Community First Choice Option (CFCO)
Fee For Service Rate Codes for 7/1/2019
- Document is also available in Portable Document Format (PDF)
| FFS – Home Delivered and Congregate Meals | |||||
|---|---|---|---|---|---|
| Rate Code |
Description | Effective Date | Rate | ||
| 3183 | HOME DELIVERED MEALS – CFCO | 7/1/2019 | Reference Range $4.25– $12.50 | ||
| 3184 | CONGREGATE MEALS – CFCO | 7/1/2019 | Reference Range $4.25– $12.50 | ||
| 3185 | HOME DELIVERED MEALS – (WKND) – CFCO | 7/1/2019 | Reference Range $4.25– $12.50 | ||
| NHTD – Home Delivered and Congregate Meals | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9781 | NHTDWVR Cong/Home Meals Tot Charge | Current and after 7/1/19 | Reference Range $4.25– $12.50 | ||
| FFS – Personal Emergency Response Units (PERS) | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 2513 | PERS INSTALLATION CHARGE | Current and after 7/1/19 | Average rate is approximately $45.00 | ||
| 2514 | PERS MONTHLY SERVICE CHARGE | Current and after 7/1/19 | Limit of one single unit claim per month. Provider–specific average rate of about $30. | ||
| FFS – Assistive Technology – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3186 | ASSISTIVE TECHNOLOGY (AT) – CFCO | 7/1/2019 | Submit charged amount up to $15,000. | ||
| TBI – Assistive Technology – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9857 | TBI Waiver Assistive Technology Total Charges | Current and after 7/1/19 | Submit charged amount up to $15,000. | ||
| NHTD Assistive Technology – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9752 | NHTD Assist Tech Total Charges | Current and after 7/1/19 | Submit charged amount up to $15,000. | ||
| CONSOLIDATED CHILDREN´S 1915 (c) Assistive–Adaptive Technology – Annual Cap $15,000 | |||||
| 1915(c) Childrens Consolidated Waiver | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 8037 | ADAPTIVE AND ASSISTIVE EQUIPMENT – $1.00 UNIT | 7/1/2019 | $1.00 PER UNIT. | ||
| 8038 | ADAPTIVE AND ASSISTIVE EQUIPMENT – $10.00 UNIT | 7/1/2019 | $10.00 PER UNIT. | ||
| 8039 | ADAPTIVE AND ASSISTIVE EQUIPMENT – $100.00 UNIT | 7/1/2019 | $100.00 PER UNIT. | ||
| 8040 | ADAPTIVE AND ASSISTIVE EQUIPMENT – $1000.00 UNIT | 7/1/2019 | $1000.00 PER UNIT. | ||
| OPWDD Adaptive Technology – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 4482 | Adaptive Tech $1/Unit Fee | Current and after 7/1/19 | Adaptive Tech $1/Unit Fee | ||
| 4483 | Adaptive Tech $10/Unit Fee | Current and after 7/1/19 | Adaptive Tech $10/Unit Fee | ||
| 4484 | Adaptive Tech $100/Unit Fee | Current and after 7/1/19 | Adaptive Tech $100/Unit Fee | ||
| 4485 | Adaptive Tech $1000/Unit Fee | Current and after 7/1/19 | Adaptive Tech $1000/Unit Fee | ||
| FFS – V Mods – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3193 | VEHICLE MODIFICATIONS – CFCO | 7/1/2019 | Submit charged amount up to $15,000. | ||
| OPWDD – V Mods – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3167 | VEHICLE ADAPT; OPWDD CFCO;STATE | 7/1/2019 | $1.00 PER UNIT. | ||
| 3168 | VEHICLE ADAPT; OPWDD CFCO;STATE | 7/1/2019 | $10.00 PER UNIT. | ||
| 3169 | VEHICLE ADAPT; OPWDD CFCO;STATE | 7/1/2019 | $100.00 PER UNIT. | ||
| 3170 | VEHICLE ADAPT; OPWDD CFCO;STATE | 7/1/2019 | $1000.00 PER UNIT. | ||
| NHTD V Mods – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9750 | NHTDWVR Vehicle Adaptation | Current and after 7/1/19 | Submit charged amount up to $15,000. | ||
| CONSOLIDATED CHILDREN´S 1915 (c) – V Mods– Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 8041 | VEHICLE MODIFICATIONS – $1.00 UNIT | 7/1/2019 | $1.00 PER UNIT. | ||
| 8042 | VEHICLE MODIFICATIONS – $10.00 UNIT | 7/1/2019 | $10.00 PER UNIT. | ||
| 8043 | VEHICLE MODIFICATIONS – $100.00 UNIT | 7/1/2019 | $100.00 PER UNIT. | ||
| 8044 | VEHICLE MODIFICATIONS – $1000.00 UNIT | 7/1/2019 | $1000.00 PER UNIT. | ||
| FFS Environmental Modifications – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3192 | ENVIRONMENTAL MODIFICATIONS – CFCO | 7/1/2019 | Submit charged amount up to $15,000. | ||
| OPWDD Environmental Modifications – Annual Cap 15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 4476 | ENV MODS; OPWDD CFCO; | Current and after 7/1/19 | $1 PER UNIT FEE; STATE. | ||
| 4477 | ENV MODS; OPWDD CFCO; | Current and after 7/1/19 | $10 PER UNIT FEE; STATE. | ||
| 4478 | ENV MODS; OPWDD CFCO; | Current and after 7/1/19 | $100 PER UNIT FEE; STATE. | ||
| 4479 | ENV MODS; OPWDD CFCO; | Current and after 7/1/19 | $1000 PER UNIT FEE; STATE. | ||
| TBI Environmental Modifications – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9874 | TBI WVR ENVIRON MODS $1000.00 PER UNIT FEE | Current and after 7/1/19 | $1000.00 UNIT. | ||
| NHTD Environmental Modifications – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9762 | NHTDWVR ENVIRON MOD TOT CHARGES | Current and after 7/1/19 | Submit charged amount up to $15,000. | ||
| CONSOLIDATED CHILDREN´S 1915 (c) Environmental Modifications – Annual Cap $15,000 | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 8032 | ENVIRONMENTAL MODIFICATIONS – $1.00 UNIT | 7/1/2019 | $1.00 PER UNIT. | ||
| 8034 | ENVIRONMENTAL MODIFICATIONS – $10.00 UNIT | 7/1/2019 | $10.00 PER UNIT. | ||
| 8035 | ENVIRONMENTAL MODIFICATIONS – $100.00 UNIT | 7/1/2019 | $100.00 PER UNIT. | ||
| 8036 | ENVIRONMENTAL MODIFICATIONS – $1000.00 UNIT | 7/1/2019 | $1000.00 PER UNIT. | ||
| FFS– MOVING ASSISTANCE $5,000.00 One Time Payment | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3188 | MOVING ASSISTANCE (HOURLY) –CFCO | 7/1/2019 | Submit charged amount up to $5,000. | ||
| NHTD – MOVING ASSISTANCE $5,000.00 One Time Payment | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9787 | NHTDWVR MOV ASS´T PROG TOTAL CHARGE | Current and after 7/1/19 | Submit charged amount up to $5,000. | ||
| OPWDD MOVING ASSISTANCE $5,000.00 One Time Payment | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 7449 | MOVING ASSISTANCE | 7/1/2019 | $10.00 Per Unit. Max $990.00 per day | ||
| FFS CTS $5,000 – One Time Payment | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3187 | COMMUNITY TRANSITION SERVICES (CFCO) | 7/1/2019 | Submit charged amount up to $5,000. | ||
| TBI/NHTD CTS $5,000 – One Time Payment | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 9758 | NHTDWVR COM TRANSIT SVR TOT CHARGE | 7/1/2019 | Submit charged amount up to $5,000. | ||
| 9867 | TBI WAIVER COMM TRANS RATE CD 20 – $1000.00 PER UNIT | 7/1/2019 | Submit charged amount up to $5,000. | ||
| OPWDD – CTS $5,000 – One Time Payment | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 4786 | COM TRANS SVCS; VIA FI: Vol; | Current and after 7/1/19 | $10.00 Per Unit. Max $990.00 per day | ||
| OPWDD Community Habilitation ( COM HAB) ( SAME) | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 4722 | Comm/Res Hab Vol; INDIV 1/4 HR – Downstate | 7/1/2019 | $10.43 | ||
| 4722 | Comm/Res Hab Vol; INDIV 1/4 HR – Upstate | 7/1/2019 | $10.40 | ||
| 4723 | Comm/Res Hab Vol; Group–2; 1/4 HR – Downstate | 7/1/2019 | $6.51 | ||
| 4723 | Comm/Res Hab Vol; Group–2; 1/4 HR – Upstate | 7/1/2019 | $6.50 | ||
| 4724 | Comm/Res Hab Vol; Group–3; 1/4 HR – Downstate | 7/1/2019 | $5.20 | ||
| 4724 | Comm/Res Hab Vol; Group–3; 1/4 HR – Upstate | 7/1/2019 | $4.92 | ||
| 4741 | Comm/Res Hab: STATE: Group–1; 1/4 HR – Downstate | 7/1/2019 | $10.43 | ||
| 4741 | Comm/Res Hab: STATE: Group–1; 1/4 HR – Upstate | 7/1/2019 | $10.40 | ||
| 4742 | Comm/Res Hab: STATE: Group–2; 1/4 HR – Downstate | 7/1/2019 | $6.51 | ||
| 4742 | Comm/Res Hab: STATE: Group–2; 1/4 HR – Upstate | 7/1/2019 | $6.50 | ||
| 4743 | Comm/Res Hab: STATE: Group–3; 1/4 HR – Downstate | 7/1/2019 | $5.20 | ||
| 4743 | Comm/Res Hab: STATE: Group–3; 1/4 HR – Upstate | 7/1/2019 | $4.92 | ||
| 4755 | COM HAB: Agy Sup: Vol; INDIV 1/4 HR – Downstate | 7/1/2019 | $10.43 | ||
| 4755 | COM HAB: Agy Sup: Vol; INDIV 1/4 HR – Upstate | 7/1/2019 | $10.40 | ||
| 4756 | COM HAB: Agy Sup: Vol; Group 1/4 HR – Downstate | 7/1/2019 | $6.51 | ||
| 4756 | COM HAB: Agy Sup: Vol; Group 1/4 HR – Upstate | 7/1/2019 | $6.50 | ||
| CONSOLIDATED CHILDREN´S 1915 (c) Community Habilitation ( COM HAB) (SAME) | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 8012 | Individual – hourly/downstate habilitation | 7/1/2019 | $41.70 | ||
| 8012 | Individual – hourly/upstate habilitation | 7/1/2019 | $41.61 | ||
| 8013 | Group of 2 hourly/downstate habilitation | 7/1/2019 | $26.04 | ||
| 8013 | Group of 2 hourly/upstate habilitation | 7/1/2019 | $26.01 | ||
| 8014 | Group of 3+ hourly/downstate habilitation | 7/1/2019 | $20.78 | ||
| 8014 | Group of 3+ hourly/upstate habilitation | 7/1/2019 | $19.67 | ||
| FFS– NON WAIVER – SAME | |||||
| Personal care rate codes + a new companion add on code when applicable | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 3171 | ADL/IADL SKILL ACQUISITION SVCS – CFCO NON–DD (Rate code 3171 for upstate and downstate is the same), | As of 7/1/19 | NYC $5.50, Rest of State $11.00 | ||
| CDPAP – SAME | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 2401 | CDPAP 1 CLIENT, HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2402 | CDPAP 2 OR MORE CLIENTS HOURLY, PER CLIENT | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2403 | CDPAP 1 CLIENT, HOURLY, ENHANCED | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2404 | CDPAP 2 OR MORE CLIENTS HOURLY PER CLIENT EN | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2405 | CDPAP 1 CLIENT LIVE–IN | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2406 | CDPAP 2 OR MORE CLIENTS, PER CLIENT LIVE–IN | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2422 | CDPAP 1 CLIENT, QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2423 | CDPAP 2 CLIENTS, PER CLIENT, QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2424 | CDPAP 1 CLIENT ENHANCED RATE QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2425 | CDPAP 2 CLIENTS, PER CLIENT,ENHANCED RATE QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| CERTIFIED HOME HEALTH AIDE SAME | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 2499 | HOME HEALTH SHARED AIDE | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/chha/rates | ||
| 2610 | HOME HEALTH AIDE | https://www.health.ny.gov/facilities/long_term_care/reimbursement/chha/rates | |||
| PERSONAL CARE LEVELS I & II SAME | |||||
| Rate Code |
Description | Effective Date | Rate | ||
| 2501 | PCA LEVEL 1, SHARED AIDE, BASIC, HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2502 | PCA LEVEL II, SHARED AIDE, BASIC, HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2507 | PCA LEVEL 1, SHARED AIDE, BASIC, QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2508 | PCA LEVEL II, SHARED AIDE, BASIC, QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2593 | PCA LEVEL I, 1 CLIENT, QUARTER HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2594 | PCA LEVEL I, 2 CLIENTS, PER CLIENT 1/4 HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2595 | PCA LEVEL II, 1 CLIENT, 1/4 HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2596 | PCA LEVEL II, 2 CLIENTS PER CLIENT 1/4 HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2597 | PCA LEVEL II, 1 CLIENT, HARD TO SERVE, 1/4 HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2598 | PCA LEVEL II, 2 CLIENTS, HARD TO SERVE 1/4 HOUR | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2601 | PCA LEVEL I, ONE CLIENT HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2602 | PCA LEVEL 1 TWO CLIENTS HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2623 | PCA LEVEL 2 TWO CLIENTS HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2622 | PCA LEVEL 2 ONE CLIENT HOURLY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2626 | PCA LEVEL 2 ONE CLIENT HOURLY – SECONDARY CODE | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2627 | PCA LEVEL 2 2 CLIENTS HOURLY – PER CLIENT, SECONDARY CODE | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2632 | PCA LEVEL 2, ONE CLIENT DAILY | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| 2633 | PCA LEVEL 2, 2 CLIENTS DAILY (PER CLIENT) | 1/1/2018 | https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr | ||
| Rate Codes highlighted in yellow are pending CMS approval | |||||
| * NEW RATE CODES ARE IN BOLD | |||||
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