Summer Training Project , Siva Sivani Institute of Management , PDGM ( Marketing)
2020 - Not All About PDGM - Healthcare Provider Solutions ... · considerations for patients where...
Transcript of 2020 - Not All About PDGM - Healthcare Provider Solutions ... · considerations for patients where...
2020 - Not All About PDGM!
ATTACHMENTS
Presented by: Melinda A. Gaboury, COS-C
pdgmimpact.com
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OASIS Considerations for Medicare PDGM Patients
This document provides PDGM transition guidance including OASIS time point, data set version and M0090 Date Assessment Completed
considerations for patients where resulting assessments must provide the Health Insurance Prospective Payment System (HIPPS) code for a
PDGM payment period that begins January 1, 2020 or later.
Type of Episode/Payment Period OASIS Time Point, Data Set Version, and M0090 (Date Assessment Completed) Guidance
1) SOC IN 2019 FOR A 2019 PPS PAYMENT EPISODE
- Patient admitted to home care during the period
December 27, 2019 – December 31, 2019 for an
initial 60-day PPS payment episode that begins prior
to January 1, 2020.
Start of Care (SOC): M0100 - RFA 1
o This assessment must be conducted using OASIS-D.
o Note that the HHA has up to 5 days after the SOC to complete the SOC assessment.
If the assessment is completed on 12/27/2019-12/31/2019, for (M0090), enter the actual date the
assessment is completed.
If the assessment is completed in 2020, for (M0090), enter the artificial date “12/31/2019”.
2) RECERT in 2019 for a 2020 PDGM PAYMENT PERIOD
- Patient to be recertified during the period of
December 27, 2019 – December 31, 2019 for a
subsequent 30-day PDGM payment period beginning
on or after January 1, 2020.
Recertification (Follow-up): M0100 - RFA 4
o This assessment must be conducted using OASIS-D1.
If the assessment is completed on 12/27/19-12/31/19, for (M0090), enter the artificial date
“1/1/2020”.
If the assessment is completed in 2020, for (M0090), enter the actual date the assessment is
completed.
3) ROC/RECERT in 2019 for a 2020 PDGM PAYMENT PERIOD
- Patient returns to HH in 2019 after a qualifying
inpatient stay where the requirement timeframe to
complete a ROC overlaps with the requirement
timeframe to complete a Recertification, AND the
recertification is for a 30-day PDGM payment period
beginning on or after January 1, 2020.
Resumption of Care (ROC): M0100 - RFA 3
o This assessment must be conducted using OASIS-D1.
If the assessment is completed in 2019, for (M0090), enter the artificial date “1/1/2020”.
If the assessment is completed in 2020, for (M0090), enter the actual date the assessment is
completed.
For all other assessments conducted in compliance with established assessment completion dates, enter the actual date the assessment is
completed for M0090.
• Assessments with a M0090 - Date Assessment Completed on or before December 31, 2019 must be completed with OASIS-D.
• Assessments with a M0090 - Date Assessment Completed on or after January 1, 2020 must be completed with OASIS-D1.
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TABLE 16–CY 2020 PDGM LUPA THRESHOLD AND CASE MIX WEIGHT FOR
EACH HHRG PAYMENT GROUP
HIPPS Clinical Group and Functional
Level
Timing and
Admission Source
Comorbidity
Adjustment
(0 = none, 1 =
single
comorbidity,
2 = interaction)
Visit
Threshold
(10th
percentile or
2 -
whichever is
higher)
CY 2020
Weights
1FC11 Behavioral Health – High Early - Community 0 4 1.1798
1FC21 Behavioral Health – High Early - Community 1 4 1.2305
1FC31 Behavioral Health – High Early - Community 2 4 1.3271
2FC11 Behavioral Health – High Early - Institutional 0 4 1.3599
2FC21 Behavioral Health – High Early - Institutional 1 4 1.4106
2FC31 Behavioral Health – High Early - Institutional 2 4 1.5072
3FC11 Behavioral Health – High Late - Community 0 2 0.7737
3FC21 Behavioral Health – High Late - Community 1 2 0.8244
3FC31 Behavioral Health – High Late - Community 2 3 0.9211
4FC11 Behavioral Health – High Late - Institutional 0 3 1.2212
4FC21 Behavioral Health - High Late - Institutional 1 3 1.2719
4FC31 Behavioral Health - High Late - Institutional 2 3 1.3685
1FA11 Behavioral Health - Low Early - Community 0 3 0.9284
1FA21 Behavioral Health - Low Early - Community 1 4 0.9791
1FA31 Behavioral Health - Low Early - Community 2 3 1.0757
2FA11 Behavioral Health - Low Early - Institutional 0 3 1.1085
2FA21 Behavioral Health - Low Early - Institutional 1 3 1.1592
2FA31 Behavioral Health - Low Early - Institutional 2 3 1.2558
3FA11 Behavioral Health - Low Late - Community 0 2 0.5223
3FA21 Behavioral Health - Low Late - Community 1 2 0.5730
3FA31 Behavioral Health - Low Late - Community 2 2 0.6697
4FA11 Behavioral Health - Low Late - Institutional 0 2 0.9698
4FA21 Behavioral Health - Low Late - Institutional 1 2 1.0205
4FA31 Behavioral Health - Low Late - Institutional 2 2 1.1171
1FB11 Behavioral Health - Medium Early - Community 0 4 1.0907
1FB21 Behavioral Health - Medium Early - Community 1 4 1.1414
1FB31 Behavioral Health - Medium Early - Community 2 5 1.2381
2FB11 Behavioral Health - Medium Early - Institutional 0 4 1.2708
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2FB21 Behavioral Health - Medium Early - Institutional 1 4 1.3216
2FB31 Behavioral Health - Medium Early - Institutional 2 3 1.4182
3FB11 Behavioral Health - Medium Late - Community 0 2 0.6847
3FB21 Behavioral Health - Medium Late - Community 1 2 0.7354
3FB31 Behavioral Health - Medium Late - Community 2 2 0.8320
4FB11 Behavioral Health - Medium Late - Institutional 0 3 1.1321
4FB21 Behavioral Health - Medium Late - Institutional 1 3 1.1828
4FB31 Behavioral Health - Medium Late - Institutional 2 3 1.2795
1DC11 Complex - High Early - Community 0 3 1.2086
1DC21 Complex - High Early - Community 1 2 1.2594
1DC31 Complex - High Early - Community 2 2 1.3560
2DC11 Complex - High Early - Institutional 0 4 1.3888
2DC21 Complex - High Early - Institutional 1 4 1.4395
2DC31 Complex - High Early - Institutional 2 4 1.5361
3DC11 Complex - High Late - Community 0 2 0.8026
3DC21 Complex - High Late - Community 1 2 0.8533
3DC31 Complex - High Late - Community 2 2 0.9500
4DC11 Complex - High Late - Institutional 0 3 1.2500
4DC21 Complex - High Late - Institutional 1 3 1.3008
4DC31 Complex - High Late - Institutional 2 3 1.3974
1DA11 Complex - Low Early - Community 0 3 0.9530
1DA21 Complex - Low Early - Community 1 3 1.0037
1DA31 Complex - Low Early - Community 2 2 1.1004
2DA11 Complex - Low Early - Institutional 0 3 1.1331
2DA21 Complex - Low Early - Institutional 1 3 1.1839
2DA31 Complex - Low Early - Institutional 2 3 1.2805
3DA11 Complex - Low Late - Community 0 2 0.5470
3DA21 Complex - Low Late - Community 1 2 0.5977
3DA31 Complex - Low Late - Community 2 2 0.6943
4DA11 Complex - Low Late - Institutional 0 2 0.9944
4DA21 Complex - Low Late - Institutional 1 2 1.0452
4DA31 Complex - Low Late - Institutional 2 2 1.1418
1DB11 Complex - Medium Early - Community 0 3 1.1464
1DB21 Complex - Medium Early - Community 1 3 1.1972
1DB31 Complex - Medium Early - Community 2 2 1.2938
2DB11 Complex - Medium Early - Institutional 0 4 1.3266
2DB21 Complex - Medium Early - Institutional 1 4 1.3773
2DB31 Complex - Medium Early - Institutional 2 4 1.4739
3DB11 Complex - Medium Late - Community 0 2 0.7404
3DB21 Complex - Medium Late - Community 1 2 0.7911
3DB31 Complex - Medium Late - Community 2 2 0.8878
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4DB11 Complex - Medium Late - Institutional 0 3 1.1878
4DB21 Complex - Medium Late - Institutional 1 3 1.2386
4DB31 Complex - Medium Late - Institutional 2 3 1.3352
1HC11 MMTA - Cardiac - High Early - Community 0 5 1.2297
1HC21 MMTA - Cardiac - High Early - Community 1 5 1.2804
1HC31 MMTA - Cardiac - High Early - Community 2 4 1.3770
2HC11 MMTA - Cardiac - High Early - Institutional 0 4 1.4098
2HC21 MMTA - Cardiac - High Early - Institutional 1 4 1.4605
2HC31 MMTA - Cardiac - High Early - Institutional 2 5 1.5571
3HC11 MMTA - Cardiac - High Late - Community 0 2 0.8236
3HC21 MMTA - Cardiac - High Late - Community 1 2 0.8743
3HC31 MMTA - Cardiac - High Late - Community 2 3 0.9710
4HC11 MMTA - Cardiac - High Late - Institutional 0 4 1.2711
4HC21 MMTA - Cardiac - High Late - Institutional 1 3 1.3218
4HC31 MMTA - Cardiac - High Late - Institutional 2 4 1.4184
1HA11 MMTA - Cardiac - Low Early - Community 0 4 0.9668
1HA21 MMTA - Cardiac - Low Early - Community 1 4 1.0176
1HA31 MMTA - Cardiac - Low Early - Community 2 4 1.1142
2HA11 MMTA - Cardiac - Low Early - Institutional 0 4 1.1469
2HA21 MMTA - Cardiac - Low Early - Institutional 1 4 1.1977
2HA31 MMTA - Cardiac - Low Early - Institutional 2 4 1.2943
3HA11 MMTA - Cardiac - Low Late - Community 0 2 0.5608
3HA21 MMTA - Cardiac - Low Late - Community 1 2 0.6115
3HA31 MMTA - Cardiac - Low Late - Community 2 2 0.7081
4HA11 MMTA - Cardiac - Low Late - Institutional 0 3 1.0082
4HA21 MMTA - Cardiac - Low Late - Institutional 1 3 1.0590
4HA31 MMTA - Cardiac - Low Late - Institutional 2 3 1.1556
1HB11 MMTA - Cardiac - Medium Early - Community 0 5 1.1179
1HB21 MMTA - Cardiac - Medium Early - Community 1 5 1.1686
1HB31 MMTA - Cardiac - Medium Early - Community 2 5 1.2652
2HB11 MMTA - Cardiac - Medium Early - Institutional 0 5 1.2980
2HB21 MMTA - Cardiac - Medium Early - Institutional 1 4 1.3487
2HB31 MMTA - Cardiac - Medium Early - Institutional 2 5 1.4453
3HB11 MMTA - Cardiac - Medium Late - Community 0 2 0.7118
3HB21 MMTA - Cardiac - Medium Late - Community 1 2 0.7625
3HB31 MMTA - Cardiac - Medium Late - Community 2 3 0.8592
4HB11 MMTA - Cardiac - Medium Late - Institutional 0 3 1.1593
4HB21 MMTA - Cardiac - Medium Late - Institutional 1 3 1.2100
4HB31 MMTA - Cardiac - Medium Late - Institutional 2 4 1.3066
1IC11 MMTA - Endocrine - High Early - Community 0 5 1.3874
1IC21 MMTA - Endocrine - High Early - Community 1 5 1.4381
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1IC31 MMTA - Endocrine - High Early - Community 2 5 1.5348
2IC11 MMTA - Endocrine - High Early - Institutional 0 4 1.5675
2IC21 MMTA - Endocrine - High Early - Institutional 1 4 1.6182
2IC31 MMTA - Endocrine - High Early - Institutional 2 4 1.7149
3IC11 MMTA - Endocrine - High Late - Community 0 3 0.9813
3IC21 MMTA - Endocrine - High Late - Community 1 3 1.0321
3IC31 MMTA - Endocrine - High Late - Community 2 3 1.1287
4IC11 MMTA - Endocrine - High Late - Institutional 0 4 1.4288
4IC21 MMTA - Endocrine - High Late - Institutional 1 3 1.4795
4IC31 MMTA - Endocrine - High Late - Institutional 2 3 1.5762
1IA11 MMTA - Endocrine - Low Early - Community 0 4 1.0979
1IA21 MMTA - Endocrine - Low Early - Community 1 4 1.1486
1IA31 MMTA - Endocrine - Low Early - Community 2 4 1.2453
2IA11 MMTA - Endocrine - Low Early - Institutional 0 3 1.2780
2IA21 MMTA - Endocrine - Low Early - Institutional 1 3 1.3288
2IA31 MMTA - Endocrine - Low Early - Institutional 2 4 1.4254
3IA11 MMTA - Endocrine - Low Late - Community 0 2 0.6919
3IA21 MMTA - Endocrine - Low Late - Community 1 2 0.7426
3IA31 MMTA - Endocrine - Low Late - Community 2 3 0.8392
4IA11 MMTA - Endocrine - Low Late - Institutional 0 3 1.1393
4IA21 MMTA - Endocrine - Low Late - Institutional 1 3 1.1900
4IA31 MMTA - Endocrine - Low Late - Institutional 2 3 1.2867
1IB11 MMTA - Endocrine -Medium Early - Community 0 5 1.2712
1IB21 MMTA - Endocrine - Medium Early - Community 1 5 1.3219
1IB31 MMTA - Endocrine - Medium Early - Community 2 4 1.4186
2IB11 MMTA - Endocrine - Medium Early - Institutional 0 5 1.4513
2IB21 MMTA - Endocrine - Medium Early - Institutional 1 4 1.5020
2IB31 MMTA - Endocrine - Medium Early - Institutional 2 5 1.5987
3IB11 MMTA - Endocrine - Medium Late - Community 0 3 0.8651
3IB21 MMTA - Endocrine - Medium Late - Community 1 3 0.9159
3IB31 MMTA - Endocrine - Medium Late - Community 2 3 1.0125
4IB11 MMTA - Endocrine - Medium Late - Institutional 0 3 1.3126
4IB21 MMTA - Endocrine - Medium Late - Institutional 1 3 1.3633
4IB31 MMTA - Endocrine - Medium Late - Institutional 2 4 1.4600
1JC11 MMTA - GI/GU - High Early - Community 0 4 1.1975
1JC21 MMTA - GI/GU - High Early - Community 1 3 1.2482
1JC31 MMTA - GI/GU - High Early - Community 2 3 1.3449
2JC11 MMTA - GI/GU - High Early - Institutional 0 4 1.3776
2JC21 MMTA - GI/GU - High Early - Institutional 1 4 1.4283
2JC31 MMTA - GI/GU - High Early - Institutional 2 4 1.5250
3JC11 MMTA - GI/GU - High Late - Community 0 2 0.7914
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3JC21 MMTA - GI/GU - High Late - Community 1 2 0.8422
3JC31 MMTA - GI/GU - High Late - Community 2 2 0.9388
4JC11 MMTA - GI/GU - High Late - Institutional 0 3 1.2389
4JC21 MMTA - GI/GU - High Late - Institutional 1 3 1.2896
4JC31 MMTA - GI/GU - High Late - Institutional 2 4 1.3863
1JA11 MMTA - GI/GU - Low Early - Community 0 3 0.9559
1JA21 MMTA - GI/GU - Low Early - Community 1 3 1.0066
1JA31 MMTA - GI/GU - Low Early - Community 2 3 1.1032
2JA11 MMTA - GI/GU - Low Early - Institutional 0 3 1.1360
2JA21 MMTA - GI/GU - Low Early - Institutional 1 3 1.1867
2JA31 MMTA - GI/GU - Low Early - Institutional 2 4 1.2833
3JA11 MMTA - GI/GU - Low Late - Community 0 2 0.5498
3JA21 MMTA - GI/GU - Low Late - Community 1 2 0.6005
3JA31 MMTA - GI/GU - Low Late - Community 2 2 0.6972
4JA11 MMTA - GI/GU - Low Late - Institutional 0 3 0.9973
4JA21 MMTA - GI/GU - Low Late - Institutional 1 3 1.0480
4JA31 MMTA - GI/GU - Low Late - Institutional 2 3 1.1446
1JB11 MMTA - GI/GU - Medium Early - Community 0 4 1.1106
1JB21 MMTA - GI/GU - Medium Early - Community 1 4 1.1614
1JB31 MMTA - GI/GU - Medium Early - Community 2 4 1.2580
2JB11 MMTA - GI/GU - Medium Early - Institutional 0 4 1.2907
2JB21 MMTA - GI/GU - Medium Early - Institutional 1 4 1.3415
2JB31 MMTA - GI/GU - Medium Early - Institutional 2 4 1.4381
3JB11 MMTA - GI/GU - Medium Late - Community 0 2 0.7046
3JB21 MMTA - GI/GU - Medium Late - Community 1 2 0.7553
3JB31 MMTA - GI/GU - Medium Late - Community 2 2 0.8520
4JB11 MMTA - GI/GU - Medium Late - Institutional 0 3 1.1520
4JB21 MMTA - GI/GU - Medium Late - Institutional 1 3 1.2028
4JB31 MMTA - GI/GU - Medium Late - Institutional 2 4 1.2994
1KC11 MMTA - Infectious - High Early - Community 0 3 1.2283
1KC21 MMTA - Infectious - High Early - Community 1 3 1.2790
1KC31 MMTA - Infectious - High Early - Community 2 3 1.3757
2KC11 MMTA - Infectious - High Early - Institutional 0 3 1.4084
2KC21 MMTA - Infectious - High Early - Institutional 1 3 1.4591
2KC31 MMTA - Infectious - High Early - Institutional 2 4 1.5558
3KC11 MMTA - Infectious - High Late - Community 0 2 0.8222
3KC21 MMTA - Infectious - High Late - Community 1 2 0.8730
3KC31 MMTA - Infectious - High Late - Community 2 2 0.9696
4KC11 MMTA - Infectious - High Late - Institutional 0 3 1.2697
4KC21 MMTA - Infectious - High Late - Institutional 1 3 1.3204
4KC31 MMTA - Infectious - High Late - Institutional 2 3 1.4171
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1KA11 MMTA - Infectious - Low Early - Community 0 3 0.9888
1KA21 MMTA - Infectious - Low Early - Community 1 3 1.0396
1KA31 MMTA - Infectious - Low Early - Community 2 3 1.1362
2KA11 MMTA - Infectious - Low Early - Institutional 0 3 1.1689
2KA21 MMTA - Infectious - Low Early - Institutional 1 3 1.2197
2KA31 MMTA - Infectious - Low Early - Institutional 2 4 1.3163
3KA11 MMTA - Infectious - Low Late - Community 0 2 0.5828
3KA21 MMTA - Infectious - Low Late - Community 1 2 0.6335
3KA31 MMTA - Infectious - Low Late - Community 2 2 0.7301
4KA11 MMTA - Infectious - Low Late - Institutional 0 2 1.0302
4KA21 MMTA - Infectious - Low Late - Institutional 1 3 1.0810
4KA31 MMTA - Infectious - Low Late - Institutional 2 3 1.1776
1KB11 MMTA - Infectious - Medium Early - Community 0 3 1.1147
1KB21 MMTA - Infectious - Medium Early - Community 1 3 1.1655
1KB31 MMTA - Infectious - Medium Early - Community 2 4 1.2621
2KB11 MMTA - Infectious - Medium Early - Institutional 0 3 1.2948
2KB21 MMTA - Infectious - Medium Early - Institutional 1 4 1.3456
2KB31 MMTA - Infectious - Medium Early - Institutional 2 4 1.4422
3KB11 MMTA - Infectious - Medium Late - Community 0 2 0.7087
3KB21 MMTA - Infectious - Medium Late - Community 1 2 0.7594
3KB31 MMTA - Infectious - Medium Late - Community 2 2 0.8560
4KB11 MMTA - Infectious - Medium Late - Institutional 0 3 1.1561
4KB21 MMTA - Infectious - Medium Late - Institutional 1 3 1.2069
4KB31 MMTA - Infectious - Medium Late - Institutional 2 4 1.3035
1AC11 MMTA - Other - High Early - Community 0 4 1.2436
1AC21 MMTA - Other - High Early - Community 1 4 1.2943
1AC31 MMTA - Other - High Early - Community 2 4 1.3910
2AC11 MMTA - Other - High Early - Institutional 0 4 1.4237
2AC21 MMTA - Other - High Early - Institutional 1 4 1.4744
2AC31 MMTA - Other - High Early - Institutional 2 5 1.5711
3AC11 MMTA - Other - High Late - Community 0 2 0.8375
3AC21 MMTA - Other - High Late - Community 1 2 0.8883
3AC31 MMTA - Other - High Late - Community 2 2 0.9849
4AC11 MMTA - Other - High Late - Institutional 0 3 1.2850
4AC21 MMTA - Other - High Late - Institutional 1 3 1.3357
4AC31 MMTA - Other - High Late - Institutional 2 3 1.4324
1AA11 MMTA - Other - Low Early - Community 0 4 1.0124
1AA21 MMTA - Other - Low Early - Community 1 4 1.0631
1AA31 MMTA - Other - Low Early - Community 2 4 1.1597
2AA11 MMTA - Other - Low Early - Institutional 0 3 1.1925
2AA21 MMTA - Other - Low Early - Institutional 1 3 1.2432
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2AA31 MMTA - Other - Low Early - Institutional 2 3 1.3398
3AA11 MMTA - Other - Low Late - Community 0 2 0.6063
3AA21 MMTA - Other - Low Late - Community 1 2 0.6570
3AA31 MMTA - Other - Low Late - Community 2 2 0.7537
4AA11 MMTA - Other - Low Late - Institutional 0 3 1.0538
4AA21 MMTA - Other - Low Late - Institutional 1 3 1.1045
4AA31 MMTA - Other - Low Late - Institutional 2 3 1.2011
1AB11 MMTA - Other - Medium Early - Community 0 5 1.1454
1AB21 MMTA - Other - Medium Early - Community 1 5 1.1962
1AB31 MMTA - Other - Medium Early - Community 2 4 1.2928
2AB11 MMTA - Other - Medium Early - Institutional 0 4 1.3255
2AB21 MMTA - Other - Medium Early - Institutional 1 4 1.3763
2AB31 MMTA - Other - Medium Early - Institutional 2 5 1.4729
3AB11 MMTA - Other - Medium Late - Community 0 2 0.7394
3AB21 MMTA - Other - Medium Late - Community 1 2 0.7901
3AB31 MMTA - Other - Medium Late - Community 2 3 0.8867
4AB11 MMTA - Other - Medium Late - Institutional 0 3 1.1868
4AB21 MMTA - Other - Medium Late - Institutional 1 3 1.2376
4AB31 MMTA - Other - Medium Late - Institutional 2 4 1.3342
1LC11 MMTA - Respiratory - High Early - Community 0 4 1.2089
1LC21 MMTA - Respiratory - High Early - Community 1 4 1.2596
1LC31 MMTA - Respiratory - High Early - Community 2 4 1.3563
2LC11 MMTA - Respiratory - High Early - Institutional 0 4 1.3890
2LC21 MMTA - Respiratory - High Early - Institutional 1 4 1.4398
2LC31 MMTA - Respiratory - High Early - Institutional 2 4 1.5364
3LC11 MMTA - Respiratory - High Late - Community 0 2 0.8029
3LC21 MMTA - Respiratory - High Late - Community 1 2 0.8536
3LC31 MMTA - Respiratory - High Late - Community 2 3 0.9502
4LC11 MMTA - Respiratory - High Late - Institutional 0 3 1.2503
4LC21 MMTA - Respiratory - High Late - Institutional 1 3 1.3010
4LC31 MMTA - Respiratory - High Late - Institutional 2 3 1.3977
1LA11 MMTA - Respiratory - Low Early - Community 0 4 0.9633
1LA21 MMTA - Respiratory - Low Early - Community 1 4 1.0141
1LA31 MMTA - Respiratory - Low Early - Community 2 4 1.1107
2LA11 MMTA - Respiratory - Low Early - Institutional 0 4 1.1434
2LA21 MMTA - Respiratory - Low Early - Institutional 1 4 1.1942
2LA31 MMTA - Respiratory - Low Early - Institutional 2 4 1.2908
3LA11 MMTA - Respiratory - Low Late - Community 0 2 0.5573
3LA21 MMTA - Respiratory - Low Late - Community 1 2 0.6080
3LA31 MMTA - Respiratory - Low Late - Community 2 2 0.7047
4LA11 MMTA - Respiratory - Low Late - Institutional 0 3 1.0047
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4LA21 MMTA - Respiratory - Low Late - Institutional 1 3 1.0555
4LA31 MMTA - Respiratory - Low Late - Institutional 2 3 1.1521
1LB11 MMTA - Respiratory - Medium Early - Community 0 4 1.1011
1LB21 MMTA - Respiratory - Medium Early - Community 1 5 1.1518
1LB31 MMTA - Respiratory - Medium Early - Community 2 5 1.2484
2LB11 MMTA - Respiratory - Medium Early - Institutional 0 4 1.2812
2LB21 MMTA - Respiratory - Medium Early - Institutional 1 4 1.3319
2LB31 MMTA - Respiratory - Medium Early - Institutional 2 5 1.4285
3LB11 MMTA - Respiratory - Medium Late - Community 0 2 0.6950
3LB21 MMTA - Respiratory - Medium Late - Community 1 2 0.7457
3LB31 MMTA - Respiratory - Medium Late - Community 2 2 0.8424
4LB11 MMTA - Respiratory - Medium Late - Institutional 0 3 1.1425
4LB21 MMTA - Respiratory - Medium Late - Institutional 1 3 1.1932
4LB31 MMTA - Respiratory - Medium Late - Institutional 2 4 1.2898
1GC11 MMTA - Surgical Aftercare - High Early - Community 0 4 1.2226
1GC21 MMTA - Surgical Aftercare - High Early - Community 1 5 1.2733
1GC31 MMTA - Surgical Aftercare - High Early - Community 2 4 1.3700
2GC11 MMTA - Surgical Aftercare - High Early - Institutional 0 5 1.4027
2GC21 MMTA - Surgical Aftercare - High Early - Institutional 1 5 1.4535
2GC31 MMTA - Surgical Aftercare - High Early - Institutional 2 5 1.5501
3GC11 MMTA - Surgical Aftercare - High Late - Community 0 2 0.8166
3GC21 MMTA - Surgical Aftercare - High Late - Community 1 2 0.8673
3GC31 MMTA - Surgical Aftercare - High Late - Community 2 2 0.9639
4GC11 MMTA - Surgical Aftercare - High Late - Institutional 0 4 1.2640
4GC21 MMTA - Surgical Aftercare - High Late - Institutional 1 4 1.3147
4GC31 MMTA - Surgical Aftercare - High Late - Institutional 2 4 1.4114
1GA11 MMTA - Surgical Aftercare - Low Early - Community 0 3 0.9117
1GA21 MMTA - Surgical Aftercare - Low Early - Community 1 3 0.9624
1GA31 MMTA - Surgical Aftercare - Low Early - Community 2 4 1.0591
2GA11 MMTA - Surgical Aftercare - Low Early - Institutional 0 3 1.0918
2GA21 MMTA - Surgical Aftercare - Low Early - Institutional 1 4 1.1426
2GA31 MMTA - Surgical Aftercare - Low Early - Institutional 2 4 1.2392
3GA11 MMTA - Surgical Aftercare - Low Late - Community 0 2 0.5057
3GA21 MMTA - Surgical Aftercare - Low Late - Community 1 2 0.5564
3GA31 MMTA - Surgical Aftercare - Low Late - Community 2 2 0.6530
4GA11 MMTA - Surgical Aftercare - Low Late - Institutional 0 3 0.9531
4GA21 MMTA - Surgical Aftercare - Low Late - Institutional 1 3 1.0038
4GA31 MMTA - Surgical Aftercare - Low Late - Institutional 2 4 1.1005
1GB11 MMTA - Surgical Aftercare -
Medium Early - Community 0 4
1.0647
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1GB21 MMTA - Surgical Aftercare -
Medium Early - Community 1 4
1.1154
1GB31 MMTA - Surgical Aftercare -
Medium Early - Community 2 5
1.2121
2GB11 MMTA - Surgical Aftercare -
Medium Early - Institutional 0 4
1.2448
2GB21 MMTA - Surgical Aftercare -
Medium Early - Institutional 1 5
1.2956
2GB31 MMTA - Surgical Aftercare -
Medium Early - Institutional 2 5
1.3922
3GB11 MMTA - Surgical Aftercare -
Medium Late - Community 0 2
0.6587
3GB21 MMTA - Surgical Aftercare -
Medium Late - Community 1 2
0.7094
3GB31 MMTA - Surgical Aftercare -
Medium Late - Community 2 2
0.8060
4GB11 MMTA - Surgical Aftercare -
Medium Late - Institutional 0 3
1.1061
4GB21 MMTA - Surgical Aftercare -
Medium Late - Institutional 1 4
1.1568
4GB31 MMTA - Surgical Aftercare -
Medium Late - Institutional 2 4
1.2535
1EC11 MS Rehab - High Early - Community 0 5 1.3465
1EC21 MS Rehab - High Early - Community 1 5 1.3972
1EC31 MS Rehab - High Early - Community 2 5 1.4938
2EC11 MS Rehab - High Early - Institutional 0 6 1.5266
2EC21 MS Rehab - High Early - Institutional 1 6 1.5773
2EC31 MS Rehab - High Early - Institutional 2 6 1.6739
3EC11 MS Rehab - High Late - Community 0 2 0.9404
3EC21 MS Rehab - High Late - Community 1 2 0.9911
3EC31 MS Rehab - High Late - Community 2 3 1.0878
4EC11 MS Rehab - High Late - Institutional 0 4 1.3879
4EC21 MS Rehab - High Late - Institutional 1 4 1.4386
4EC31 MS Rehab - High Late - Institutional 2 5 1.5352
1EA11 MS Rehab - Low Early - Community 0 5 1.0813
1EA21 MS Rehab - Low Early - Community 1 5 1.1321
1EA31 MS Rehab - Low Early - Community 2 5 1.2287
2EA11 MS Rehab - Low Early - Institutional 0 5 1.2614
2EA21 MS Rehab - Low Early - Institutional 1 5 1.3122
2EA31 MS Rehab - Low Early - Institutional 2 5 1.4088
3EA11 MS Rehab - Low Late - Community 0 2 0.6753
3EA21 MS Rehab - Low Late - Community 1 2 0.7260
3EA31 MS Rehab - Low Late - Community 2 2 0.8226
4EA11 MS Rehab - Low Late - Institutional 0 4 1.1227
4EA21 MS Rehab - Low Late - Institutional 1 3 1.1735
4EA31 MS Rehab - Low Late - Institutional 2 4 1.2701
11
1EB11 MS Rehab - Medium Early - Community 0 5 1.1915
1EB21 MS Rehab - Medium Early - Community 1 5 1.2422
1EB31 MS Rehab - Medium Early - Community 2 5 1.3389
2EB11 MS Rehab - Medium Early - Institutional 0 5 1.3716
2EB21 MS Rehab - Medium Early - Institutional 1 6 1.4223
2EB31 MS Rehab - Medium Early - Institutional 2 6 1.5190
3EB11 MS Rehab - Medium Late - Community 0 2 0.7854
3EB21 MS Rehab - Medium Late - Community 1 2 0.8362
3EB31 MS Rehab - Medium Late - Community 2 3 0.9328
4EB11 MS Rehab - Medium Late - Institutional 0 4 1.2329
4EB21 MS Rehab - Medium Late - Institutional 1 4 1.2836
4EB31 MS Rehab - Medium Late - Institutional 2 4 1.3803
1BC11 Neuro - High Early - Community 0 5 1.4548
1BC21 Neuro - High Early - Community 1 5 1.5055
1BC31 Neuro - High Early - Community 2 5 1.6021
2BC11 Neuro - High Early - Institutional 0 5 1.6349
2BC21 Neuro - High Early - Institutional 1 5 1.6856
2BC31 Neuro - High Early - Institutional 2 5 1.7823
3BC11 Neuro - High Late - Community 0 2 1.0487
3BC21 Neuro - High Late - Community 1 3 1.0994
3BC31 Neuro - High Late - Community 2 3 1.1961
4BC11 Neuro - High Late - Institutional 0 4 1.4962
4BC21 Neuro - High Late - Institutional 1 4 1.5469
4BC31 Neuro - High Late - Institutional 2 4 1.6435
1BA11 Neuro - Low Early - Community 0 5 1.1928
1BA21 Neuro - Low Early - Community 1 5 1.2435
1BA31 Neuro - Low Early - Community 2 4 1.3401
2BA11 Neuro - Low Early - Institutional 0 5 1.3729
2BA21 Neuro - Low Early - Institutional 1 5 1.4236
2BA31 Neuro - Low Early - Institutional 2 5 1.5203
3BA11 Neuro - Low Late - Community 0 2 0.7867
3BA21 Neuro - Low Late - Community 1 2 0.8374
3BA31 Neuro - Low Late - Community 2 2 0.9341
4BA11 Neuro - Low Late - Institutional 0 3 1.2342
4BA21 Neuro - Low Late - Institutional 1 4 1.2849
4BA31 Neuro - Low Late - Institutional 2 4 1.3815
1BB11 Neuro - Medium Early - Community 0 5 1.3525
1BB21 Neuro - Medium Early - Community 1 5 1.4032
1BB31 Neuro - Medium Early - Community 2 5 1.4998
2BB11 Neuro - Medium Early - Institutional 0 6 1.5326
2BB21 Neuro - Medium Early - Institutional 1 6 1.5833
12
2BB31 Neuro - Medium Early - Institutional 2 6 1.6800
3BB11 Neuro - Medium Late - Community 0 2 0.9464
3BB21 Neuro - Medium Late - Community 1 2 0.9971
3BB31 Neuro - Medium Late - Community 2 3 1.0938
4BB11 Neuro - Medium Late - Institutional 0 4 1.3939
4BB21 Neuro - Medium Late - Institutional 1 4 1.4446
4BB31 Neuro - Medium Late - Institutional 2 5 1.5412
1CC11 Wound - High Early - Community 0 5 1.5156
1CC21 Wound - High Early - Community 1 5 1.5663
1CC31 Wound - High Early - Community 2 5 1.6629
2CC11 Wound - High Early - Institutional 0 5 1.6957
2CC21 Wound - High Early - Institutional 1 5 1.7464
2CC31 Wound - High Early - Institutional 2 5 1.8430
3CC11 Wound - High Late - Community 0 3 1.1095
3CC21 Wound - High Late - Community 1 3 1.1602
3CC31 Wound - High Late - Community 2 3 1.2569
4CC11 Wound - High Late - Institutional 0 4 1.5570
4CC21 Wound - High Late - Institutional 1 4 1.6077
4CC31 Wound - High Late - Institutional 2 4 1.7043
1CA11 Wound - Low Early - Community 0 5 1.2468
1CA21 Wound - Low Early - Community 1 4 1.2976
1CA31 Wound - Low Early - Community 2 4 1.3942
2CA11 Wound - Low Early - Institutional 0 4 1.4269
2CA21 Wound - Low Early - Institutional 1 4 1.4777
2CA31 Wound - Low Early - Institutional 2 4 1.5743
3CA11 Wound - Low Late - Community 0 2 0.8408
3CA21 Wound - Low Late - Community 1 3 0.8915
3CA31 Wound - Low Late - Community 2 3 0.9881
4CA11 Wound - Low Late - Institutional 0 3 1.2882
4CA21 Wound - Low Late - Institutional 1 3 1.3390
4CA31 Wound - Low Late - Institutional 2 3 1.4356
1CB11 Wound - Medium Early - Community 0 5 1.3911
1CB21 Wound - Medium Early - Community 1 5 1.4418
1CB31 Wound - Medium Early - Community 2 5 1.5385
2CB11 Wound - Medium Early - Institutional 0 5 1.5712
2CB21 Wound - Medium Early - Institutional 1 5 1.6219
2CB31 Wound - Medium Early - Institutional 2 5 1.7186
3CB11 Wound - Medium Late - Community 0 3 0.9850
3CB21 Wound - Medium Late - Community 1 3 1.0358
3CB31 Wound - Medium Late - Community 2 3 1.1324
4CB11 Wound - Medium Late - Institutional 0 4 1.4325
13
4CB21 Wound - Medium Late - Institutional 1 4 1.4832
4CB31 Wound - Medium Late - Institutional 2 4 1.5799 Source: CY 2018 Medicare claims data for episodes ending on or before December 31, 2018 (as of July 31, 2019) for which
we had a linked OASIS assessment. LUPA episodes, outlier episodes, and episodes with PEP adjustments were excluded.
14
1 ‐ History of falls (2 or more falls ‐ or any fall with an injury ‐ in the past 12 months)2 ‐ Unintentional weight loss of a total of 10 pounds or more in the past 12 months3 ‐ Multiple hospitalizations (2 or more) in the past 6 months4 ‐ Multiple emergency department visits ( 2 or more) in the past 6 months5 ‐ Decline in mental, emotional, or behavioral status in the past 3 months6 ‐ Reported or observed history of difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months7 ‐ Currently taking 5 or more medications8 ‐ Currently reports exhaustion9 ‐ Other risk(s) not listed in 1 ‐ 810 ‐ None of the above
M1820 Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes:0 ‐ Able to obtain, put on, and remove clothing and shoes without assistance.1 ‐ Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient.2 ‐ Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes.3 ‐ Patient depends entirely upon another person to dress lower body.
M1830 Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair) .0 ‐ Able to bathe self in shower or tub independently, including getting in and out of tub/shower.1 ‐ With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower.2 ‐ Able to bathe in shower or tub with the intermittent assistance of another person: (a) for intermittent supervision or encouragement or reminders, OR (b) get in and out of the shower or tub, OR, (c) for washing difficult to reach areas.3 ‐ Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision.4 ‐ Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode.5 ‐ Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath.6 ‐ Unable to participate effectively in bathing and is bathed totally by another person.
M1033 Risk for Hospitalization: Which of the following signs or symptoms characterize this patient as at risk for hospitalization? (Mark all that apply.)
0 ‐ Able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance.1 ‐ Able to dress upper body without assistance if clothing is laid out or handed to the patient.
3 ‐ Patient depends entirely upon another person to dress the upper body.2 ‐ Someone must help the patient put on upper body clothing.
M1800 Grooming: Current ability to tend safely to personal hygiene needs (i.e., washing face and hands, hair care, shaving or make up, teeth or denture care, fingernail care). 0 ‐ Able to groom self unaided, with or without the use of assistive devices or adapted methods.1 ‐ Grooming utensils must be placed within reach before able to complete grooming activities.2 ‐ Someone must assist the patient to groom self.3 ‐ Patient depends entirely upon someone else for grooming needs.
M1810 Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front‐opening shirts and blouses, managing zippers, bu
15
M1840 Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode.0 ‐ Able to get to and from the toilet and transfer independently with or without a device.1 ‐ When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.2 ‐ Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).3 ‐ Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently.4 ‐ Is totally dependent in toileting.
M1850 Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast0 ‐ Able to independently transfer.1 ‐ Able to transfer with minimal human assistance or with use of an assistive device.2 ‐ Able to bear weight and pivot during the transfer process but unable to transfer self.3 ‐ Unable to transfer self and is unable to bear weight or pivot when transferred by another person.4 ‐ Bedfast, unable to transfer but is able to turn and position self in bed.5 ‐ Bedfast, unable to transfer and is unable to turn and position self.
M1860 Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety0 ‐ Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e. needs no human assistance or assistive 1 ‐ With the use of a one‐handed device (e.g. cane, single crutch, hemi‐walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.2 ‐ Requires use of a two‐handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.3 ‐ Able to walk only with the supervision or assistance of another person at all times.4 ‐ Chairfast, unable to ambulate but is able to wheel self independently.5 ‐ Chairfast, unable to ambulate and is unable to wheel self.6 ‐ Bedfast, unable to ambulate or be up in a chair.
16
HCPCS Code Descriptor Effective Date Code TypeA4212 Non coring needle or stylet 4/1/2019 Non‐routine SupplyA4213 Syringe, Sterile, 20 cc or greater 4/1/2019 Non‐routine SupplyA4215 Needle, sterile, any size, each 4/1/2019 Non‐routine SupplyA4216 Sterile water/saline up to 10ml 4/1/2019 Non‐routine SupplyA4217 Sterile water/saline 500ml 4/1/2019 Non‐routine SupplyA4244 Alcohol or peroxide, per pint 4/1/2019 Non‐routine SupplyA4245 Alcohol wipes, per box 4/1/2019 Non‐routine SupplyA4246 Betadine or phisohex solution, per pint 4/1/2019 Non‐routine SupplyA4247 Betadine or iodine swabs/wipes, per box 4/1/2019 Non‐routine SupplyA4248 Chlorhexidine, containing anticeptic, 1ml 4/1/2019 Non‐routine SupplyA4310 Insert tray w/o bag/cath 4/1/2019 Non‐routine SupplyA4311 Catheter w/o bag 2‐way latex 4/1/2019 Non‐routine SupplyA4312 Cath w/o bag 2‐way silicone 4/1/2019 Non‐routine SupplyA4313 Catheter w/bag 3‐way 4/1/2019 Non‐routine SupplyA4314 Cath w/drainage 2‐way latex 4/1/2019 Non‐routine SupplyA4315 Cath w/drainage 2‐way silcne 4/1/2019 Non‐routine SupplyA4316 Cath w/drainage 3‐way 4/1/2019 Non‐routine SupplyA4320 Irrigation tray 4/1/2019 Non‐routine SupplyA4321 Cath therapeutic irrig agent 4/1/2019 Non‐routine SupplyA4322 Irrigation syringe 4/1/2019 Non‐routine SupplyA4326 Male external catheter 4/1/2019 Non‐routine SupplyA4327 Fem urinary collect dev cup 4/1/2019 Non‐routine SupplyA4328 Fem urinary collect pouch 4/1/2019 Non‐routine SupplyA4330 Stool collection pouch 4/1/2019 Non‐routine SupplyA4331 Extension drainage tubing 4/1/2019 Non‐routine SupplyA4332 Lubricant for cath insertion 4/1/2019 Non‐routine SupplyA4333 Urinary cath anchor device 4/1/2019 Non‐routine SupplyA4334 Urinary cath leg strap 4/1/2019 Non‐routine SupplyA4335 Incontinence supply 4/1/2019 Non‐routine SupplyA4338 Indwelling catheter latex 4/1/2019 Non‐routine SupplyA4340 Indwelling catheter special 4/1/2019 Non‐routine SupplyA4344 Cath indw foley 2 way silicn 4/1/2019 Non‐routine SupplyA4346 Cath indw foley 3 way 4/1/2019 Non‐routine SupplyA4349 Male ext catheter, with or without adhes 4/1/2019 Non‐routine SupplyA4351 Straight tip urine catheter 4/1/2019 Non‐routine SupplyA4352 Coude tip urinary catheter 4/1/2019 Non‐routine SupplyA4353 Intermittent urinary cath 4/1/2019 Non‐routine SupplyA4354 Cath insertion tray w/bag 4/1/2019 Non‐routine SupplyA4355 Bladder irrigation tubing 4/1/2019 Non‐routine SupplyA4356 Ext ureth clmp or compr dvc 4/1/2019 Non‐routine SupplyA4357 Bedside drainage bag 4/1/2019 Non‐routine SupplyA4358 Urinary leg bag 4/1/2019 Non‐routine SupplyA4360 disposable external urethral clamp or com 4/1/2019 Non‐routine SupplyA4361 Ostomy face plate 4/1/2019 Non‐routine SupplyA4362 Solid skin barrier 4/1/2019 Non‐routine SupplyA4363 Ostomy clamp, any type, replacement on 4/1/2019 Non‐routine Supply
17
A4364 Liq adhes for facial prosth 4/1/2019 Non‐routine SupplyA4366 Ostomy vent, any type, each 4/1/2019 Non‐routine SupplyA4367 Ostomy belt 4/1/2019 Non‐routine SupplyA4368 Ostomy filter 4/1/2019 Non‐routine SupplyA4368 Ostomy pouch filter 4/1/2019 Non‐routine SupplyA4369 Skin barrier liquid per oz 4/1/2019 Non‐routine SupplyA4371 Skin barrier powder per oz 4/1/2019 Non‐routine SupplyA4372 Skin barrier solid 4x4 equiv 4/1/2019 Non‐routine SupplyA4373 Skin barrier with flange 4/1/2019 Non‐routine SupplyA4375 Drainable plastic pch w fcpl 4/1/2019 Non‐routine SupplyA4376 Drainable rubber pch w fcplt 4/1/2019 Non‐routine SupplyA4377 Drainable plstic pch w/o fp 4/1/2019 Non‐routine SupplyA4378 Drainable rubber pch w/o fp 4/1/2019 Non‐routine SupplyA4379 Urinary plastic pouch w fcpl 4/1/2019 Non‐routine SupplyA4380 Urinary rubber pouch w fcplt 4/1/2019 Non‐routine SupplyA4381 Urinary plastic pouch w/o fp 4/1/2019 Non‐routine SupplyA4382 Urinary hvy plstc pch w/o fp 4/1/2019 Non‐routine SupplyA4383 Urinary rubber pouch w/o fp 4/1/2019 Non‐routine SupplyA4384 Ostomy faceplt/silicone ring 4/1/2019 Non‐routine SupplyA4385 Ost skn barrier sld ext wear 4/1/2019 Non‐routine SupplyA4387 Ost clsd pouch w att st barr 4/1/2019 Non‐routine SupplyA4388 Drainable pch w ex wear barr 4/1/2019 Non‐routine SupplyA4389 Drainable pch w st wear barr 4/1/2019 Non‐routine SupplyA4390 Drainable pch ex wear convex 4/1/2019 Non‐routine SupplyA4391 Urinary pouch w ex wear barr 4/1/2019 Non‐routine SupplyA4392 Urinary pouch w st wear barr 4/1/2019 Non‐routine SupplyA4393 Urine pch w ex wear bar conv 4/1/2019 Non‐routine SupplyA4394 Ostomy pouch liq deodorant 4/1/2019 Non‐routine SupplyA4395 Ostomy pouch solid deodorant 4/1/2019 Non‐routine SupplyA4396 Peristomal hernia supprt blt 4/1/2019 Non‐routine SupplyA4397 Irrigation supply sleeve 4/1/2019 Non‐routine SupplyA4398 Ostomy irrigation bag 4/1/2019 Non‐routine SupplyA4399 Ostomy irrig cone/cath w brs 4/1/2019 Non‐routine SupplyA4400 Ostomy irrigation set 4/1/2019 Non‐routine SupplyA4402 Lubricant per ounce 4/1/2019 Non‐routine SupplyA4404 Ostomy ring each 4/1/2019 Non‐routine SupplyA4405 Nonpectin based ostomy paste 4/1/2019 Non‐routine SupplyA4406 Pectin based ostomy paste 4/1/2019 Non‐routine SupplyA4407 Ext wear ost skn barr <=4sq” 4/1/2019 Non‐routine SupplyA4408 Ext wear ost skn barr >4sq” 4/1/2019 Non‐routine SupplyA4409 Ost skn barr w flng <=4 sq” 4/1/2019 Non‐routine SupplyA4410 Ost skn barr w flng >4sq” 4/1/2019 Non‐routine SupplyA4411 Ostomy skin barrier, solid 4x4 or equiv., e 4/1/2019 Non‐routine SupplyA4412 Ostomy pouch, drainable, high output, fo 4/1/2019 Non‐routine SupplyA4413 2 pc drainable ost pouch w/ filter 4/1/2019 Non‐routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 4/1/2019 Non‐routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 4/1/2019 Non‐routine Supply
18
A4416 Ost pch clsd w barrier/filtr 4/1/2019 Non‐routine SupplyA4417 Ost pch w bar/bltinconv/fltr 4/1/2019 Non‐routine SupplyA4418 Ost pch clsd w/o bar w filtr 4/1/2019 Non‐routine SupplyA4419 Ost pch for bar w flange/flt 4/1/2019 Non‐routine SupplyA4420 Ost pch clsd for bar w lk fl 4/1/2019 Non‐routine SupplyA4421 (6) Ostomy supply misc 4/1/2019 Non‐routine SupplyA4422 Ost pouch absorbent material 4/1/2019 Non‐routine SupplyA4423 Ost pch for bar w lk fl/fltr 4/1/2019 Non‐routine SupplyA4424 Ost pch drain w bar & filter 4/1/2019 Non‐routine SupplyA4425 Ost pch drain for barrier fl 4/1/2019 Non‐routine SupplyA4426 Ost pch drain 2 piece system 4/1/2019 Non‐routine SupplyA4427 Ost pch drain/barr lk flng/f 4/1/2019 Non‐routine SupplyA4428 Urine ost pouch w faucet/tap 4/1/2019 Non‐routine SupplyA4429 Urine ost pouch w bltinconv 4/1/2019 Non‐routine SupplyA4430 Ost urine pch w b/bltin conv 4/1/2019 Non‐routine SupplyA4431 Ost pch urine w barrier/tapv 4/1/2019 Non‐routine SupplyA4432 Os pch urine w bar/fange/tap 4/1/2019 Non‐routine SupplyA4433 Urine ost pch bar w lock fln 4/1/2019 Non‐routine SupplyA4434 Ost pch urine w lock flng/ft 4/1/2019 Non‐routine SupplyA4435 Ostomy pouch, drainable, high output, w 4/1/2019 Non‐routine SupplyA4455 Adhesive remover per ounce 4/1/2019 Non‐routine SupplyA4456 Adhesive remover, wipes, any type 4/1/2019 Non‐routine SupplyA4458 Reusable enema bag 4/1/2019 Non‐routine SupplyA4459 Manual Pump Enema System, Includes Ba 4/1/2019 Non‐routine SupplyA4460 Elastic compression bandage 4/1/2019 Non‐routine SupplyA4461 Surgical dressing holder, non‐reusable, ea 4/1/2019 Non‐routine SupplyA4463 Surgical dressing holder, reusable, each 4/1/2019 Non‐routine SupplyA4481 Tracheostoma filter 4/1/2019 Non‐routine SupplyA4575 Topical hyperbaric oxygen chamber, dispo 4/1/2019 Non‐routine SupplyA4623 Tracheostomy inner cannula 4/1/2019 Non‐routine SupplyA4625 Trach care kit for new trach 4/1/2019 Non‐routine SupplyA4626 Tracheostomy cleaning brush 4/1/2019 Non‐routine SupplyA4649 Surgical supplies 4/1/2019 Non‐routine SupplyA4657 Syringe, with or without needle, each 4/1/2019 Non‐routine SupplyA4930 Sterile, gloves per pair 4/1/2019 Non‐routine SupplyA4932 Rectal thermometer, reusable, any type, 4/1/2019 Non‐routine SupplyA5051 Pouch clsd w barr attached 4/1/2019 Non‐routine SupplyA5052 Clsd ostomy pouch w/o barr 4/1/2019 Non‐routine SupplyA5053 Clsd ostomy pouch faceplate 4/1/2019 Non‐routine SupplyA5054 Clsd ostomy pouch w/flange 4/1/2019 Non‐routine SupplyA5055 Stoma cap 4/1/2019 Non‐routine SupplyA5056 Ostomy pouch, drainable, with extended 4/1/2019 Non‐routine SupplyA5057 Ostomy pouch, drainable, with extended 4/1/2019 Non‐routine SupplyA5061 Pouch drainable w barrier at 4/1/2019 Non‐routine SupplyA5062 Drnble ostomy pouch w/o barr 4/1/2019 Non‐routine SupplyA5063 Drain ostomy pouch w/flange 4/1/2019 Non‐routine SupplyA5071 Urinary pouch w/barrier 4/1/2019 Non‐routine Supply
19
A5072 Urinary pouch w/o barrier 4/1/2019 Non‐routine SupplyA5073 Urinary pouch on barr w/flng 4/1/2019 Non‐routine SupplyA5081 Continent stoma plug 4/1/2019 Non‐routine SupplyA5082 Continent stoma catheter 4/1/2019 Non‐routine SupplyA5083 Continent Device, Stoma Absorptive Cove 4/1/2019 Non‐routine SupplyA5093 Ostomy accessory convex inse 4/1/2019 Non‐routine SupplyA5102 Bedside drain btl w/wo tube 4/1/2019 Non‐routine SupplyA5105 Urinary Suspensory With Leg Bag or With 4/1/2019 Non‐routine SupplyA5112 Urinary leg bag 4/1/2019 Non‐routine SupplyA5113 Latex leg strap 4/1/2019 Non‐routine SupplyA5114 Foam/fabric leg strap 4/1/2019 Non‐routine SupplyA5120 Skin barrier, wipes or swabs, each 4/1/2019 Non‐routine SupplyA5121 Solid skin barrier 6x6 4/1/2019 Non‐routine SupplyA5122 Solid skin barrier 8x8 4/1/2019 Non‐routine SupplyA5126 Disk/foam pad +or‐ adhesive 4/1/2019 Non‐routine SupplyA5131 Appliance cleaner 4/1/2019 Non‐routine SupplyA6010 Collagen based wound filler, dry form, ste 4/1/2019 Non‐routine SupplyA6011 Collagen based wound filler, gel/paste, st 4/1/2019 Non‐routine SupplyA6020 Collage wound dressing 4/1/2019 Non‐routine SupplyA6021 Collagen dressing, sterile, 16 sq. in. or les 4/1/2019 Non‐routine SupplyA6022 Collagen dressing, sterile, more than 16 s 4/1/2019 Non‐routine SupplyA6023 Collagen dressing, sterile, more than 48 s 4/1/2019 Non‐routine SupplyA6024 Collagen dressing wound filler, sterile, pe 4/1/2019 Non‐routine SupplyA6154 Wound pouch each 4/1/2019 Non‐routine SupplyA6196 Alginate or other fiber gelling dressing, w 4/1/2019 Non‐routine SupplyA6197 Alginate or other fiber gelling dressing, w 4/1/2019 Non‐routine SupplyA6198 Alginate or other fiber gelling dressing, w 4/1/2019 Non‐routine SupplyA6199 Alginate or other fiber gelling dressing, w 4/1/2019 Non‐routine SupplyA6203 Composite dressing, sterile, pad size 16 sq 4/1/2019 Non‐routine SupplyA6204 Composite dressing, sterile, pad size more 4/1/2019 Non‐routine SupplyA6205 Composite dressing, sterile, pad size more 4/1/2019 Non‐routine SupplyA6206 Contact layer, sterile, 16 sq. in. or less, ea 4/1/2019 Non‐routine SupplyA6207 Contact layer, sterile, more than 16 sq. in 4/1/2019 Non‐routine SupplyA6208 Contact layer, sterile, more than 48 sq. in 4/1/2019 Non‐routine SupplyA6209 Foam dressing, wound cover, sterile, pad 4/1/2019 Non‐routine SupplyA6210 Foam dressing, wound cover, sterile, pad 4/1/2019 Non‐routine SupplyA6211 Foam dressing, wound cover, sterile, pad 4/1/2019 Non‐routine SupplyA6212 Foam dressing, wound cover, sterile, pad 4/1/2019 Non‐routine SupplyA6213 Foam dressing, wound cover, sterile, pad 4/1/2019 Non‐routine SupplyA6214 Foam dressing, wound cover, sterile, pad 4/1/2019 Non‐routine SupplyA6215 Foam dressing, wound filler, sterile, per g 4/1/2019 Non‐routine SupplyA6219 Gauze, non‐impregnated, sterile, pad size 4/1/2019 Non‐routine SupplyA6220 Gauze, non‐impregnated, sterile, pad size 4/1/2019 Non‐routine SupplyA6221 Gauze, non‐impregnated, sterile, pad size 4/1/2019 Non‐routine SupplyA6222 Gauze, impregnated with other than wate 4/1/2019 Non‐routine SupplyA6223 Gauze, impregnated with other than wate 4/1/2019 Non‐routine SupplyA6224 Gauze, impregnated with other than wate 4/1/2019 Non‐routine Supply
20
A6228 Gauze, impregnated water or normal sali 4/1/2019 Non‐routine SupplyA6229 Gauze, impregnated, water or normal sal 4/1/2019 Non‐routine SupplyA6230 Gauze, impregnated, water or normal sal 4/1/2019 Non‐routine SupplyA6231 Gauze, impregnated, hydrogel, for direct 4/1/2019 Non‐routine SupplyA6232 Gauze, impregnated, hydrogel, for direct 4/1/2019 Non‐routine SupplyA6233 Gauze, impregnated, hydrogel, for direct 4/1/2019 Non‐routine SupplyA6234 Hydrocolloid dressing, wound cover, steri 4/1/2019 Non‐routine SupplyA6235 Hydrocolloid dressing, wound cover, steri 4/1/2019 Non‐routine SupplyA6236 Hydrocolloid dressing, wound cover, steri 4/1/2019 Non‐routine SupplyA6237 Hydrocolloid dressing, wound cover, steri 4/1/2019 Non‐routine SupplyA6238 Hydrocolloid dressing, wound cover, steri 4/1/2019 Non‐routine SupplyA6239 Hydrocolloid dressing, wound cover, steri 4/1/2019 Non‐routine SupplyA6240 Hydrocolloid dressing, wound filler, paste 4/1/2019 Non‐routine SupplyA6241 Hydrocolloid dressing, wound filler, dry fo 4/1/2019 Non‐routine SupplyA6242 Hydrogel dressing, wound cover, sterile, p 4/1/2019 Non‐routine SupplyA6243 Hydrogel dressing, wound cover, sterile, p 4/1/2019 Non‐routine SupplyA6244 Hydrogel dressing, wound cover, sterile, p 4/1/2019 Non‐routine SupplyA6245 Hydrogel dressing, wound cover, sterile, p 4/1/2019 Non‐routine SupplyA6246 Hydrogel dressing, wound cover, sterile, p 4/1/2019 Non‐routine SupplyA6247 Hydrogel dressing, wound cover, sterile, p 4/1/2019 Non‐routine SupplyA6248 Hydrogel dressing, wound filler, gel, steril 4/1/2019 Non‐routine SupplyA6251 Specialty absorptive dressing, wound cov 4/1/2019 Non‐routine SupplyA6252 Specialty absorptive dressing, wound cov 4/1/2019 Non‐routine SupplyA6253 Specialty absorptive dressing, wound cov 4/1/2019 Non‐routine SupplyA6254 Specialty absorptive dressing, wound cov 4/1/2019 Non‐routine SupplyA6255 Specialty absorptive dressing, wound cov 4/1/2019 Non‐routine SupplyA6256 Specialty absorptive dressing, wound cov 4/1/2019 Non‐routine SupplyA6257 Transparent film, sterile, 16 sq. in. or less 4/1/2019 Non‐routine SupplyA6258 Transparent film, sterile, more than 16 sq 4/1/2019 Non‐routine SupplyA6259 Transparent film, sterile, more than 48 sq 4/1/2019 Non‐routine SupplyA6261 Wound filler, gel/paste sterile, per fluid o 4/1/2019 Non‐routine SupplyA6262 Wound filler, dry form, sterile, per gram, 4/1/2019 Non‐routine SupplyA6266 Gauze, impregnated, other than water, no 4/1/2019 Non‐routine SupplyA6402 Sterile gauze <= 16 sq in 4/1/2019 Non‐routine SupplyA6403 Sterile gauze>16 <= 48 sq in 4/1/2019 Non‐routine SupplyA6404 Sterile gauze > 48 sq in 4/1/2019 Non‐routine SupplyA6405 Sterile elastic gauze /yd 4/1/2019 Non‐routine SupplyA6406 Sterile non‐elastic gauze/yd 4/1/2019 Non‐routine SupplyA6407 Packing strips, non‐impregnated, sterile, u 4/1/2019 Non‐routine SupplyA6410 Sterile eye pad 4/1/2019 Non‐routine SupplyA6412 Eye patch, occlusive, each 4/1/2019 Non‐routine SupplyA6440 Zinc Paste >=3"<5" w/roll 4/1/2019 Non‐routine SupplyA6441 Padding bandage, non‐elastic, non‐woven 4/1/2019 Non‐routine SupplyA6442 Conforming bandage, non‐elastic, knitted 4/1/2019 Non‐routine SupplyA6443 Conforming bandage, non‐elastic, knitted 4/1/2019 Non‐routine SupplyA6444 Conforming bandage, non‐elastic, knitted 4/1/2019 Non‐routine SupplyA6445 Conforming bandage, non‐elastic, knitted 4/1/2019 Non‐routine Supply
21
A6446 Conforming bandage, non‐elastic, knitted 4/1/2019 Non‐routine SupplyA6447 Conforming bandage, non‐elastic, knitted 4/1/2019 Non‐routine SupplyA6448 Light compression bandage, elastic, knitte 4/1/2019 Non‐routine SupplyA6449 Light compression bandage, elastic, knitte 4/1/2019 Non‐routine SupplyA6450 Light compression bandage, elastic, knitte 4/1/2019 Non‐routine SupplyA6451 Moderate compression bandage, elastic, 4/1/2019 Non‐routine SupplyA6452 High compression bandage, elastic, knitte 4/1/2019 Non‐routine SupplyA6453 Self‐adherent bandage, elastic, non‐knitte 4/1/2019 Non‐routine SupplyA6454 Self‐adherent bandage, elastic, non‐knitte 4/1/2019 Non‐routine SupplyA6455 Self‐adherent bandage, elastic, non‐knitte 4/1/2019 Non‐routine SupplyA6456 Zinc paste impregnated bandage, non‐ela 4/1/2019 Non‐routine SupplyA6457 Tubular dressing with or without elastic, a 4/1/2019 Non‐routine SupplyA6531 Gradient Compression Stocking, Below Kn 4/1/2019 Non‐routine SupplyA6532 Gradient Compression Stocking, Below Kn 4/1/2019 Non‐routine SupplyA6545 Gradient Compression Wrap, non‐elastic, 4/1/2019 Non‐routine SupplyA7040 One way chest drain valve 4/1/2019 Non‐routine SupplyA7041 Water seal drainage container and tubing 4/1/2019 Non‐routine SupplyA7045 Exhalation port with or without swivel use 4/1/2019 Non‐routine SupplyA7047 Oral Interface Used With Respiratory Suct 4/1/2019 Non‐routine SupplyA7048 Vacuum drainage collection unit and tubi 4/1/2019 Non‐routine SupplyA7501 Tracheostoma valve w diaphra 4/1/2019 Non‐routine SupplyA7502 Replacement diaphragm/fplate 4/1/2019 Non‐routine SupplyA7503 HMES filter holder or cap 4/1/2019 Non‐routine SupplyA7504 Tracheostoma HMES filter 4/1/2019 Non‐routine SupplyA7505 HMES or trach valve housing 4/1/2019 Non‐routine SupplyA7506 HMES/trachvalve adhesivedisk 4/1/2019 Non‐routine SupplyA7507 Integrated filter & holder 4/1/2019 Non‐routine SupplyA7508 Housing & Integrated Adhesiv 4/1/2019 Non‐routine SupplyA7509 Heat & moisture exchange sys 4/1/2019 Non‐routine SupplyA7520 Tracheostomy/larynectomy tube, non‐cuf 4/1/2019 Non‐routine SupplyA7521 Tracheostomy/larynectomy tube, cuffed 4/1/2019 Non‐routine SupplyA7522 Tracheostomy/larynectomy tube, stainles 4/1/2019 Non‐routine SupplyA7523 Tracheostomy shower protector, each 4/1/2019 Non‐routine SupplyA7524 Tracheostomy stent/stud/button, each 4/1/2019 Non‐routine SupplyA7527 Tracheostomy/laryngectomy tube plug/st 4/1/2019 Non‐routine SupplyK0614 chem/antiseptic solution, 8oz. 4/1/2019 Non‐routine SupplyK0620 tubular elastic dressing 4/1/2019 TherapyG0193 Endoscopic study swallow functn 4/1/2019 TherapyG0194 Sensory testing endoscopic study 4/1/2019 TherapyG0195 Clinical eval swallowing funct 4/1/2019 TherapyG0196 Eval of swallowing with radioopa 4/1/2019 TherapyG0197 Eval of pt for prescip speech devi 4/1/2019 TherapyG0198 Patient adapation & train for spe 4/1/2019 TherapyG0199 Reevaluation of patient use spec 4/1/2019 TherapyG0200 Eval of patient prescip of voice p 4/1/2019 TherapyG0201 Modi for training in use voice pro 4/1/2019 TherapyG0281 Elec stim unattend for press 4/1/2019 Therapy
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G0282 Elect stim wound care not pd 4/1/2019 TherapyG0283 Elec stim other than wound 4/1/2019 TherapyG0329 Electromagntic tx for ulcers 4/1/2019 TherapyG0515 Development of cognitive skills to improv 4/1/2019 Therapy0019T Extracorp shock wave tx, ms 4/1/2019 Therapy0020T Extracorp shock wave tx, ft 4/1/2019 Therapy
64550 Apply neurostimulator 4/1/2019 Therapy90901 Biofeedback train, any meth 4/1/2019 Therapy90911 Biofeedback peri/uro/rectal 4/1/2019 Therapy92507 Speech/hearing therapy 4/1/2019 Therapy92508 Speech/hearing therapy 4/1/2019 Therapy92510 Rehab for ear implant 4/1/2019 Therapy92521 Evaluation of speech fluency (eg, stutterin 4/1/2019 Therapy92522 Evaluation of speech sound production (e 4/1/2019 Therapy92523 with evaluation of language comprehensi 4/1/2019 Therapy92524 Behavioral and qualitative analysis of voic 4/1/2019 Therapy92526 Oral function therapy 4/1/2019 Therapy92597 Evaluation for use and/or fitting of voice 4/1/2019 Therapy92601 Cochlear implt f/up exam < 7 4/1/2019 Therapy92602 Reprogram cochlear implt < 7 4/1/2019 Therapy92603 Cochlear implt f/up exam 7 > 4/1/2019 Therapy92604 Reprogram cochlear implt 7 > 4/1/2019 Therapy92605 Eval for nonspeech device rx 4/1/2019 Therapy92606 Non‐speech device service 4/1/2019 Therapy92607 Ex for speech device rx, 1hr 4/1/2019 Therapy92608 Ex for speech device rx addl 4/1/2019 Therapy92609 Use of speech device service 4/1/2019 Therapy92610 Evaluate swallowing function 4/1/2019 Therapy92611 Motion fluoroscopy/swallow 4/1/2019 Therapy92612 Endoscopy swallow tst (fees) 4/1/2019 Therapy92614 Laryngoscopic sensory test 4/1/2019 Therapy92616 Fees w/laryngeal sense test 4/1/2019 Therapy95831 Limb muscle testing, manual 4/1/2019 Therapy95832 Hand muscle testing, manual 4/1/2019 Therapy95833 Body muscle testing, manual 4/1/2019 Therapy95834 Body muscle testing, manual 4/1/2019 Therapy95851 Range of motion measurements 4/1/2019 Therapy95852 Range of motion measurements 4/1/2019 Therapy96000 Motion analysis, video/3d 4/1/2019 Therapy96001 Motion test w/ft press meas 4/1/2019 Therapy96002 Dynamic surface emg 4/1/2019 Therapy96003 Dynamic fine wire emg 4/1/2019 Therapy96105 Assessment of aphasia 4/1/2019 Therapy96125 Standardized Cognitive Performance Test 4/1/2019 Therapy97012 Mechanical traction therapy 4/1/2019 Therapy97016 Vasopneumatic device therapy 4/1/2019 Therapy97018 Paraffin bath therapy 4/1/2019 Therapy
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97022 Whirlpool therapy 4/1/2019 Therapy97024 Diathermy treatment 4/1/2019 Therapy97026 Infrared therapy 4/1/2019 Therapy97028 Ultraviolet therapy 4/1/2019 Therapy97032 Electrical stimulation 4/1/2019 Therapy97033 Electric current therapy 4/1/2019 Therapy97034 Contrast bath therapy 4/1/2019 Therapy97035 Ultrasound therapy 4/1/2019 Therapy97036 Hydrotherapy 4/1/2019 Therapy97039 Physical therapy treatment 4/1/2019 Therapy97110 Therapeutic exercises 4/1/2019 Therapy97112 Neuromuscular reeducation 4/1/2019 Therapy97113 Aquatic therapy/exercises 4/1/2019 Therapy97116 Gait training therapy 4/1/2019 Therapy97124 Massage therapy 4/1/2019 Therapy97139 Physical medicine procedure 4/1/2019 Therapy97140 Manual therapy 4/1/2019 Therapy97150 Group therapeutic procedures 4/1/2019 Therapy97161 PT Eval Low Complex 20 Min 4/1/2019 Therapy97162 PT Eval Mod Complex 30 Min 4/1/2019 Therapy97163 PT Eval High Complex 45 Min 4/1/2019 Therapy97164 PT Re‐eval Est Plan Care 4/1/2019 Therapy97165 OT Eval Low Complex 20 Min 4/1/2019 Therapy97166 OT Eval Mod Complex 30 Min 4/1/2019 Therapy97167 OT Eval High Complex 45 Min 4/1/2019 Therapy97168 OT Re‐eval Est Plan Care 4/1/2019 Therapy97530 Therapeutic activities 4/1/2019 Therapy97533 Sensory integration 4/1/2019 Therapy97535 Self care mngment training 4/1/2019 Therapy97537 Community/work reintegration 4/1/2019 Therapy97542 Wheelchair mngment training 4/1/2019 Therapy97545 Work hardening 4/1/2019 Therapy97546 Work hardening add‐on 4/1/2019 Therapy97597 debridement;surface area less than or eq 4/1/2019 Therapy97598 debridement; total wound(s) surface grea 4/1/2019 Therapy97602 Wound care non‐selective 4/1/2019 Therapy97605 Negative pressure wound therapy (eg vac 4/1/2019 Therapy97606 Negative pressure wound therapy (eg vac 4/1/2019 Therapy97607 Negative pressure wound therapy, (eg, va 4/1/2019 Therapy97608 Negative pressure wound therapy, (eg, va 4/1/2019 Therapy97750 Physical performance test 4/1/2019 Therapy97755 Assistive technology assessment (eg, to re 4/1/2019 Therapy97760 Orthotic(s) management and training (inc 4/1/2019 Therapy97761 Prosthetic training, upper and/or lower e 4/1/2019 Therapy97763 Orthotic(s)/prosthetic(s) management an 4/1/2019 Therapy97799 Physical medicine procedure 4/1/2019 Therapy
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