Certified Home Health Agencies

New York State Medicaid - Episodic Payment System
Information for Providers
Effective October 1, 2015

Base price for 60-day episode: $3,629
Assessment Reason Clinical Group Functional Group Age Group Case Mix Index Outlier Threshold Rate Code Rate Code Description Rate (Base Price X CMI)
0 A E 1 0.452807 $1,927 4810 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1 $1,643.24
0 A E 2/3 0.504006 $2,224 4811 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2 $1,829.04
0 A E 2/3 0.504006 $2,224 4812 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3 $1,829.04
0 A E 4/5 0.585921 $2,785 4813 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4 $2,126.31
0 A E 4/5 0.585921 $2,785 4814 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5 $2,126.31
0 A E 6 0.617586 $3,266 4815 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6 $2,241.22
0 A F 1 0.702950 $3,567 4816 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1 $2,551.01
0 A F 2/3 0.819911 $4,383 4817 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2 $2,975.46
0 A F 2/3 0.819911 $4,383 4818 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3 $2,975.46
0 A F 4/5 0.907107 $4,876 4819 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4 $3,291.89
0 A F 4/5 0.907107 $4,876 4820 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5 $3,291.89
0 A F 6 1.007894 $5,281 4821 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6 $3,657.65
0 A G 1 0.849427 $5,008 4822 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1 $3,082.57
0 A G 2/3 0.912432 $4,399 4823 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2 $3,311.22
0 A G 2/3 0.912432 $4,399 4824 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3 $3,311.22
0 A G 4/5 1.102867 $5,604 4825 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4 $4,002.30
0 A G 4/5 1.102867 $5,604 4826 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5 $4,002.30
0 A G 6 1.414112 $7,941 4827 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6 $5,131.81
0 B E 1 0.509369 $2,739 4828 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1 $1,848.50
0 B E 2/3 0.553038 $3,068 4829 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2 $2,006.97
0 B E 2/3 0.553038 $3,068 4830 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3 $2,006.97
0 B E 4/5 0.572074 $3,022 4831 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4 $2,076.06
0 B E 4/5 0.572074 $3,022 4832 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5 $2,076.06
0 B E 6 0.622687 $3,008 4833 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6 $2,259.73
0 B F 1 0.780885 $4,433 4834 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1 $2,833.83
0 B F 2/3 0.840023 $5,000 4835 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2 $3,048.44
0 B F 2/3 0.840023 $5,000 4836 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3 $3,048.44
0 B F 4/5 0.937378 $5,502 4837 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4 $3,401.74
0 B F 4/5 0.937378 $5,502 4838 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5 $3,401.74
0 B F 6 1.028746 $5,885 4839 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6 $3,733.32
0 B G 1 1.092859 $7,599 4840 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1 $3,965.99
0 B G 2/3 1.232401 $7,958 4841 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2 $4,472.38
0 B G 2/3 1.232401 $7,958 4842 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3 $4,472.38
0 B G 4/5 1.463466 $8,441 4843 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4 $5,310.92
0 B G 4/5 1.463466 $8,441 4844 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5 $5,310.92
0 B G 6 1.598097 $10,042 4845 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6 $5,799.49
0 C E 1 0.558310 $2,993 4846 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1 $2,026.11
0 C E 2/3 0.633471 $3,633 4847 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2 $2,298.87
0 C E 2/3 0.633471 $3,633 4848 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3 $2,298.87
0 C E 4/5 0.686172 $3,964 4849 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4 $2,490.12
0 C E 4/5 0.686172 $3,964 4850 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5 $2,490.12
0 C E 6 0.840921 $5,070 4851 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6 $3,051.70
0 C F 1 1.002994 $6,011 4852 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1 $3,639.87
0 C F 2/3 1.158492 $7,341 4853 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2 $4,204.17
0 C F 2/3 1.158492 $7,341 4854 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3 $4,204.17
0 C F 4/5 1.288122 $7,578 4855 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4 $4,674.59
0 C F 4/5 1.288122 $7,578 4856 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5 $4,674.59
0 C F 6 1.353817 $8,393 4857 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6 $4,913.00
0 C G 1 1.255548 $9,971 4858 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1 $4,556.38
0 C G 2/3 1.765983 $13,862 4859 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2 $6,408.75
0 C G 2/3 1.765983 $13,862 4860 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3 $6,408.75
0 C G 4/5 1.771950 $12,456 4861 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4 $6,430.41
0 C G 4/5 1.771950 $12,456 4862 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5 $6,430.41
0 C G 6 2.053545 $19,280 4863 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6 $7,452.31
1 A E 1 0.332762 $1,653 4864 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1 $1,207.59
1 A E 2/3 0.363709 $1,840 4865 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2 $1,319.90
1 A E 2/3 0.363709 $1,840 4866 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3 $1,319.90
1 A E 4/5 0.530811 $2,898 4867 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4 $1,926.31
1 A E 4/5 0.530811 $2,898 4868 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5 $1,926.31
1 A E 6 0.562811 $3,360 4869 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6 $2,042.44
1 A F 1 0.791566 $4,277 4870 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1 $2,872.59
1 A F 2/3 0.831011 $4,462 4871 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2 $3,015.74
1 A F 2/3 0.831011 $4,462 4872 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3 $3,015.74
1 A F 4/5 1.071553 $5,730 4873 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4 $3,888.67
1 A F 4/5 1.071553 $5,730 4874 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5 $3,888.67
1 A F 6 1.179460 $6,488 4875 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6 $4,280.26
1 A G 1 0.981051 $6,040 4876 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1 $3,560.23
1 A G 2/3 0.934703 $6,526 4877 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2 $3,392.04
1 A G 2/3 0.934703 $6,526 4878 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3 $3,392.04
1 A G 4/5 1.352765 $7,359 4879 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4 $4,909.18
1 A G 4/5 1.352765 $7,359 4880 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5 $4,909.18
1 A G 6 1.688639 $9,775 4881 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6 $6,128.07
1 B E 1 0.388856 $2,215 4882 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1 $1,411.16
1 B E 2/3 0.424835 $2,520 4883 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2 $1,541.73
1 B E 2/3 0.424835 $2,520 4884 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3 $1,541.73
1 B E 4/5 0.543620 $3,269 4885 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4 $1,972.80
1 B E 4/5 0.543620 $3,269 4886 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5 $1,972.80
1 B E 6 0.604803 $4,139 4887 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6 $2,194.83
1 B F 1 0.820958 $5,206 4888 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1 $2,979.26
1 B F 2/3 0.953452 $5,623 4889 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2 $3,460.08
1 B F 2/3 0.953452 $5,623 4890 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3 $3,460.08
1 B F 4/5 1.180360 $7,007 4891 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4 $4,283.53
1 B F 4/5 1.180360 $7,007 4892 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5 $4,283.53
1 B F 6 1.285284 $7,647 4893 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6 $4,664.30
1 B G 1 1.116057 $7,830 4894 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1 $4,050.17
1 B G 2/3 1.353569 $9,821 4895 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2 $4,912.10
1 B G 2/3 1.353569 $9,821 4896 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3 $4,912.10
1 B G 4/5 1.875498 $12,237 4897 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4 $6,806.18
1 B G 4/5 1.875498 $12,237 4898 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5 $6,806.18
1 B G 6 2.058527 $12,825 4899 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6 $7,470.39
1 C E 1 0.396614 $2,191 4900 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1 $1,439.31
1 C E 2/3 0.547722 $3,854 4901 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2 $1,987.68
1 C E 2/3 0.547722 $3,854 4902 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3 $1,987.68
1 C E 4/5 0.817780 $5,430 4903 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4 $2,967.72
1 C E 4/5 0.817780 $5,430 4904 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5 $2,967.72
1 C E 6 0.666473 $4,763 4905 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6 $2,418.63
1 C F 1 1.067897 $6,834 4906 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1 $3,875.40
1 C F 2/3 1.384701 $8,756 4907 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2 $5,025.08
1 C F 2/3 1.384701 $8,756 4908 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3 $5,025.08
1 C F 4/5 1.532221 $9,402 4909 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4 $5,560.43
1 C F 4/5 1.532221 $9,402 4910 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5 $5,560.43
1 C F 6 1.762728 $11,584 4911 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6 $6,396.94
1 C G 1 1.647950 $13,664 4912 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1 $5,980.41
1 C G 2/3 2.583864 $27,573 4913 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2 $9,376.84
1 C G 2/3 2.583864 $27,573 4914 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3 $9,376.84
1 C G 4/5 2.252574 $16,868 4915 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4 $8,174.59
1 C G 4/5 2.252574 $16,868 4916 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5 $8,174.59
1 C G 6 3.124578 $27,900 4917 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6 $11,339.09
N/A N/A N/A N/A N/A N/A 4919 EPS ASSESSMENT WITH NO OASIS - 18 AND OLDER LUPA Only
N/A N/A N/A N/A 0.332762 $1,653 4920 EPS MATERNITY, NO OASIS, 18 AND OLDER $1,207.59