Certified Home Health Agencies
New York State Medicaid - Episodic Payment System

Information for Providers

Effective May 1, 2012

Base price for 60-day episode: $5,633

Assessment Reason Clinical Group Functional Group Age Group Case Mix Index Outlier Threshold Rate Code Rate Code Description
0 A E 1 0.243422 $2,463 4810 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1
0 A E 2 0.270204 $2,777 4811 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2
0 A E 3 0.353172 $3,660 4812 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3
0 A E 4 0.391753 $4,248 4813 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4
0 A E 5 0.417818 $4,463 4814 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5
0 A E 6 0.453213 $5,063 4815 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6
0 A F 1 0.445330 $5,106 4816 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1
0 A F 2 0.555396 $6,318 4817 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2
0 A F 3 0.623688 $6,718 4818 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3
0 A F 4 0.653467 $7,193 4819 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4
0 A F 5 0.697292 $7,682 4820 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5
0 A F 6 0.799501 $9,485 4821 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6
0 A G 1 0.738765 $9,723 4822 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1
0 A G 2 0.789251 $9,533 4823 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2
0 A G 3 1.164316 $12,478 4824 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3
0 A G 4 1.098168 $13,844 4825 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4
0 A G 5 1.182747 $13,301 4826 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5
0 A G 6 1.460267 $17,619 4827 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6
0 B E 1 0.327631 $3,745 4828 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1
0 B E 2 0.359436 $4,129 4829 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2
0 B E 3 0.409674 $4,605 4830 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3
0 B E 4 0.431726 $4,910 4831 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4
0 B E 5 0.405071 $4,822 4832 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5
0 B E 6 0.377278 $4,407 4833 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6
0 B F 1 0.553853 $6,991 4834 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1
0 B F 2 0.691567 $8,254 4835 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2
0 B F 3 0.745467 $8,160 4836 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3
0 B F 4 0.804546 $9,344 4837 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4
0 B F 5 0.895241 $10,917 4838 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5
0 B F 6 1.054706 $13,252 4839 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6
0 B G 1 0.922024 $12,476 4840 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1
0 B G 2 1.123777 $14,813 4841 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2
0 B G 3 1.285185 $16,003 4842 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3
0 B G 4 1.430612 $19,047 4843 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4
0 B G 5 1.634943 $23,139 4844 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5
0 B G 6 1.857543 $24,194 4845 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6
0 C E 1 0.412667 $5,468 4846 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1
0 C E 2 0.402839 $5,041 4847 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2
0 C E 3 0.639065 $8,130 4848 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3
0 C E 4 0.667792 $8,821 4849 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4
0 C E 5 0.864168 $12,891 4850 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5
0 C E 6 0.740507 $11,656 4851 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6
0 C F 1 0.788233 $10,512 4852 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1
0 C F 2 0.799586 $9,952 4853 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2
0 C F 3 1.056082 $13,501 4854 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3
0 C F 4 1.163389 $15,063 4855 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4
0 C F 5 1.441520 $22,292 4856 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5
0 C F 6 1.481917 $21,663 4857 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6
0 C G 1 1.300295 $22,945 4858 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1
0 C G 2 1.769794 $25,991 4859 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2
0 C G 3 1.963598 $26,423 4860 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3
0 C G 4 2.006213 $26,602 4861 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4
0 C G 5 2.113511 $26,679 4862 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5
0 C G 6 2.188192 $26,917 4863 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6
1 A E 1 0.288999 $2,997 4864 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1
1 A E 2 0.397141 $4,551 4865 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2
1 A E 3 0.490221 $5,425 4866 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3
1 A E 4 0.515132 $5,705 4867 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4
1 A E 5 0.498359 $5,623 4868 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5
1 A E 6 0.492849 $6,161 4869 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6
1 A F 1 0.692819 $7,532 4870 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1
1 A F 2 0.788907 $8,670 4871 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2
1 A F 3 0.835994 $8,765 4872 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3
1 A F 4 0.920684 $9,522 4873 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4
1 A F 5 1.006464 $10,799 4874 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5
1 A F 6 1.023034 $12,536 4875 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6
1 A G 1 0.938262 $11,629 4876 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1
1 A G 2 0.895651 $11,698 4877 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2
1 A G 3 1.306854 $15,121 4878 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3
1 A G 4 1.416371 $16,654 4879 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4
1 A G 5 1.663304 $19,896 4880 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5
1 A G 6 1.737871 $23,649 4881 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6
1 B E 1 0.415081 $5,069 4882 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1
1 B E 2 0.451890 $5,529 4883 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2
1 B E 3 0.516701 $6,002 4884 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3
1 B E 4 0.517821 $6,500 4885 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4
1 B E 5 0.497128 $6,318 4886 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5
1 B E 6 0.441300 $5,947 4887 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6
1 B F 1 0.764817 $9,265 4888 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1
1 B F 2 0.881146 $9,793 4889 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2
1 B F 3 0.934108 $9,720 4890 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3
1 B F 4 1.002502 $11,108 4891 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4
1 B F 5 1.117406 $13,219 4892 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5
1 B F 6 1.213227 $15,096 4893 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6
1 B G 1 1.131558 $14,640 4894 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1
1 B G 2 1.685680 $24,551 4895 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2
1 B G 3 1.993754 $25,600 4896 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3
1 B G 4 1.962024 $25,322 4897 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4
1 B G 5 2.106841 $26,186 4898 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5
1 B G 6 2.245630 $26,954 4899 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6
1 C E 1 0.511326 $7,213 4900 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1
1 C E 2 0.589849 $8,078 4901 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2
1 C E 3 0.744325 $9,008 4902 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3
1 C E 4 0.765381 $10,269 4903 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4
1 C E 5 0.812514 $12,148 4904 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5
1 C E 6 0.770740 $12,225 4905 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6
1 C F 1 0.814777 $11,865 4906 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1
1 C F 2 1.012439 $13,897 4907 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2
1 C F 3 1.321204 $16,018 4908 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3
1 C F 4 1.626294 $24,054 4909 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4
1 C F 5 1.809058 $25,848 4910 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5
1 C F 6 2.038663 $26,278 4911 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6
1 C G 1 1.606753 $27,172 4912 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1
1 C G 2 2.331468 $27,570 4913 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2
1 C G 3 2.614637 $29,456 4914 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3
1 C G 4 2.519058 $29,150 4915 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4
1 C G 5 2.525514 $28,309 4916 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5
1 C G 6 2.480934 $28,600 4917 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6
N/A N/A N/A N/A 0.001000 $99,999 4919 EPS ASSESSMENT, NO OASIS, 18 AND OLDER
N/A N/A N/A N/A 0.243422 $2,463 4920 EPS MATERNITY, NO OASIS, 18 AND OLDER
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