Community First Choice Option (CFCO)

MANAGED CARE CLAIM REPORTING – CFCO

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Home Delivered and Congregate Meals
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used where
N/A HOME DELIVERED MEALS – CFCO S5170 N/A 1/1/2020 837I 837I Revenue codes are required on a UB–04 or a HFCA 1450 claim
N/A HOME DELIVERED MEALS– (WKND)– CFCO S5170 TV 1/1/2020 837I 837I  
FFS Personal Emergency Response Units (PERS)
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used
N/A PERS INSTALLATION CHARGE S5160 N/A Current and after 1/1/2020 837P 837P  
N/A PERS MONTHLY SERVICE CHARGE S5161 N/A Current and after 1/1/2020 837P 837P  
Assistive/Adaptive Technology – Annual Cap of $15,000.
FFS – Assistive Technology
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P)  
N/A ASSISTIVE TECHNOLOGY (AT)– CFCO T2028 HA 1/1/2020 837P 837P  
V–MODS – Annual cap of $15,000.
Rate Code Description     Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used
N/A VEHICLE MODIFICATIONS – CFCO T2039 N/A 1/1/2020 Invoice 837I  
Environmental Modifications – Annual cap of $15,000.
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used
N/A ENVIRONMENTAL MODIFICATIONS – CFCO S5165 HA 1/1/2020 Invoice 837I  
Moving Assistance – $5,000 – one time payment
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used
N/A MOVING ASSISTANCE (HOURLY) –CFCO T2038 N/A 1/1/2020 Invoice 837I  
Community Transition Service (CTS) $5,000 – one time payment
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used
N/A COMMUNITY TRANSITION SERVICES (CFCO) T2038 BP (Use when billing for purchase) BR (Use when billing for rent) 1/1/2020 Invoice 837I  
SAME with Companion Add–on
Rate Code Description HCPCS Code Modifier Code Effective Date Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code 0999 (Patient Convenience items/other) may be used
N/A ADL/IADL SKILL ACQUISITION SVCS – CFCO NON–DD (Level II only) H2014 TG 1/1/2020 837P 837P  
CDPAP Personal Care
Rate Code Description HCPCS Code Modifier Code Effective Date 1/1/2020 Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Link To CDPAP Rates
N/A CDPAP 1 CLIENT, HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 2 OR MORE CLIENTS HOURLY, PER CLIENT Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 1 CLIENT, HOURLY, ENHANCED Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 2 OR MORE CLIENTS HOURLY PER CLIENT EN Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 1 CLIENT LIVE–IN Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 2 OR MORE CLIENTS, PER CLIENT LIVE–IN Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 1 CLIENT, QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 2 CLIENTS, PER CLIENT, QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 1 CLIENT ENHANCED RATE QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A CDPAP 2 CLIENTS, PER CLIENT,ENHANCED RATE QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
CERTIFIED HOME Health AIDE
Rate Code Description HCPCS Code Modifier Code Effective Date 1/1/2020 Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Link to Personal Care Rates
N/A HOME HEALTH SHARED AIDE Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A HOME HEALTH AIDE Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
PERSONAL CARE LEVELS I & II (Use Personal Care codes to bill SAME service)
Rate Code Description HCPCS Code Modifier Code Effective Date 1/1/2020 Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Link to Personal Care Rates
N/A PCA LEVEL 1, SHARED AIDE, BASIC, HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL II, SHARED AIDE, BASIC, HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 1, SHARED AIDE, BASIC, QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL II, SHARED AIDE, BASIC, QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL I, 1 CLIENT, QUARTER HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL I, 2 CLIENTS, PER CLIENT 1/4 HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL II, 1 CLIENT, 1/4 HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL II, 2 CLIENTS PER CLIENT 1/4 HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL II, 1 CLIENT, HARD TO SERVE, 1/4 HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL II, 2 CLIENTS, HARD TO SERVE 1/4 HOUR Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL I, ONE CLIENT HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 1 TWO CLIENTS HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 2 TWO CLIENTS HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 2 ONE CLIENT HOURLY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 2 ONE CLIENT HOURLY– SECONDARY CODE Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 2 2 CLIENTS HOURLY– PER CLIENT, SECONDARY CODE Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 2, ONE CLIENT DAILY Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
N/A PCA LEVEL 2, 2 CLIENTS DAILY (PER CLIENT) Will use the UBC Code Will use the UBC Modifier, if applicable No change to the current rate 837P 837P https://www.health.ny.gov/facilities/long_term_care/reimbursement/pcr
Community Habilitation OPWDD COM HAB (OPWDD SAME)
Rate Code Description HCPCS Code Modifier Code Effective Date 1/1/2020 Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code
4722 Comm/Res Hab Vol; INDIV 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4722 Comm/Res Hab Vol; INDIV 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4723 Comm/Res Hab Vol; Group–2; 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4723 Comm/Res Hab Vol; Group–2; 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4724 Comm/Res Hab Vol; Group–3; 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4724 Comm/Res Hab Vol; Group–3; 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4741 Comm/Res Hab: STATE: Group–1; 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4741 Comm/Res Hab: STATE: Group–1; 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4742 Comm/Res Hab: STATE: Group–2; 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4742 Comm/Res Hab: STATE: Group–2; 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4743 Comm/Res Hab: STATE: Group–3; 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4743 Comm/Res Hab: STATE: Group–3; 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4755 COM HAB: Agy Sup: Vol; INDIV 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4755 COM HAB: Agy Sup: Vol; INDIV 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
4756 COM HAB: Agy Sup: Vol; Group 1/4 HR – Downstate N/A N/A 1/1/2020 837I 837I 0240
4756 COM HAB: Agy Sup: Vol; Group 1/4 HR – Upstate N/A N/A 1/1/2020 837I 837I 0240
Community Habilitation – Children´s Waiver SAME
Rate Code Description HCPCS Code Modifier Code Effective Date 1/1/2020 Billing Format (UB04/837I,HCFA/837P,Invoice) Encounter Submission Format (837I/837P) Revenue Code
8012 Community Habilitation – Individual – hourly/downstate N/A N/A 1/1/2020 837I 837I 0240
8012 Community Habilitation Individual – hourly/upstate N/A N/A 1/1/2020 837I 837I 0240
8013 Community Habilitation Group of 2 hourly/downstate N/A N/A 1/1/2020 837I 837I 0240
8013 Community Habilitation Group of 2 hourly/upstate N/A N/A 1/1/2020 837I 837I 0240
8014 Community Habilitation Group of 3 hourly/downstate N/A N/A 1/1/2020 837I 837I 0240
8014 Community Habilitation Group of 3 hourly/upstate N/A N/A 1/1/2020 837I 837I 0240