIC OXY CHMBR EACH SUB 15 MIN 19.73 $19.73 --- -- 009 0 0 0.00 $0.00 Y
1 Z7610 MISC DRUGS AND MED SUPPLIES, ADMIN STAT 0.01 $0.01 --- -- 009 0 0 0.00 $0.00 N
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1 Z7614 HOPTEL SERVICES/ROOM/BOARD 32.53 $32.53 --- -- 009 0 0 0.00 $0.00 N
1 Z8550 MSSP-CASE MANAGEMENT 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8551 MSSP-ADMINSTRATION 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8554 MSSP-ADULT DAY CARE-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8555 MSSP-ADULT DAY CARE-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8556 MSSP-HOUSING ASSISTANCE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8557 MSSP-NON MED HOME EQUIP 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8558 MSSP-EMERGENCY MOVE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8559 MSSP-IHSS/CHORE-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8560 MSSP-IHSS/CHORE-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8561 MSSP-IHSS/PERSONAL CARE-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8562 MSSP-IHSS/PERSONAL CARE-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8563 MSSP-IHSS/PERSONAL CARE-VISIT 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8564 MSSP-IHSS/HEALTH CARE-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8565 MSSP-IHSS/HEALTH CARE-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8566 MSSP-IHSS/HEALTH CARE-VISIT 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8567 MSSP-IHSS/PROTECTIVE SVCS-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8568 MSSP-IHSS/PROTECTIVE SVCS-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
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1 Z8573 MSSP-PURCHASED ASSMNT-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8574 MSSP-RESPITE IN-HOME-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8575 MSSP-RESPITE IN-HOME-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8576 MSSP-RESPITE OUT-OF-HOME-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8580 MSSP-CONGREGATE MEALS 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8581 MSSP-HOME DELIVERED MEALS 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
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1 Z8583 MSSP-SOCIAL REASSURANCE-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8584 MSSP-THERAPEUTIC COUNSELING-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
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1 Z8586 MSSP-MONEY MGMT-HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
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1 Z8589 MSSP-COMM DEVICE-MONTHLY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8590 MSSP-PERSONAL CARE-ITEM 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8591 MSSP-RESPITE OUT-OF-HOME-DAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8592 MSSP PURCH SPEC. CASE MGMT ONE TIME ONLY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8593 MSSP TRANSPORTATION ESCORT HOUR 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8594 MSSP PURCHASE CASE MANAGEMENT MO 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
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1 Z8596 MSSP - SOCIAL REASSURANCE - MONTH 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8597 MSSP-TRANSPORTATION-ONE WAY 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8598 MSSP-RESTORATION OF UTILITY SERVICE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8599 MSSP-TEMPORARY LODGING 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8600 MSSP-TCM-TRANSITION TO WAIVER 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8601 MSSP-TCM-NO TRANSITION TO WAIVER 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z8603 MSSP-CHORE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
1 Z9725 INITIAL INFANT HEAR-SCREEN-HOSP/INP 30.00 $30.00 --- -- 009 0 0 0.00 $0.00 N
1 Z9726 INITIAL INFANT HEAR-SCREEN-OUTPATIENT 30.00 $30.00 --- -- 009 0 0 0.00 $0.00 N
1 Z9727 INFANT HEARING RESCREEN-OUTPATIENT 30.00 $30.00 --- -- 009 0 0 0.00 $0.00 N