10-144 C.M.R. ch. 101, §III-28
PROC CODE | MODIFIER | DESCRIPTION | UNIT OF SERVICE | *MAXIMUM ALLOWANCE Through 7/31/18 | *MAXIMUM ALLOWANCE 8/1/18-6/30/19 | *MAXIMUM ALLOWANCE Effective 7/1/19 | ||
H2021 | HI | Treatment services for children with cognitive impairments and functional limitations (community based wrap around services) 1:1 | 15 Minutes | $9.02 | $10.68 | $10.54 | ||
H2021 | HQ | HI | UN | Treatment services for children with cognitive impairments and functional limitations (community based wrap around services) GROUP- UN two patients served | 15 MINUTES | $4.77 | $5.36 | $5.32 |
H2021 | HQ | HI | UP | Treatment services for children with cognitive impairments and functional limitations (community based wrap around services) GROUP- UP three patients served | 15 MINUTES | $3.26 | $3.69 | $3.66 |
H2021 | HQ | HI | UQ | Treatment services for children with cognitive impairments and functional limitations (community based wrap around services) GROUP- UQ four patients served | 15 MINUTES | $2.51 | $2.86 | $2.83 |
H2021 | HK | specialized services for children with cognitive impairments and functional limitations (community based wrap around services) 1:1 | 15 minutes | $12.46 | $14.79 | $14.59 | ||
H2021 | HQ | HK | UN | specialized services for children with cognitive impairments and functional limitations (community based wrap around services) Group- UN two patients served | 15 minutes | $6.48 | $7.47 | $7.38 |
H2021 | HQ | HK | UP | specialized services for children with cognitive impairments and functional limitations (community based wrap around services) Group- UP three patients served | 15 minutes | $4.40 | $5.11 | $5.05 |
H2021 | HQ | HK | UQ | specialized services for children with cognitive impairments and functional limitations (community based wrap around services) Group- UQ four patients served | 15 minutes | $3.36 | $3.97 | $3.91 |
G9007 | HA | BCBA services | 15 MINUTES | $16.60 | $16.60 | |||
P.L. 2017, ch. 460, Part C, Sec. C-1 directed that rulemaking authorized by the Sec. C-1 law would be "major substantive" rules. Sec. C-1 provided for certain rate increases, and rulemaking, for Section 28 services.
Providers must ensure that the 2% increase in reimbursement rates as required via P.L. 2017, Ch. 460 Part D,effective August 1, 2018 is applied in full to wages and benefits for employees who provide direct services. Providers must document compliance with this requirement in their financial records and provide such documentation to the Department upon request.
*The Department is seeking and anticipates receiving CMS approval for this Section. Pending approval, theDepartment will reimburse providers under the new increased rate retroactively to8/1/2018 pursuant to P.L. 2017, ch. 460.
Definition of Modifiers
HQ: group
HI: base service
HK: Specialized Services
UN: two patients served
UP: three patients served
UQ: four patients served
10-144 C.M.R. ch. 101, §III-28
8/29/2019 - filing 2019-143