Introduction

This file provides a list of variables for each HEAL analylsis file, with brief descriptors of each variableOn the the COS_Final tab, a list of HEAL's derived "categories of service" is provided

On the final tab, "user advisories" are provided to identify common problems or known issues with the data

2/7/2017

On the penultimate tab (Code Book), values for various Medicaid variables (aid categories, coverage categories, NDC billing codes, rate codes, etc.) are provided

HEAL Processed “Analysis Files” All Claims File (217M records in 2015) – All “categories of service”. One row per transaction

(collapsing multiple rows from a single claim/encounter), except for some categories of service that are “rolled-up” into monthly claims (but individual claims/encounters are available in Pharmacy File and Other Unrolled File).

Inpatient File (1.8M records in 2015) – Data limited to inpatient categories of service – created for faster processing of inpatient data

DX File (432M records in 2015) – Full DX information from every claim or encounter (up to 20 possible fields) one row per diagnosis, with unique identifier to link back to the individual claim/encounter in the All Claims, Inpatient, and Other Unrolled files – Includes AHRQ Clinical Classification Software (CCS) category and AHRQ Chronic Condition Indicator (CCI) for each diagnosis listed

Procedure File (310M records in 2015) – Full procedure information from every claim or encounter (up to 20 possible fields) one row per procedure, with unique identifier to link back to the individual claim/encounter in All Claims, Inpatient, and Other Unrolled files

Pharmacy File (45M records in 2015) – Every prescription filled with billing NDC, etc. – data in All Claims file are rolled up into monthly totals with no information on individual prescriptions

Other Unrolled File (81M records in 2015) – Each individual non-pharmacy claim/encounter that has been “rolled-up” into monthly totals (see categories of service with asterisks) in All Claims File

Rate Code File (151M records in 2015) – Every individual rate code for each claim/encounter – All Claims file has a single rate code listed - unique identifier to link back to the individual claim/encounter in All Claims and Other Unrolled files

Eligibility File (12M records in 2015) – For each patient on Medicaid for any period 1/1/06 to present, complete eligibility information by month as described above. After any linkage of eligibility information to other data sets using “facial identifiers” (such as name, SSN, CIN, DOB, street address etc.), facial identifiers are removed, and MOB and an anonymized research ID assigned to each patient for allow linkage across claims/encounters are provided.

All Claims File (allclaims3_cleaned)Variable Variable Description Comment

ADMIT_DX_CD Admitting DX May differ from Prim_DXADMIT_SRC_CD Source of admission Inpatient - See CodeBook tab for valuesambsurgflag Flag for ambulatory surgery claims Dummy = 1 for ambulatory surgery claimsBILL_NPI NPI of billing provider See prov_loc_addr.sas7bdat for values and namesBILL_PROV_ID Billing provider ID See prov_loc_addr.sas7bdat for values and namesccs_cat AHRQ Clinical Classification Software (CCS) category For Prin_DX_Codechronic_flag AHRQ Chronic Conidition Indicator (CCI) For Prin_DX_Code

clm_tp Flag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

cos_final Derived "category of service" See COS_Final tab for values and descriptionsdate_mo_end Month service ended Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startDERIVED_PROC_SRC_CD Proc code type (CPT, HCPCS, ICD) for Proc_Cd_1 See CodeBook tab for valuesDRG_CD DRG Code Currently Invaliddx_allnonobnb Non-OB or Newborn DX For Prin_DX_Codedx1 ICD - Secondary diagnosisdx2 ICD - Secondary diagnosisdx3 ICD - Secondary diagnosisGoodAdm Flag for derived admission/discharge claims Use GoodAdm = "Y" for counting hospital admsLOC_OF_SRV Provider locator code for site of service See prov_loc_addr.sas7bdat for values and namesMBR_DEATH_IND Member death See CodeBook tab for valuesMBR_ID Medicaid Recipient ID Original - not de-dupedmedicaid_pd Paid expenditures Medicaidmedicare_pd Total payment Medicaremember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped where possible De-duped IDsnew_tcn Unique claim identifierPAT_STATUS_CD Patient status See CodeBook tab for valuesPRIM_DX_CD ICD - Principal diagnosisPROC_CD_1 Procedure code (first listed)PROV_GRP_PROV_ID Provider group ID See prov_loc_addr.sas7bdat for values and namespx_eandm_flag Evaluation and management visit flag Dummy = 1 for primary, specialty care, OBGYN E and M visitspx1 Procedure codepx2 Procedure codepx3 Procedure codeRATE_CD Rate Code FFS claims only - See CodeBook tab for valuesREFER_ORD_PROV_ID Referring provider ID See prov_loc_addr.sas7bdat for values and namesSPEC_CD Provider specialty See CodeBook tab for valuessrv_dt Service start datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Service end datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dtTotalallpayors Total payments all payorstrueadm Derived admission date for "sequential" admissions First adm date for multiple records for single admtruedisch Derived Discharge date for "sequential" admissions Last dis date for multiple records for single admtype_alt_care_dt Start date for "alternative care" (inpatient only)

12/20/2016

Inpatient File (allhospsb_final_cleaned_110116)Variable Variable Description Comment

Admit_Dx_Cd Admitting DX May differ from Prim_DXAdmit_Src_Cd Source of admission Inpatient - Uncertain reliability - See CodeBook tab for valuesBill_NPI NPI of billing provider See prov_loc_addr.sas7bdat for values and namesBill_Prov_ID Provider ID See prov_loc_addr.sas7bdat for values and namesccs_cat AHRQ Clinical Classification Software (CCS) category For Prin_DX_Codechronic_flag AHRQ Chronic Conidition Indicator (CCI) For Prin_DX_Code

clm_tpFlag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

cos_final Derived "category of service" See COS_Final tab for values and descriptionsdate_mo_end Month service ended (truedisch for inpatient Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started (trueadm for inpatient) Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startDRG_Cd DRG Code Currently InvalidDX_AllNonOBNB Derived admission type flag Dummy = 1 for NonOBNewBorn - Derived from CCS_Catdx1 ICD - Secondary diagnosisdx2 ICD - Secondary diagnosisdx3 ICD - Secondary diagnosisGoodAdm Flag for derived admission/discharge claims Use GoodAdm = "Y" for counting hospital admsLoc_of_Srv Provider locator code for site of service See prov_loc_addr.sas7bdat for values and namesMbr_Death_Ind Member death indicator See CodeBook tab for valuesMbr_ID Medicaid Recipient ID Original - not de-dupedmedicaid_pd Paid expenditures Medicaidmedicare_pd Total payment Medicaremember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped wher possible De-duped IDsnew_tcn Unique claim identifierPat_Status_Cd Patient status See CodeBook tab for valuesPrim_Dx_Cd ICD - Principal diagnosisProc_Cd_1 ICD - procedure codepx1 ICD - procedure codepx2 ICD - procedure codepx3 ICD - procedure codeRate_Cd Rate Code FFS claims only - See CodeBook tab for valuesRefer_Ord_Prov_ID Referring provider ID See prov_loc_addr.sas7bdat for values and namesSpec_Cd Provider specialty See CodeBook tab for valuessrv_dt Admission datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Discharge datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dtTotalallpayors Total payments all payorstrueadm Derived admission date for "sequential" admissions First adm date for multiple records for single admtruedisch Derived Discharge date for "sequential" admissions Last dis date for multiple records for single admtype_alt_care_dt Start date for "alternative care" (inpatient)

Possible additions when DRG fixedAdmType Derived admission type (Medical, surgical, mental health, etc)Adm_Med Derived admission type flagAdm_Surg Derived admission type flagAdm_MH Derived admission type flagAdm_Subst Derived admission type flagAdm_Injury Derived admission type flagAdm_Cancer Derived admission type flagAdm_OB Derived admission type flagAdm_NB Derived admission type flagAdm_Other Derived admission type flagAdm_AllNonOBNB Derived admission type flagAdm_ACS Derived admission type flag

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DX File (dx_final_cleaned)Variable Variable Description Comment

admit_dx-ind Indicator to identify "admitting" DX for inpatient claims 1 = Admitting DX; 0 = Other DXBILL_NPI NPI of billing provider See prov_loc_addr.sas7bdat for values and namesBILL_PROV_ID Provider ID See prov_loc_addr.sas7bdat for values and namesccs_cat AHRQ Clinical Classification Software (CCS) categorychronic_flag Chronic Contidion Flag

clm_tp Flag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

cos_final Derived "category of service" See COS_Final tab for values and descriptionsdate_mo_end Month service ended Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startdx_cd ICD Codembr_id Medicaid Recipient ID Original - not de-dupedmember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped wher possible De-duped IDsnew_tcn Unique claim identifierprim_dx_ind Indicator to identify principal DX 1 = Principal DX; 0 = Secondary DXsrv_dt Service start datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Service end datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dttrueadm Derived admission date for "sequential" admissions First adm date for multiple records for single admtruedisch Derived Discharge date for "sequential" admissions Last dis date for multiple records for single adm

DX_AAA Derived DX for subset of chronic DX and Charlson catsSee

CCS ICD9 with CCI Chronic Flag WITH DX CATS V3.xlsxCCS ICD10 with CCI Chronic Flag WITH DX CATS V3.xlsx

DX_BBB Derived DX for subset of chronic DX and Charlson catsSee

CCS ICD9 with CCI Chronic Flag WITH DX CATS V3.xlsxCCS ICD10 with CCI Chronic Flag WITH DX CATS V3.xlsx

… … …

DX_ZZZ Derived DX for subset of chronic DX and Charlson catsSee

CCS ICD9 with CCI Chronic Flag WITH DX CATS V3.xlsxCCS ICD10 with CCI Chronic Flag WITH DX CATS V3.xlsx

1/6/2017

Procedure File (px_final_cleaned)Variable Variable Description Comment

BILL_NPI NPI of billing provider See prov_loc_addr.sas7bdat for values and namesBILL_PROV_ID Provider ID See prov_loc_addr.sas7bdat for values and names

clm_tpFlag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

cos_final Derived "category of service" See COS_Final tab for values and descriptionsdate_mo_end Month service ended Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startDERIVED_PROC_SRC_CD Proc code type (CPT, HCPCS, ICD) See CodeBook tab for valuesmbr_id Medicaid Recipient ID Original - not de-dupedmember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped wher possible De-duped IDsnew_tcn Unique claim identifierPRIM_DX_CD Principal DX

PRINC_PROC_IND Prinicipal procedure indicator"Y" - Principal Procedure; "N" - Not Principal Procedure

[Missing in majority of claims/encounters]proc_cd Procedure Codesrv_dt Service start datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Service end datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dttrueadm Derived admission date for "sequential" admissions First adm date for multiple records for single admtruedisch Derived Discharge date for "sequential" admissions Last dis date for multiple records for single adm

2/7/2017

Pharmacy File (drugs_cleaned)Variable Variable Description Comment

BILL_NPI Provider ID See prov_loc_addr.sas7bdat for values and namesBILL_PROV_ID NPI of billing provider See prov_loc_addr.sas7bdat for values and namesclm_tp Flag for data source: FFS or MMC (with MMC capitation indicator) See CodeBook tab for values

cos_final Flag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

date_mo_end Month service ended Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startMBR_ID Medicaid Recipient ID Original - not de-dupedmedicaid_pd Paid expenditures Medicaidmedicare_pd Total payment Medicaremember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped wher possible De-duped IDs

NDC National Drug Code11-digit "billing" NCD code - Trim last 2 digits (package code)

and see "Drug Info File from MDW - NCD9 - Trimmed.xls " for9-digit billing NDC codes (current and historic) for NY Medicaid formulary

new_tcn Unique claim identifierNUM_OF_REFILLS_AUTH Number of refills authorizedord_dt Ordered datePRESC_ORD_PROV_ID Prescriber ID See prov_loc_addr.sas7bdat for values and namesPRIM_DX_CD Principal DXPROC_CD_1 Procedure code (captures no NDC devices, etc.)QTY_DISP Quanity dispensedservice_month Service month from claims YYYYMMsrv_dt Fill datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Service end datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dtSUPPLY_DAYS Days supplyTHER_CLASS_FORMULARY_CD Therapeutic class formulary code See CodeBook tab for valuesTotalallpayors Total payments all payors

Missingprescriber_prov_npi Prescriber NPI

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Other COS_Final Roll-Ups File (unrolled_cleaned)Variable Variable Description Comment

BILL_NPI NPI of billing provider See prov_loc_addr.sas7bdat for values and namesBILL_PROV_ID Billing provider ID See prov_loc_addr.sas7bdat for values and namesccs_cat AHRQ Clinical Classification Software (CCS) category

clm_tp Flag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

cos_final Derived "category of service" See COS_Final tab for values and descriptionsdate_mo_end Month service ended Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startDERIVED_PROC_SRC_CD Proc code type (CPT, HCPCS, ICD) for Proc_Cd_1dx1 ICD - Secondary diagnosisdx2 ICD - Secondary diagnosisdx3 ICD - Secondary diagnosisLOC_OF_SRV Provider locator code for site of service See prov_loc_addr.sas7bdat for values and namesMBR_DEATH_IND Member death See CodeBook tab for valuesMBR_ID Medicaid Recipient ID Original - not de-dupedmedicaid_pd Paid expenditures Medicaidmedicare_pd Total payment Medicaremember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped wher possible De-duped IDsnew_tcn Unique claim identifierPAT_STATUS_CD Patient statusPRIM_DX_CD ICD - Principal diagnosisPROC_CD_1 Procedure code (first listed)PROV_GRP_PROV_ID Provider group ID See prov_loc_addr.sas7bdat for values and namespx1 ICD - procedure codepx2 ICD - procedure codepx3 ICD - procedure codeRATE_CD Rate Code FFS claims onlyREFER_ORD_PROV_ID Referring provider ID See prov_loc_addr.sas7bdat for values and namesservice_month Service month from claims YYYYMMSPEC_CD Provider specialtysrv_dt Service start datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Service end datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dtTotalallpayors Total payments all payors

12/20/2016

Rate Codes (rate_codes_cleaned)Variable Variable Description Comment

BILL_NPI NPI of billing provider See prov_loc_addr.sas7bdat for values and namesBILL_PROV_ID Billing provider ID See prov_loc_addr.sas7bdat for values and names

clm_tp Flag for data source: FFS or MMC (with MMC capitation and denial indicator)

See CodeBook tab for valuesclm_tp = "A" should be excluded when examing costs

cos_final Derived "category of service" See COS_Final tab for values and descriptionsdate_mo_end Month service ended Jan/2000 = 1date_mo_end_adj Month service ended adjusted For cos_final 01, 02, 04 = mo of truedisch, all else = date_mo_enddate_mo_start Month service started Jan/2000 = 1date_mo_start_adj Month service started adjusted For cos_final 01, 02, 04 = mo of trueadm, all else = date_mo_startLOC_OF_SRV Provider locator code for site of service See prov_loc_addr.sas7bdat for values and namesMBR_ID Medicaid Recipient ID Original - not de-dupedmember_dupe_flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmember_id Medicaid Recipient ID - De-duped wher possible De-duped IDsnew_tcn Unique claim identifierPRIM_DX_CD ICD - Principal diagnosisPROC_CD_1 Procedure code (first listed)RATE_CD Rate Code FFS claims only - See CodeBook tab for valuessrv_dt Service start datesrv_dt_adj Service start date adjusted For cos_final 01, 02, 04 = trueadm, all else = srv_dtsrv_end_dt Service end datesrv_end_dt_adj Service end date adjusted For cos_final 01, 02, 04 = truedisch, all else = srv_end_dttrueadm Derived admission date for "sequential" admissions First adm date for multiple records for single admtruedisch Derived Discharge date for "sequential" admissions Last dis date for multiple records for single adm

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Eligibility File (together_all_ev_finalcut_16updt)Vairable Variable Description Comment

Mbr_ID Medicaid Recipient ID Original - not de-dupedMember_ID Medicaid Recipient ID - De-duped wher possible De-duped IDsMember_Dupe_Flag Member_ID has dupe Dummy = 1 for IDs with possible remaining dupesmbr_birth_dt Date of birthmbr_sex_cd Gender See CodeBook tab for valuesmbr_race_cd Race See CodeBook tab for valuesmbr_ethnic_cd See CodeBook tab for valueswhite_ethnic_cd Ethnicity = White Y = Yes, N= No, U=Unknownnative_hi_or_opi_ethnic_cd Ethnicity = Hawaiian/OtherPacific Islander Y = Yes, N= No, U=Unknownhispanic_or_latino_ethnic_cd Ethnicity = Hispanic or Latino Y = Yes, N= No, U=Unknownblk_or_af_amer_ethnic_cd Ethnicity = Black or African American Y = Yes, N= No, U=Unknownasian_ethnic_cd Ethnicity = Asian Y = Yes, N= No, U=Unknownamer_ind_or_ak_nat_ethnic_cd Ethniciy = Native American Y = Yes, N= No, U=Unknownmbr_ssn Social Security Numberaid_catg73 Medicaid "recipient aid" category month 73 Mo73=Jan/2006 - See CodeBook tab for values…aid_catg198 Medicaid "recipient aid" category month 192 Mo198=Jun/2016 - See CodeBook tab for valuesmcaid_cov73 Medicaid "coverage category month 73 Mo73=Jan/2006 - See CodeBook tab for values…mcid_cov198 Medicaid "coverage category month 192 Mo198=Jun/2016 - See CodeBook tab for valueszip73 Zip Code month 73 Mo73=Jan/2006 - See CodeBook tab for values…zip198 Zip Code month 192 Mo198=Jun/2016 - See CodeBook tab for valuesstr_addr73 Street address month 73 Mo73=Jan/2006 - See CodeBook tab for values…str_addr198 Street address month 120 Mo198=Jun/2016 - See CodeBook tab for valuescounty_cd73 Recipient fiscal county code month 73 Mo73=Jan/2006 - See CodeBook tab for values…county_cd198 Recipient fiscal county code month 192 Mo198=Jun/2016 - See CodeBook tab for valuesmcaid_cd73 On Medicaid month 73 Mo73=Jan/2006…mcaid_cd192 On Medicaid month 192 Mo198=Jun/2016on_mmc73 On Medicare month 73 Mo73=Jan/2006; Pre-1/2010 all values = 0 (missing)…on_mmc192 On Medicare month 192 Mo198=Jun/2016mcare_Start_dt Medicare start datemcare_Start_mo Medicare start month Jan/2000 = 1

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Derived Category of Service (cos_final)Code Code Description Comment

01 IP Inpatient 02 IP OMH 03 OPWDD Residential Office for People with Developmental Disabilities04 IP OASAS 05 Professional Services during IP Does not include cos_final 0306 ED 07 Prof Services during ED 08 Primary Care 09 Specialty Care 10 OBGYN 11 Substance Abuse 12 Methadone 13 Mental Health 14 Psychology 15 Renal Dialysis 16 Ophthalmology 17 Optometry 18 Podiatry 19 PTRehab 20 DiagLabXRay 21 DME*22 Dental 23 Home Health* *Monthly total24 Personal Care* *Monthly total25 LTHHC* *Monthly total26 Nursing Care 27 Adult Daycare 28 PERS emerg. Response* *Monthly total29 SNF 30 ICF 31 Hospice 32 RTF 33 ALP (assisted living program)34 Pharmacy* *Monthly total35 EmergTran* *Monthly total36 NonEmergTrans* *Monthly total37 Early Intervention 38 School Supportive Hlth 39 Child Care 40 Community Rehab* *Monthly total41 Case Management* *Monthly total42 Medicaid managed care43 Family Health Plus 44 School Based Health Center77 Other PCP/Spec/OBGYN Potentially ED related88 MMC Stoploss, unspecified94 Stays for observation99 Other Ambulatory Med/Surg Other outpatient claims not otherwise classified

12/20/2016

This is code book for variables used in analysis files with code values and descriptors for the variables2/7/2017

ADMIT_SRC_CD AID_CATGCode Value Code Description Code ValueCode Description1 PHYSICIAN REFERRAL 00 SYSTEM GENERATED FROM ENCOUNTER2 CLINIC REFERRAL 01 DEFAULT (FP)3 HMO REFERRAL 02 DEFAULT (FNP)4 TRANSFER FROM A HOSPITAL 09 09 PG-ADC (FP) (OBSOLETE AS OF 02/19/07)5 TRANSFER FROM A SKILLED NURSING FACILITY 10 FA-FAMILY ASSISTANCE (FP)6 TRANSFER FROM ANOTHER FACILITY 11 ADC-U (FP)7 EMERGENCY ROOM 12 IV-E AND NON IV-E (FP)8 COURT/LAW ENFORCEMENT 13 13 PG-ADC (FP) (OBSOLETE AS OF 02/19/07)9 INFORMATION NOT AVAILABLE 15 HOME RELIEF (FP)A TRANSFER FROM A CRITICAL ACCESS HOSPITAL 16 TANF WITH DEPRIVATION (FP)B TRANSFER FROM ANOTHER HOME HEALTH AGENCY 17 TANF WITHOUT DEPRIVATION (FP)C READMISSION FROM SAME HOME HEALTH AGENCY 18 SAFETY NET WITHOUT DEPRIVATION (FP)D TRANSFER FROM ONE HOSPITAL DISTRUCT TO ANOTHER 19 SAFETY NET NON-CASH (FP)E TRANSFER FROM AMBULATORY SURGICAL CENTER 20 SUPPLEMENTAL PAYMENT (NYC) (FNP) 100% LOCALF TRANSFER FROM HOSPICE 21 LIF WITHOUT DEPRIVATION - S/CC (FP)

23 MA - CHILD WELFARE (FP)24 MA-AGED (FP)25 MA-BLIND (FP)26 MA-DISABLED (FP)27 ADC MEDICALLY NEEDY (FP)28 PUBLIC HOME (FNP)30 PRESUMPTIVE ELIG FOR CHILDREN (FP)31 POVERTY LEVEL CHILD (FP)32 LIF RELATED WITH DEPRIVATION (FP)35 PRESUMPTIVE ELIG HOME CARE (FNP)36 RESERVED37 ALIEN ELIGIBILITY (FNP)38 ALIEN ELIGIBILITY (FP)39 FNP RELATED PARENT LIVING CHILD (FP)40 PUBLIC SHELTER - 100% LOCAL (FNP)41 PRESUMPTIVE ELIGIBILITY PRENATAL A (FP)42 PRESUMPTIVE ELIGIBILITY PRENATAL B (FP)43 PRENATAL CARE (FP)44 EXPANDED COVERAGE INFANT (200% FPL) (FP)45 CHILD 1-6 (133% FPL) (FP)47 CHILD WELFARE - 100% LOCAL (FNP)48 CHILD CONTINUOUS COVERAGE (FP)49 EXPANDED - CONTINUOUS COVERAGE (FP)50 SSI AGED (FP)51 SSI BLIND (FP)52 SSI DISABLED (FP)53 SSI - PENDING AGED (FP)54 SSI - PENDING BLIND (FP)55 SSI - PENDING DISABLED (FP)56 FAMILY PLANNING COVERAGE (FP)57 POVERTY LEVEL INFANT (FP)58 INFANT-CONTINUOUS COVERAGE (200% FPL) (FP)59 CAP/MA GUARANTEE (FNP) ST/LCL OBSOLETE ON 10/22/0760 SAFETY NET-AGED (FP)61 SAFETY NET-BLIND (FP)62 SAFETY NET-DISABLED (FP)63 SAFETY NET (FP)64 COLORECTAL AND PROSTATE TREATMENT PROGRAM66 EMERGENCY SHELTER (FP)67 SAFETY NET W/DEPRIVATION (FP)68 FHP SINGLES/CHILDLESS COUPLES69 FHP PARENTS/19-20 YEAR OLDS 150% FPL FP70 FHP PREGNANT WOMAN 100% FPL71 CHILD 6-19 (100-133% FPL) (FP)72 FHP PREGNANT WOMAN 200% FPL73 WORKING DISABLED BUY-IN FP74 BREAST AND CERVICAL CANCER TREATMENT PROGRAM (<65)75 BREAST AND CERVICAL CANCER TREATMENT PROGRAM (>64)76 LEGAL ALIENS (FNP)77 BREAST CANCER TREATMENT PROGRAM (MALE) (FNP)78 LIF/SN/TL - CASH79 LIF/SN/TL - NC80 DISASTER MEDICAID RELIEF (FP)81 CHILD CONTINUOUS COVERAGE82 MEDICAID BUY-IN-DISABLED BASIC GROUP83 MEDICAID BUY-IN-MEDICALLY IMPROVED84 FHP PARENTS/19-20 YEAR OLDS 150% FPL86 Medicaid children, ages 6-18 years, with income > 100% FPL but = 133% FPL87 FAMILY PLANNING EXTENSION PROG88 INPATIENT FNP89 INPATIENT FFP90 SINGLE/CHILDLESS COUPLES (FP)91 TANF/SN/LIF W/O DEPRIVATION AND SN-NC/SCC (FP)99 SYSTEM GENERATED FROM CLAIMB0 LESS THAN 100 FPL ALIESSA - WRAP SVS - COPAY EXMPTB1 100-138 FPL ALIESSA - WRAP SVS - LOW COST SHARINGB2 139-150 FPL AI-AN - 0 PREM - NO COST SHARINGB3 139-150 FPL - 0 PREM - LOW COST SHARINGB4 151-200 FPL AI-AN - 20 PREM - NO COST SHARINGB5 151-200 FPL - 20 PREM - HIGHER COST SHARINGH0 ADT GRP(19-64) SINGLE/CHILDLESS CPLES 100-133%(FP)H1 ADULT GROUP(19-64) <133% OR 19/20 133-150% (FP)H2 APTC PREMIUM PAYMENTS >133-150% (FNP)H3 CHILD HEALTH PLUS<19 UNDOCUMENTED (FNP)H4 CHILD HEALTH PLUS<19 (FEDERALLY PARTICIPATING)H5 UNDOCUMENTED PREGNANT WOMEN 0-200% (FNP)P1 LIF Without Deprivation (FP)P2 LIF Related with Deprivation (FP)P5 Safety Net without Deprivation (FP)P7 ADC Medically Needy (FP)P8 LIF/SN/TL – Cash (FP)P9 LIF/SN/TL – NC (FP)

clm_typ COUNTY_CD DateMoCode ValueCode Description Note: County fiscally responsible for patient 1 Jan-00A Denied encounter claim Code ValueCode Description 2 Feb-00B Encounter claim 00 SYSTEM GENERATED FROM CLAIM 3 Mar-00C Fee-For-Service claim 01 ALBANY 4 Apr-00E Capitated encounter claim 02 ALLEGANY 5 May-00

03 BROOME 6 Jun-0004 CATTARAUGUS 7 Jul-0005 CAYUGA 8 Aug-0006 CHAUTAUQUA 9 Sep-0007 CHEMUNG 10 Oct-0008 CHENANGO 11 Nov-0009 CLINTON 12 Dec-0010 COLUMBIA 13 Jan-0111 CORTLAND 14 Feb-0112 DELAWARE 15 Mar-0113 DUTCHESS 16 Apr-0114 ERIE 17 May-0115 ESSEX 18 Jun-0116 FRANKLIN 19 Jul-0117 FULTON 20 Aug-0118 GENESEE 21 Sep-0119 GREENE 22 Oct-0120 HAMILTON 23 Nov-0121 HERKIMER 24 Dec-0122 JEFFERSON 25 Jan-0223 LEWIS 26 Feb-0224 LIVINGSTON 27 Mar-0225 MADISON 28 Apr-0226 MONROE 29 May-0227 MONTGOMERY 30 Jun-0228 NASSAU 31 Jul-0229 NIAGARA 32 Aug-0230 ONEIDA 33 Sep-0231 ONONDAGA 34 Oct-0232 ONTARIO 35 Nov-0233 ORANGE 36 Dec-0234 ORLEANS 37 Jan-0335 OSWEGO 38 Feb-0336 OTSEGO 39 Mar-0337 PUTNAM 40 Apr-0338 RENSSELAER 41 May-0339 ROCKLAND 42 Jun-0340 ST LAWRENCE 43 Jul-0341 SARATOGA 44 Aug-0342 SCHENECTADY 45 Sep-0343 SCHOHARIE 46 Oct-0344 SCHUYLER 47 Nov-0345 SENECA 48 Dec-0346 STEUBEN 49 Jan-0447 SUFFOLK 50 Feb-0448 SULLIVAN 51 Mar-0449 TIOGA 52 Apr-0450 TOMPKINS 53 May-0451 ULSTER 54 Jun-0452 WARREN 55 Jul-0453 WASHINGTON 56 Aug-0454 WAYNE 57 Sep-0455 WESTCHESTER 58 Oct-0456 WYOMING 59 Nov-0457 YATES 60 Dec-0458 BRONX(NOT USED BY BRADFORD) 61 Jan-0559 KINGS(NOT USED BY BRADFORD) 62 Feb-0560 SENECA NATION OF INDIANS 63 Mar-0561 SHINNECOCK TRIBE 64 Apr-0562 TUSCARORA NATION 65 May-0563 TONAWANDA-SENEC TONAWANDA-SENECA NATION 66 Jun-0564 ONONDAGA NATION ONONDAGA NATION 67 Jul-0566 NEW YORK CITY 68 Aug-0567 NYS OFFICE OF MENTAL HEALTH 69 Sep-0568 NYS OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL 70 Oct-0569 NYS DEPT OF HEALTH(BRADFORD MARS USE) 71 Nov-0570 OTHER - (MARS DEFAULTED VALUE) 72 Dec-0571 OTHER-CLAIMS PROCESSING(BRADFORD) ( UPSTATE-MARS U 73 Jan-0672 STATEWIDE (BRADFORD MARS USE ONLY) 74 Feb-0678 NY HEALTH BENEFIT EXCHANGE 75 Mar-0697 NYS OFFICE OF MENTAL HEALTH 76 Apr-0698 NYS OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL 77 May-0699 NYS DEPT OF HEALTH 78 Jun-06

79 Jul-0680 Aug-0681 Sep-0682 Oct-0683 Nov-0684 Dec-0685 Jan-0786 Feb-0787 Mar-0788 Apr-0789 May-0790 Jun-0791 Jul-0792 Aug-0793 Sep-0794 Oct-0795 Nov-0796 Dec-0797 Jan-0898 Feb-08

99 Mar-08100 Apr-08101 May-08102 Jun-08103 Jul-08104 Aug-08105 Sep-08106 Oct-08107 Nov-08108 Dec-08109 Jan-09110 Feb-09111 Mar-09112 Apr-09113 May-09114 Jun-09115 Jul-09116 Aug-09117 Sep-09118 Oct-09119 Nov-09120 Dec-09121 Jan-10122 Feb-10123 Mar-10124 Apr-10125 May-10126 Jun-10127 Jul-10128 Aug-10129 Sep-10130 Oct-10131 Nov-10132 Dec-10133 Jan-11134 Feb-11135 Mar-11136 Apr-11137 May-11138 Jun-11139 Jul-11140 Aug-11141 Sep-11142 Oct-11143 Nov-11144 Dec-11145 Jan-12146 Feb-12147 Mar-12148 Apr-12149 May-12150 Jun-12151 Jul-12152 Aug-12153 Sep-12154 Oct-12155 Nov-12156 Dec-12157 Jan-13158 Feb-13159 Mar-13160 Apr-13161 May-13162 Jun-13163 Jul-13164 Aug-13165 Sep-13166 Oct-13167 Nov-13168 Dec-13169 Jan-14170 Feb-14171 Mar-14172 Apr-14173 May-14174 Jun-14175 Jul-14176 Aug-14177 Sep-14178 Oct-14179 Nov-14180 Dec-14181 Jan-15182 Feb-15183 Mar-15184 Apr-15185 May-15186 Jun-15187 Jul-15188 Aug-15189 Sep-15190 Oct-15191 Nov-15192 Dec-15193 Jan-16194 Feb-16195 Mar-16196 Apr-16197 May-16

198 Jun-16199 Jul-16200 Aug-16201 Sep-16202 Oct-16203 Nov-16204 Dec-16

MBF_DEATH_IND MBR_MCARE_CD Code ValueCode Description Code Value Code Description1 Member dead at service end date A MEDICARE A 0 Member alive at service end date B MEDICARE B missing Missing value C MEDICARE AB

D MEDICARE D E MEDICARE AD F MEDICARE BD G MEDICARE ABD H MEDICARE ABDQMB I MEDICARE ADQMB J MEDICARE BDQMB K MEDICARE DQMB Q MEDICARE ABQMB R MEDICARE AQMB S MEDICARE BQMB T MEDICARE QMB U MEDICARE PART A, B, ENRL IN C V MEDICARE PART A,B,D, ENRL IN C W MEDICARE PART A, B, ENRL IN C AND QMB X MEDICARE PART A, B, D, ENRL IN C AND QMB

mbr_ethnic_cd MBR_RACE_CD 6 characters based on individual ethnic variables Code Value Code DescriptionY = Yes, N= No, U=Unknown 0 UNKNOWN DUE TO TMA ELIG In following order: 1 CAUCASOID (WHITE)-NOT OF HISPANIC ORIGIN

white_ethnic_cd 2 NEGROID (BLACK)-NOT OF HISPANIC ORIGIN native_hi_or_opi_ethnic_cd 3 MONGOLOID (ASIAN)-OR PACIFIC ISLANDER hispanic_or_latino_ethnic_cd 4 AMERICAN INDIAN (NATIVE AMERICAN)-OR ALASKAN NATIVblk_or_af_amer_ethnic_cd 5 PUERTO RICAN - HISPANIC asian_ethnic_cd 9 OTHER amer_ind_or_ak_nat_ethnic_cd

See User Advisories for alternative approaches See User Advisories for alternative approaches

MBR_SEX_CD mcaid_covCode Value Code Description Code ValueCode Description0 SYSTEM GENERATED FROM MEMBER MOAS 00 SYSTEM GENERATED FROM CLAIMF FEMALE 01 ALL BENEFITS (A)M MALE 02 OUTPATIENT CARE ONLY (C)U UNKNOWN OR UNBORN 03 CATASTROPHICZ SYSTEM GENERATED FROM ENCOUNTER 04 NOT ELIGIBLE (N)

05 SANCTIONED (K)06 PROVISIONAL ELIGIBILITY (V)

CLAIM_SEX_CD 07 EMERGENCY SERVICES ONLY (E)1 MALE 08 PRESUMPTIVE ELIGIBILITY - HOME CARE (H)2 FEMALE 09 MEDICARE SAVINGS PROGRAM

10 ELIGIBLE EXCEPT NFS (B)11 LEGAL ALIEN - FULL COVERAGE13 PRESUMPTIVE ELIGIBILITY - PRENATAL A (I)14 PRESUMPTIVE ELIGIBILITY - PRENATAL B (J)15 PERINATAL CARE (L)16 HOME RELIEF (HR) (T)17 NO MA - HI HEALTH INSURANCE CONT ONLY18 FAMILY PLANNING SERVICES ONLY (F)19 COMMUNITY COV W COMMUNITY LTC20 COMMUNITY COV NO LTC21 OUTPATIENT WITH COMMUNITY LTC22 OUPTPATIENT WITH NO LTC23 OUTPATIENT NO NURSING FACILITY24 COMM COV NO LTC ALIEN 5YR BAN25 INPATIENT HOSPITAL ONLY - FNP26 INPATIENT HOSPITAL ONLY - FFP27 FAMILY PLANNING NO TRANSPORTATION30 CLIENT IS ELIG FOR MCAID AND ENROLLED IN A PCP (P)31 CLIENT IS ELIG FOR CAPITN GUARANTEE SERVS ONLY (G)32 HR CLIENT ENROLLED IN A PCP (Q)33 HR CLIENT ELIG FOR CAPITN GUARANTEE SERVS ONLY (R34 FAMILY HEALTH PLUS (U)36 FAMILY HEALTH PLUS GUARANTEE (W)

PAT_STATUS_CD DERIVED_PROC_SRC_CDCode Value Code Description Code ValueCode Description00 SYSTEM GENERATED FROM CLAIM I ICD01 DISCHARGE / TRANSFER TO HOME/SELF CARE H CPT/HCPCS02 TRANSFER TO A DRG HOSPITAL U Unknown03 DISCHARGE / TRANSFER TO SKILLED NURSING FACILITY04 DISCHARGE/TRANSFER TO INTER CARE FACILITY/HRF05 TRANSFERRED TO A CANCER CTR/CHILDREN HOSPITAL06 DISCHARGE TO HOME UNDER CARE OF HOME HEALTH ORG.07 LEFT AGAINST MEDICAL ADVICE08 DISCHARGED TO HOME IV THERAPY09 ADMITTED TO INPATIENT HOSPITAL1 SYSTEM GENERATED FROM CLAIM10 SAME DAY TRANSFER (OBSOLETE MAR-2005)11 SYSTEM GENERATED FROM CLAIM12 SYSTEM GENERATED FROM ENCOUNTER13 ON HOSPITAL LEAVE-BED RESERVED (RHCF-ONLY) (OBSOLETE MAR-2005)14 ON LEAVE OF ABSENCE-BAD RESERVED (RHCF-ONLY) (OBSOLETE MAR-2005)15 PATIENT HAS RETURNED TO THE RHCF W/IN 1 DAY OF THE DATE (OBSOLETE MAR-2005)16 AWOL - (CHILD CARE AGENCIES ONLY) (OBSOLETE MAR-2005)17 TRIAL DISCHARGE - (CHILD CARE AGENCIES ONLY) (OBSOLETE MAR-2005)18 ADMITTED ON "FROM DATE"/STILL A PATIENT ON "TO DATE" (OBSOLETE MAR-2005)19 SYSTEM GENERATED FROM ENCOUNTER2 SYSTEM GENERATED FROM CLAIM20 EXPIRED21 DISCHARGE/TRANSFER TO COURT/LAW ENFORCEMENT22 NEONATE TRANSFER FROM WEIGHT GAIN (OBSOLETE MAR-2005)23 SYSTEM GENERATED FROM ENCOUNTER24 SYSTEM GENERATED FROM ENCOUNTER25 SYSTEM GENERATED FROM ENCOUNTER26 SYSTEM GENERATED FROM ENCOUNTER27 SYSTEM GENERATED FROM ENCOUNTER28 SYSTEM GENERATED FROM ENCOUNTER29 SYSTEM GENERATED FROM ENCOUNTER30 STILL A PATIENT/RESIDENT31 SYSTEM GENERATED FROM CLAIM32 SYSTEM GENERATED FROM ENCOUNTER33 SYSTEM GENERATED FROM ENCOUNTER34 SYSTEM GENERATED FROM ENCOUNTER35 SYSTEM GENERATED FROM ENCOUNTER36 SYSTEM GENERATED FROM ENCOUNTER37 SYSTEM GENERATED FROM ENCOUNTER38 SYSTEM GENERATED FROM ENCOUNTER39 SYSTEM GENERATED FROM ENCOUNTER40 EXPIRED AT HOME41 EXPIRED AT MEDICAL FACILITY42 EXPIRED - PLACE UNKNOWN43 DISCHARGED TO FEDERAL HOSPITAL44 SYSTEM GENERATED FROM ENCOUNTER45 SYSTEM GENERATED FROM ENCOUNTER46 SYSTEM GENERATED FROM ENCOUNTER47 SYSTEM GENERATED FROM ENCOUNTER48 SYSTEM GENERATED FROM ENCOUNTER49 SYSTEM GENERATED FROM ENCOUNTER50 HOSPICE - HOME51 HOSPICE - MEDICAL FACILITY53 SYSTEM GENERATED FROM ENCOUNTER60 SYSTEM GENERATED FROM ENCOUNTER61 TRANSFER WITHIN FACILITY - MDCR SWING BED62 DISCHARGE/TRANSFER TO INPATIENT REHAB FACILITY63 DISCHARGE/TRANSFER TO MCARE LTC HOSPITAL64 DISCHARGE/TRANSFER TO SNF CERTIFIED UNDER MCAID65 DISCHAGE /TRANSFER TO PSYCHIATRIC HOSPITAL66 DISCHARGE TRANSFER TO CRITICAL ACCESS HOSPITAL67 SYSTEM GENERATED FROM ENCOUNTER68 SYSTEM GENERATED FROM ENCOUNTER69 DESIGNATED DISASTER ALTERNATIVE CARE SITE70 DISCHARGE/TRANSFER TO ANOTHER HEALTH CARE INST71 SYSTEM GENERATED FROM CLAIM72 SYSTEM GENERATED FROM ENCOUNTER73 SYSTEM GENERATED FROM ENCOUNTER74 SYSTEM GENERATED FROM ENCOUNTER76 SYSTEM GENERATED FROM ENCOUNTER77 SYSTEM GENERATED FROM ENCOUNTER79 SYSTEM GENERATED FROM ENCOUNTER80 SYSTEM GENERATED FROM ENCOUNTER81 HOME-SELF CARE WITH PLANNED READMISSION82 SHORT TERM HOSPITAL WITH PLANNED READMISSION83 SNF WITH PLANNED READMISSION84 CUST/SUPP CARE WITH PLANNED READMISSION85 CANCER/CHILD HOSP WITH PLANNED READMISSION86 HOME HEALTH SERVICE WITH PLANNED READMISSION87 COURT/LAW ENFORCEMENT WITH PLANNED READMISSION88 FEDERAL HOSPITAL WITH PLANNED READMISSION89 SWING BED WITH PLANNED READMISSION9 SYSTEM GENERATED FROM CLAIM90 REHAB FACILITY/UNIT WITH PLANNED READMISSION91 LTCH WITH PLANNED READMISSION92 NURSING FACILITY MCR-CERTIFIED W PLANNED READMIT93 PSYCHIATRIC HOSPITAL/UNIT W PLANNED READMISSION94 CRITICAL ACCESS HOSPITAL WITH PLANNED READMISSION95 OTHER INSTITUTION WITH PLANNED READMISSION98 SYSTEM GENERATED FROM ENCOUNTER99 SYSTEM GENERATED FROM ENCOUNTERX0 SYSTEM GENERATED FROM CLAIMXX SYSTEM GENERATED FROM CLAIM

RATE_CDCode Value Code DescriptionRATE_CD RATE_DESC0000 SYSTEM GENERATED FROM MEMBER PA0002 SYSTEM GENERATED FROM MEMBER PA0003 SYSTEM GENERATED FROM MEMBER PA0029 SYSTEM GENERATED FROM CLAIM0033 SYSTEM GENERATED FROM MEMBER PA0042 SYSTEM GENERATED FROM MEMBER PA0043 SYSTEM GENERATED FROM CLAIM0054 SYSTEM GENERATED FROM MEMBER PA0055 SYSTEM GENERATED FROM MEMBER PA0066 SYSTEM GENERATED FROM MEMBER PA0072 SYSTEM GENERATED FROM MEMBER PA0073 SYSTEM GENERATED FROM MEMBER PA0080 SYSTEM GENERATED FROM MEMBER PA0088 SYSTEM GENERATED FROM MEMBER PA0089 SYSTEM GENERATED FROM MEMBER PA0091 SYSTEM GENERATED FROM MEMBER PA0095 SYSTEM GENERATED FROM MEMBER PA0097 SYSTEM GENERATED FROM MEMBER PA0099 SYSTEM GENERATED FROM MEMBER PA0100 SYSTEM GENERATED FROM CLAIM0101 SYSTEM GENERATED FROM MEMBER PA0105 SYSTEM GENERATED FROM MEMBER PA0106 SYSTEM GENERATED FROM MEMBER PA0115 SYSTEM GENERATED FROM MEMBER PA0116 SYSTEM GENERATED FROM MEMBER PA0121 SYSTEM GENERATED FROM MEMBER PA0129 SYSTEM GENERATED FROM MEMBER PA0134 SYSTEM GENERATED FROM MEMBER PA0137 SYSTEM GENERATED FROM MEMBER PA0141 SYSTEM GENERATED FROM MEMBER PA0142 SYSTEM GENERATED FROM CLAIM0147 SYSTEM GENERATED FROM MEMBER PA0156 SYSTEM GENERATED FROM MEMBER PA0158 SYSTEM GENERATED FROM MEMBER PA0170 SYSTEM GENERATED FROM MEMBER PA0173 SYSTEM GENERATED FROM MEMBER PA0174 SYSTEM GENERATED FROM MEMBER PA0175 SYSTEM GENERATED FROM MEMBER PA0177 SYSTEM GENERATED FROM MEMBER PA0188 SYSTEM GENERATED FROM MEMBER PA0190 SYSTEM GENERATED FROM MEMBER PA0194 SYSTEM GENERATED FROM MEMBER PA0199 SYSTEM GENERATED FROM MEMBER PA0200 SYSTEM GENERATED FROM MEMBER PA0201 SYSTEM GENERATED FROM MEMBER PA0208 SYSTEM GENERATED FROM MEMBER PA0220 SYSTEM GENERATED FROM CLAIM0222 SYSTEM GENERATED FROM MEMBER PA0226 SYSTEM GENERATED FROM MEMBER PA0233 SYSTEM GENERATED FROM MEMBER PA0240 SYSTEM GENERATED FROM MEMBER PA0242 SYSTEM GENERATED FROM MEMBER PA0251 SYSTEM GENERATED FROM MEMBER PA0259 SYSTEM GENERATED FROM MEMBER PA0260 SYSTEM GENERATED FROM MEMBER PA0262 SYSTEM GENERATED FROM MEMBER PA0264 SYSTEM GENERATED FROM MEMBER PA0265 SYSTEM GENERATED FROM MEMBER PA0266 SYSTEM GENERATED FROM MEMBER PA0267 SYSTEM GENERATED FROM MEMBER PA0268 SYSTEM GENERATED FROM MEMBER PA0274 SYSTEM GENERATED FROM MEMBER PA0284 SYSTEM GENERATED FROM MEMBER PA0287 SYSTEM GENERATED FROM MEMBER PA0300 SYSTEM GENERATED FROM CLAIM0317 SYSTEM GENERATED FROM MEMBER PA0330 SYSTEM GENERATED FROM MEMBER PA0332 SYSTEM GENERATED FROM MEMBER PA0352 SYSTEM GENERATED FROM MEMBER PA0400 SYSTEM GENERATED FROM CLAIM0401 SYSTEM GENERATED FROM MEMBER PA0403 SYSTEM GENERATED FROM MEMBER PA0422 SYSTEM GENERATED FROM MEMBER PA0502 SYSTEM GENERATED FROM MEMBER PA0508 SYSTEM GENERATED FROM MEMBER PA0513 SYSTEM GENERATED FROM MEMBER PA0514 SYSTEM GENERATED FROM MEMBER PA0595 SYSTEM GENERATED FROM MEMBER PA0601 SYSTEM GENERATED FROM MEMBER PA0622 SYSTEM GENERATED FROM MEMBER PA0742 SYSTEM GENERATED FROM MEMBER PA0787 SYSTEM GENERATED FROM MEMBER PA0806 SYSTEM GENERATED FROM MEMBER PA0811 SYSTEM GENERATED FROM MEMBER PA0900 SYSTEM GENERATED FROM CLAIM0905 SYSTEM GENERATED FROM MEMBER PA0907 SYSTEM GENERATED FROM MEMBER PA0992 SYSTEM GENERATED FROM CLAIM1000 RESERVED/FUTURE PROGRAMS1001 RESERVED/FUTURE PROGRAMS1002 RESERVED/FUTURE PROGRAMS1003 RESERVED/FUTURE PROGRAMS1004 RESERVED/FUTURE PROGRAMS1005 RESERVED/FUTURE PROGRAMS1006 RESERVED/FUTURE PROGRAMS1007 RESERVED/FUTURE PROGRAMS

1008 RESERVED/FUTURE PROGRAMS1009 RESERVED/FUTURE PROGRAMS1010 RESERVED/FUTURE PROGRAMS1011 RESERVED/FUTURE PROGRAMS1012 RESERVED/FUTURE PROGRAMS1013 RESERVED/FUTURE PROGRAMS1014 RESERVED/FUTURE PROGRAMS1015 RESERVED/FUTURE PROGRAMS1016 RESERVED/FUTURE PROGRAMS1017 RESERVED/FUTURE PROGRAMS1018 RESERVED/FUTURE PROGRAMS1019 RESERVED/FUTURE PROGRAMS1020 RESERVED/FUTURE PROGRAMS1021 RESERVED/FUTURE PROGRAMS1022 RESERVED/FUTURE PROGRAMS1023 RESERVED/FUTURE PROGRAMS1024 RESERVED/FUTURE PROGRAMS1025 RESERVED/FUTURE PROGRAMS1026 RESERVED/FUTURE PROGRAMS1027 RESERVED/FUTURE PROGRAMS1028 RESERVED/FUTURE PROGRAMS1029 RESERVED/FUTURE PROGRAMS1030 RESERVED/FUTURE PROGRAMS1031 RESERVED/FUTURE PROGRAMS1032 RESERVED/FUTURE PROGRAMS1033 RESERVED/FUTURE PROGRAMS1034 RESERVED/FUTURE PROGRAMS1035 RESERVED/FUTURE PROGRAMS1036 RESERVED/FUTURE PROGRAMS1037 RESERVED/FUTURE PROGRAMS1038 RESERVED/FUTURE PROGRAMS1039 RESERVED/FUTURE PROGRAMS1040 RESERVED/FUTURE PROGRAMS1041 RESERVED/FUTURE PROGRAMS1042 RESERVED/FUTURE PROGRAMS1043 RESERVED/FUTURE PROGRAMS1044 RESERVED/FUTURE PROGRAMS1045 RESERVED/FUTURE PROGRAMS1046 RESERVED/FUTURE PROGRAMS1047 RESERVED/FUTURE PROGRAMS1048 RESERVED/FUTURE PROGRAMS1049 RESERVED/FUTURE PROGRAMS1050 RESERVED/FUTURE PROGRAMS1051 RESERVED/FUTURE PROGRAMS1052 RESERVED/FUTURE PROGRAMS1053 RESERVED/FUTURE PROGRAMS1054 MA CVRD NON-CARE CVRD SRVC FOR DUAL-OPD-APGMRDDTBI1055 MA CVRD NON-CARE CVRD SRVC FOR DUAL-OPD-BNDMRDDTBI1056 MA CVRD NON-CARE CVRD SRVC FOR DUAL-OPD-CAPMRDDTBI1057 MA CVRD NON-CARE CVRD SRVC FOR DUAL-DTC-APGMRDDTBI1058 MA CVRD NON-CARE CVRD SRVC FOR DUAL-DTC-BNDMRDDTBI1059 MA CVRD NON-CARE CVRD SRVC FOR DUAL-DTC-CAPMRDDTBI1060 RESERVED/FUTURE PROGRAMS1061 RESERVED/FUTURE PROGRAMS1062 RESERVED/FUTURE PROGRAMS1063 RESERVED/FUTURE PROGRAMS1064 RESERVED/FUTURE PROGRAMS1065 RESERVED/FUTURE PROGRAMS1066 RESERVED/FUTURE PROGRAMS1067 RESERVED/FUTURE PROGRAMS1068 RESERVED/FUTURE PROGRAMS1069 RESERVED/FUTURE PROGRAMS1070 RESERVED/FUTURE PROGRAMS1071 RESERVED/FUTURE PROGRAMS1072 RESERVED/FUTURE PROGRAMS1073 RESERVED/FUTURE PROGRAMS1074 RESERVED/FUTURE PROGRAMS1075 RESERVED/FUTURE PROGRAMS1076 RESERVED/FUTURE PROGRAMS1077 RESERVED/FUTURE PROGRAMS1078 RESERVED/FUTURE PROGRAMS1079 RESERVED/FUTURE PROGRAMS1080 RESERVED/FUTURE PROGRAMS1081 RESERVED/FUTURE PROGRAMS1082 RESERVED/FUTURE PROGRAMS1083 RESERVED/FUTURE PROGRAMS1084 RESERVED/FUTURE PROGRAMS1085 RESERVED/FUTURE PROGRAMS1086 RESERVED/FUTURE PROGRAMS1087 RESERVED/FUTURE PROGRAMS1088 RESERVED/FUTURE PROGRAMS1089 RESERVED/FUTURE PROGRAMS1090 RESERVED/FUTURE PROGRAMS1091 RESERVED/FUTURE PROGRAMS1092 RESERVED/FUTURE PROGRAMS1093 RESERVED/FUTURE PROGRAMS1094 RESERVED/FUTURE PROGRAMS1095 RESERVED/FUTURE PROGRAMS1096 RESERVED/FUTURE PROGRAMS1097 RESERVED/FUTURE PROGRAMS1098 RESERVED/FUTURE PROGRAMS1099 RESERVED/FUTURE PROGRAMS1100 RESERVED/FUTURE PROGRAMS1101 RESERVED/FUTURE PROGRAMS1102 DOH DTC APG ART 28 INTEGRATED SVC (DSRIP)1103 DOH DTC APG ART 28 INTEG SVC - CAPITAL (DSRIP)1104 DOH OPD APG ART 28 INTEGRATED SVC (DSRIP)1105 DOH OPD APG ART 28 INTEG SVC - CAPITAL (DSRIP)1106 OMH DTC APG ART 31 INTEGRATED SVC (DSRIP)

1107 OMH DTC APG ART 31 INTEG SVC - CAPITAL (DSRIP)1108 OMH DTC APG ART 31 INTEGRATED SVC SED (DSRIP)1109 OMH DTC APG ART 31 INTEG SVC SED - CAPITAL (DSRIP)1110 OMH OPD APG ART 31 INTEGRATED SVC (DSRIP)1111 OMH OPD APG ART 31 INTEG SVC - CAPITAL (DSRIP)1112 OMH OPD APG ART 31 INTEGRATED SVC SED (DSRIP)1113 OMH OPD APG ART 31 INTEG SVC SED - CAPITAL (DSRIP)1114 OASAS DTC APG ART 32 INTEGRATED SVC (DSRIP)1115 OASAS DTC APG ART 32 INTEG SVC - CAPITAL (DSRIP)1116 OASAS DTC APG MMTP INTEGRATED SVC (DSRIP)1117 OASAS DTC APG MMTP INTEG SVC - CAPITAL (DSRIP)1118 OASAS OPD APG ART 32 INTEGRATED SVC (DSRIP)1119 OASAS OPD APG ART 32 INTEG SVC - CAPITAL (DSRIP)1120 OASAS OPD APG MMTP INTEGRATED SVC (DSRIP)1121 OASAS OPD APG MMTP INTEG SVC - CAPITAL (DSRIP)1122 OMH OPD APG ART 31 INTEGR OUTPT SVC (IOS)1123 OMH OPD APG ART 31 INTEGR OUTPT SVC - CAP (IOS)1124 OMH OPD APG ART 31 INTEGR OUTPT SVC SED (IOS)1125 OMH OPD APG ART 31 INTEGR OUTPT SVC SED -CAP (IOS)1126 MA CVRD NON-MEDICARE CVRD SRVCS FOR DUALS-OPD-APG1127 NON-MEDICARE CVRD DUALS-OPD-CAP ADD-ON(NOT IN USE)1128 MA CVRD NON-MEDICARE CVRD SRVCS FOR DUALS-DTC-APG1129 NON-MEDICARE CVRD DUALS-DTC-CAP ADD-ON(NOT IN USE)1130 OASAS DTC APG MMTP INTEGR OUTPT SVC (IOS)1131 OASAS DTC APG MMTP INTEGR OUTPT SVC - CAP (IOS)1132 OASAS OPD APG ART 32 INTEGR OUTPT SVC (IOS)1133 OASAS OPD APG ART 32 INTEGR OUTPT SVC - CAP (IOS)1134 OASAS OPD APG MMTP INTEGR OUTPT SVC (IOS)1135 OASAS OPD APG MMTP INTEGR OUTPT SVC - CAP (IOS)1136 OMH - DTC ARTICLE 31 CLINIC (UT EXEMPT) APG1137 OMH - DTC ART 31 CLINIC (UT EXEMPT)-CAP ADD-ON1138 OMH - DTC ARTICLE 31 CLINIC (SED) (UT EXEMPT) APG1139 OMH-DTC ART 31 CLINIC (SED) (UT EXEMPT)-CAP ADD-ON1140 OMH - HOSP ARTICLE 31 CLINIC (UT EXEMPT) APG1141 OMH - HOSP ART 31 CLINIC (UT EXEMPT)-CAP ADD-ON1142 OMH - HOSP ARTICLE 31 CLINIC (SED) (UT EXEMPT) APG1143 OMH-HOSP ART 31 CLINIC (SED)(UT EXEMPT)-CAP ADD-ON1144 SUD RES STABILIZATION TX SRVS EXCLUDES ROOM/BOARD1145 SUD RES REHABILITATION TX SRVS EXCLUDES ROOM/BOARD1146 SUD RES REINTEGRATION TX SRVS EXCLUDES ROOM/BOARD1200 HOPD ORDERED AM (INSTITUTIONAL CLAIM XOVER)1210 CHILD CARE GENERAL CARE CONGREGATE1211 CHILD CARE AGENCIES, CRITICAL CARE1212 RESIDENTIAL TREATMENT FACILITY1213 CHILD CARE - AIDS1214 CHILD CARE BOARDER BABY1215 CHILD CARE MATERNITY1216 CHILD CARE HARD-TO-PLACE1217 CHILD CARE THERAPEUTIC BOARDING HOME1218 CHILD CARE DIAGNOSTIC1219 CHILD CARE SPECIAL OTHER 011220 CHILD CARE GENERAL CARE FBH1221 CHILD CARE SPECIAL OTHER 031222 RTF EDUCATION 10-MONTH FOSTER CARE1223 RTF EDUCATION 12-MONTH FOSTER CARE1224 RTF EDUCATION 10-MONTH NON-FOSTER CARE1225 RTF EDUCATION 12-MONTH NON-FOSTER CARE1226 FITTING OF SPECTACLES; MONOFOCAL; BIFOCAL; MULTIFO1227 FITTING OF SPECTACLES PLUS EYEGLASS MATERIAL (FRAM1228 COMPREHENSIVE WHEELCHAIR EVALUATION AND MANAGEMEN1229 HIV-NEGATIVE TANF ADULT (HIVSNP)1230 HIV-NEGATIVE TANF CHILD (HIVSNP)1231 HIV-NEGATIVE SSI CORE (HIVSNP)1232 HIV-NEGATIVE SSI ADULT1300 HCI FULL MO RATE - SED1301 HCI 1ST MO TRANS RATE - SED1302 HCI 1ST HALF MO RATE - SED1303 HCI 2ND HALF MO RATE - SED1304 HCI 1/2 MO INP HOS RT - SED1305 HCI FULL MO INP HOS RT - SED1306 FCSS IND RATE - SED1307 FCSS GROUP RATE - SED1308 SKILL BLD IND RATE - SED1309 SKILL BLD GROUP RATE - SED1310 DAY HAB IND RATE - SED1311 DAY HAB GROUP RATE - SED1312 SNCAS IND RATE - SED1313 SNCAS GROUP RATE - SED1314 PROV SRV IND RATE - SED1315 PVOC SRV GROUP RATE - SED1316 SUPPORT EMP IND RATE - SED1317 RESP SER LESS FULL DAY - SED1318 RESP SER FULL DAY - SED1319 CAMT IND RATE - SED1320 CAMT GROUP RATE - SED1321 ICRS IND RATE - SED1322 IHSS IND RATE - SED1323 CRIS RESP LESS FULL DA - SED1324 CRISIS RESP FULL DAY - SED1325 ADP ASSIS EQUIP RATE - SED1326 ACCESS MODIFY RATE - SED1327 HCI FULL MO RATE - DD1328 HCI 1ST MO TRANS RATE - DD1329 HCI 1ST HALF MO RATE - DD1330 HCI 2ND HALF MO RATE - DD1331 HCI 1/2 MO INP HOS RT - DD1332 HCI FULL MO INP HOS RT - DD1333 FCSS IND RATE - DD1334 FCSS GROUP RATE - DD

1335 SKILL BLD IND RATE - DD1336 SKILL BLD GROUP RATE - DD1337 DAY HAB IND RATE - DD1338 DAY HAB GROUP RATE - DD1339 SNCAS IND RATE - DD1340 SNCAS GROUP RATE - DD1341 PVOC SRV IND RATE - DD1342 PVOC SRV GROUP RATE - DD1343 SUPPORT EMP IND RATE - DD1344 RESP SER LESS FULL DAY - DD1345 RESP SER FULL DAY - DD1346 CAMT IND RATE - DD1347 CAMT GROUP RATE - DD1348 ICRS IND RATE - DD1349 IHSS IND RATE - DD1350 CRIS RESP LESS FULL DA - DD1351 CRISIS RESP FULL DAY - DD1352 ADP ASSIS EQUIP RATE - DD1353 ACCESS MODIFY RATE - DD1354 HCI FULL MO RATE - MED F1355 HCI 1ST MO TRANS RATE - MED F1356 HCI 1ST HALF MO RATE - MED F1357 HCI 2ND HALF MO RATE - MED F1358 HCI 1/2/ MO INP HOS RT - MED F1359 HCI FULL MO IN HOS RT - MED F1360 FCSS IND RATE - MED F1361 FCSS GROUP RATE - MED F1362 SKIL BLD IND RATE - MED F1363 SKILL BLD GROUP RATE - MED F1364 DAY HAB IND RATE - MED F1365 DAY HAB GROUP RATE - MED F1366 SNCAS IND RATE - MED F1367 SNCAS GROUP RATE - MED F1368 PVOC SRV IND RATE - MED F1369 PVOC SRV GROUP RATE - MED F1370 SUPPORT EMP IND RATE - MED F1371 RESP SER LESS FULL DAY - MED F1372 RESP SER FULL DAY - MED F1373 CAMT IND RATE - MED F1374 CAMT GROUP RATE - MED F1375 ICRS IND RATE - MED F1376 IHSS IND RATE - MED F1377 CRIS RESP LESS FULL DA - MED F1378 CRISIS RESP FULL DAY - MED F1379 ADP ASSIS EQUIP RATE - MED F1380 ACCESS MODIFY RATE - MED F1381 SBHC FLU SEASONAL VACCINES - ADMINISTRATION ONLY1382 SBHC FLU H1N1 VACCINE - ADMINISTRATION ONLY1383 SBHC PNEUMO, VACCINES - ADMINISTRATION ONLY1384 HEALTH & BEHAV ASSESS/INTERVENTION-INDIV-15 MIN1385 HEALTH & BEHAV ASSESS/INTERVENTION-GROUP-15 MIN1386 HEALTH HOME SERVICES1387 HEALTH HOME SERVICES - OUTREACH1397 LARC ON SAME DAY AS ABORTION - DTC1398 LARC ON SAME DAY AS ABORTION - OPD1399 LARC INSERTION - SAME DOS AS ABORTION14 SYSTEM GENERATED FROM ENCOUNTER140 SYSTEM GENERATED FROM ENCOUNTER1400 HOSPITAL OUTPATIENT APG1401 HOSPITAL AMBULATORY SURGERY APG1402 HOSPITAL EMERGENCY ROOM APG1403 HOSPITAL OUTPATIENT APG - CAPTIAL ADD-ON1404 HOSPITAL AMBULATORY SURGERY APG - CAPTIAL ADD-ON1405 HOSPITAL EMERGENCY ROOM APG - CAPITAL ADD-ON1406 HOSPITAL OUTPATIENT APG - EXISTING RATE FOR BLEND1407 D & T CLINIC APG1408 D & T AMBULATORY SURGERY APG1409 D & T CLINIC APG - CAPITAL ADD-ON1410 D & T AMBULATORY SURGERY APG - CAPITAL ADD-ON1411 D & T CLINIC APG - EXISTING RATE FOR BLEND1412 D & T AMBULATORY SURGERY APG - EXIST RATE BLEND1413 HOSPITAL OP APG OUT OF STATE1414 HOSPITAL OP APG OUT OF STATE - EXISTING RATE BLEND1415 HOSPITAL OP APG OUT OF STATE - CAPITAL ADD-ON1416 HOSPITAL AMB SURG APG OUT OF STATE1417 RESERVED FOR FUTURE USE1418 HOSPITAL AMB SURG APG OUT OF STATE - CAPITAL ADD1419 HOSPITAL ER APG OUT OF STATE1420 RESERVED FOR FUTURE USE1421 HOSPITAL ER APG OUT OF STATE - CAPITAL ADD-ON1422 DTC GENERAL CLINIC- APG EPISODE BASE RATE1423 DTC GENERAL CLINIC- APG EPISODE BLEND PAYMENT1424 DTC GENERAL CLINIC- APG EPISODE CAPITAL ADD-ON1425 DTC CLINIC MR/DD/TBI - APG EPISODE BASE RATE1426 DTC CLINIC MR/DD/TBI - APG EPISODE BLEND PAYMENT1427 DTC CLINIC MR/DD/TBI - APG EPISODE CAPITAL ADD-ON1428 D&T CLINIC APG - DENTAL CLINIC1429 RESERVED FOR FUTURE USE1430 D&T CLINIC APG - EXIST RATE BLEND - DENTAL CLINIC1431 D&T CLINIC APG - CAPITAL ADD-ON - DENTAL CLINIC1432 HOSPITAL CLINIC - APG EPISODE BASE RATE1433 HOSPITAL CLINIC - APG EPISODE BLEND PAYMENT1434 HOSPITAL CLINIC - APG EPISODE CAPITAL ADD-ON1435 D&T CLINIC APG - GEN CLINIC (MR/DD/TBI PATIENT)1436 D&T CLIN APG - EXIST BLND - GEN CL (MR/DD/TBI PAT)1437 D&T CLINIC APG - CAP ADD-ON - GEN CLIN (MR/DD/TBI)1438 D&T CLINIC APG - RENAL CLINIC1439 D&T CLINIC APG - EXIST RATE BLEND - RENAL CLINIC1440 D&T CLINIC APG - CAPITAL ADD-ON - RENAL CLINIC

1441 HOSPITAL OUT OF STATE CLINIC - EPISODE PAYMENT1442 HOSPITAL OUT OF STATE CLINIC - EPISODE EXISTG RATE1443 HOSPITAL OUT OF STATE CLINIC - EPISODE CAPL ADD-ON1444 HOSPITAL OUTPATIENT APG - SCHOOL BASED HEALTH PRO1445 HOSPITAL OUTPATIENT APG - EXISTING RATE FOR BLEND1446 HOSPITAL OUTPATIENT APG - CAPITAL ADD-ON -SCHOOL1447 D & T CLINIC APG - SCHOOL BASED HEALTH PROJECT1448 D & T CLINIC APG - EXISTING RATE FOR BLEND - SCHO1449 D & T CLINIC - APG CAPITAL ADD-ON - SCHOOL BASED H1450 HOSPITAL APG - SCHOOL BASED HEALTH CLINIC(EPISODE)1451 HOSPITAL APG - SBHC BLEND AMOUNT (EPISODE)1452 HOSPITAL APG - SBHC CAPITAL ADD-ON (EPISODE)1453 D&T CLINIC APG - SCHOOL BASED HEALTH (EPISODE)1454 D&T CLINIC APG - SBHC BLEND AMOUNT (EPISODE)1455 D&T CLINIC APG - SBHC CAPITAL ADD-ON (EPISODE)1456 D&T CLINIC APG - RENAL (EPISODE)1457 D&T CLINIC APG - RENAL BLEND AMOUNT (EPISODE)1458 D&T CLINIC APG - RENAL CAPITAL ADD-ON (EPISODE)1459 D&T CLINIC APG - DENTAL (EPISODE)1460 D&T CLINIC APG - DENTAL BLEND AMOUNT (EPISODE)1461 D&T CLINIC APG -DENTAL CAPITAL ADD-ON (EPISODE)1462 RESERVED/FUTURE PROGRAMS1463 RESERVED/FUTURE PROGRAMS1464 RESERVED/FUTURE PROGRAMS1465 RESERVED FOR FUTURE USE APG1466 RESERVED FOR FUTURE USE APG1467 RESERVED FOR FUTURE USE APG1468 OASAS - ARTICLE 32 MEDICAL VISIT1469 RESERVED FOR FUTURE USE APG1470 OASAS - ART 32 APG MEDICAL VISIT CAPITAL ADD-ON1471 OASAS - MMTP MEDICAL VISIT1472 RESERVED FOR FUTURE USE APG1473 OASAS - MMTP APG MEDICAL VISIT CAPITAL ADD-ON1474 OMH - ARTICLE 31 MEDICAL VISIT A1475 RESERVED FOR FUTURE USE APG1476 OMH - ART 31 APG MEDICAL VISIT A CAPITAL ADD-ON1477 OMH - ARTICLE 31 MEDICAL VISIT A (SED)1478 RESERVED FOR FUTURE USE APG1479 OMH - ART 31 APG MED VISIT A (SED) CAPITAL ADD-ON1480 OMH DTC APG ART 31 INTEGR OUTPT SVC (IOS)1481 RESERVED FOR FUTURE USE APG1482 OMH DTC APG ART 31 INTEGR OUTPT SVC - CAP (IOS)1483 OMH DTC APG ART 31 INTEGR OUTPT SVC SED (IOS)1484 RESERVED FOR FUTURE USE APG1485 OMH DTC APG ART 31 INTEGR OUTPT SVC SED -CAP (IOS)1486 OASAS DTC APG ART 32 INTEGR OUTPT SVC (IOS)1487 RESERVED FOR FUTURE USE APG1488 OASAS DTC APG ART 32 INTEGR OUTPT SVC - CAP (IOS)1489 HOSPITAL OP APG - MR/DD/TBI PATIENT (EPISODE)1490 HOSPITAL OP APG BLEND PAYMENT - MR/DD/TBI (EPISD)1491 HOSPITAL OP APG CAPITAL ADD-ON - MR/DD/TBI (EPISD)1492 RESERVED/FUTURE PROGRAMS1493 RESERVED/FUTURE PROGRAMS1494 RESERVED/FUTURE PROGRAMS1495 APG GEN CLINIC MR/DD/TBI-EPISODE PYMT (EDIT EXMPT)1496 APG GEN CLIN MR/DD/TBI-EPSODE PYMNT-EDIT EXMPT-BND1497 APG GEN CLIN MR/DD/TBI-EPSODE PYMNT-EDIT EXMPT-CAP1498 APG GEN CLINIC MR/DD/TBI (EDIT EXEMPT)1499 APG GEN CLINIC MR/DD/TBI (EDIT EXEMPT)-BLEND AMT1500 APG GEN CLINIC MR/DD/TBI (EDIT EXEMPT)-CAP ADD-ON1501 HOSPITAL OPD APG - MR/DD/TBI PATIENT (VISIT BASED)1502 HOSPITAL OPD APG BLEND PAYMENT-MR/DD/TBI (VISIT)1503 HOSPITAL OPD APG CAPITAL ADD-ON-MR/DD/TBI (VISIT)1504 OMH APG - FREE-STANDING ARTICLE 31 CLINIC1505 OMH APG - FREE-STANDING ARTICLE 31 CLINIC - BLEND1506 OMH APG - FREE-STANDING ARTICLE 31 CLINIC- CAPITAL1507 OMH APG - FS ARTICLE 31 CLINIC - OFF-SITE1508 OMH APG - FS ARTICLE 31 CLINIC - OFF-SITE - BLEND1509 OMH APG - FS ARTICLE 31 CLINIC - OFF-SITE -CAPITAL1510 OMH APG - FREE-STANDING ARTICLE 31 CLINIC (SED)1511 OMH APG - FS ARTICLE 31 CLINIC (SED)-BLEND PAYMENT1512 OMH APG - FS ARTICLE 31 CLINIC (SED)-CAPITAL ADDON1513 OMH APG - FS ARTICLE 31 CLINIC - OFF-SITE (SED)1514 OMH APG -FS ARTICLE 31 CLINIC -OFF-SITE(SED) BLEND1515 OMH APG-FS ARTICLE 31 CLINIC -OFFSITE(SED) CAPITAL1516 OMH - HOSPITAL ARTICLE 31 CLINIC1517 OMH APG -HOSPITAL ARTICLE 31 CLINIC -BLEND PAYMENT1518 OMH APG -HOSPITAL ARTICLE 31 CLINIC -CAPITAL ADDON1519 OMH - HOSPITAL ARTICLE 31 CLINIC - OFF-SITE1520 OMH APG -HOSPITAL ARTICLE 31 CLINIC -OFFSITE BLEND1521 OMH APG-HOSPITAL ARTICLE 31 CLINIC-OFFSITE-CAPITAL1522 OMH - HOSPITAL ARTICLE 31 CLINIC (SED)1523 OMH APG - HOSPITAL ARTICLE 31 CLINIC (SED) - BLEND1524 OMH APG - HOSPITAL ARTICLE 31 CLINIC(SED) -CAPITAL1525 OMH - HOSPITAL ARTICLE 31 CLINIC -OFF-SITE(SED)1526 OMH -HOSP ARTICLE 31 CLINIC - OFF-SITE (SED)-BLEND1527 OMH -HOSP ARTICLE 31 CLINIC -OFFSITE (SED)-CAPITAL1528 OASAS - HOSPITAL ARTICLE 32 CLINIC1529 OASAS - HOSPITAL ARTICLE 32 CLINIC-BLEND AMT1530 OASAS - HOSPITAL ARTICLE 32 CLINIC-CAP ADD-ON1531 OASAS - HOSPITAL MMTP1532 OASAS - HOSPITAL MMTP-BLEND AMT1533 OASAS - HOSPITAL MMTP-CAPITAL ADD-ON1534 OPWDD APG - HOSPITAL ARTICLE 16 CLINIC1535 OPWDD APG - HOSPITAL ARTICLE 16 CLINIC-BLEND AMT1536 OPWDD APG - HOSPITAL ART 16 CLINIC-CAPITAL ADD-ON1537 OPWDD APG - HOSPITAL ARTICLE 16 CLINIC - OFF-SITE1538 OPWDD APG - HOSP ART 16 CLINIC -OFF-SITE-BLND AMT1539 OPWDD APG - HOSP ART 16 CLINIC-OFF-SITE-CAP ADD-ON

154 SYSTEM GENERATED FROM ENCOUNTER1540 OASAS - FREE-STANDING ARTICLE 32 CLINIC1541 OASAS - FREE-STANDING ART 32 CLINIC-BLEND AMT1542 OASAS - FREE-STANDING ART 32 CLINIC-CAP ADD-ON1543 OASAS - FREE-STANDING MMTP1544 OASAS - FREE-STANDING MMTP-BLEND AMT1545 OASAS - FREE-STANDING MMTP-CAPITAL ADD-ON1546 OPWDD APG - FREE-STANDING ARTICLE 16 CLINIC1547 OPWDD APG - FREE-STANDING ART 16 CLINIC-BLEND AMT1548 OPWDD APG - FREE-STANDING ART 16 CLINIC-CAP ADD-ON1549 OPWDD APG-FREE-STANDING ARTICLE 16 CLINIC-OFF-SITE1550 OPWDD APG-FREE-STAND ART 16 CLIN-OFF-SITE-BLEND1551 OPWDD APG-FREE-STAND ART 16 CLIN-OFF-SITE-CAPITAL1552 OASAS APG - ARTICLE 32 CLINIC MEDICAL VISIT1553 RESERVED FOR FUTURE USE APG1554 OASAS APG - ART 32 CLINIC MED VISIT- CAP ADD-ON1555 OASAS APG - MMTP CLINIC MEDICAL VISIT1556 RESERVED FOR FUTURE USE APG1557 OASAS APG - MMTP CLINIC MED VISIT- CAP ADD-ON1558 OASAS APG - HOSP ARTICLE 32 OP REHAB MEDICAL VISIT1559 RESERVED FOR FUTURE USE APG1560 OASAS APG-HOSP ART 32 OP REHAB MED VISIT-CAPITAL1561 OASAS APG - HOSPITAL ARTICLE 32 OUTPATIENT REHAB1562 OASAS APG - HOSP ART 32 OUTPATIENT REHAB-BLEND AMT1563 OASAS APG-HOSP ART 32 OUTPATIENT REHAB-CAP ADD-ON1564 OASAS-FREE-STANDING MMTP (WEEKLY VISIT-BASED)1565 OASAS FREE-STAND MMTP (WKLY VST-BASED) BLEND AMT1566 OASAS FREE-STAND MMTP (WKLY VST-BASED) CAP ADDON1567 OASAS - HOSPITAL MMTP (WEEKLY VISIT-BASED)1568 OASAS - HOSP MMTP (WEEKLY VISIT-BASED) BLEND AMT1569 OASAS - HOSP MMTP (WEEKLY VISIT-BASED) CAP ADDON1570 OASAS APG - ARTICLE 32 OP REHAB MEDICAL VISIT1571 RESERVED FOR FUTURE USE APG1572 OASAS APG - ART 32 OP REHAB MED VISIT-CAP ADD-ON1573 OASAS APG - ARTICLE 32 OUTPATIENT REHAB1574 OASAS APG - ARTICLE 32 OUTPATIENT REHAB-BLEND AMT1575 OASAS APG - ART 32 OUTPATIENT REHAB-CAP ADD-ON1576 OMH - APG HOSPITAL ARTICLE 31 CLINIC (CRISIS)1577 OMH - HOSP ART 31 CLINIC (CRISIS)-BLEND AMT1578 OMH - HOSP ART 31 CLINIC (CRISIS)-CAP ADD-ON1579 OMH- APG FREE-STANDING ARTICLE 31 CLINIC (CRISIS)1580 OMH-FREE-STANDING ART 31 CLINIC (CRISIS)-BLEND AMT1581 OMH-FREE-STANDING ART 31 CLINIC(CRISIS)-CAP ADD-ON1582 OMH- APG HOSP ARTICLE 31 CLINIC (CRISIS) (SED)1583 OMH - HOSP ART 31 CLINIC (CRISIS) (SED)-BLEND AMT1584 OMH - HOSP ART 31 CLINIC (CRISIS) (SED)-CAP ADD-ON1585 OMH- APG FREE-STAND ART 31 CLINIC (CRISIS) (SED)1586 OMH-FREE-STAND ART 31 CLINIC(CRISIS)(SED)-BLEND1587 OMH-FREE-STAND ART 31 CLINIC(CRISIS)(SED)-CAPITAL1588 OMH- APG HOSPITAL ARTICLE 31 MEDICAL VISIT1589 RESERVED FOR FUTURE USE APG1590 OMH - HOSP ART 31 MEDICAL VISIT-CAPITAL ADD-ON1591 OMH- APG HOSPITAL ARTICLE 31 MEDICAL VISIT (SED)1592 RESERVED FOR FUTURE USE APG1593 OMH - HOSP ART 31 MED VISIT (SED)-CAPITAL ADD-ON1594 DOH OPD APG ART 28 INTEGR OUTPT SVC (IOS)1595 DOH OPD APG ART 28 INTEGR OUTPT SVC - BLEND (IOS)1596 DOH OPD APG ART 28 INTEGR OUTPT SVC - CAP (IOS)1597 DOH DTC APG ART 28 INTEGR OUTPT SVC (IOS)1598 DOH DTC APG ART 28 INTEGR OUTPT SVC - BLEND (IOS)1599 DOH DTC APG ART 28 INTEGR OUTPT SVC - CAP (IOS)1601 D&T PCAP INITIAL PRENATAL CARE VISIT1602 D&T PCAP FOLLOW-UP PRENATAL CARE VISIT1603 D&T PCAP POST-PARTUM CARE1604 MOMS HEALTH SUPPORTIVE SERVICE1605 OPWDD SPECIALTY HOSPITAL; VOL OPERATED; PER DIEM1606 MOMS HEALTH SUPPORT SERVICES UNDER 181607 AIDS NURSING UNDER 181608 FQHC SHORTFALL PAYMENT1609 FQHC SHORTFALL PAYMENT1610 ALL INCLUSIVE1611 ABORTION1612 HOME TRANSFUSION1613 HOME VISIT1614 BLOOD PRODUCTS/11615 LAAM (WEEKLY) /51616 CHC,WCC,PEDIATRIC1617 FAMILY PLANNING1618 METHADANE MAINTENANCE TREATMENT PROGRAM1619 CHEST1620 DENTAL1621 DENTAL SCHOOL, MANAGED CARE EXEMPT1622 INITIAL VISIT (CLINIC)1623 ANTEPARTUM VISIT1624 LABOR1625 DELIVERY AND AFTERCARE1626 POSTPARTUM HOME AND OFFICE VISIT1627 COMP PHYS EXAM (SCHOOL HEALTH PROJECT)1628 ROUTINE VISIT (SCHOOL HEALTH PROJECT)1629 PART-TIME CLINIC SERVICES1630 AMBULATORY SURGERY - LEVEL I1631 AMBULATORY SURGERY - LEVEL II1632 AMBULATORY SURGERY - LEVEL III1633 AMBULATORY SURGERY - LEVEL IV1634 ADDITIONAL SURGERY - LEVEL I1635 ADDITIONAL SURGERY - LEVEL II1636 ADDITIONAL SURGERY - LEVEL III1637 ADDITIONAL SURGERY - LEVEL IV1638 TB CLINIC, CLS III PT DESIGNATION, INC PHYS

1639 TB CLINIC, CLS III PT DESIGNATION, EXC PHYS1640 TB CLINIC, CLS II PATIENT DESIGNATION1641 HEMODIALYSIS FACILITY SESSION1642 HOME HEMODIALYSIS CAPD/CCPD WEEKLY1643 HOME HEMODIALYSIS CAPD/CCPD DAILY1644 HOME HEMODIALYSIS EXTENDED PERITONEAL 0-19 HRS.1645 HOME HEMODIALYSIS EXTENDED PERITONEAL 20-29 HRS1646 HOME HEMODIALYSIS EXTENDED PERITONEAL 30 HRS/MORE1647 PAC 1 WELL CARE EXAMINATION, CHILD AGE 0-21648 PAC 2 ANNUAL WELL CARE EXAM, AGE 3-171649 PAC 3 DIAG INVEST CLASS I PROBLEM, AGE 0-171650 PAC 4 MANAGEMENT CLASS I PROBLEM, AGE 0-171651 PAC 5 MEDICATION ADMINISTRATION1652 PAC 6 ANNUAL EXAMINATION, ADULT OVER 171653 PAC 7 DIAG INVEST CLASS 2 PROBLEM, AGE OVER 171654 PAC 8 MANAGEMENT CLASS 2 PROBLEM, AGE OVER 171655 PAC 9 INITIAL PRENATAL EVALUATION1656 PAC10 PRENATL/POSTPARTUM VT, AGE 34+ OR -191657 PAC11 PRENATAL/POSTPARTUM VISIT, AGE 19-341658 PAC12 ANNUAL GYNECOLOGICAL EXAMINATION1659 PAC 13 DIAGN INVEST REPRODUCTIVE PROBLEM1660 PAC 14 MANAGEMENT REPRODUCTIVE PROBLEM1661 PAC 15 DIAG INVEST OF CLASS 3 PROBLEM1662 PAC 16 MANAGEMENT OF CLASS 3 PROBLEM1663 PAC 17 DIAG INVEST OF CLASS 4 PROBLEM1664 PAC 18 MANAGEMENT CHEMO/RADIOTHERAPY TREATMENT1665 PAC 19 MANAGEMENT OF CLASS 4 PROBLEM1666 PAC 20 MANAGEMENT OF CLASS 5 PROBLEM1667 PAC 21 AUDIOLOGICAL TESTING1668 PAC 22 OPTHALMOLOGICAL SERVICES1669 PAC 23 SPEECH AND REHABILITATION THERAPY1670 PAC 24 DIAG INVEST W/NUCLEAR/CAT IMAGING1671 METHADONE MAINTENANCE TREATMENT PROG (MMTP) WEEKLY1672 COMP ASSESS & DIAG CLINIC-AUDIOLOGICAL EVALUATION1673 COMP ASSESSMENT & DIAGNOSTIC CLINIC - EEG1674 COMP ASSESSMENT & DIAGNOSTIC CLINIC - ERG1675 COMP ASSESSMENT & DIAGNOSTIC CLINIC-SKIN BIOPSY1676 COMP ASSESSMENT & DIAG CLINIC-URINE BAG CATHETER1677 COMP ASSESSMENT & DIAG CL-NEUROLOGIC ASSESSMENT1678 COMP ASSESSMENT & DIAG CLINIC - PSYCHOLOGICAL EXAM1679 COMP ASSESSMENT & DIAG CL-BEHAVIORAL ASSESSMENT1680 COMP ASSESSMENT & DIAG CL-PSYCHIATRIC. EVALUATION1681 COMP ASSESSMENT & DIAG CLINIC-SPEECH EVALUATION1682 COMP ASSESSMENT & DIAG CL-PHYSIATRIC EVALUATION1683 COMP ASSESSMENT & DIAG CL-CT SCAN W/OUT CONTOUR1684 COMP ASSESSMENT & DIAG CLINIC-CT SCAN W/CONTOUR1685 COMP ASSESSMENT & DIAG CLINIC-GENETIC COUNSELING1686 COMP ASSESSMENT & DIAG CLINIC-NERVE BIOPSY1687 COMP ASSESSMENT & DIAG MUSCLE BIOPSY SUPERFICIAL1688 COMP ASSESSMENT & DIAG CL-MUSCLE BIOBIOPSY (DEEP)1689 COMP ASSESSMENT & DIAG CLIN-LUMBAR PUNCH MULT LVLS1690 COMP ASSESSMENT & DIAG CL-LUMBAR PUNCH SINGLE LVL1691 COMP ASSESSMENT & DIAGNOSTIC CLINIC - EMG1692 COMP ASSESSMENT & DIAG CLINIC-GENETIC SCREENING1693 COMP ASSESSMENT & DIAG CL-VISUALLY EVOKED RESPONSE1694 COMP ASSESSMENT & DIAG CLINIC-HEARING TEST1695 HIV COUNSELING AND TESTING VISIT1696 POST-TEST HIV COUNSELING VISIT - NEGATIVE RESULTS1697 INITIAL COMP HIV MEDICAL EVALUATION VISIT1698 DRUG/IMMUNOTHERAPY VST-HIV INFECTED PT.1699 MONITORING VST-ASYMPTOMATIC HIV DISEASE1700 OTHER PAS AMBULATORY SURGERY PROCEDURE(S)1701 PAS 1 - NERVE REPAIR1702 PAS 2 - EYE THERAPEUTIC1703 PAS 3 - EYE REPAIR1704 PAS 4 - LENS REMOVE/REPLACE1705 PAS 5 - EYE LASER THERAPEUTIC1706 PAS 6 - EYE MUSCLE REPAIR1707 PAS 7 - EYE REPAIR1708 PAS 8 - EAR THERAPEUTIC1709 PAS 9 - NASAL/PARANASAL THERAPEUTIC1710 PAS 10 - RHINO/SEPTO PLASTY1711 PAS 11 - TONSIL/ADENOID THERAPEUTIC1712 PAS 12 - NASAL/TRACHEAL ENDOSCOPE1713 PAS 13 - THORACIC DIAGNOSTIC/THERAPEUTIC1714 PAS 14 - VASCULAR DIAGNOSTIC II1715 PAS 15 - VASCULAR REPAIR1716 PAS 16 - VASCULAR DIAGNOSTIC/THERAPEUTIC1717 PAS 17 - UPPER G.I. DIAGNOSTIC/THERAPEUTIC1718 PAS 18 - LOWER G.I. DIAGNOSTIC/THERAPEUTIC1719 PAS 19 - RECTAL DIAGNOSTIC/THERAPEUTIC1720 PAS 20 - HEPATIC DIAGNOSTIC/THERAPEUTIC1721 PAS 21 - HEPATIC ENDOSCOPY1722 PAS 22 - HERNIA REPAIR1723 PAS 23 - CYSTOSCOPE1724 PAS 24 - UROLOGICAL THERAPEUTIC1725 PAS 25 - LITHOTRIPSY1726 PAS 26 - MALE GENITAL DIAGNOSTIC1727 PAS 27 - GENITO-URINARY REPAIR1728 PAS 28 - MALE GENITAL THERAPEUTIC1729 PAS 29 - LAPAROSCOPY1730 PAS 30 - OVIDUCT DIAGNOSTIC/THERAPEUTIC1731 PAS 31 - GYN DIAGNOSTIC/THERAPEUTIC1732 PAS 32 - DILATION AND CURETTAGE1733 PAS 33 - SOFT TISSUE REPAIR1734 PAS 34 - BONE THERAPEUTIC1735 PAS 35 - ARTHROSCOPY1736 PAS 36 - BONE REPAIR1737 PAS 37 - SOFT TISSUE THERAPY

1738 PAS 38 - BREAST DIAGNOSTIC/THERAPEUTIC1739 PAS 39 - BREAST REPAIR1740 PAS 40 - SKIN DIAGNOSTIC/THERAPEUTIC1741 PAS 41 - SKIN REPAIR1742 PAS 42 - UROLOGICAL DIAGNOSTIC1743 ADDITIONAL SURGERY - PAS 11744 ADDITIONAL SURGERY - PAS 21745 ADDITIONAL SURGERY - PAS 31746 ADDITIONAL SURGERY - PAS 41747 ADDITIONAL SURGERY - PAS 51748 ADDITIONAL SURGERY - PAS 61749 ADDITIONAL SURGERY - PAS 71750 ADDITIONAL SURGERY - PAS 81751 ADDITIONAL SURGERY - PAS 91752 ADDITIONAL SURGERY - PAS 101753 ADDITIONAL SURGERY - PAS 111754 ADDITIONAL SURGERY - PAS 121755 ADDITIONAL SURGERY - PAS 131756 ADDITIONAL SURGERY - PAS 141757 ADDITIONAL SURGERY - PAS 151758 ADDITIONAL SURGERY - PAS 161759 ADDITIONAL SURGERY - PAS 171760 ADDITIONAL SURGERY - PAS 181761 ADDITIONAL SURGERY - PAS 191762 ADDITIONAL SURGERY - PAS 201763 ADDITIONAL SURGERY - PAS 211764 ADDITIONAL SURGERY - PAS 221765 ADDITIONAL SURGERY - PAS 231766 ADDITIONAL SURGERY - PAS 241767 ADDITIONAL SURGERY - PAS 251768 ADDITIONAL SURGERY - PAS 261769 ADDITIONAL SURGERY - PAS 271770 ADDITIONAL SURGERY - PAS 281771 ADDITIONAL SURGERY - PAS 291772 ADDITIONAL SURGERY - PAS 301773 ADDITIONAL SURGERY - PAS 311774 ADDITIONAL SURGERY - PAS 321775 ADDITIONAL SURGERY - PAS 331776 ADDITIONAL SURGERY - PAS 341777 ADDITIONAL SURGERY - PAS 351778 ADDITIONAL SURGERY - PAS 361779 ADDITIONAL SURGERY - PAS 371780 ADDITIONAL SURGERY - PAS 381781 ADDITIONAL SURGERY - PAS 391782 ADDITIONAL SURGERY - PAS 401783 ADDITIONAL SURGERY - PAS 411784 ADDITIONAL SURGERY - PAS 421785 OUT OF STATE CLINIC SERVICE, GENERAL1786 OUT OF STATE CLINIC SERVICE, SPECIALTY I1787 OOS CLINIC SERVICE, SPECIALTY II1788 OOS CLINIC SERVICE, SPECIALTY III1789 OOS PSYCH CLINIC BRIEF VISITS1790 OOS PSYCH CLINIC EVALUATION1791 OOS PSYCH CLIN 1/2 HR INDIVIDUAL THERAPY1792 OOS PSYCH CLINIC 1 HR INDIVIDUAL THERAPY1793 OOS PSYCH CLIN 1 & 1/2 HR INDIVIDUAL THERAPY1794 OOS PSYCH CLINIC 1/2 HR COLLATERAL VISIT1795 OOS PSYCH CLINIC 1 HR COLLATERAL VISIT1796 OOS PSYCH CLINIC 1/2 HR GROUP THERAPY1797 OOS PSYCH CLINIC 1 HR GROUP THERAPY1798 OOS PSYCH CLINIC NEUROLOGICAL EVALUATION1799 OOS PSYCH CLINIC NEUROLOGICAL FOLLOW UP1800 HEMO, EPO ADD-ON UP TO 10,000 UNITS1801 HEMO, EPO ADD-ON 10,000 UNITS OR MORE1802 POST-TEST HIV COUNSELING VISIT - POSTIVE RESULTS1803 PAC GROUPER ACCESS CODE1804 PAS GROUPER ACCESS CODE-PRINCIPAL PROCEDURE1805 PAS GROUPER ACCESS CODE-ADDITIONAL PROCEDURE1806 HEMO, EPO ADD-ON PER 1,000 UNITS1807 D&T ADD-ON1808 D & T ADD-ON TO RATE CODE 65241809 D & T ADD-ON TO RATE CODE 65291810 D & T ADD-ON TO RATE CODE 65621811 PAS-45 VITRECTOMY W THERAPY DRUG IMP1812 ADDITIONAL SURGERY-PAS 451813 TB/HIV COUNSELING W/O TESTING-MC CLIENT1814 STD/HIV COUNSELING W/O TESTING - MC CLIENT1815 TB/HIV COUNSELING & TESTING-MC CLIENT1816 STD/HIV COUNSELING & TESTING-MC CLIENT1817 TB/HIV POST TEST NEGATIVE-MC CLIENT1818 STD/HIV POST TEST NEGATIVE-MC CLIENT1819 TB/HIV POST TEST POSITIVE-MC CLIENT1820 STD/HIV POST TEST POSITIVE-MC CLIENT1821 SNF REGULAR RATE MC ENROLLEE1822 SNF AIDS MC ENROLLEE1823 SNF NEURO-BEHAVIORAL MC ENROLLEE1824 SNF PEDIATRICS MC ENROLLEE1825 SNF TRAUMATIC BRAIN INJURY MC ENROLLEE1826 SNF VENTILATOR DEPENDENT MC ENROLLEE1830 ALIESSA TANF/SN 0-20 YRS MALE/FEMALE - MC ENROLLEE1831 ALIESSA TANF/SN 21+ MALE/FEMALE - MC ENROLLEE1832 ALIESSA SSI 6 MONTHS/21 YRS + M/F - MC ENROLLEE1833 ALIESSA FHP 19-64/21-64 M/F - MC ENROLLEE1834 ALIESSA MATERNAL DELIVERY PAYMT - MC ENROLLEE1835 ALIESSA MATERNAL DELIVERY PAYMT-FHP - MC ENROLLEE1836 HIV/AIDS TANF/SN 6 MOS. - 20 YRS M/F (ALIESSA)1837 HIV/AIDS TANF/SN 21 - 64 YRS M/F (ALIESSA)1838 HIV/AIDS SSI CORE ADULT/CHILD (ALIESSA)1839 MC CAP RATE - ALIESSA BHP RECIPIENTS

1850 DAY HEALTH CARE SERVICE (HIV)1851 HEALTH HOME/OMH-TCM1852 HEALTH HOME OUTREACH/OMH TCM1853 HEALTH HOME PLUS/CARE MANAGEMENT1854 HEALTH HOME SERVICES - HARP (LOW)1855 HEALTH HOME SERVICES - HARP (MED)1856 HEALTH HOME SERVICES - HARP (HIGH)1857 HEALTH HOME SERVICES - NON-HARP (LOW)1858 HEALTH HOME SERVICES - NON-HARP (MED)1859 HEALTH HOME SERVICES - NON-HARP (HIGH)1860 HEALTH HOME SERVICES - ADULT HOME TRANSITION1861 ADULT HOME ASSESSMENT AND MANAGEMENT FEE1862 HEALTH HOME OUTREACH (ADULT)1863 HEALTH HOME OUTREACH (CHILDREN)1864 HEALTH HOME SERVICES - CHILDREN (LOW)1865 HEALTH HOME SERVICES - CHILDREN (MED)1866 HEALTH HOME SERVICES - CHILDREN (HIGH)1867 HEALTH HOME SERVICES-CHILDREN (HIGH FIDELITY WRAP)1868 HEALTH HOME - CANS ASSESSMENT (CHILDREN)1869 RESERVED FOR HEALTH HOME SERVICES1870 RESERVED FOR HEALTH HOME SERVICES1871 RESERVED FOR HEALTH HOME SERVICES1872 RESERVED FOR HEALTH HOME SERVICES1873 RESERVED FOR HEALTH HOME SERVICES1874 RESERVED FOR HEALTH HOME SERVICES1875 RESERVED FOR HEALTH HOME SERVICES1876 RESERVED FOR HEALTH HOME SERVICES1877 RESERVED FOR HEALTH HOME SERVICES1878 RESERVED FOR HEALTH HOME SERVICES1879 RESERVED FOR HEALTH HOME SERVICES1880 HEALTH HOME/AIDS/HIV CASE MANAGEMENT1881 HEALTH HOME OUTREACH/AIDS/HIV CASE MANAGEMENT1882 HEALTH HOME/MATS1883 HEALTH HOME OUTREACH/MATS1884 RESERVED FOR HEALTH HOME SERVICES1885 HEALTH HOME/CIDP CASE MANAGEMENT1886 RESERVED FOR HEALTH HOME SERVICES1887 RESERVED FOR HEALTH HOME SERVICES1888 RESERVED FOR HEALTH HOME SERVICES1889 RESERVED FOR HEALTH HOME SERVICES1890 RESERVED FOR HEALTH HOME SERVICES1891 RESERVED FOR HEALTH HOME SERVICES1892 RESERVED FOR HEALTH HOME SERVICES1893 RESERVED FOR HEALTH HOME SERVICES1894 RESERVED FOR HEALTH HOME SERVICES1895 RESERVED FOR HEALTH HOME SERVICES1896 RESERVED FOR HEALTH HOME SERVICES1897 RESERVED FOR HEALTH HOME SERVICES1898 RESERVED FOR HEALTH HOME SERVICES1899 RESERVED FOR HEALTH HOME SERVICES1900 SYSTEM GENERATED FROM CLAIM1921 LT HOME CARE RESPIRATORY CARE1946 SYSTEM GENERATED FROM CLAIM1954 SYSTEM GENERATED FROM CLAIM1996 SYSTEM GENERATED FROM CLAIM1999 SYSTEM GENERATED FROM CLAIM2000 PSYCH EVAL PROC CODE 90791 (SSHSP)2001 PSYCH EVAL PROC CODE 90792 (SSHSP)2002 PSYCH EVAL PROC CODE 96101 (SSHSP)2003 PSYCH EVAL PROC CODE 96105 (SSHSP)2004 PSYCH EVAL PROC CODE 96110 (SSHSP)2005 PSYCH EVAL PROC CODE 96111 (SSHSP)2006 PSYCH EVAL PROC CODE 96116 (SSHSP)2007 PSYCH EVAL PROC CODE 96118 (SSHSP)2008 PSYCH CNSIG PROC CODE 90832 (SSHSP)2009 PSYCH CNSIG PROC CODE 90833 (SSHSP)2010 PSYCH CNSIG PROC CODE 90834 (SSHSP)2011 PSYCH CNSIG PROC CODE 90836 (SSHSP)2012 PSYCH CNSIG PROC CODE 90837 (SSHSP)2013 PSYCH CNSIG PROC CODE 90838 (SSHSP)2014 PSYCH CNSIG PROC CODE 90785 (SSHSP)2015 PSYCH CNSIG PROC CODE 90811 (SSHSP)2016 PSYCH CNSIG PROC CODE 90812 (SSHSP)2017 PSYCH CNSIG PROC CODE 90813 (SSHSP)2018 PSYCH CNSIG PROC CODE 90814 (SSHSP)2019 PSYCH CNSIG PROC CODE 90815 (SSHSP)2020 PSYCH CNSIG PROC CODE 90847 (SSHSP)2021 PSYCH CNSIG PROC CODE 90853 (SSHSP)2022 PSYCH CNSIG PROC CODE 90857 (SSHSP)2023 SPEECH EVAL CODE 92521 (SSHSP)2024 SPEECH PROC CODE 92507 (SSHSP)2025 SPEECH PROC CODE 92508 (SSHSP)2026 SPEECH PROC CODE 92520 (SSHSP)2027 SPEECH PROC CODE 92526 (SSHSP)2028 SPEECH PROC CODE 92597 (SSHSP)2029 SPEECH PROC CODE 92626 (SSHSP)2030 SPEECH PROC CODE 92627 (SSHSP)2031 AUDIO EVAL PROC CODE 92550 (SSHSP)2032 AUDIO EVAL PROC CODE 92552 (SSHSP)2033 AUDIO EVAL PROC CODE 92553 (SSHSP)2034 AUDIO EVAL PROC CODE 92555 (SSHSP)2035 AUDIO EVAL PROC CODE 92556 (SSHSP)2036 AUDIO EVAL PROC CODE 92557 (SSHSP)2037 AUDIO EVAL PROC CODE 92565 (SSHSP)2038 AUDIO EVAL PROC CODE 92567 (SSHSP)2039 AUDIO EVAL PROC CODE 92568 (SSHSP)2040 AUDIO EVAL PROC CODE 92570 (SSHSP)2041 AUDIO EVAL PROC CODE 92571 (SSHSP)2042 AUDIO EVAL PROC CODE 92572 (SSHSP)

2043 AUDIO EVAL PROC CODE 92576 (SSHSP)2044 AUDIO EVAL PROC CODE 92577 (SSHSP)2045 AUDIO EVAL PROC CODE 92579 (SSHSP)2046 AUDIO EVAL PROC CODE 92582 (SSHSP)2047 AUDIO EVAL PROC CODE 92583 (SSHSP)2048 AUDIO EVAL PROC CODE 92585 (SSHSP)2049 AUDIO EVAL PROC CODE 92586 (SSHSP)2050 AUDIO EVAL PROC CODE 92587 (SSHSP)2051 AUDIO EVAL PROC CODE 92588 (SSHSP)2052 SPEECH EVAL CODE 92522 (SSHSP)2053 SPEECH EVAL CODE 92523 (SSHSP)2054 SPEECH EVAL CODE 92524 (SSHSP)2055 AUDIO EVAL PROC CODE 92595 (SSHSP)2056 AUDIO EVAL CODE 92620 (SSHSP)2057 AUDIO EVAL CODE 92621 (SSHSP)2058 PT PROC CODE 97001 (SSHSP)2059 PT PROC CODE 97002 (SSHSP)2060 PT/OT PROC CODE 97010 (SSHSP)2061 PT/OT PROC CODE 97012 (SSHSP)2062 PT/OT PROC CODE 97014 (SSHSP)2063 PT/OT PROC CODE 97016 (SSHSP)2064 PT/OT PROC CODE 97018 (SSHSP)2065 PT/OT PROC CODE 97022 (SSHSP)2066 PT/OT PROC CODE 97024 (SSHSP)2067 PT/OT PROC CODE 97026 (SSHSP)2068 PT/OT PROC CODE 97028 (SSHSP)2069 PT/OT PROC CODE 97032 (SSHSP)2070 PT/OT PROC CODE 97033 (SSHSP)2071 PT/OT PROC CODE 97034 (SSHSP)2072 PT/OT PROC CODE 97035 (SSHSP)2073 PT/OT PROC CODE 97036 (SSHSP)2074 PT/OT PROC CODE 97110 (SSHSP)2075 PT/OT PROC CODE 97112 (SSHSP)2076 PT/OT PROC CODE 97113 (SSHSP)2077 PT/OT PROC CODE 97116 (SSHSP)2078 PT/OT PROC CODE 97124 (SSHSP)2079 PT PROC CODE 97139 (SSHSP)2080 PT/OT PROC CODE 97140 (SSHSP)2081 PT PROC CODE 97150 (SSHSP)2082 OT PROC CODE 97003 (SSHSP)2083 OT PROC CODE 97004 (SSHSP)2084 PT/OT PROC CODE 97530 (SSHSP)2085 PT/OT PROC CODE 97532 (SSHSP)2086 PT/OT PROC CODE 97533 (SSHSP)2087 PT/OT PROC CODE 97535 (SSHSP)2088 PT/OT PROC CODE 97537 (SSHSP)2089 PT/OT PROC CODE 97542 (SSHSP)2090 MED EVAL PROC CODE 99201 (SSHSP)2091 MED EVAL PROC CODE 99202 (SSHSP)2092 MED EVAL PROC CODE 99203 (SSHSP)2093 MED EVAL PROC CODE 99204 (SSHSP)2094 MED EVAL PROC CODE 99205 (SSHSP)2095 MED EVAL PROC CODE 99211 (SSHSP)2096 MED EVAL PROC CODE 99212 (SSHSP)2097 MED EVAL PROC CODE 99213 (SSHSP)2098 MED EVAL PROC CODE 99214 (SSHSP)2099 MED EVAL PROC CODE 99215 (SSHSP)21 SYSTEM GENERATED FROM ENCOUNTER2100 OT PROC CODE 97150 (SSHSP)2101 SKILLED NURSING PROC CODE T1001 (SSHSP)2102 SKILLED NURSING PROC CODE T1002 (SSHSP)2103 NURSING PROC CODE T1003 (SSHSP)2104 TRANSPORTATION PROC CODE T2003 (SSHSP)2105 TRANSPORTATION PROC CODE A0110 (SSHSP)2106 TRANSPORTATION PROC CODE A0120 (SSHSP)2107 PT/OT THERPY PROC CODE 97760 (SSHSP)2108 PT/OT THERPY PROC CODE 97761 (SSHSP)2109 PT/OT THERPY PROC CODE 97762 (SSHSP)2114 SYSTEM GENERATED FROM MEMBER PA2122 SYSTEM GENERATED FROM MEMBER PA2154 SYSTEM GENERATED FROM MEMBER PA2190 HOME HEALTH SHARED AIDE EPS EXEMPT2191 HOME HEALTH AIDE EPS EXEMPT2192 NURSING EPS EXEMPT2193 OCCUPATIONAL THERAPY EPS EXEMPT2194 PHYSICAL THERAPY EPS EXEMPT2195 SPEECH PATHOLOGY EPS EXEMPT2200 UNDETERMINED MANAGED CARE MEMBER2201 TANF/SN 0-20 YRS MALE/FEMALE (AS OF 4/1/08)2202 TANF/SN <6 MONTHS-14 FEMALE2203 TANF/SN 15-20 FEMALE2204 TANF/SN 6 MONTHS-20 MALE2205 TANF/SN 21+ MALE/FEMALE (AS OF 4/1/08)2206 SN 21-29 MALE/FEMALE2207 SN 30-64 MALE/FEMALE2208 SSI <6 MONTHS MALE/FEMALE2209 SSI 6 MONTHS + MALE/FEMALE (AS OF 8/1/08)2210 SSI 21-64 MALE/FEMALE2211 SSI 65+ MALE/FEMALE2212 CAPITATION TYPE XII2213 CAPITATION TYPE XIII2214 CAPITATION TYPE XIV2215 CAPITATION TYPE XV2216 CAPITATION TYPE XVI2217 CAPITATION TYPE XVII2218 CAPITATION TYPE XVIII2219 CAPITATION TYPE XIX2220 CAPITATION TYPE XX2221 MA-TANF/SN <6 MONTHS MALE/FEMALE

2222 MA-TANF/SN 6 MONTHS-14 FEMALE2223 MA-TANF/SN 15-20 FEMALE2224 MA-TANF/SN 6 MONTHS-20 MALE2225 MA-TANF 21-64 MALE/FEMALE2226 MA-SN 21-29 MALE/FEMALE2227 MA-SN 30-64 MALE/FEMALE2228 MA-SSI <6 MONTHS MALE/FEMALE2229 MA-SSI 6 MONTHS-20 MALE/FEMALE2230 MA-SSI 21-64 MALE/FEMALE2231 MA-SSI 65+ MALE/FEMALE2232 FHP 19-64 MALE/FEMALE (AS OF 4/1/08)2233 ADULTS W/OUT CHILDREN 19-29 MALE/FEMALE2234 ADULTS W/OUT CHILDREN 30-64 MALE/FEMALE2235 CAPITATION TYPE XXXV2236 CAPITATION TYPE XXXVI2237 CAPITATION TYPE XXXVII2238 CAPITATION TYPE XXXVIII2239 CAPITATION TYPE XXXIX2240 CAPITATION TYPE XL2241 HIP 1 - OVER AGE 652242 HIP 1 - UNDER AGE 652243 HIP 1-NURSING HOME (OBSOLETE)2244 HIP/SUFFOLK CAPITATION PLAN2245 HIP/WESTCHESTER CAPITATION PLAN2246 SSI 6 MONTH-64 MALE/FEMALE DUALLY ELIGIBLE2247 SSI 65+ MALE/FEMALE DUALLY ELIGIBLE2248 MONTHLY CARE COORDINATION FEE (PCCM)2249 MONTHLY CARE COORDINATION FEE (BROOME CTY)2251 HIP 2 - OVER 212252 HIP 2 - UNDER 212253 SUNSET PARK CAPITIATION CONTRACT2254 SOCIAL HEALTH MAINT ORG (SHMO) ELDER PLAN2255 METROPOLITAN HMO-AFDC2256 METROPOLITAN HMO-HR2257 METROPOLITAN HMO-MA ONLY2258 METROPOLITAN HMO-SSI2259 SUNSET PARK HMO-ADC2260 SUNSET PARK HMO-SSI2261 KIDS ONEIDA2262 PCP SPECIAL CARE ACTUARIAL CLASS 22263 PCP SPECIAL CARE ACTUARIAL CLASS 32264 PCP SPECIAL CARE ACTUARIAL CLASS 42265 PCP SPECIAL CARE ACTUARIAL CLASS 52266 PCP SPECIAL CARE ACTUARIAL CLASS 62267 PCP SPECIAL CARE ACTUARIAL CLASS 72268 PCP SPECIAL CARE ACTUARIAL CLASS 82269 PCP SPECIAL CARE ACTUARIAL CLASS 92270 PCP SPECIAL CARE ACTUARIAL CLASS 102271 ALL < 6 MO. M&F (0 MO. - 5 MO.)2272 HIV/AIDS TANF/SN CHILD 6 MONTH-20 YRS M/F2273 HIV/AIDS TANF/SN ADULT 21-64 YRS M/F2274 HIV/AIDS SSI CHILD 6 MONTHS - 20 YRS M/F2275 HIV/AIDS SSI ADULT 21+ YRS M/F2276 AIDS TANF/SN 6 MONTHS-20 MALE/FEMALE2277 AIDS TANF/SN 21-64 MALE/FEMALE2278 AIDS SSI 6 MONTHS-20 MALE/FEMALE2279 AIDS SSI 21+ MALE/FEMALE2280 PCP SPECIAL CARE ACTUARIAL CLASS 292281 PCP SPECIAL CARE ACTUARIAL CLASS 302282 PCP SPECIAL CARE ACTUARIAL CLASS 312283 CORRESPONDS TO HIP SPECIAL CARE RATE 22412284 CORRESPONDS TO HIP SPECIAL CARE RATE 22422285 CORRESPONDS TO HIP SPECIAL CARE RATE 22512286 CORRESPONDS TO HIP SPECIAL CARE RATE 22522287 CORRESPONDS TO HIP SPECIAL CARE RATE 22442288 CORRESPONDS TO HIP SPECIAL CARE RATE 22452289 CORRESPONDS TO HIP SPECIAL CARE RATE 22542290 STERILIZATION DURING DELIVERY2291 MANAGED CARE - LOW BIRTH WEIGHT PAYMENT2292 MATERNAL DELIVERY PAYMENT- FAMILY HEALTH PLUS2293 MATERNAL DELIVERY PAYMENT - MEDICAID MANAGED CARE2294 MANAGED CARE STOP/LOSS MENTAL HEALTH OUTPATIENT2295 MANAGED CARE STOP/LOSS 30-DAY COMB MENT HLTH/SUBST2296 HIV/SNP INPATIENT STOP LOSS2297 MC STOP / LOSS NURS HM SVCS GT 60 DAYS /CAL YR2298 MANAGED CARE PLAN-NEWBORN DELIVERY PAYMENT2299 MANAGED CARE STOP/LOSS-INPATIENT2300 CASE MANAGEMENT SERVICES - 1/4 HOUR2301 CASE MANAGEMENT CARE AT HOME-LEVEL I-DWNST2302 CASE MANAGEMENT CARE AT HOME-LEVEL II- DWNST2303 CASE MANAGEMENT CARE AT HOME-LEVEL-I-UPSTATE2304 CASE MANAGEMENT CARE AT HOME-LEVEL II-UPSTATE2305 CASE MANAGEMENT CARE AT HOME-LEVEL III - DWNST2306 CASE MANAGEMENT CARE AT HOME-LEVEL III - UPSTATE2307 CASE MANAGEMENT - CARE AT HOME - LEVEL I - DDSO2308 CASE MANAGEMENT CARE AT HOME LEVEL II - DDSO2309 CASE MANAGEMENT CARE AT HOME LEVEL III -DDSO2310 OUT OF STATE PSYCH. HOSP. FOR AGES 21-642311 OPWDD CARE AT HOME WAIVER2312 CASE MANAGEMENT CARE AT HOME - LEVEL V- DWNST2313 CASE MANAGEMENT CARE AT HOME - LEVEL IV - UPSTATE2314 CASE MANAGEMENT CARE AT HOME - LEVEL V - UPSTATE2315 CASE MANAGEMENT CARE AT HOME - LEVEL IV - DSSO2316 CASE MANAGEMENT CARE AT HOME - LEVEL V - DSSO2317 CASE MANAGEMENT-CARE AT HOME LEVEL-VI - DWNST2318 CASE MANAGEMENT-CARE AT HOME LEVEL-VI - UPSTATE2319 CASE MANAGEMENT-CARE AT HOME LEVEL-VI - DDSO2320 CASE MANAGEMENT-CARE AT HOME LEVEL-VII - DWNST2321 CASE MANAGEMENT-CARE AT HOME LEVEL-VII - UPSTATE

2322 CASE MANAGEMENT-CARE AT HOME LEVEL-VII - DDSO2323 CASE MANAGEMENT-CARE AT HOME LEVEL-VIII - DWNST2324 CASE MANAGEMENT-CARE AT HOME LEVEL-VIII - UPSTATE2325 CASE MANAGEMENT-CARE AT HOME LEVEL-VIII - DDSO2326 CASE MANAGEMENT-CARE AT HOME LEVEL-IX - DWNST2327 CASE MANAGEMENT-CARE AT HOME LEVEL-IX - UPSTATE2328 CASE MANAGEMENT-CARE AT HOME LEVEL-IX - DDSO2329 CASE MANAGEMENT-CARE AT HOME LEVEL-X-DWNST2330 CASE MANAGEMENT-CARE AT HOME LEVEL-X-UPSTATE2331 CASE MANAGEMENT-CARE AT HOME LEVEL-X-DSSO2332 CARE AT HOME I/II PALLIATIVE CARE FAMILY EDUCATIO2333 CARE AT HOME I/II PALLIATIVE CARE PAIN AND SYMPTO2334 CARE AT HOME I/II PALLIATIVE CARE BEREAVEMENT SER2335 CARE AT HOME I/II PALLIATIVE CARE MASSAGE THERAPY2336 CARE AT HOME I/II PALLIATIVE CARE EXPRESSIVE THER2337 SYSTEM GENERATED FROM MEMBER PA2340 PRE-PAID MENTAL HEALTH PLAN (PMHP)2341 PARTIAL CAP TANF/SN < 212342 PARTIAL CAP TANF/SN 21+2343 PARTIAL CAP SSI < 212344 PARTIAL CAP SSI 21+2350 MANAGED LTC; SSI 21-64/LEVEL I2351 MANAGED LTC; SSI 21-64/LEVEL II2352 MANAGED LTC; SSI 21-64/LEVEL III2353 MANAGED LTC; SSI 21-64/LEVEL IV2354 MANAGED LTC; SSI 65+/LEVEL I2355 MANAGED LTC; SSI 65+/LEVEL II2356 MANAGED LTC; SSI 65+/LEVEL III2357 MANAGED LTC; SSI 65+/LEVEL IV2358 MANAGED LTC; MA ONLY SSI 21-64/LEVEL I2359 MANAGED LTC; MA ONLY SSI 21-64/LEVEL II2360 MANAGED LTC; MA ONLY SSI 21-64/LEVEL III2361 MANAGED LTC; MA ONLY SSI 21-64/LEVEL IV2362 MANAGED LTC; MA ONLY 65+/LEVEL I2363 MANAGED LTC; MA ONLY 65+/LEVEL II2364 MANAGED LTC; MA ONLY 65+/LEVEL III2365 MANAGED LTC; MA ONLY 65+/LEVEL IV2366 MANAGED LTC HR 30-64 LEVEL 12367 MANAGED LTC HR 30-64 LEVEL 22368 RESERVED/FUTURE PROGRAMS2369 MANAGED LTC HR 30-64 LEVEL 42370 DUALLY ELIGIBLE SSI 21-64 MALE/FEMALE2371 DUALLY ELIGIBLE SSI 65+ MALE/FEMALE2372 RESERVED/FUTURE PROGRAMS2373 MANAGED LTC MA ONLY HR 30-64 LEVEL 42374 MAP 18-64 EXISTING (PRIOR TO 1/1/12)2375 MAP 65+ EXISTING (PRIOR TO 1/1/12)2376 RESERVED/FUTURE PROGRAMS2377 RESERVED/FUTURE PROGRAMS2378 RESERVED/FUTURE PROGRAMS2379 RESERVED/FUTURE PROGRAMS2380 RESERVED/FUTURE PROGRAMS2381 RESERVED/FUTURE PROGRAMS2382 RESERVED/FUTURE PROGRAMS2383 RESERVED/FUTURE PROGRAMS2384 RESERVED/FUTURE PROGRAMS2385 RESERVED/FUTURE PROGRAMS2386 RESERVED/FUTURE PROGRAMS2387 RESERVED/FUTURE PROGRAMS2388 RESERVED/FUTURE PROGRAMS2389 RESERVED/FUTURE PROGRAMS2390 RESERVED/FUTURE PROGRAMS2391 RESERVED/FUTURE PROGRAMS2392 RESERVED/FUTURE PROGRAMS2393 COMMONWEALTH AGE 21+ DUAL ELIGIBLE2394 COMMONWEALTH AGE 21+ DUAL ELIGIBLE2395 COMMONWEALTH AGE 21+ NON-DUAL ELIGIBLE2396 COMMONWEALTH AGE 21+ NON-DUAL ELIGIBLE2397 PACE (CCM) AGE 55+ NON-DUAL ELIGIBLE2398 PACE (CCM) AGE 55+ NON-DUAL ELIGIBLE2399 PACE (ILS/EDDY/LORETTO) AGE 55+ NON-DUAL ELIGIBLE2400 SYSTEM GENERATED FROM MEMBER PA2401 CONSUMER DIRECT PERS ASSIST 1 CLIENT HOURLY2402 CONS DIRECT PERS ASSIST 2 OR > CLNTS HRLY PER CLNT2403 CONS DIR PERS ASSIST 1 CLNT HRLY ENHANCED RATE2404 CONS DIR PERS ASSIST 2 OR > CLNTS HRLY PER CLNT EN2405 CONSUMER DIRECT PERSONAL ASSIST 1 CLNT LIVE-IN2406 CONS DIR PERS ASSIST 2 OR > CLNTS PER CLNT LIVE-IN2407 CONSUMER DIRECT PERSSONAL ASSIST DAILY CAPITATED2408 CONS DIR PERS ASSIST DAILY CAPITATED ENHANCED2409 CONSUMER DIRECT PERSONAL ASSIST MONTHLY CAPITATED2410 CONS DIR PERS ASSIST MONTHLY CAPITATED ENHANCED2411 CONSUMER DIRECT PERSONAL ASSIST NURSING ASSISTANCE2412 LIMITED LICENSURE-RN-QUARTER HOUR2413 LIMITED LICENSURE-PERS. CARE-QUARTER HOUR2414 LMTD LIC HC SVCS AGNCY RUGS II GRP-CC DAILY2415 LMTD LIC HC SVCS AGNCY RUGS II GRP-BA DAILY2416 LMTD LIC HC SVCS AGNCY RUGS II GRP-BB DAILY2417 LMTD LIC HC SVCS AGNCY RUGS II GRP-BC DAILY2418 LMTD LIC HC SVCS AGNCY RUGS II GRP-PA DAILY2419 LMTD LIC HC SVCS AGNCY RUGS II GRP-PB DAILY2420 LMTD LIC HC SVCS AGNCY RUGS II GRP-PC DAILY2421 LMTD LIC HC SVCS AGNCY RUGS II GRP-PD DAILY2422 CDPAP 1 CLIENT, QUARTER HOUR2423 CDPAP 2 CLIENTS, PER CLIENT, QUARTER HOUR2424 CDPAP 1 CLIENT, ENHANCED RATE, QUARTER HOUR2425 CDPAP 2 CLIENTS, PER CLIENT, ENHANCED RATE, QTR HR2426 PF WAIVER - AGE 0 - 20 - DUAL - WAIVER2427 PF WAIVER - AGE 0 - 20 - DUAL - NON-WAIVER

2428 PF WAIVER - AGE 0 - 20 - NON-DUAL - WAIVER2429 PF WAIVER - AGE 0 - 20 - NON-DUAL - NON-WAIVER2430 PF WAIVER - AGE 21 - 49 - DUAL - WAIVER2431 PF WAIVER - AGE 21 - 49 - DUAL - NON-WAIVER2432 PF WAIVER - AGE 21 - 49 - NON-DUAL - WAIVER2433 PF WAIVER - AGE 21 - 49 - NON-DUAL - NON-WAIVER2434 PF WAIVER - AGE 50+ - DUAL - WAIVER2435 PF WAIVER - AGE 50+ - DUAL - NON-WAIVER2436 PF WAIVER - AGE 50+ - NON-DUAL - WAIVER2437 PF WAIVER - AGE 50+ - NON-DUAL - NON-WAIVER2438 OPWDD FIDA - AGE 21 -49 MEDICARE DUAL2439 OPWDD FIDA - AGE 50+ MEDICARE DUAL2440 AIDS ADULT DAY HEALTH CARE SERVICE - LEVEL I2441 AIDS ADULT DAY HEALTH CARE SERVICE - LEVEL II2442 AIDS ADULT DAY HEALTH CARE SERVICE - LEVEL III2446 SYSTEM GENERATED FROM CLAIM2461 SYSTEM GENERATED FROM MEMBER PA2469 SYSTEM GENERATED FROM CLAIM2470 SYSTEM GENERATED FROM MEMBER PA2472 SYSTEM GENERATED FROM MEMBER PA2487 SYSTEM GENERATED FROM MEMBER PA2493 SYSTEM GENERATED FROM CLAIM2494 SYSTEM GENERATED FROM MEMBER PA2495 SYSTEM GENERATED FROM MEMBER PA2496 SYSTEM GENERATED FROM CLAIM2497 SYSTEM GENERATED FROM CLAIM2498 CHHA - NURSING VISIT FOR FRAGILE CHILDREN2499 HOME HEALTH SHARED AIDE2500 HOME HEALTH CARE ADD-ON2501 PCAI, SHARED AIDE, BASIC, HOURLY2502 PCAII, SHARED AIDE, BASIC, HOURLY2503 PCAIII, SHARED AIDE, BASIC, HOURLY2504 PCAI, SHARED AIDE, E, W&H, HOURLY2505 PCAII, SHARED AIDE, E, W&H, HOURLY2506 PCAIII, SHARED AIDE, E, W&H, HOURLY2507 PCAI, SHARED AIDE, BASIC, QUARTER HOUR2508 PCAII, SHARED AIDE, BASIC, QUARTER HOUR2509 PCAIII, SHARED AIDE, BASIC, QUARTER HOUR2510 PCAI, SHARED AIDE, E, W&H, QUARTER HOUR2511 PCAII, SHARED AIDE, E, W&H, QUARTER HOUR2512 PCAIII, SHARED AIDE, E, W&H, QUARTER HOUR2513 PERS INSTALLATION CHARGE2514 PERS MONTHLY SERVICE CHARGE2515 HHAS (FS) HOME HEALTH AIDE (HRLY) SECONDARY CODE2516 RHCF (HB) HOME HEALTH AIDE (HRLY) SECONDARY CODE2517 HHAS (FS) HOME HEALTH AIDE SECONDARY CODE2518 RHCF (HB) HOME HLTH AIDE (HR OR VISIT) SECONDAY CD2519 RHCF (FS) HOME HEALTH AIDE SECONDARY CODE2520 RESIDENTIAL SUBSTANCE ABUSE TREATMENT2521 AMBULATORY SUBSTANCE ABUSE TREATMENT (NMS)2522 AMBULATORY SUBSTANCE ABUSE TREATMENT (MS-E)2523 AMBULATORY SUBSTANCE ABUSE TREATMENT (NMS-OP)2524 SYSTEM GENERATED FROM MEMBER PA2531 MMTP BUPRENORPH LOWDO 2-10 MGS2532 MMTP BUPRENORPH MEDDO 12-20 MGS2533 MMTP BUPRENORPH HIDO 22-26 MGS2534 MMTP BUPRENORPH MAXDO 28+ MGS2539 SYSTEM GENERATED FROM MEMBER PA2540 NURSING HOME BASED LTHHC TELEHEALTH INSTALLATION2541 NUR HOME BASED LTHHC TELEHEALTH MTLY MNTRG TYPE I2542 NUR HOME BASED LTHHC TELEHEALTH MTLY MNTRG TYPE II2543 NUR HOME BASED LTHHC TELEHEALTH MTLY MNTRG TYP III2544 HOSPITAL BASED LTHHC TELEHEALTH INSTALLATION2545 HPTL BASED LTHHC TELEHEALTH MTLY MNTRG TYPE I2546 HPTL BASED LTHHC TELEHEALTH MTLY MNTRG TYPE II2547 HPTL BASED LTHHC TELEHEALTH MTLY MNTRG TYP III2548 COMMUNITY BASED LTHHC TELEHEALTH INSTALLATION2549 COM BASED LTHHC TELEHEALTH MTLY MNTRG TYPE I2550 COM BASED LTHHC TELEHEALTH MTLY MNTRG TYPE II2551 COM BASED LTHHC TELEHEALTH MTLY MNTRG TYP III2552 COMMUNITY BASED CHHA TELEHEALTH INSTALLATION2553 COM BASED CHHA TELEHEALTH MTLY MNTRG TYPE I2554 COM BASED CHHA TELEHEALTH MTLY MNTRG TYPE II2555 COM BASED CHHA TELEHEALTH MTLY MNTRG TYP III2556 NURSING HOME BASED CHHA TELEHEALTH INSTALLATION2557 NUR HOME BASED CHHA TELEHEALTH MTLY MNTRG TYPE I2558 NUR HOME BASED CHHA TELEHEALTH MTLY MNTRG TYPE II2559 NUR HOME BASED CHHA TELEHEALTH MTLY MNTRG TYP III2560 HOSPITAL BASED CHHA TELEHEALTH INSTALLATION2561 HPTL BASED CHHA TELEHEALTH MTLY MNTRG TYPE I2562 HPTL BASED CHHA TELEHEALTH MTLY MNTRG TYPE II2563 HPTL BASED CHHA TELEHEALTH MTLY MNTRG TYP III2564 CHHA -SEASONAL FLU VACCINE FOR INDIV 19 AND OLDER2565 CHHA - SEASONAL FLU VACCINE FOR IND UNDER AGE 192566 CHHA - PNEUMOCOCCAL VACCINE FOR IND19 AND OLDER2567 CHHA - PNEUMOCOCCAL VACCINE FOR IND UNDER AGE 192568 CHHA - H1N1 VACCINE FOR INDIVIDUALS 19 AND OLDER2569 CHHA - H1N1 VACCINE FOR INDIVIDUALS UNDER AGE 192570 PSYCH INPATIENT ELECTCONVUL THERAPY (ECT) ADD-ON2571 PSYCHIATRIC INPATIENT NON-OPERATING PER DIEM2572 MEDICAL LANGUAGE ASSISTANCE SERVICE - INPATIENT2574 SYSTEM GENERATED FROM MEMBER PA2581 SYSTEM GENERATED FROM MEMBER PA2583 SYSTEM GENERATED FROM MEMBER PA2585 SYSTEM GENERATED FROM MEMBER PA2589 DIRECT MEDICAL EDUCATION (DME) ADD-ON2590 MEDICAID NOT PAYABLE WITH SERIOUS ADVERSE EVENT2591 DRG WITH SERIOUS ADVERSE EVENTS2592 PER DIEM WITH SERIOUS ADVERSE EVENTS

2593 PCA LEVEL I, 1 CLIENT, QUARTER HOUR2594 PCA LEVEL I, 2 CLIENTS, PER CLIENT 1/4 HOUR2595 PCA LEVEL II, 1 CLIENT, 1/4 HOUR2596 PCA LEVEL II, 2 CLIENTS PER CLIENT 1/4 HOUR2597 PCA LEVEL II, 1 CLIENT HARD TO SERVE 1/4 HOUR2598 PCA LVL 2, 2 CLNTS/CLNT HARD TO SERVE 1/4 HOUR2599 PCA LEVEL II, OMRDD, 1/4 HOUR2600 SYSTEM GENERATED FROM MEMBER PA2601 PCA LEVEL I, ONE CLIENT HOURLY2602 PCA LEVEL 1 2 CLIENTS HOURLY (PER CLIENT)2603 PCA LEVEL 1 3 CLIENTS HOURLY (PER CLIENT)2604 PCA LVL 1 4 CLIENTS HOURLY (PER CLIENT)2605 PCA LVL 1 1 CLIENT HOURLY-SECONDARY CODE2606 PCA LVL 1 2 CLNT HRLY, PER CLIENT SECONDARY CODE2607 PERSONAL CARE AIDE LEVEL 1-2 HOUR RATE2608 PERSONAL CARE AIDE LEVEL 1-LIVE IN 14 HOURS2609 LONGTERM HOME MAINT TASK - EARS INSTALLATION2610 HOME HEALTH AIDE2611 LONG TERM HOME HEALTH AIDE2612 PCA LEVEL 1 ONE CLIENT DAILY2613 PCA LEVEL 1 2 CLIENTS DAILY (PER CLIENT)2614 PCS, PCA LEVEL I, 3 CLIENTS DAILY (PER CLIENT)2615 PCS, PCA LEVEL1, 4 CLIENTS DAILY (PER CLIENT)2616 LONGTERM CARE MAINT-TASK2-EARS COMM BASED2617 HHA/AIDS, HOME NURSING PRIV DUTY, LPN, HOURLY2618 HHA, AIDS HOME NURSING PRIV DUTY, RN, HOURLY2619 HHA, AIDS,NURSING SERVICES, EPISODIC, RN2620 NURSING2621 LONG TERM NURSING2622 PCA LEVEL 2 ONE CLIENT HOURLY2623 PCA LEVEL 2 TWO CLIENTS HOURLY (PER CLIENT)2624 PCA LEVEL 2 THREE CLIENTS HOURLY (PER CLIENT)2625 PCA LEVEL 2 FOUR CLIENTS HOURLY (PER CLIENT)2626 PCA LEVEL 2 ONE CLIENT HOURLY-SECONDARY CODE2627 PCA LEVEL 2 CLIENTS HOURLY, PER CLNT-SECONDARY CD2628 PERSONAL CARE AIDE LEVEL 2 - 2 HOUR RATE2629 PERSONAL CARE AIDE LEVEL 2 - LIVE IN 14 HOURS2630 PERSONAL CARE AID LEVEL 2 - 2 CHILDERN HOURLY2631 LONG TERM HOMEMAKER2632 PCA LEVEL 2 ONE CLIENT DAILY2633 PCA LEVEL 2 2 CLIENTS DAILY (PER CLIENT)2634 PCA LEVEL 2 3 CLIENTS DAILY (PER CLIENT)2635 PCA LVL 2 4 CLIENTS DAILY (PER CLIENT)2636 LONG TERM HOME CARE MOVING ASSISTANCE2637 LONG TERM HOME CARE MEDICAL SOCIAL SERVICES2638 LONG TERM HOME CARE CONGREGATE MEALS2639 LONG TERM CARE SOCIAL DAY CARE2640 OCCUPATIONAL THERAPY2641 LONG TERM OCCUPATIONAL THERAPY2642 PCA LEVEL 1 & 2 - LIVE-IN 14 HRS-2 CLNT (PER CLNT)2643 PCA LEVEL 1& 2 - HOLIDAY DIFFER-2 CLNT (PER CLNT)2644 PCA LEVEL 1 & 2 - HR RATE-2 CLNTS (PER CLIENT)2645 PCA LEVEL 2 -1 CLIENT HOURLY-HOLIDAY RATE2646 PCA LEV2-2 CLIENTS HOURLY(PER CLIENT) HOLIDAY RATE2647 PCA LEVEL 2 - 1 CLIENT DAILY-HOLIDAY RATE2648 PCA LVL 2-2 CLIENTS DAILY(PER CLIENT) HOLIDAY RATE2649 HOLIDAY DIFF PCA LEV 1 & 2 MONROE COUNTY ONLY2650 PHYSICAL THERAPY2651 LONG TERM PHYSICAL THERAPY2652 AUDIOLOGY (LTHHCP)2653 PCA LEVEL 1-2 HR RATE-HOLIDAY DIFFENTIAL2654 PCA LEVEL 1 - ONE CLIENT DAILY-HOLIDAY RATE2656 PCA LVL 1-2 HR RT-2 CLNT PER CLIENT- HOLIDAY DIFF2657 PCA LEV1-2 CLIENT DAILY(PER CLIENT) HOLIDAY RATE2658 PCA LEVEL 2-2 HR RATE-2 CLIENTS, PER CLIENT2659 PCA LEVEL 1 - ONE CLIENT HOURLY-HOLIDAY RATE2660 SPEECH THER (OBS, REPLACED BY 2662 EFF 1/2/80)2661 LONG TERM SPEECH THERAPY2662 SPEECH PATHOLOGY2663 RESPITE LTH CARE - PCA-HHA SVRCS (FREE STANDING)2664 LONG TERM HOME CARE MOVING ASSISTANCE - ROOM2665 RESPITE COMMUNITY 24-HRS PERSONAL CARE AID2666 HHA, AIDS, PCA LEVEL II, 1 CLIENT, HOURLY2667 HHA ,AIDS, PCA LEVEL II, 2 OR MORE CLIENTS, HOURLY2668 HHA, AIDS, HOME HEALTH AIDE, HOURLY2669 HOME HEALTH AIDE (PER HOUR)2670 CONTINUOUS NURSING SERVICES, HOURLY2671 LONG TERM HOUSEKEEPER2672 PCA TRANSPORTATION TO & FROM WORK2673 PCA-TRANSPORTATION DURING WORK2674 PCA MILEAGE TO & FROM WORK 5-15 MILES ONONDAGA2675 PCA MILEAGE TO & FROM WORK 16-25 MILES ONONDAGA2676 PCA MILEAGE TO & FROM WORK OVER 25 MILES ONONDAGA2677 HHA, AIDS, PHYSICAL THERAPY, 1 CLNT, 1 VISIT2678 HHA, AIDS, OCCUPATIONAL THERAPY, 1 CLNT, 1 VISIT2679 HHA, AIDS, SPEECH THERAPHY, 1 CLIENT, 1 VISIT2680 SPEECH EVAL (OBS - REPLACED BY 2662 1/2/80)2681 LONG TERM PERSONAL CARE2682 LONG TERM HOME CARE MEAL DELIVERED WEEKDAYS2683 PCA MEAL ALLOWANCE - LUNCH2684 PCA MEAL ALLOWANCE - DINNER2685 LTHHCP HOME DELIVERED MEALS (WEEKEND)2686 NURSING - AIDS2687 HHA, AIDS - NURSING2688 COMMUNITY LTHHC, PRI + SCREEN2689 COMMUNITY LTHHC, PERS2690 LTHHCP - RESPITE CARE (HOSPITAL)2691 LONG TERM HOME MAINTENANCE TASKS2692 RESPITE LONG TERM HOME SNF CARE

2693 RESPITE LONG TERM HOME HRF CARE2694 RESPITE LONG TERM HOME CARE NURSING2695 RESPITE LONG TERM HOME HEALTH AIDE2696 RESPITE LONG TERM HOME CARE HOMEMAKER2697 RESPITE LONG TERM HOME CARE HOUSEKEEPER2698 LONG TERM HOMECARE NUTRITION CNSLNG/ED SRV2699 LONG TERM CARE RESPIRATORY CARE2700 FOSTER FAMILY CARE SUBSTITUTE CAREGIVER2701 PCA LEVEL 2 - LIVE-IN -10 HRS -1 CLIENT2702 PCA LEVEL 2 - LIVE-IN -10 HRS -2 CLNTS PER CLIENT2703 PCA LEVEL 2 - LIVE-IN -11 HRS -1 CLIENT2704 PCA LEVEL 2 - LIVE-IN -11 HRS -2 CLNTS PER CLIENT2705 PCA LEVEL 2 - LIVE-IN -12 HRS -1 CLIENT2706 PCA LEVEL 2 - LIVE-IN -12 HRS -2 CLNTS PER CLIENT2707 PCA LEVEL 2 - LIVE-IN -13 HRS -1 CLIENT2708 PCA LEVEL 2 - LIVE-IN -13 HRS -2 CLNTS PER CLIENT2709 PCA LEVEL 2 - LIVE-IN -14 HRS -1 CLIENT2710 PCA LEV EL2 - LIVE-IN -14 HRS -2 CLNTS PER CLIENT2711 PCA LEVEL 2 - LIVE-IN -15 HRS -1 CLIENT2712 PCA LEVEL 2 - LIVE-IN -15 HRS -2 CLNTS PER CLIENT2713 PCA LEVEL 2 - LIVE-IN -16 HRS -1 CLIENT2714 PCA LEVEL 2 - LIVE-IN -16 HRS -2 CLNTS PER CLIENT2715 PCA LEVEL 1 - 2 CLNTS HRLY PER CLNT HOLIDAY DIFF2716 PCA LEVEL 2 - 2 CLNTS HRLY PER CLNT HOLIDAY DIFF2717 PCA LEVEL 1 - 1 CLIENT HOURLY - HOLIDAY DIFF2718 PCA LEVEL 2 - 1 CLIENT HOURLY - HOLIDAY DIFF2719 PCA LEVEL 1 - TRANSPORTATION TO AND FROM WORK2720 PCA LEVEL 2 - TRANSPORTATION TO AND FROM WORK2721 PCA LEVEL 1 - TRANSPORTATION DURING WORK2722 PCA LEVEL 2 - TRANSPORTATION DURING WORK2723 PCA LEVEL 1 -MILEAGE TO & FROM WORK - 5-15 MILES2724 PCA LEVEL 2 -MILEAGE TO & FROM WORK - 5-15 MILES2725 PCA LEVEL 1 -MILEAGE TO & FROM WORK - 16-25 MILES2726 PCA LEVEL 2 -MILEAGE TO & FROM WORK - 16-25 MILES2727 PCA LEVEL 1 -MILEAGE TO & FROM WORK - OVER 25 MILE2728 PCA LEVEL 2 -MILEAGE TO & FROM WORK - OVER 25 MILE2729 PCA LEVEL 2 - MEAL ALLOWANCE LUNCH2730 PERSONAL CARE AIDE LEVEL 2 - DINNER2731 FOSTER FAMILY PERSONAL CARE - MONTHLY2732 FOSTER FAMILY PERSONAL CARE - DAILY2733 PCA 1 PUBLIC TRANSPORTATION DURING WORK2734 PCA II PUBLIC TRANSPORTATION DURING WORK2735 PCA I PUBLIC TRANSPORTATION DURING WORK W/TRANSFER2736 PCAII PUBLIC TRANS DURING WORK W/TRANSFER2737 PCAII - 2 HOUR HOLIDAY RATE2738 PCAII -2 HR RATE - 2 CLNTS PER CLNT HOLIDAY RATE2739 PCAII - 2 HOUR RATE - SECONDARY CODE2740 PCAII - ONE CLIENT DAILY - SECONDARY CODE2741 PCA I - NURSING SUPERVISION2742 PCA II - NURSING SUPERVISION2743 PCA II - ONE CLIENT HOURLY - OVER 8 HOURS/DAY2744 PCA I - INDIVIDUAL PROVIDER - HOURLY (RATE 1)2745 PCA I - INDIVIDUAL PROVIDER - HOURLY (RATE 2)2746 PCA I - INDIVIDUAL PROVIDER - HOURLY (RATE 3)2747 PCA II - INDIVIDUAL PROVIDER - HOURLY (RATE 1)2748 PCA II - INDIVIDUAL PROVIDER - HOURLY (RATE 2)2749 PCA II - INDIVIDUAL PROVIDER - HOURLY (RATE 3)2750 PCA II - INDIVIDUAL PROVIDER - HOURLY (RATE 4)2751 PCA II - INDIVIDUAL PROVIDER - DAILY (RATE 1)2752 PCA II - INDIVIDUAL PROVIDER - DAILY (RATE 2)2753 PCA II - 2 HR RATE - 2 CLNTS PER CLNT - SECONDARY2754 PCA II - 2 CLIENTS DAILY PER CLIENT -SECONDARY2755 PCA I - 2 CLIENTS HOURLY PER CLIENT - HOLIDAY2756 PCA I - 1 CLIENT HOURLY 4 OR MORE HOURS PER DAY2757 PCA II -1 CLIENT HOURLY 4 OR MORE HOURS PER DAY2758 PCA I - 1 CLIENT SERVICE PREMIUM HOURLY2759 PCA II - 1 CLIENT SERVICE PREMIUM HOURLY2760 PCA I - 1 CLIENT LIVE-IN-HOURLY2761 PCA II -1 CLIENT LIVE-IN-HOURLY2762 PCA II -2 CLIENTS LIVE-IN HOURLY PER CLIENT2763 PCA I - PREMIUM HOURLY2764 PCA II - PREMIUM HOURLY2765 PCA II - LIVE-IN HOURLY2766 PCA II I- ONE CLIENT HOURLY2767 PCA III - TWO CLIENTS HOURLY2768 PCA III - LIVE-IN 10 HOURS - ONE CLIENT2769 PCA III - LIVE-IN 10 HOURS -2 CLIENTS PER CLIENT2770 PCA III - LIVE-IN 11 HOURS - ONE CLIENT2771 PCA III - LIVE-IN 11 HOURS - 2 CLIENTS PER CLIENT2772 PCA III - LIVE-IN 12 HOURS - ONE CLIENT2773 PCA III - LIVE-IN 12 HOURS - 2 CLIENTS PER CLIENT2774 PCA III - LIVE-IN 13 HOURS - ONE CLIENT2775 PCA III - LIVE-IN 13 HOURS - 2 CLIENTS PER CLIENT2776 PCA III - LIVE-IN 14 HOURS - ONE CLIENT2777 PCA III - LIVE-IN 14 HOURS - 2 CLIENTS PER CLIENT2778 PCA III - LIVE-IN 15 HOURS - ONE CLIENT2779 PCA III - LIVE-IN 15 HOURS - 2 CLIENTS PER CLIENT2780 PCA III - LIVE-IN 16 HOURS - ONE CLIENT2781 PCA III - LIVE-IN 16 HOURS - 2 CLIENTS PER CLIENT2782 PCA III - 1 CLIENT 14 HOUR LIVE-IN HOLIDAY DIFF2783 PCA II - 1 CLIENT 12 HOUR LIVE-IN HOLIDAY DIFF2784 PCA II - 1 CLIENT 2 HOUR RATE, HOLIDAY DIFF2785 PCA II - 1 CLIENT 12 HOUR LIVE-IN HOLIDAY RATE2786 PCA II - 1 CLIENT HOURLY HOLIDAY DIFF - SECONDARY2787 NURSING ASSESSMENT2788 PCA I - 2 HOUR RATE - SECONDARY CODE2789 PCA II - 1 CLIENT 10 HOUR LIVE-IN HOLIDAY RATE2790 PCA I - 1 CLIENT, 2 HOUR, HOLIDAY RATE2791 PCA I - 2 CLIENTS, 2 HOUR, HOLIDAY RATE

2792 PCA I - 1 CLIENT, SHARED AIDE HOLIDAY RATE2793 PCA II - 1 CLIENT, SHARED AIDE HOLIDAY RATE2794 PCA II - 1 CLIENT, LIVE-IN HOURLY HOLIDAY RATE2795 PCA TRANSPORTATION OVER 99 MILES2796 PCA II - ONE CLIENT HOURLY - OMR/DD DOWNSTATE2797 PCA III - ONE CLIENT HOURLY - OMR/DD DOWNSTATE2798 PCA II - ONE CLIENT HOURLY - OMR/DD UPSTATE2799 PCA III - ONE CLIENT HOURLY - OMR/DD UPSTATE2800 DAY CARE, PER VISIT2801 DAY CARE, 1 HOUR2802 DAY CARE, 2 HOURS2803 DAY CARE, 3 HOURS2804 DAY CARE, 4 HOURS2805 DAY CARE, 5 HOURS2806 DAY CARE, 6 HOURS2807 DAY CARE, 7 HOURS2808 DAY CARE, 8 HOURS2809 LONG TERM HOME MAINT TASK - EARS INSTALLATION2810 LONG TERM HOME HEALTH AIDE (HOSPITAL BASED)2811 LONG TERM NURSING (HOSPITAL BASED)2812 LONG TERM OCCUPATIONAL THERAPY, HOSPITAL BASED2813 LONG TERM PHYSICAL THERAPY, HOSPITAL BASED2814 LONG TERM SPEECH THERAPY (HOSPITAL BASED)2815 LONG TERM HOMEMAKER (HOSPITAL BASED)2816 LONG TERM HOUSEKEEPER (HOSPITAL BASED)2817 LONG TERM PERSONAL CARE (HOSPITAL BASED)2818 LONG TERM HOME MAINT TASK II - EARS, HOSP BASE2819 INPATIENT AWAITING ALC PLACEMENT, SNF LEVEL2820 INPATIENT GENERAL - RESPITE2821 LONG TERM HOME MAINTENANCE TASKS2822 RESPITE LONG TERM HOME SNF CARE2823 RESPITE LONG TERM HOME HRF CARE2824 RESPITE LONG TERM HOME CARE NURSING2825 RESPITE LONG TERM HOME HEALTH AIDE2826 RESPITE LONG TERM HOME CARE HOMEMAKER2827 RESPITE LONG TERM HOME CARE HOUSEKEEPER2828 LONG TERM HOMECARE NUTRITION CNSLNG/ED SERVICE2829 LONG TERM HOME CARE RESPIRATORY CARE2830 LONG TERM HOME CARE CONGREGATE MEALS2831 LONG TERM HOME CARE MOVING ASSISTANCE2832 LONG TERM HOME CARE MEDICAL SOCIAL SERVICES2833 LONG TERM CARE SOCIAL DAY CARE2834 RESPITE LTHC - PCA, HHA SERVICES, HOSPITAL BASED2835 LONG TERM HOME CARE HOME DELIVERED MEALS2836 RESPITE LONG TERM CARE - HOSPITAL2837 RESPITE HOSPITAL 24HRS - PERSONAL CARE AIDE2838 SPECIAL CARE-NON-MEDICARE, HOSPITAL BASED2839 SPECIAL CARE - MEDICARE (HOSPITAL BASED)2840 HIGH LEVEL CARE - NON-MEDICARE, HOSPITAL BASED2841 HOME HEALTH AIDE (PER VISIT OR PER HOUR)2842 NURSING2843 HIGH LEVEL CARE - MEDICARE, HOSPITAL BASED2844 OCCUPATIONAL THERAPY2845 PHYSICAL THERAPY2846 SPEECH THERAPY (OBS - REPLACED BY 2847 1/2/80)2847 SPEECH PATHOLOGY2848 SPEECH EVALUATION (OBS - REPLACES BY 2847 1/2/80)2849 PHYSICAL THERAPY EVALUATION2850 GENERAL2851 HOSPITAL SUBDIVISION - DETOXIFICATION2852 HOSPITAL SUBDIVISION - PSYCH - DRG EXEMPT2853 HOSPITAL SUBDIVISION - REHAB - DRG EXEMPT2854 HOSPITAL SUBDIVISION - TUBERCULOSIS2855 MENTAL RETARDATION ACUTE CARE2856 INPATIENT ACUTE CARE - EXCLUDING PHYS SERVICES2857 OOS FLAT RATE OVERPAY - PERCENTAGE CALCULATED2858 PRIVATE PSYCHIATRIC HOSPITALS2859 SPECIALTY HOSPITAL-BED RESERVATION2860 GENERAL2861 NON-OCCUPANT SERVICE (SUBCHAPTER H)2862 MEDICARE2863 NON-MEDICARE2864 LONG TERM HOME CARE MOVING ASSISTANCE-ROOM2865 HOSPITAL SUBDIVISION - DRUG DETOXIFICATION2866 OUT OF STATE MATERNITY2867 OUT OF STATE NEWBORN2868 OUT OF STATE PEDIATRIC2869 OUT OF STATE INTENSIVE CARE2870 OUTPATIENT DEPARTMENT2871 DETOXIFICATION (ALCOHOLISM OR DRUG ABUSE)2872 METHADONE MAINTENANCE TREATMENT PROGRAM2873 PREGNANT ADDICTS AND ADDICTED MOTHERS2874 TUBERCULOSIS2875 FAMILY MEDICINE2876 KIDNEY CLINIC2877 AMBULATORY SURGERY (HOSPITAL BASED)2878 HOME HEALTH AIDE (PER HOUR)2879 GENERAL - ER2880 PART-TIME CLINIC SERVICES2881 GERIATRIC DAY CARE2882 HALFWAY HOUSE2883 RENAL OR HEMODIALYSIS2884 PSYCHIATRIC DAY CARE2885 PSYCHIATRIC NIGHT CARE2886 REFERRED AMBULATORY2887 CHILD REHABILITATION2888 COMP PHYSICAL EXAM (SCHOOL HLTH PROJECT)2889 ROUTINE VISIT (SCHOOL HEALTH PROJECT)2890 GENERAL

2891 NON-OCCUPANT SERVICE (SUBCHAPTER H)2892 HRF/MR2893 ALT CARE DAY, SNF LEVEL PRIVATE PSYCH HOSPITAL2894 ALT CARE DAY, SNF LEVEL STATE OPERATED PC'S2895 ALT CARE DAY, SNF LEVEL RESIDENTIAL TREATMENT FAC2896 ALT CARE DAY, HRF LEVEL PRIVATE PSYCH HOSPITAL2897 ALT CARE DAY, HRF LEVEL STATE OPERATED PC'S2898 ALT CARE DAY, HRF LEVEL RESIDENTIAL TREATMENT FAC2899 INPATIENT AWAITING ALC PLACEMENT, HRF LEVEL29 SYSTEM GENERATED FROM ENCOUNTER2900 AMBULATORY SURGERY - LEVEL I2901 AMBULATORY SURGERY - LEVEL II2902 AMBULATORY SURGERY - LEVEL III2903 AMBULATORY SURGERY - LEVEL IV2904 ADDITIONAL SURGERY - LEVEL I2905 ADDITIONAL SURGERY - LEVEL II2906 ADDITIONAL SURGERY - LEVEL III2907 ADDITIONAL SURGERY - LEBEL IV2908 AIDS UNIT - DRG EXEMPT2909 AIDS CLINIC2910 HEMODIALYSIS FACILITY SESSION2911 HOME HEMODIALYSIS CAPD/CCPD WEEKLY2912 HOME HEMODIALYSIS CAPD/CCPD DAILY2913 HOME HEMODIALYSIS EXTENDED PERITONEAL 0-19 HOURS2914 HOME HEMODIALYSIS EXTENDED PERITONEAL 20-29 HOURS2915 HOME HEMO EXTENDED PERITONEAL 30 OR MORE HOURS2916 PAC 1 WELL CARE EXAMINATION, CHILD AGE 0-22917 PAC 2 ANNUAL WELL CARE EXAM, AGE 3-172918 PAC3 DIAG INVEST CLASS 1 PROBLEM, AGE 0-172919 PAC 4 MANAGEMENT CLASS I PROBLEM, AGE 0-172920 PAC 5 MEDICATION ADMINISTRATION2921 PAC 6 ANNUAL EXAMINATION, ADULT OVER 172922 PAC 7 DIAG INVEST CLASS 2 PROBLEM, AGE 17+2923 PAC 8 MANAGEMENT CLASS 2 PROBLEM, AGE OVER 172924 PAC 9 INITIAL PRENATAL EVALUATION2925 PAC10 PRENATAL/POSTPARTM VISIT, AGE 34+ OR -192926 PAC11 PRENATAL/POSTPARTUM VISIT, AGE 19-342927 PAC 12 ANNUAL GYNECOLOGICAL EXAMINATION2928 PAC 13 DIAG INVEST REPRODUCTIVE PROBLEM2929 PAC 14 MANAGEMENT REPRODUCTIVE PROBLEM2930 PAC 15 DIAG INVEST OF CLASS 3 PROBLEM2931 PAC 16 MANAGEMENT OF CLASS 3 PROBLEM2932 PAC 17 DIAG INVEST OF CLASS 4 PROBLEM2933 PAC18 MANAGEMENT CHEMO/RADIOTHERAPY TREATMENT2934 PAC 19 MANAGEMENT OF CLASS 4 PROBLEM2935 PAC 20 MANAGEMENT OF CLASS 5 PROBLEM2936 PAC 21 AUDIOLOGICAL TESTING2937 PAC 22 OPTHALMOLOGICAL SERVICES2938 PAC 23 SPEECH AND REHABILIATION THERAPY2939 PAC 24 DIAG INVEST W/NUVLEAR/CAT IMAGING2940 AIDS CLINIC, INITIAL VISIT2941 AIDS CLINIC, FOLLOW-UP VISIT, EXTENDED2942 AIDS CLINIC, FOLLOW-UP VISIT (ROUTINE)2943 AIDS CLINIC, INFUSION THERAPY (BLOOD)2944 AIDS CLINIC, INFUSION THERAPY, CHEMOTHERAPY2945 AIDS CLINIC, SUBSEQUENT COMPREHENSIVE VISIT2946 DIAGNOSIS RELATED GROUPS2947 CANCER HOSPITALS - DRG EXEMPT2948 REHABILITATION HOSPITALS - DRG EXEMPT2949 CHILDREN HOSPITALS - DRG EXEMPT2950 AWAITING ALC-RES HLTH CARE FAC - DRG FAC2951 AWAITING ALC-MEDCALY RELATED HOMECARE SERVICE2952 OUT-OF-STATE HOSPITAL - DRG EXEMPT2953 OUT-OF-STATE HOSPITAL - DRG2954 AWAITING ALC-RES HLTH CARE FAC - NON-DRG2955 AWAITING ALC-MED RELATED HOMECARE - NON-DRG2956 LONG STAY DAY OUTLIERS2957 ALCOHOLISM REHAB. - DRG EXEMPT2958 OUT-OF-STATE DRG DAY OUTLIERS2959 OTHER DRG EXEMPT2960 INPATIENT ADMISSION CLAIM2961 AIDS CLINIC, THERAPEUTIC VISIT2962 AWAITING ALC-RHCF - NON-DRG PSYCH UNIT2963 AWAITING ALC-MED RELATED HC - NON-DRG PSYCH2964 AWAITING ALC PLACEMENNT-RHCF-NON-DRG AIDS CENTER2965 AWAITING ALC-MED RELATED HC-NON-DRG AIDS CENTER2966 AWAITING ALC-RHCF -NON-DRG ALCOHOL REHAB2967 ALC-MED. RELATED HCS-NON-DRG ALCOHOL REHAB2968 AWAITING ALC-RHCF-NON-DRG OTHER EXEMPT UNIT2969 ALC-MED RELATED HC-NON-DRG OTHER EXEMPT UNIT2970 AWAITING ALC-RHCF-NON-DRG MEDICAL REHAB UNIT2971 ALC-MED RELATED HC-NON-DRG MEDICAL REHAB2972 CONTINUOUS NURSING SERVICES, HOURLY2973 METHADONE MAINTENANCE TREATMENT PROGRAM, WEEKLY2974 PCA II - 8 HOUR SHIFT (VISIT)2975 PCA I - 1 CLIENT PREMIUM RTE AIDS CASES HOURLY2976 PCA II - 1 CLNT PREMIUM RT AIDS CASES HOURLY2977 PCAI - 2 CLIENT PREMIUM RTE AIDS CASES HOURLY2978 PCA II - 2 CLIENT PREMIUM RT AIDS CASES HOURLY2979 PCA I - 1 CL ENHANCED RT GEGRAPHICLY DIFF HOURLY2980 PCA II - 1 CL ENHANCED RT GEGRAPHICLY DIFF HOURLY2981 PCA I - 2 CL ENHANCED RT GEGRAPHICLY DIFF HOURLY2982 PCA II - 2 CL ENHANCED RT GEGRAPHICLY DIFF HOURLY2983 HIV COUNSELING AND TESTING VISIT2984 POST-TEST HIV COUNSELING VISIT - NEGATIVE RESULT2985 INITIAL COMP HIV MEDICAL EVALUATION VISIT2986 DRUG/IMMUNOTHERAPY VISIT - HIV INFECTED PATIENT2987 MONITORING VISIT - ASYMPTOMATIC HIV DISEASE2988 AIDS DENTAL CLINIC VISIT

2989 OB HIV COUNSLG/TESTING - UNREGISTERED PTS2990 DRG - CAPITAL ADD-ON2991 DRG SHORT-STAY OUTLIER PER DIEM CAPITL ADDON2992 HOSPITAL SWING BED PER DIEM2993 DRUG REHABILITATION UNIT - DRG EXEMPT2994 EPILEPSY UNIT - DRG EXEMPT2995 TB UNIT-DRG EXEMPT2996 TOP 20 DRGS (GROUP OPERATING CPD)2997 OOS-SPAD TRANSFER PER DIEM2998 OOS-SPAD OUTLIER PER DIEM2999 PRIMARY CARE HOSPITAL PER DIEM3000 BONE MARROW TRANSPLANT PER DIEM3001 PAS 1 - NERVE REPAIR3002 PAS 2 - EYE THERAPEUTIC3003 PAS 3 - EYE REPAIR3004 PAS 4 - LENS REMOVE/REPLACE3005 PAS 5 - EYE LASER THERAPEUTIC3006 PAS 6 - EYE MUSCLE REPAIR3007 PAS 7 - EYE REPAIR3008 PAS 8 - EAR THERAPEUTIC3009 PAS 9 - NASAL/PARANASAL THERAPEUTIC3010 PAS 10 - RHINO/SEPTO PLASTY3011 PAS 11 - TONSIL/ADENOID THERAPEUTIC3012 PAS 12 - NASAL/TRACHEAL ENDOSCOPE3013 PAS 13 - THORACIC DIAGNOSTIC/THERAPEUTIC3014 PAS 14 - VASCULAR DIAGNOSTIC II3015 PAS 15 - VASCULAR REPAIR3016 PAS 16 - VASCULAR DIAGNOSTIC/THERAPEUTIC3017 PAS 17 - UPPER G.I. DIAGNOSTIC/THERAPEUTIC3018 PAS 18 - LOWER G.I. DIAGNOSTIC/THERAPEUTIC3019 PAS 19 - RECTAL DIAGNOSTIC/THERAPEUTIC3020 PAS 20 - HEPATIC DIAGNOSTIC/THERAPEUTIC3021 PAS 21 - HEPATIC ENDOSCOPY3022 PAS 22 - HERNIA REPAIR3023 PAS 23 - CYSTOSCOPE3024 PAS 24 - UROLOGICAL THERAPEUTIC3025 PAS 25 - LITHOTRIPSY3026 PAS 26 - MALE GENITAL DIAGNOST3027 PAS 27 - GENITO-URINARY REPAIR3028 PAS 28 - MALE GENITAL THERAPEUTIC3029 PAS 29 - LAPAROSCOPY3030 PAS 30 - OVIDUCT DIAGNOSTIC/THERAPEUTIC3031 PAS 31 - GYN DIAGNOSTIC/THERAPEUTIC3032 PAS 32 - DILATION AND CURETTAGE3033 PAS 33 - SOFT TISSUE REPAIR3034 PAS 34 - BONE THERAPEUTIC3035 PAS 35 - ARTHROSCOPY3036 PAS 36 - BONE REPAIR3037 PAS 37 - SOFT TISSUE THERAPY3038 PAS 38 - BREAST DIAGNOSTIC/THERAPEUTIC3039 PAS 39 - BREAST REPAIR3040 PAS 40 - SKIN DIAGNOSTIC/THERAPEUTIC3041 PAS 41 - SKIN REPAIR3042 PAS 42 - UROLOGICAL DIAGNOSTIC3043 ADDITIONAL SURGERY - PAS 13044 ADDITIONAL SURGERY - PAS 23045 ADDITIONAL SURGERY - PAS 33046 ADDITIONAL SURGERY - PAS 43047 ADDITIONAL SURGERY - PAS 53048 ADDITIONAL SURGERY - PAS 63049 ADDITIONAL SURGERY - PAS 73050 ADDITIONAL SURGERY - PAS 83051 ADDITIONAL SURGERY - PAS 93052 ADDITIONAL SURGERY - PAS 103053 ADDITIONAL SURGERY - PAS 113054 ADDITIONAL SURGERY - PAS 123055 ADDITIONAL SURGERY - PAS 133056 ADDITIONAL SURGERY - PAS 143057 ADDITIONAL SURGERY - PAS 153058 ADDITIONAL SURGERY - PAS 163059 ADDITIONAL SURGERY - PAS 173060 ADDITIONAL SURGERY - PAS 183061 ADDITIONAL SURGERY - PAS 193062 ADDITIONAL SURGERY - PAS 203063 ADDITIONAL SURGERY - PAS 213064 ADDITIONAL SURGERY - PAS 223065 ADDITIONAL SURGERY - PAS 233066 ADDITIONAL SURGERY - PAS 243067 ADDITIONAL SURGERY - PAS 253068 ADDITIONAL SURGERY - PAS 263069 ADDITIONAL SURGERY - PAS 273070 ADDITIONAL SURGERY - PAS 283071 ADDITIONAL SURGERY - PAS 293072 ADDITIONAL SURGERY - PAS 303073 ADDITIONAL SURGERY - PAS 313074 ADDITIONAL SURGERY - PAS 323075 ADDITIONAL SURGERY - PAS 333076 ADDITIONAL SURGERY - PAS 343077 ADDITIONAL SURGERY - PAS 353078 ADDITIONAL SURGERY - PAS 363079 ADDITIONAL SURGERY - PAS 373080 ADDITIONAL SURGERY - PAS 383081 ADDITIONAL SURGERY - PAS 393082 ADDITIONAL SURGERY - PAS 403083 ADDITIONAL SURGERY - PAS 413084 ADDITIONAL SURGERY - PAS 423085 PAS 43 - ORAL SURGERY3086 ADDITIONAL SURGERY - PAS 433087 OTHER PAS AMBULATORY SURGERY PROCEDURES

3088 PAC GROUPER ACCESS CODE3089 PAS GROUPER ACCESS CODE-PRINCIPAL PROC3090 PAS GROUPER ACCESS CODE-ADDITIONAL PROC3091 DAY HOSPITAL VISIT3092 CHEMO CLINIC SERVICE3093 PAS 44 - STEREOTACTIC RAD THER OF BRAIN3094 ADDITIONAL SURGERY - PAS 443095 PAS 45 VITRECTOMY WITH THERAPY DRUG IMP3096 ADDITIONAL SURGERY-PAS 453097 OBSERVATION BED SERVICES3098 HYPERBARIC TREATMENT3099 HEAD INJURY/TRAUMA CLINIC3100 ORTHOPEDIC REHAB CLINIC3101 HOSP-BASED PCAP INITIAL PRENATAL CARE VISIT3102 HOSP-BASED PCAP FOLLOW-UP PRENATAL VISIT3103 HOSPITAL-BASED PCAP POST-PARTUM CARE3104 HEMO, EPO ADD-ON UP TO 10,000 UNITS3105 HEMO, EPO ADD-ON 10,000 UNITS OR MORE3106 HEMO, EPO ADD-ON PER 1,000 UNITS3107 MONTHLY DIALYSIS SVCS-MEDICARE CROSSOVER3109 HIV COUNSELING VISIT (NO TESTIING)3110 CHAP SCREENING EXAMINATION3111 POST-TEST HIV COUNSELING VISIT-POS RESULT3112 AIDS CLINIC, INFUS. THERAPY-1 UNIT BLOOD3113 AIDS CLINIC, INFUS. THERAPY-2 UNITS BLOOD3114 AIDS CLINIC, INFUS. THERAPY-3 UNITS BLOOD3115 AIDS CLINIC, INFUS. THERAPY-4 UNITS BLOOD3116 OUT-OF-STATE ALCOHOL REHAB UNIT - NON-DRG3117 OUT-OF-STATE DRUG REHAB UNIT - DRG EXEMPT3118 ALC-RHCF-NONDRG DRUG REHAB3119 ALC-MED RELATED HC-NONDRG DRUG REHAB3120 ALC-RHCF-NONDRG EPILEPSY UNIT3121 ALC-MED RELATED HC-NONDRG EPILEPSY UNIT3122 ALC-RHCF - NON-DRG TB UNIT3123 ALC-MED RELATED HC-NON-DR TB UNIT3124 CARDIO-PULMONARY CLINIC3125 PEDIATRIC IV GAMMA GLOBULIN CLINIC3126 ALC-NF-NONDRG PRIM CARE HOSP3127 ALC-MED RELATED HC-NONDRG PRIM CARE HOSP3128 ALC-NF-NONDRG BONE MARROW TRANS3129 ALC-MED RELATED HC-NONDRG BONE MAR TRANS3130 GME/WORKER INCENTIVE - DRG DISCHARGE3131 GME/WORKER INCENTIVE EXEMPT UNIT DSCGE-PSYCH3132 GME/WORKER INCNTVE EXMPT UNIT DSCGE-MED REHAB3133 GME/WORKER INCENTIVE EXEMPT UNIT DSCGE-AIDS3134 GME/WRKER INCENT. EXMPT UNIT DSCHGE-ALC REHAB3135 GME/WKR INCENT. EXMPT UNIT DISCGE-DRUG REHAB3136 GME/WKR INCENT. EXEMPT UNIT DISCGE-EPILEPSY3137 GME/WKR INCENT. EXEMPT UNIT DISCGE-SPEC. HOSP3138 NEWBORN HEARING SCRNG SVC-1ST/INITIAL STAGE3139 NEWBORN HEARING SCRNG SVC-2ND/FOLLOWUP STG3140 HYPERBARIC THERAPY - 1/2 HOUR3141 SCREENING FOR ORTHODONTIC TREATMENT3142 TC INTAKE EXAM MANAGED CARE3143 ASSISTIVE TECHNOLOGY (LTHHCP)3144 COMMUNITY TRANSITIONAL SERVICES (LTHHCP)3145 HOME AND COMMUNITY SUPPORT SERVICE (LTHHCP)3160 SYSTEM GENERATED FROM CLAIM3170 SYSTEM GENERATED FROM CLAIM3201 NY/NY CONNECT-13202 NY/NY CONNECT-23203 NY/NY CONNECT-33204 NY/NY CONNECT-43205 NY/NY CONNECT-53206 NY/NY CONNECT-63207 NY/NY CONNECT-73208 NY/NY CONNECT-83209 NY/NY CONNECT-93210 NY/NY CONNECT-103211 NY/NY CONNECT-113212 NY/NY CONNECT-123213 NY/NY CONNECT-133214 NY/NY CONNECT-143215 NY/NY CONNECT-153216 NY/NY CONNECT-163217 NY/NY CONNECT-173218 NY/NY CONNECT-183219 NY/NY CONNECT-193220 NY/NY CONNECT-203230 ONE FARE TRANSPORTATION TOKEN: METHADON3231 TWO FARE TRANSPORTATION TOKEN: METHADON3257 INDIVID BRIEF PSYCHOTHERAPY 20-30 MIN WITH PATIENT3258 INDIVID COMPR PSYCHOTHERAPY 45-50 MIN WITH PATIENT3259 FAMILY PSYCHOTHERAPY WITH OR W/O PATIENT PRESENT3276 SYSTEM GENERATED FROM CLAIM3299 ALP PRE-ADMISSION ASSESSMENT3300 RUGS II GROUP-RA, MEDICARE3301 RUGS II GROUP-RA, NON-MEDICARE3302 RUGS II GROUP-RB, MEDICARE3303 RUGS II GROUP-RB, NON-MEDICARE3304 RUGS II GROUP-SA, MEDICARE3305 RUGS II GROUP-SA, NON-MEDICARE3306 RUGS II GROUP-SB, MEDICARE3307 RUGS II GROUP-SB, NON-MEDICARE3308 RUGS II GROUP-CA, MEDICARE3309 RUGS II GROUP-CA, NON-MEDICARE3310 RUGS II GROUP-CB, MEDICARE3311 RUGS II GROUP-CB, NON-MEDICARE3312 RUGS II GROUP-CC, MEDICARE

3313 RUGS II GROUP-CC, NON-MEDICARE3314 RUGS II GROUP-CD, MEDICARE3315 RUGS II GROUP-CD, NON-MEDICARE3316 RUGS II GROUP-BA, MEDICARE3317 RUGS II GROUP-BA, NON-MEDICARE3318 RUGS II GROUP-BB, MEDICARE3319 RUGS II GROUP-BB, NON-MEDICARE3320 RUGS II GROUP-BC, MEDICARE3321 RUGS II GROUP-BC, NON-MEDICARE3322 RUGS II GROUP-PA, MEDICARE3323 RUGS II GROUP-PA, NON-MEDICARE3324 RUGS II GROUP-PB, MEDICARE3325 RUGS II GROUP-PB, NON-MEDICARE3326 RUGS II GROUP-PC, MEDICARE3327 RUGS II GROUP-PC, NON-MEDICARE3328 RUGS II GROUP-PD, MEDICARE3329 RUGS II GROUP-PD, NON-MEDICARE3330 RUGS II GROUP-PE, MEDICARE3331 RUGS II GROUP-PE, NON-MEDICARE3332 RUGS II GROUP-RVA, MEDICARE3333 RUGS III GROUP-RVA, NON-MEDICARE3334 RUGS III GROUP-RVB, MEDICARE3335 RUGS III GROUP-RVB, NON-MEDICARE3336 RUGS III GROUP-RVC, MEDICARE3337 RUGS III GROUP-RVC, NON-MEDICARE3338 RUGS III GROUP-RHA, MEDICARE3339 RUGS III GROUP-RHA, NON-MEDICARE3340 RUGS III GROUP-RHB, MEDICARE3341 RUGS III GROUP-RHB, NON-MEDICARE3342 RUGS III GROUP-RHC, MEDICARE3343 RUGS III GROUP-RHC, NON-MEDICARE3344 RUGS III GROUP-RHD, MEDICARE3345 RUGS III GROUP-RHD, NON-MEDICARE3346 RUGS III GROUP-RMA, MEDICARE3347 RUGS III GROUP-RMA, NON-MEDICARE3348 RUGS III GROUP-RMB, MEDICARE3349 RUGS III GROUP-RMB, NON-MEDICARE3350 RUGS III GROUP-RMC, MEDICARE3351 RUGS III GROUP-RMC, NON-MEDICARE3352 RUGS III GROUP-RLA, MEDICARE3353 RUGS III GROUP-RLA, NON-MEDICARE3354 RUGS III GROUP-RLB, MEDICARE3355 RUGS III GROUP-RLB, NON-MEDICARE3356 RUGS III GROUP-SE1, MEDICARE3357 RUGS III GROUP-SE1, NON-MEDICARE3358 RUGS III GROUP-SE2, MEDICARE3359 RUGS III GROUP-SE2, NON-MEDICARE3360 RUGS III GROUP-SE3, MEDICARE3361 RUGS III GROUP-SE3, NON-MEDICARE3362 RUGS III GROUP-SSA, MEDICARE3363 RUGS III GROUP-SSA, NON-MEDICARE3364 RUGS III GROUP-SSB, MEDICARE3365 RUGS III GROUP-SSB, NON-MEDICARE3366 RUGS III GROUP-SSC, MEDICARE3367 RUGS III GROUP-SSC, NON-MEDICARE3368 RUGS III GROUP-CA1, MEDICARE3369 RUGS III GROUP-CA1, NON-MEDICARE3370 RUGS III GROUP-CA2, MEDICARE3371 RUGS III GROUP-CA2, NON-MEDICARE3372 RUGS III GROUP-CB1, MEDICARE3373 RUGS III GROUP-CB1, NON-MEDICARE3374 RUGS III GROUP-CB2, MEDICARE3375 RUGS III GROUP-CB2, NON-MEDICARE3376 RUGS III GROUP-CC1, MEDICARE3377 RUGS III GROUP-CC1, NON-MEDICARE3378 RUGS III GROUP-CC2, MEDICARE3379 RUGS III GROUP-CC2, NON-MEDICARE3380 RUGS III GROUP-CD1, MEDICARE3381 RUGS III GROUP-CD1, NON-MEDICARE3382 RUGS III GROUP-CD2, MEDICARE3383 RUGS III GROUP-CD2, NON-MEDICARE3384 RUGS III GROUP-IA1, MEDICARE3385 RUGS III GROUP-IA1, NON-MEDICARE3386 RUGS III GROUP-IA2, MEDICARE3387 RUGS III GROUP-IA2, NON-MEDICARE3388 RUGS III GROUP-IB1, MEDICARE3389 RUGS III GROUP-IB1, NON-MEDICARE3390 RUGS III GROUP-IB2, MEDICARE3391 RUGS III GROUP-IB2, NON-MEDICARE3392 RUGS III GROUP-BA1, MEDICARE3393 RUGS III GROUP-BA1, NON-MEDICARE3394 RUGS III GROUP-BA2, MEDICARE3395 RUGS III GROUP-BA2, NON-MEDICARE3396 RUGS III GROUP-BB1, MEDICARE3397 RUGS III GROUP-BB1, NON-MEDICARE3398 RUGS III GROUP-BB2, MEDICARE3399 RUGS III GROUP-BB2, NON-MEDICARE3400 RUGS III GROUP-PA1, MEDICARE3401 RUGS III GROUP-PA1, NON-MEDICARE3402 RUGS III GROUP-PA2, MEDICARE3403 RUGS III GROUP-PA2, NON-MEDICARE3404 RUGS III GROUP-PB1, MEDICARE3405 RUGS III GROUP-PB1, NON-MEDICARE3406 RUGS III GROUP-PB2, MEDICARE3407 RUGS III GROUP-PB2, NON-MEDICARE3408 RUGS III GROUP-PC1, MEDICARE3409 RUGS III GROUP-PC1, NON-MEDICARE3410 RUGS III GROUP-PC2, MEDICARE3411 RUGS III GROUP-PC2, NON-MEDICARE

3412 RUGS III GROUP-PD1, MEDICARE3413 RUGS III GROUP-PD1, NON-MEDICARE3414 RUGS III GROUP-PD2, MEDICARE3415 RUGS III GROUP-PD2, NON-MEDICARE3416 RUGS III GROUP-PE1, MEDICARE3417 RUGS III GROUP-PE1, NON-MEDICARE3418 RUGS III GROUP-PE2, MEDICARE3419 RUGS III GROUP-PE2, NON-MEDICARE3420 RUGS III GROUP-BC1, MEDICARE3421 RUGS III GROUP-BC1, NON-MEDICARE3422 FUTURE RUGS CATEGORY3423 FUTURE RUGS CATEGORY3424 FUTURE RUGS CATEGORY3425 FUTURE RUGS CATEGORY3426 FUTURE RUGS CATEGORY3427 FUTURE RUGS CATEGORY3428 FUTURE RUGS CATEGORY3429 FUTURE RUGS CATEGORY3430 FUTURE RUGS CATEGORY3431 FUTURE RUGS CATEGORY3432 FUTURE RUGS CATEGORY3433 FUTURE RUGS CATEGORY3434 FUTURE RUGS CATEGORY3435 FUTURE RUGS CATEGORY3436 FUTURE RUGS CATEGORY3437 FUTURE RUGS CATEGORY3438 FUTURE RUGS CATEGORY3439 FUTURE RUGS CATEGORY3440 FUTURE RUGS CATEGORY3441 FUTURE RUGS CATEGORY3442 FUTURE RUGS CATEGORY3443 FUTURE RUGS CATEGORY3444 FUTURE RUGS CATEGORY3445 FUTURE RUGS CATEGORY3446 FUTURE RUGS CATEGORY3447 FUTURE RUGS CATEGORY3448 FUTURE RUGS CATEGORY3449 FUTURE RUGS CATEGORY3450 FUTURE RUGS CATEGORY3451 FUTURE RUGS CATEGORY3452 PACE FULL CAPITATION AGE 55+ DUAL ELIGIBLE3453 PACE FULL CAPITATION AGE 55+ DUAL ELIGIBLE3454 PACE 55+ NONDUAL EXISTING (PRIOR TO 1/1/12)3455 PACE 55+ DUAL EXISTING (PRIOR TO 1/1/12)3456 FULL CAPITATION AGE 21-64 DUAL ELIGIBLE3457 FULL CAPITATION AGE 21-64 DUAL ELIGIBLE3458 FULL CAPITATION AGE 21-64 NON-DUAL ELIG3459 FULL CAPITATION AGE 21-64 NON-DUAL ELIG3460 FULL CAPITATION AGE 65+ DUAL ELIGIBLE3461 FULL CAPITATION AGE 65+ DUAL ELIGIBLE3462 FULL CAPITATION AGE 65+ NON-DUAL ELIG3463 FULL CAPITATION AGE 65+ NON-DUAL ELIG3464 PREPACE PARTIAL CAPITATION AGE 55+ DUAL ELIG3465 PREPACE PARTIAL CAPITATION AGE 55+ DUAL ELIG3466 PARTIAL CAPITATION AGE 21-64 DUAL ELIG3467 PARTIAL CAPITATION AGE 21-64 DUAL ELIG3468 PARTIAL CAPITATION AGE 21-64 DUAL ELIG3469 PARTIAL CAPITATION AGE 21-64 NON-DUAL ELIG3470 PARTIAL CAPITATION AGE 21-64 NON-DUAL ELIG3471 MLTC LV3 PARTIAL CAP: 18-643472 PARTIAL CAPITATION AGE 65+ DUAL ELIG3473 PARTIAL CAPITATION AGE 65+ DUAL ELIG3474 PARTIAL CAPITATION AGE 65+ NON-DUAL ELIG3475 MLTC PARTIAL CAP: 65+3476 PREPACE PARTIAL CAPIT. AGE 55+ NON-DUAL ELIG3477 MLTC PACE & PREPACE: 55+3478 MLTC PARTIAL CAP AGE 18+3479 MLTC 21+ NHC3480 MLTC 21+ NON-NHC3481 MAP 18-64 NHC3482 MAP 18-64 NON-NHC3483 MAP 65+ NHC3484 MAP 65+ NON-NHC3485 PACE 55+ DUAL NHC3486 PACE 55+ DUAL NON-NHC3487 PACE 55+ NONDUAL NHC3488 PACE 55+ NONDUAL NON-NHC3489 PRIMARY FIDA AGE 21+ DUAL ELIGIBLE3490 PRIMARY FIDA: NURSING FACILITY LEVEL OF CARE3513 SYSTEM GENERATED FROM MEMBER PA3593 SYSTEM GENERATED FROM MEMBER PA3622 SYSTEM GENERATED FROM MEMBER PA3753 NEURO-BEHAVIORAL, MEDICARE3754 NEURO-BEHAVIORAL, NON-MEDICARE3755 AIDS, MEDICARE3756 AIDS, NON-MEDICARE3757 HEAD INJURY, MEDICARE3758 HEAD INJURY, NON-MEDICARE3759 VENTILATOR DEPENDENT, MEDICARE3760 VENTILATOR DEPENDENT, NON-MEDICARE3761 RESPITE, MEDICARE3762 PEDIATRIC, NON-MEDICARE3763 PEDIATRIC, MEDICARE3764 PEDIATRIC, NON-MEDICARE3765 PEDIATRIC, MEDICARE3766 AIDS, MEDICARE3767 AIDS, NON-MEDICARE3768 HEAD INJURY, MEDICARE3769 HEAD INJURY, NON-MEDICARE

3770 VENTILATOR DEPENDENT, MEDICARE3771 VENTILATOR DEPENDENT, NON-MEDICARE3772 RESPITE, MEDICARE3773 HEAD INJURY MCARE PT D (HS)(FB)3774 HEAD INJURY MCARE PT B&D (HB)(FS)3775 VENTILATOR DEPENDENT MCARE PT D (HB)(FS)3776 VENTILATOR DEPENDENT MCARE PT B&D (HB)(FS)3777 RESPITE MCARE PT D (HB)(FS)3778 RESPITE MCARE PT B&D (HB)(FS)3800 DAY CARE, PER VISIT3801 DAY CARE, 1 HOUR3802 DAY CARE, 2 HOURS3803 DAY CARE, 3 HOURS3804 DAY CARE, 4 HOURS3805 DAY CARE, 5 HOURS3806 DAY CARE, 6 HOURS3807 DAY CARE, 7 HOURS3808 DAY CARE, 8 HOURS3809 DAY CARE, 8.5 HOURS3810 NON-MEDICARE3811 NON-OCCUPANT (SUBCHAPTER H) /33812 MEDICARE3813 SPECIAL CARE NON-MEDICARE3814 SPECIAL CARE MEDICARE3815 SPECIAL CARE HIGH LEVEL NONMEDICARE - OOS ONLY3816 SPECIAL CARE HIGH LEVEL MEDICARE - OOS ONLY3817 SNF/GENERAL - RESPITE3819 RESPITE NURSING 24HRS-PERSONAL CARE LTHHC3820 GENERAL3821 NON-OCCUPANT(SUBCHAPTER H) /33822 HRF/MR3823 LONG TERM HME MAIN TASK-EARS INSTALLATION3824 COMMUNITY RN RESPITE NURSING3825 COMMUNITY LPN RESPITE NURSING3826 HOSPITAL RN RESPITE NURSING3827 HOSPITAL LPN RESPITE NURSING3828 NURSING HOME RN RESPITE NURSING3829 NURSING HOME LPN RESPITE NURSING3830 HOSPITAL LTHHC, PRI + SCREEN3831 HOSPITAL LTHHC, PERS3832 VOICF EDUCATIONAL SERVICES3833 DAY HEALTH CARE TRANSPORT, ROUNDTRIP3834 DAY HEALTH CARE TRANSPORT, ONE-WAY3835 DAY HEALTH CARE TRANSPORT WHEELCHAIR/AMBULATORY3836 NURSING FACILITY CASH ASSESSMENT RATE3837 NURSING FACIL FINANCIALLY DISADVANT PGM (FS) (HB)3838 NURSING FACIL MCARE PART D COVERAGE (FS) (HB)3839 NURSING FACIL MCARE PARTS B & D COVERAGE (FS) (HB)3840 SPECIAL CARE MCARE PT D OOS ONLY (HB)(FS)3841 SPECIAL CARE MCARE PT B&D OOS ONLY (HB)(FS)3842 SPECIAL CARE HI LEV MCARE PT D OOS ONLY (HB)(FS)3843 SPECIAL CARE HI LEV MCARE PT B&D OOS ONLY (HB)(FS)3844 NEURO BEHAVIORAL MCARE PT D (HB)(FS)3845 NEURO BEHAVIORAL MCARE PT B&D (HB)(FS)3846 PEDIATRIC MCARE PT D (HB)(FS)3847 PEDIATRIC MCARE PT B&D (HB)(FS)3848 AIDS MCARE PT D (HB)(FS)3849 AIDS MCARE PT B&D (HB)(FS)3850 LONG TERM HOME HEALTH AIDE (RHCF)3851 LONG TERM NURSING (RHCF)3852 LONG TERM OCCUPATIONAL THERAPY (RHCF)3853 LONG TERM PHYSICAL THERAPY (RHCF)3854 LONG TERM SPEECH THERAPY (RHCF)3855 LONG TERM HOMEMAKER (RHCF)3856 LONG TERM HOUSEKEEPER (RHCF)3857 LONG TERM PERSONAL CARE (RHCF)3858 LONG TERM MAINT TASK 11-EARS, NURSING HOME3859 RESPITE LTHC-PCA RHCF SERVICE (FREE STANDING)3860 LONG TERM HOME CARE MOVING ASSISTANCE - ROOM3861 LONG TERM HOME MAINTENANCE TASKS3862 RESPITE LONG TERM HOME SNF CARE3863 RESPITE LONG TERM HOME HRF CARE3864 RESPITE LONG TERM CARE NURSING3865 RESPITE LONG TERM HOME HEALTH AIDE3866 RESPITE LONG TERM HOME CARE HOMEMAKER3867 RESPITE LONG TERM CARE HOUSEKEEPER3868 LTHC NUTRITION COUNSLNG/EDUCATIONAL SERVICE3869 LONG TERM HOME CARE RESPIRATORY CARE3870 LONG TERM HOME CARE MOVING ASSISTANCE3871 LONG TERM HOME CARE MEDICAL SOCIAL SERVICES3872 LONG TERM HOME CARE CONGREGATE MEALS3873 LONG TERM CARE SOCIAL DAY CARE3874 LONG TERM HOME CARE HOME DELIVERED MEALS3875 LTHHCP-RESPITE CARE (HOSPITAL)3876 HOME HEALTH AIDE3877 NURSING3878 OCCUPATIONAL THERAPY3879 PHYSICAL THERAPY3880 SPEECH PATHOLOGY3881 S/HMO CO-PAY - PODIATRY3882 S/HMO CO-PAY-PRESCRIP DRUGS & INSULIN SUPP3883 S/HMO CO-PAY - OPD MENTAL HEALTH MD3884 S/HMO CO-PAY - EMERGENCY CARE - WITHIN USA3885 S/HMO CO-PAY - EMERGENCY CARE - OUTSIDE USA3886 S.HMO CO-PAY-PRESCRIP DRUGS & INSULIN SUPP3887 S/HMO CO-PAY - PRIVATE DUTY NURSING3888 S/HMO CO-PAY - DENTAL CARE - EXTRACTIONS3889 S/HMO CO-PAY - DENTAL CARE - DENTURES3890 S/HMO CO-PAY-DENTAL CARE-DENTURE REPAIR

3891 S/HMO CO-PAY - VISION CARE - EYE GLASSES3892 S/HMO CO-PAY - HEARING AIDS3893 S/HMO CO-PAY - TRANSPORTATION3894 S/HMO CO-PAY - SNF3895 S/HMO CO-PAY - ICF3896 S/HMO CO-PAY - NURSING3897 S/HMO CO-PAY - PHYSICAL THERAPY3898 S/HMO CO-PAY - OCCUPATIONAL THERAPY3899 S/HMO CO-PAY - SPEECH THERAPY3900 S/HMO CO-PAY - PERSONAL CARE3901 S/HMO CO-PAY - CHORE3902 S/HMO CO-PAY - MEALS3903 S/HMO CO-PAY - DAY HOSPITAL3904 S/HMO CO-PAY - RESPITE - SNF3905 S/HMO CO-PAY - RESPITE - HRF3906 S/HMO CO-PAY - RESPITE - IN HOME3907 S/HMO CO-PAY - ELECTRONIC MONITORING3908 S/HMO FULL FEE-FOR-SERV-PSYCH HOSPITAL3909 S/HMO FULL FEE-FOR-SERV-PODIATRY3910 S/HMO FULL FEE/SRV-MNTL HLTH-NURSE PRACT3911 S/HMO FULL FEE/SRV-OPD MENTAL HEALTH-MD3912 S/HMO FULL FEE/SRV-PRIVATE DUTY NURSING3913 S/HMO FULL FEE/SRV-DENTAL CARE - EXTRACTION3914 S/HMO FULL FEE/SRV-DENTAL CARE - DENTURE3915 S/HMO FULL FEE/SRV-DENTURE REPAIRS3916 S/HMO FULL FEE/SRV-DENTAL CARE - ROUTINE3917 S/HMO FULL FEE/SRV-VISION-EYE GLASSES3918 S/HMO FULL FEE-FOR-SERVICE - HEARING AIDS3919 S/HMO FULL FEE-FOR-SERVICE - SNF3920 S/HMO FULL FEE-FOR-SERVICE - ICF3921 S/HMO FULL FEE-FOR-SERVICE - NURSING3922 S/HMO FULL FEE/SRV-PHYSICAL THERAPY3923 S/HMO FULL FEE/SRV-OCCUPATIONAL THERAPY3924 S/HMO FULL FEE/SRV-SPEECH THERAPY3925 S/HMO FULL FEE-FOR-SERVICE-PERSONAL CARE3926 S/HMO FULL FEE-FOR-SERVICE - CHORE3927 S/HMO FULL FEE-FOR SERVICE - MEALS3928 S/HMO FULL FEE-FOR-SERVICE - DAY HOSPITAL3929 S/HMO FULL FEE-FOR-SERVICE-RESPITE - SNF3930 S/HMO FULL FEE-FOR-SERVICE-RESPITE - HRF3931 S/HMO FULL FEE/SERV-RESPITE-IN HOME3932 S/HMO FULL FEE/SRV-ELECTRONIC MONITORING3933 RHCF DAY CARE, I HR - RESPITE3934 RHCF DAY CARE, 2 HRS - RESPITE3935 RHCF DAY CARE, 3 HRS - RESPITE3936 RHCF DAY CARE, 4 HRS - RESPITE3937 RHCF DAY CARE, 5 HRS - RESPITE3938 RHCF DAY CARE, 6 HRS - RESPITE3940 RHCF DAY CARE, 7 HRS - RESPITE3941 RHCF DAY CARE, 8 HRS - RESPITE3942 HRF/GENERAL - RESPITE3943 HRF/MR - RESPITE3944 S/HMO FULL FEE-FOR-SERV-PRIVATE PREMIUM3945 HOSPICE ROUTINE HOME CARE3946 HOSPICE INPATIENT RESPITE3947 HOSPICE GENERAL INPATIENT3948 HOSPICE CONTINUOUS HOME CARE-MIN 8 HOURS3949 HOSPICE CONTINUOUS HOME CARE-MIN 9 HOURS3950 HOSPICE CONTINUOUS HOME CARE-MIN 10 HOURS3951 HOSPICE CONTINUOUS HOME CARE-MIN 11 HOURS3952 HOSPICE CONTINUOUS HOME CARE-MIN 12 HOURS3953 HOSPICE CONTINUOUS HOME CARE-MIN 13 HOURS3954 HOSPICE CONTINUOUS HOME CARE-MIN 14 HOURS3955 HOSPICE CONTINUOUS HOME CARE-MIN 15 HOURS3956 HOSPICE CONTINUOUS HOME CARE-MIN 16 HOURS3957 HOSPICE CONTINUOUS HOME CARE-MIN 17 HOURS3958 HOSPICE CONTINUOUS HOME CARE-MIN 18 HOURS3959 HOSPICE CONTINUOUS HOME CARE-MIN 19 HOURS3960 HOSPICE CONTINUOUS HOME CARE-MIN 20 HOURS3961 HOSPICE CONTINUOUS HOME CARE-MIN 21 HOURS3962 HOSPICE CONTINUOUS HME CARE-MIN 22 HOURS3963 HOSPICE CONTINUOUS HOME CARE-MIN 33 HOURS3964 HOSPICE CONTINUOUS HOME CARE-MIN 24 HOURS3965 HOSPICE-INPATIENT RESPITE CARE - COINSURANCE3966 HOSPICE - DRUG - COINSURANCE3967 NURSING - AIDS3968 RHCP/CHHA - CONT. NURSING SVCS - HOURLY3969 HOSPICE ROUTINE HOME CARE-AIDS PTS3970 HOSPICE ROUTINE HOME CARE-ESCORT SERVICES3971 HOSPICE CONT. HOME CARE-AIDS PTS - 8 HOURS3972 HOSPICE CONT. HOME CARE AIDS PTS - 9 HOURS3973 HOSPICE CONT. HOME CARE-AIDS PTS - 10 HOURS3974 HOSPICE CONT. HOME CARE-AIDS PTS - 11 HOURS3975 HOSPICE CONT. HOME CARE-AIDS PTS - 12 HOURS3976 HOSPICE CONT. HOME CARE-AIDS PTS - 13 HOURS3977 HOSPICE CONT. HOME CARE-AIDS PTS - 14 HOURS3978 HOSPICE CONT. HOME CARE-AIDS PTS - 15 HOURS3979 HOSPICE CONT. HOME CARE-AIDS PTS - 16 HOURS3980 HOSPICE CONT. HOME CARE-AIDS PTS - 17 HOURS3981 HOSPICE CONT. HOME CARE-AIDS PTS - 18 HOURS3982 HOSPICE CONT. HOME CARE-AIDS PTS - 19 HOURS3983 HOSPICE CONT. HOME CARE-AIDS PTS - 20 HOURS3984 HOSPICE CONT. HOME CARE-AIDS PTS - 21 HOURS3985 HOSPICE CONT. HOME CARE-AIDS PTS - 22 HOURS3986 HOSPICE CONT. HOME CARE-AIDS PTS - 23 HOURS3987 HOSPICE CONT. HOME CARE-AIDS PTS - 24 HOURS3988 HOSPICE GENERAL INPATIENT-AIDS PATIENTS3989 HOSPICE ROUTINE HC ESCORT SVC. - AIDS PTS3990 HOSPICE-STAND ALONE INPATIENT FACILITY

4000 SYSTEM GENERATED FROM CLAIM4001 STATE OP PSYCH CENTER - PSYCH INPATIENT4002 ST OP PSYCH CENTER-CHILDREN ADOLESCENT4003 ST OP PSYCH CENTER-INFIRMARY4004 ST OP PSYCH CENTER-MEDICAL/SURGICAL4005 PRIVATE PSYCH HOSP - REHABILITATION4006 HOSP SUBDIVISION-PSYCH REHABILITATION4007 BRIEF EVALUATION4008 FULL EVALUATION4009 CRISIS OUTREACH VISIT4010 INTERIM CRISIS VISIT4011 FQHC FQHC GROUP PSYCHOTHERAPY4012 FQHC FQHC OFF-SITE SERVICES (INDIV)4013 FQHC INDIVIDUAL THRESHOLD VISIT4014 FQHC GROUP PSYCHOTHERAPY (SBHC)4015 FQHC OFF-SITE SERVICE (INDV) (SBHC)4016 FQHC - INDIVIDUAL THRESHOLD VISIT (SBHC)4017 FQHC INDIVIDUAL SMOKING CESS CSLG4018 FQHC GROUP SMOKING CESS CSLG4019 FQHC INDIVIDUAL SMOKING CESS CSLG (SBHC)4020 FQHC GROUP SMOKING CESS CSLG (SBHC)4021 FQHC INITIAL COMPREHENSIVE HIV MEDICAL EVAL VISIT4022 FQHC MONITORING VISIT - ASYMPTOMATIC HIV4023 FQHC HIV COUNSELING VISIT (NO TESTING)4024 FQHC HIV COUNSELING AND TESTING VISIT4025 FQHC POSTTEST HIV COUNSELING VISIT-POSITIVE RESULT4026 FQHC GROUP PSYCHOTHERAPY - COURT MANDATED4027 FQHC OFF-SITE SERVICES (INDIV) - COURT ORDERED4028 FQHC INDIVIDUAL THRESHOLD VISIT - COURT ORDERED4029 FQHC GROUP PSYCHOTHERAPY (PART-TIME)4030 FQHC OFF-SITE SERVICES (INDIV) (PART-TIME)4031 FQHC INDIVIDUAL THRESHOLD VISIT (PART-TIME)4032 FQHC INIT COMPREHENSIVE HIV MED EVAL VISIT (SBHC)4033 FQHC MONITORING VISIT - ASYMPTOMATIC HIV (SBHC)4034 FQHC HIV COUNSELING VISIT (NO TESTING) (SBHC)4035 FQHC HIV COUNSELING AND TESTING VISIT (SBHC)4036 FQHC POSTTEST HIV COUNSEL VISIT-POS RESULT (SBHC)4037 FQHC INIT COMPRHENSIV HIV MED EVAL VISIT (PT-TIME)4038 FQHC MONITORING VISIT - ASYMPTOMATIC HIV (PT-TIME)4039 FQHC HIV COUNSELING VISIT (NO TESTING) (PART-TIME)4040 FQHC HIV COUNSELING AND TESTING VISIT (PART-TIME)4041 FQHC POSTEST HIV COUNSEL VISIT-POS RESLT (PT-TIME)4049 CPEP EXTENDED OBSERVATION BEDS4050 OMH CLINIC TREATMENT-REGULAR4051 OMH CLINIC TREATMENT-BRIEF4052 OMH CLINIC TREATMENT-GROUP4053 OMH CLINIC TREATMENT - HOME VISIT4054 OMH CLINIC TREATMENT - CRISIS SERVICE4055 OMH CLINIC TREATMENT PRE-ADMISSION - REGULAR4056 OMH CLINIC TREATMENT - COLLATERAL VISIT4060 OMH DAY TREATMENT - FULL DAY4061 OMH DAY TREATMENT-HALF DAY4062 OMH DAY TREATMENT-BRIEF4063 OMH DAY TREATMENT - HOME VISIT4064 MENTAL HEALTH DAY TREATMENT-CRISIS SERVICE4065 MEN.HEALTH DAY TREAT.PRE-ADMISSION - FULL DAY4066 OMH DAY TREATMENT - COLLATERAL4067 MEN.HEALTH DAY TREATMENT PRE-ADMISSION - HALF DAY4068 OMH MNTL HEALTH DAY TRTMNT-COLLATERAL VISIT BRIEF4070 OMH CONTINUING TREATMENT - FULL DAY4071 OMH CONTINUING TREATMENT - HALF DAY4072 OMH CONTINUING TREATMENT - BRIEF4073 OMH CONTINUING TREATMENT - HOME VISIT4074 OMH CONTINUING TREATMENT - CRISIS SERVICE4075 OMH CONTINUING TRTMNT - PRE-ADMISSION - FULL DAY4076 OMH CONTINUING TREATMENT - COLLATERAL VISIT4077 MEN.HEALTH CONTIN.TREAT.PRE-ADMISSION - HALF DAY4091 OMH CDT-CRISIS COPS4092 OMH CDT-GROUP COLLATERAL COPS4093 OMH CLINIC-CRISIS COPS4094 OMH CLINIC-GROUP COLLATERAL COPS4095 OMH CLINIC-COLLATERAL COPS4096 OMH CLINIC-GROUP COPS4097 OMH CLINIC-BRIEF COPS4098 OMH/COPS MANAGED CARE - REGULA4099 OMH CHILDREN'S CLINIC WEEKEND/EVENING ENRICHMENT4100 STATE OPERATED OMR DEVELOPMENTAL CENTER4101 OMR STATE OPERATED ICF/DD4102 OMRDD ST OP ICF/DD SMALL RESIDENTIAL UNIT4103 SOICF EDUCATIONAL SERVICES4104 ICF; VOL; DAY SERVICE; FULL UNIT4105 ICF; VOL; DAY SERVICE; HALF UNIT4106 ICF; VOL; VOCATIONAL SERVICE; FULL UNIT4107 ICF; VOL; VOCATIONAL SERVICE; HALF UNIT4108 ICF; VOL; INHS DAY SERVICE; FULL UNIT4109 ICF; VOL;COMM VOC; GROUP 3 + IND4110 ICF; STATE; DAY SERVICE; FULL UNIT4111 ICF; STATE; DAY SERVICE; HALF UNIT4112 ICF; STATE; VOCATIONAL SERVICE; FULL UNIT4113 ICF; STATE; VOCATIONAL SERVICE; HALF UNIT4114 ICF; STATE; INHS DAY SERVICE; FULL UNIT4115 ICF; STATE; COMM VOC; GROUP 3 + IND4116 ICF; VOL; COMM VOCATIONAL 1:14117 ICF; VOL;COMM VOC; GROUP OF 24118 ICF; STATE; COMM VOCATIONAL 1:14119 ICF; STATE; COMM VOCATIONAL 1: GROUP4140 OMR/DD REHAB LINE CLINIC TREATMENT - REG4141 OMR/DD REHAB LINE CLINIC TREATMENT - BRIEF4142 OMR/DD REHAB LINE CLINIC TREATMENT - GROUP

4143 OMR/DD REHAB LINE CLINIC TREATMENT - COLL VISIT4144 OMR/DD REHAB LINE CLINIC TREATMENT - INTAKE4145 OMR/DD REHAB LINE CLINIC TREATMENT - DIAG AND EVAL4150 OMR/DD CLINIC TREATMENT - REGULAR4151 OMR/DD CLINIC TREATMENT - BRIEF4152 OMR/DD CLINIC TREATMENT - GROUP4153 OMR/DD CLIN TREATMENT - COLLATERAL VISIT4154 OMR/DD CLINIC TREATMENT - INTAKE4155 OMR CLINIC TREATMENT - DIAGNOSIS & EVALUATION4160 OMR/DD DAY - STATE OPERATED - FULL DAY4161 OMR/DD DAY - STATE OPERATED - HALF DAY4162 OMR/DD DAY - STATE OPERATED - COLLOCATED MODEL4163 OMR/DD DAY - STATE OPERATED - INTAKE4164 OMR DAY-STATE OPERATED - DIAGNOSIS & EVALUATION4165 OMR/DD DAY - STATE OPERATED -COLLATERAL4166 OMR DAY-ST OPERATED- FULL DAY SUBCHAPTER A4167 OMR DAY-ST OPERATED-HALF DAY SUBCHAPTER A4170 OMR/DD DAY TREATMENT - FULL DAY4171 OMR/DD DAY TREATMENT - HALF DAY4172 OMR/DD DAY TREATMENT - COLLOCATED MODEL4173 OMR/DD DAY TREATMENT - INTAKE4174 OMR/DD DAY TREATMENT-DIAGNOSIS & EVALUATION4175 OMR/DD DAY TREATMENT - COLLATERAL4176 OMR/DD DAY TREATMENT-FULL DAY SUBCHAPTER A4177 OMR/DD DAY TREATMENT-HALF DAY SUBCHAPTER A4180 SPECIALTY CLINIC - MENTAL RETARDATION4200 STATE OPERATED ALCOHOLISM REHABILITATION4201 STATE OPERATED ALCOHOLISM DETOXIFICATION4202 STATE OPERATED ALCOHOLISM SERVICES, FREE STANDING4203 FED QUAL ALCOHOLISM SERVICES (DETOX)4204 FED QUAL ALCOHOLISM SERVICES (REHAB)4205 FEDERALLY QUALIFIED REHAB SERVICES IN NON-IMDS4208 OMR ST-OP PCA II - 1 CLIENT 1/4 HOURLY4209 OMR ST-OP PCA II - 1 CLIENT 1/4 HOURLY4210 RESIDENTIAL REHABILITATION SERVICES FOR YOUTH4211 HOSPITAL SUBDIVISION-ALCOHOLISM-REHAB4212 FREESTANDING INP FACILITY-ALCOHOL DETOX4213 FREESTANDING INP FACILITY - ALCOHOL REHAB4214 CD CLINIC ASSESSMNT-AT LEAST 30 MIN-ART. 324215 CD CLINIC INDIV SESSION,AT LEAST 30 MIN-ART324216 CD CLINIC GRP SESSION, AT LEAST 30 MIN-ART.324217 OASAS CD REHAB ASSESSMENT - ARTICLE 324218 OASAS CD REHAB SESSION-AT LEAST 4 HRS-ART. 324219 OASAS CD REHAB-AT LEAST 2 HRS BUT < 4 HRS-ART. 324220 OASAS RESIDENTIAL DETOX - ARTICLE 324221 OASAS OUTPATIENT DETOX - ARTICLE 324230 SYSTEM GENERATED FROM CLAIM4250 ALCOHOLISM CLINIC TREATMENT - REGULAR4251 ALCOHOLISM CLINIC TREATMENT - BRIEF4252 ALCOHOLISM CLINIC TRMT - HOME VISIT4254 ALCOHOLISM CLINIC TREATMENT COLLATERAL4255 ALCOHOLISM CLINIC TREATMENT-CRISIS VISIT4256 ALCOHOLISM DAY REHABILITATION - CRISIS4257 INDIVID BRIEF PSYCHOTHERAPY 20-30 MIN WITH PATIENT4258 INDIVID COMPR PSYCHOTHERAPY 45-50 MIN WITH PATIENT4259 FAMILY PSYCHOTHERAPY WITH OR W/O PATIENT PRESENT4260 ALCOHOLISM DAY REHAB - FULL DAY4261 ALCOHOLISM DAY REHAB - HALF DAY4262 ALCOHOLISM DAY REHAB - COLLATERAL4263 ALCOLHOLISM DAY REHABILITATION - HOME4264 COMPREHENSIVE ALCOHOLISM CARE - REGULAR4265 COMPREHENSIVE ALCOHOLISM CARE - HOME4266 COMPREHENSIVE ALCOHOLISM CARE - COLLATERAL4267 ALCOHOLISM DETOX-OUTPATIENT - REGULAR DEMO4268 STATE OPERATED MR DC - RESPITE4269 STATE OPER.ICF/DD-LOCAL DISTRICT CLIENT - RESPITE4270 THIS CODE REPLACED BY 4102 AS OF 9/15/924271 MED. SUP. SUBSTANCE ABUSE VISIT4272 DEMO ONLY MED SUPPLY SUB ABUS/ENH SERVICE4273 CD CLINIC ASSESS., AT LEAST 30 MIN-ART 284274 CD CLINIC INDIV SESSION,AT LEAST 30 MIN-ART284275 CD CLINIC GRP SESSION, AT LEAST 30 MIN-ART 284276 OASAS CD REHAB ASSESSMENT - ARTICLE 284277 OASAS CD REHAB SESSION-AT LEAST 4 HRS ART. 284278 OASAS CD REHAB-AT LEAST 2 HRS BUT < 4 HRS ART. 284279 OASAS OUTPATIENT DETOX - ARTICLE 284280 CD CLINIC ASSESS-30 MIN-FREE STANDING OCDY ART 324281 CD CLINIC INDIV-30 MIN-FREE STANDING OCDY ART 324282 CD CLINIC GROUP-30 MIN-FREE STANDING OCDY ART 324283 CD CLINIC ASSESS-30 MIN-FREE STANDING OCDY ART 284284 CD CLINIC INDIV-30 MIN-FREE STANDING OCDY ART 284285 CD CLINIC GROUP-30 MIN-FREE STANDING OCDY ART 284300 SYSTEM GENERATED FROM CLAIM4301 OMH CLINIC - REGULAR4302 OMH CLINIC - BRIEF4303 OMH CLINIC - GROUP4304 OMH CLINIC - COLLATERAL4305 OMH CLINIC - GRP COLLATERAL4306 OMH CLINIC - CRISIS4307 CONTINUING DAY TREATMENT RESERVED4308 CONTINUING DAY TREATMENT RESERVED4309 CONTINUING DAY TREATMENT RESERVED4310 CONTINUING DAY TREATMENT HALF DAY 1-404311 CONTINUING DAY TREATMENT HALF DAY 41-644312 CONTINUING DAY TREATMENT HALF DAY 65+4313 CONTINUING DAY TREATMENT RESERVED4314 CONTINUING DAY TREATMENT RESERVED4315 CONTINUING DAY TREATMENT RESERVED4316 CONTINUING DAY TREATMENT FULL DAY 1-40

4317 CONTINUING DAY TREATMENT FULL DAY 41-644318 CONTINUING DAY TREATMENT FULL DAY 65+4319 CONTINUING DAY TREATMENT RESERVED4320 CONTINUING DAY TREATMENT RESERVED4321 CONTINUING DAY TREATMENT RESERVED4322 CONTINUING DAY TREATMENT RESERVED4323 CONTINUING DAY TREATMENT RESERVED4324 CONTINUING DAY TREATMENT RESERVED4325 CONTINUING DAY TREATMENT COLLATERAL4326 CON DAY TREAT COLLATERAL - 2 HOUR 51-804327 CON DAY TREAT COLLATERAL - 2 HOUR 81+4328 CONTINUING DAY TREATMENT RESERVED4329 CONTINUING DAY TREATMENT RESERVED4330 CONTINUING DAY TREATMENT RESERVED4331 CONTINUING DAY TREATMENT GROUP COLLATERAL4332 CONTINUING DAY TREATMENT RESERVED4333 CONTINUING DAY TREATMENT RESERVED4334 CONTINUING DAY TREATMENT RESERVED4335 CONTINUING DAY TREATMENT RESERVED4336 CONTINUING DAY TREATMENT RESERVED4337 CONTINUING DAY TREATMENT CRISIS4338 CONTINUING DAY TREATMENT RESERVED4339 CONTINUING DAY TREATMENT RESERVED4340 CONTINUING DAY TREATMENT RESERVED4341 CONTINUING DAY TREATMENT RESERVED4342 CONTINUING DAY TREATMENT RESERVED4343 CONTINUING DAY TREATMENT RESERVED4344 CONTINUING DAY TREATMENT RESERVED4345 CONTINUING DAY TREATMENT RESERVED4346 CONTINUING DAY TREATMENT PRE-ADMISSION4347 CONTINUING DAY TREATMENT RESERVED4348 CONTINUING DAY TREATMENT RESERVED4349 PARTIAL HOSPITALIZATION REGULAR - 4 HOURS4350 PARTIAL HOSPITALIZATION REGULAR - 5 HOURS4351 PARTIAL HOSPITALIZATION REGULAR - 6 HOURS4352 PARTIAL HOSPITALIZATION REGULAR - 7 HOURS4353 PARTIAL HOSPITAL COLLATERAL - 1 HOUR4354 PARTIAL HOSPITAL COLLATERAL - 2 HOURS4355 PARTIAL HOSPITAL GROUP COLLATERAL - 1 HOUR4356 PARTIAL HOSPITAL GROUP COLLATERAL - 2 HOURS4357 PARTIAL HOSPITALIZATION CRISIS - 1 HOUR4358 PARTIAL HOSPITALIZATION CRISIS - 2 HOURS4359 PARTIAL HOSPITALIZATION CRISIS - 3 HOURS4360 PARTIAL HOSPITALIZATION CRISIS - 4 HOURS4361 PARTIAL HOSPITALIZATION CRISIS - 5 HOURS4362 PARTIAL HOSPITALIZATION CRISIS - 6 HOURS4363 PARTIAL HOSPITALIZATION CRISIS - 7 HOURS4364 INTENSIVE PSYCH REHAB TREATMENT - 1 HOUR4365 INTENSIVE PSYCH REHAB TREATMENT - 2 HOURS4366 INTENSIVE PSYCH REHAB TREATMENT - 3 HOURS4367 INTENSIVE PSYCH REHAB TREATMENT - 4 HOURS4368 INTENSIVE PSYCH REHAB TREATMENT - 5 HOURS4369 MONTHLY REHABILITATIVE FEE4370 SEMI-MONTHLY REHAB FEE - 1ST HALF4371 SEMI-MONTHLY REHAB FEE - 2ND HALF4372 RESPITE - GROUP OF 24373 RESPITE - GROUP OF 34374 FAMILY SUPPORT - GROUP OF 24375 FAMILY SUPPORT - GROUP OF 34376 FAMILY SUPPORT - GROUP OF 44377 FAMILY SUPPORT - GROUP OF 5 TO 84378 SKILL BUILDING - GROUP OF 24379 SKILL BUILDING - GROUP OF 34380 HCBS YOUTH PEER ADVOCATE - INDIVIDUAL4381 HCBS YOUTH PEER ADVOCATE - GROUP OF 24382 HCBS YOUTH PEER ADVOCATE - GROUP OF 34383 CHILDREN'S VOL. CRS FULL MONTH4384 CHILDREN'S VOL. CRS 1ST HALF MONTH4385 CHILDREN'S VOL. CRS 2ND HALF MONTH4386 FBT FULL MONTH4387 FBT 1ST HALF MONTH4388 FBT 2ND HALF MONTH4389 STATE OR ADULT CRS FULL MONTH4390 STATE OR ADULT CRS 1ST HALF MONTH4391 STATE OP ADULT CRS 2ND HALF MONTH4392 STATE OP CHILDREN CRS FULL MONTH4393 STATE OP CHILDREN CRS 1ST HALF MONTH4394 STATE OP CHILDREN CRS 2ND HALF MONTH4395 TEACHING FAMILY HOME FULL MONTH4396 TEACHING FAMILY HOME 1ST HALF4397 TEACHING FAMILY HOME 2ND HALF4398 HCBS FLEXIBLE RECIPIENT SERVICE DOLLARS4400 MONTHLY REHAB FEE - STATE OPERATED4401 SEMI-MONTH REHAB FEE;1ST HALF- STATE OPERATED4402 SEMI-MONTH REHAB FEE;2ND HALF- STATE OPERATED4403 HEALTH SKILLS TRAINING SERVICES - STATE OPERATED4404 SELF-ADM OF MEDCNTN TRAINING SKILLS - STATE OPER4405 SOCIALIZATION SKILL TRAINING SERVICES - STATE OPER4406 COMMUNICATION SKILLS TRNG SERVICES - STATE OPER4407 FUNCTIONAL SKILLS TRAINING SERVICES - STATE OPER4408 ASSERT/SELF-ADVOC SKILLS TR SR - STATE OPERATED4409 BEHAVIOR SKILLS TRNG SERV-STATE OPERATED4410 COMM INTGR & RES UTIL SKLS TRNG SVCS - STATE OPER4411 MOTOR SKILLS TRNG SVCS - STATE OPERATED4412 SKILLS DVLPMT TRNG SVCS - STATE OPERATED4413 MONTHLY REHAB FEE - VOLNTRY OPERATED4414 SEMI-MONTH REHAB FEE;1ST HALF- VOLNTRY OPERATED4415 SEMI-MONTH REHAB FEE;2ND HALF- VOLNTRY OPERATED4416 HEALTH SKILLS TRNG SVCS-VOLNTRY OPERATED

4417 SELF-ADM OF MEDCNTN TRNING SKILLS - VOLNTRY OPER4418 SOCIALIZATION SKILL TRNG SVCS - VOLNTRY OPERATED4419 COMMUNCTN SKILLS TRNG SERV - VOLNTRY OPERATED4420 FUNCTIONAL SKILLS TRNG SVCS - VOLNTRY OPERATED4421 ASSERT/SELF-ADVOC SKILLS TRNG - VOLNTRY OPERATED4422 BEHAVIOR SKILLS TRNG SERV - VOLNTRY OPERATED4423 CMTY INTGR & RES UTIL SKILL TRNG SVCS-VOLNTRY OPER4424 MOTOR SKILLS TRNG SVCS - VOLNTRY OPERATED4425 SKILLS DVLPMT TRNG SVCS - VOLNTRY OPERATED4426 MONTHLY CASE MANAGEMENT; STATE4427 MONTHLY CASE MANAGEMENT; VOLUNTARY4428 RES HAB; STATE-IRA SUPVD; PER DIEM4429 RES HAB; STATE-IRA SUPVD; MED LEAVE; PER DIEM4430 RES HAB; STATE-IRA SUPVD; NON-MED LEAVE; PER DIEM4431 RES HAB; STATE-FC; PER DIEM4432 RES HAB; STATE-FC; HOURLY4433 PATH TO EMPLOYMENT; STATE; INDIV; 1/4 HR4434 PATH TO EMPLOYMENT; STATE; GROUP; 1/4 HR4435 RES HAB; STATE-AT HOME; HOURLY4436 PREVOC; COMMUNITY; STATE; 1/4 HR4437 RES HAB; VOL-IRA SUPVD; PER DIEM4438 RES HAB; VOL-IRA SUPVD; MED LEAVE; PER DIEM4439 RES HAB; VOL-IRA SUPVD; NON-MED LEAVE; PER DIEM4440 RES HAB; VOLUNTARY-FC; PER DIEM4441 RES HAB; VOLUNTARY-FC; HOURLY4442 CSS; VOLUNTARY-PF; CASE STUDY; MONTHLY FEE4443 RES HAB; VOLUNTARY-AT HOME; PER DIEM4444 PATH TO EMPLOYMENT; VOL; INDIV; 1/4 HR4445 PATH TO EMPLOYMENT; VOL; GROUP; 1/4 HR4446 GRPDAY HAB-STATE;FULL UNT/OMR4447 GRPDAY HAB-STATE;HALF UNT/OMR4448 DAY HAB; STATE; > 2 HRS < THAN 34449 DAY HAB; STATE; > 1 HRS < THAN 24450 SEMP; INTENSIVE; STATE; IND; 1/4 HR4451 SEMP; INTENSIVE; STATE; GRP; 1/4 HR4452 DAY HAB; VOLUNTARY; FULL UNIT4453 GRPDAY HAB-VOL;FULL UNIT/OMR4454 GRPDAY HAB-VOL;HAL UNIT/OMR4455 SUP GRPDAY HAB-VOL FULL UNT/OMR4456 SUP GRPDAY HAB-VOL; HALF UNT/OMR4457 IND DAY HAB VOL;1/4 HR UNT/OMR4458 PREVOL-STATE;FULL UNIT/OMR4459 PREVOL-STATE; HALF UNIT/OMR4460 SEMP; EXTENDED; STATE; IND; 1/4 HR4461 SEMP; EXTENDED; STATE; GRP; 1/4 HR4462 PRE VOC; VOLUNTARY; PER DIEM4463 SUP IND DY HB VOL;1/4 HR UNT/OMR4464 PRE VOC-VOL; FULL UNIT/OMR4465 PRE VOC-VOL; HALF UNIT/OMR4466 SEMP, FULL UNIT, STATE4467 SUPPORTED EMPLOYMENT; STATE; HOURLY4468 SEMP, HALF UNIT, STATE4469 SUPPORTED EMPLOYMENT; STATE; MONTHLY4470 SUPPORTED EMPLOYMENT; VOLUNTARY; PER DIEM4471 SUPPORTED EMPLOYMENT; VOLUNTARY; MONTHLY DDP LVL 14472 SUPPORTED EMPLOY; VOL.; MONTHLY DDP LEVEL 24473 SUPPORTED EMPLOY; VOL.; MONTHLY DDP LEVEL 34474 ENVIRON MODS; STATE; $10.00 PER UNIT FEE4475 ENVIRON MODS; STATE; $100.00 PER UNIT FEE4476 ENVIRON MODS; STATE; $1.00 PER UNIT FEE - STATE4477 ENVIRON MODS; VOL.; $10.00 PER UNIT FEE - STATE4478 ENVIRON MODS; VOL; $100.00 PER UNIT FEE - STATE4479 ENVIRON MODS; VOL; $1000.00 PER UNIT FEE - STATE4480 LIVE-IN CAREGIVER SERVICES - VOLUNTARY; MONTHLY4481 CONSOLIDATED SUPPORTS & SERVICES; VOL;1/4 HR UNIT4482 ADAPTIVE TECH; VOL; $1.00 PER UNIT FEE - STATE4483 ADAPTIVE TECH; VOL; $10.00 PER UNIT FEE - STATE4484 ADAPTIVE TECH; VOL; $100.00 PER UNIT FEE - STATE4485 ADAPTIVE TECH; VOL $1000.00 PER UNIT FEE - STATE4486 HOURLY RESPITE; VOLUNTARY FSS < HOUR UNIT4487 RES RESPITE; VOLUNTARY, HALF DAY (SKILLED)4488 RES RESPITE; VOLUNTARY; FULL DAY (BASIC)4489 RES RESPITE; VOLUNTARY, FULL DAY (SKILLED)4490 RES RESPITE; STATE HOURLY (ON SITE)4491 HOURLY RESPITE; VOL; 1/4 HR UNIT FREE-STAND4492 HOURLY RESPITE; VOL; HOURLY (BASIC)4493 HOURLY RESPITE; VOL; HOURLY (SKILLED)4494 PLAN OF CARE SUPPORT SERVICES-STATE; UNIT4495 PLAN OF CARE SUPPORT SERVICES-VOLUNTARY; UNIT4496 INDIVIDUAL FAMILY EDUC & TRAINING SERV-STATE; UNIT4497 INDIVIDUAL FAMILY EDUC & TRNG SERV-VOLUNTARY;UNIT4498 GROUP FAMILY EDUC & TRAINING SERV-STATE; UNIT4499 GROUP FAMILY EDU & TRAINING SERV-VOLUNTARY; UNIT4500 FULL MONTH CONGREGATE BIP4501 FULL MONTH APARTMENT BIP4502 1/2 MONTH (FIRST HALF OF MONTH) CONGREGATE BIP4503 1/2 MONTH (FIRST HALF OF MONTH) APARTMENT BIP4504 1/2 MONTH (SECOND HALF OF MONTH) CONGREGATE BID4505 1/2 MONTH (SECOND HALF 0F MONTH) APARTMENT BIP4506 MEDICATION MGT. AND TRG. (CHILDREN)4507 SOCIALIZATION (CHILDREN)4508 ACT INTENSIVE FULL PAYMENT4509 ACT INTENSIVE PART PAYMENT4510 PROS PREADMISSION4511 ACT INPATIENT4512 ACT SERVICES4520 PROS COMM REHAB SRVCS 2-12 HRS4521 PROS COMM REHAB SRVCS 13-27 HRS4522 PROS COMM REHAB SRVCS 28-43 HRS

4523 PROS COMM REHAB SRVCS 44-60 HRS4524 PROS COMM REHAB SRVCS 61+4525 PROS CLIN TRMT ADD-ON4526 PROS INT REHAB4527 PROS ONGOING REHAB & SUPPORT4528 PROS INT REHAB - LIM LIC4529 PROS ONGOING REHAB & SUPPORT -LIM LIC4530 PREPAID MENTAL HEALTH PLAN (PMHP)4531 PROS PRE-ADMISSION - AH/NH/PC4532 PROS ENHANCED CRS 2 CONTACT - AH/NH/PC4533 PROS ENHANCED CRS 4 CONTACT - AH/NH/PC4534 PROS INTENSIVE REHABILITATION - AH/NH/PC4601 OMH CLINIC - REGULAR MC/SED4602 OMH CLINIC - BRIEF MC/SED4603 OMH CLINIC - GROUP MC/SED4604 OMH CLINIC - COLLATERAL MC/SED4605 OMH CLINIC - GROUP COLLATERAL MC/SED4606 OMH CLINIC - CRISIS MC/SED4650 ICC MONTHLY4651 ICC HALF MONTH4652 OMH HCBS CHILDREN'S WAIVER4653 RESPITE - INDIVIDUAL4654 OMH HCBS CHILDREN'S WAIVER4655 FAMILY SUPPORT - INDIVIDUAL4656 SKILL BUILDING - INDIVIDUAL4657 INTENSIVE IN-HOME HOURLY4658 INTENSIVE IN-HOME ICC STAFF4659 CRISIS RESPONSE HOURLY4660 CRISIS RESPONSE-ICC STAFF4661 ICC CASE MGT. START-UP FULL MONTH4662 ICC CASE MGT. START-UP HALF MONTH4663 ICC/INPATIENT-FULL MONTH4664 ICC/INPATIENT-HALF MONTH4665 HCBS SUPPORTED EMPLOYMENT SERVICES4666 HCBS PRE-VOCATIONAL SERVICES - INDIVIDUAL4667 HCBS PRE-VOCATIONAL SERVICES - GROUP OF 24668 HCBS PRE-VOCATIONAL SERVICES - GROUP OF 34669 CLINIC PLUS COMPREHENSIVE ASSESSMENT4670 CLINIC PLUS IN HOME SERVICES4700 RES HAB; STATE; IRA-SUPVD MONTHLY4701 RES HAB; STATE; IRA-SUPVD SEMI-MTHLY 1ST HALF4702 RES HAB; STATE; IRA-SUPVD SEMI-MTHLY 2ND HALF4703 RES HAB; STATE; IRA-SUPRT MONTHLY4704 RES HAB; STATE; IRA-SUPRT SEMI-MTHLY 1ST HALF4705 RES HAB; STATE; IRA-SUPRT SEMI-MTHLY 2ND HALF4706 RES HAB; VOL; IRA/CR -SUPVD MONTHLY4707 RES HAB; VOL; IRA/CR -SUPVD SEMI-MNTHLY 1ST HALF4708 RES HAB; VOL; IRA/CR -SUPVD SEMI-MNTHLY 2ND HALF4709 RES HAB; VOL; IRA/CR -SUPRT MONTHLY4710 RES HAB; VOL; IRA/CR -SUPRT SEMI-MNTHLY 1ST HALF4711 RES HAB; VOL; IRA/CR -SUPRT SEMI-MNTHLY 2ND HALF4712 RES HAB; STATE; FAMILY CARE MONTHLY4713 RES HAB; STATE; FAM CARE SEMI-MTHLY 1ST HALF4714 RES HAB; STATE; FAM CARE SEMI-MNTHLY 2ND HALF4715 RES HAB; VOL; FAMILY CARE MONTHLY4716 RES HAB; VOL; FAM CARE SEMI-MNTHLY 1ST HALF4717 RES HAB; VOL; FAM CARE SEMI-MNTHLY 2ND HALF4718 RES HAB-HOME; STATE; INDIV; 1/4 HOUR4719 COMM/RES HAB; STATE; INDIV;1/4 HR4720 IBS; VOL; IBP/FBA PLAN DEVELOPMENT; FLAT FEE4721 IBS; VOL; PLAN IMPLEMENTATION; 1/4 HR4722 COMM/RES HAB; VOL; INDIV;1/4 HR4723 COMM/RES HAB; VOL; GROUP-2 INDIVIDUALS; 1/4 HR4724 COMM/RES HAB; VOL; GROUP-3 INDIVIDUALS; 1/4 HR4725 COMM/RES HAB; VOL; GROUP-4+ INDIVIDUALS; 1/4 HR4726 CIDP MCCF-MONTHLY CARE COORDINATION FEE4727 COMM HAB;VOL;MONTHLY4728 COMM HAB;VOL;SEMI-MONTHLY;1ST HALF4729 COMM HAB;VOL;SEMI-MONTHLY;2ND HALF4730 CONS SUPP & SVCS-VOL;RESID & DAY SVCS; MTHLY4731 CONS SUPP & SVCS-VOL; RESID SVCS ONLY; MTHLY4732 CONS SUPP & SVCS-VOL; DAY SVCS ONLY; MTHLY4733 PLAN CARE SUP SERV - ANNUAL 1ST HALF YR, STATE4734 PLAN CARE SUP SERV - REGULAR, STATE4735 PLAN CARE SUP SERV - INITIAL, VOL4736 PLAN CARE SUP SERV - REGULAR, VOL4737 SYSTEM GENERATED FROM PROVIDER4738 SYSTEM GENERATED FROM PROVIDER4739 SYSTEM GENERATED FROM PROVIDER4741 COMM/RES HAB; STATE; GROUP-1 INDIVIDUAL; 1/4 HR4742 COMM/RES HAB; STATE; GROUP-2 INDIVIDUALS; 1/4 HR4743 COMM/RES HAB; STATE; GROUP-3 INDIVIDUALS; 1/4 HR4744 COMM/RES HAB; STATE; GROUP-4 INDIVIDUALS; 1/4 HR4745 SUPPLEMENTAL GROUP DAY HAB, FULL UNIT, STATE4746 SUPPLEMENTAL GROUP DAY HAB, HALF UNIT, STATE4747 INDIVIDUAL DAY HAB, 1/4 HOUR UNIT, STATE4748 SUPPLEMENTAL INDIVIDUAL DAY HAB, 1/4 HR UNIT,STATE4749 RESPITE-HOURLY, 1/4 HOUR UNIT, STATE4750 RESPITE-FREE STANDING, 1/4 HOUR UNIT, STATE4751 IBS; STATE; IBP/FBA PLAN DEVELOPMENT;FLAT FEE4752 IBS; STATE; PLAN IMPLEMENTATION; 1/4 HR4755 COM HAB; AGY SUP; VOL; IND; 1/4 HR4756 COM HAB; AGY SUP; VOL; GRP; 1/4 HR4757 COM HAB; CERT FAC RESID; AGY SUP; VOL; IND; 1/4 HR4758 COM HAB; CERT FAC RESID; AGY SUP; VOL; GRP; 1/4 HR4759 SEMP; AGY SUP; PHASE 1; VOL; IND; 1/4 HR4760 SEMP; AGY SUP; PHASE 1; VOL; GRP; 1/4 HR4761 SEMP; AGY SUP; PHASE 2; VOL; IND; 1/4 HR4762 SEMP; AGY SUP; PHASE 2; VOL; GRP; 1/4 HR

4763 RESPITE; AGY SUP; VOL; 1/4 HR4764 RESPITE; VIA FI FEE; VOL; 1/4 HR4765 COM HAB; VIA FI; VOL; IND; 1/4 HR4766 COM HAB; VIA FI; VOL; GRP; 1/4 HR4767 COM HAB; CERT FAC RESID; VIA FI; VOL; IND; 1/4 HR4768 COM HAB; CERT FAC RESID; VIA FI; VOL; GRP; 1/4 HR4769 SEMP; VIA FI; PHASE 1; VOL; IND; 1/4 HR4770 SEMP; VIA FI; PHASE 1; VOL; GRP; 1/4 HR4771 SEMP; VIA FI; PHASE 2; VOL; IND; 1/4 HR4772 SEMP; VIA FI; PHASE 2; VOL; GRP; 1/4 HR4773 RESPITE; VIA FI; VOL; 1/4 HR4774 RESPITE; PROV DELIV RATE; VOL; 1/4 HR4775 RESERVED FOR FUTURE USE - OPWDD HCBS WAIVER4776 RESERVED FOR FUTURE USE - OPWDD HCBS WAIVER4777 LIVE-IN CAREGIVER; VIA FI; VOL; MONTH4778 SUPPORT BROKER; VIA FI; VOL; 1/4 HR4779 SEMP; VIA FI; PHASE 1; VOL; OUTCOME: HIRED; MONTH4780 SEMP; VIA FI; PHASE 2; VOL; OUTCOME; RETAINED; MTH4781 PREVOC; COMM; IND; VOL; 1/4 HR4782 PREVOC; COMM; GROUP OF 2; VOL; 1/4 HR4783 PREVOC; COMM; GROUP OF 3+; VOL; 1/4 HR4784 RESPITE; AGY SUPPTD RATE; VOL; 1/4 HR4785 IND GOODS & SVCS; VIA FI; VOL; $10 UNIT4786 COM TRANS SVCS; VIA FI; VOL; $10 UNIT4787 FISCAL INTERMEDIARY; VOL; LEVEL 1; MTH4788 FISCAL INTERMEDIARY; VOL; LEVEL 2; MTH4789 FISCAL INTERMEDIARY; VOL; LEVEL 3; MTH4790 SEMP; INTENSIVE; VOL; IND; 1/4 HR4791 SEMP; INTENSIVE; VOL; GRP; 1/4 HR4792 SEMP; EXTENDED; VOL; IND; 1/4 HR4793 SEMP; EXTENDED; VOL; GRP; 1/4 HR4794 SEMP; PHASE 1; VOL; OUTCOME: HIRED; MONTH4795 SEMP; PHASE 2; VOL; OUTCOME: RETAINED; MTH4796 COM HAB; CERT FAC RESID; VOL; IND; 1/4 HR4797 COM HAB; CERT FAC RESID; VOL; GRP; 1/4 HR4798 COM HAB; CERT FAC RESID; STATE; IND; 1/4 HR4799 COM HAB; CERT FAC RESID; STATE; GRP; 1/4 HR4800 MEDICALLY MANAGED DETOX W/ OR W/O OBS DAYS4801 MEDICALLY SUPERVISED DETOX W/O OBS DAYS4802 MEDICALLY SUPERVISED DETOX W/1 OBS DAY4803 MEDICALLY SUPERVISED DETOX W/2 OBS DAYS4804 INPATIENT DETOX CAPITAL COST PER DIEM4805 GME PERDIEM FOR MMD W/OR W/O OBS DAYS4806 GME PERDIEM FOR MSIW W/O OBS DAYS4807 GME PERDIEM FOR MSIW W/1 OBS DAY4808 GME PERDIEM FOR MSIW W/2 OBS DAYS4810 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 14811 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 24812 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 34813 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 44814 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 54815 EPS START OF CARE, CLIN A, FUNC E, AGE GRP 64816 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 14817 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 24818 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 34819 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 44820 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 54821 EPS START OF CARE, CLIN A, FUNC F, AGE GRP 64822 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 14823 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 24824 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 34825 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 44826 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 54827 EPS START OF CARE, CLIN A, FUNC G, AGE GRP 64828 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 14829 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 24830 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 34831 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 44832 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 54833 EPS START OF CARE, CLIN B, FUNC E, AGE GRP 64834 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 14835 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 24836 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 34837 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 44838 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 54839 EPS START OF CARE, CLIN B, FUNC F, AGE GRP 64840 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 14841 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 24842 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 34843 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 44844 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 54845 EPS START OF CARE, CLIN B, FUNC G, AGE GRP 64846 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 14847 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 24848 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 34849 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 44850 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 54851 EPS START OF CARE, CLIN C, FUNC E, AGE GRP 64852 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 14853 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 24854 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 34855 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 44856 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 54857 EPS START OF CARE, CLIN C, FUNC F, AGE GRP 64858 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 14859 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 24860 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 34861 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 44862 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5

4863 EPS START OF CARE, CLIN C, FUNC G, AGE GRP 64864 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 14865 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 24866 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 34867 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 44868 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 54869 EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 64870 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 14871 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 24872 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 34873 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 44874 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 54875 EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 64876 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 14877 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 24878 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 34879 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 44880 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 54881 EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 64882 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 14883 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 24884 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 34885 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 44886 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 54887 EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 64888 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 14889 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 24890 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 34891 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 44892 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 54893 EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 64894 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 14895 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 24896 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 34897 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 44898 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 54899 EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 64900 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 14901 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 24902 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 34903 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 44904 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 54905 EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 64906 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 14907 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 24908 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 34909 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 44910 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 54911 EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 64912 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 14913 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 24914 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 34915 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 44916 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 54917 EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 64919 EPS ASSESSMENT WITH NO OASIS - 18 AND OLDER4920 EPS MATERNITY, NO OASIS, 18 AND OLDER4926 SYSTEM GENERATED FROM CLAIM5000 SKILLED NURSING (CHANNELING)5001 SKILLED NURSING (CHANNELING)5002 SKILLED NURSING (CHANNELING)5003 PHYSICAL THERAPY: IN-HOME (CHANNELING)5004 PHYSICAL THERAPY: IN-HOME (CHANNELING)5005 PHYSICAL THERAPY: IN-HOME (CHANNELING)5006 PHYSICAL THERAPY: OUT-PATIENT CHANNELING5007 HOMEMAKER/PERS CARE-HOLIDAY CHANNELING5008 SPEECH PATHOLOGY: IN-HOME (CHANNELING)5009 SPEECH PATHOLOGY: IN-HOME (CHANNELING)5010 SPEECH PATHOLOGY: IN-HOME (CHANNELING)5011 OCCUPATIONAL THERAPY: IN-HOME CHANNELING5012 OCCUPATIONAL THERAPY: IN-HOME CHANNELING5013 OCCUPATIONAL THERAPY: IN-HOME CHANNELING5014 OCCUP THERAPY: OUT-PATIENT CHANNELING5015 MENTAL HLTH SERV (CHANNELING)5016 MENTAL HLTH SERV (CHANNELING)5017 MENTAL HLTH SERV (CHANNELING)5018 TRANS SERVICES (CHANNELING)5019 TRANS SERVICES (CHANNELING)5020 TRANS SERVICES (CHANNELING)5021 TRANS SERVICES (CHANNELING)5022 TRANS SERVICES (CHANNELING)5023 DAY HEALTH AND REHAB CHANNELING5024 DAY MAINTENANCE (CHANNELING)5025 DAY MAINTENANCE (CHANNELING)5026 HOME HEALTH AIDE (CHANNELING)5027 HOME HEALTH AIDE (CHANNELING)5028 HOME HEALTH AIDE (CHANNELING)5029 HOMEMAKER/PERSONAL CARE SRVS (CHANNELING)5030 HOMEMAKER/PERSONAL CARE SRVS (CHANNELING)5031 HOMEMAKER/PERSONAL CARE SRVS (CHANNELING)5032 HOUSEKEEPING (CHANNELING)5033 HOUSEKEEPING (CHANNELING)5034 HOUSEKEEPING (CHANNELING)5035 HOUSEKEEPING (CHANNELING)5036 HOUSEKEEPING (CHANNELING)5037 HOUSEKEEPING (CHANNELING)5038 HOUSEKEEPING (CHANNELING)5039 COMPANION (CHANNELING)5040 COMPANION (CHANNELING)

5041 COMPANION (CHANNELING)5042 COMPANION (CHANNELING)5043 COMAPNION (CHANNELING)5044 COMPANION (CHANNELING)5045 COMPANION (CHANNELING)5046 HOME DELIVERED MEALS (CHANNELING)5047 CHORE SERVICES: LABOR (CHANNELING)5048 CHORE SERVICES: LABOR (CHANNELING)5049 CHORE SERVICES: LABOR (CHANNELING)5050 CHORE SERVICES: LABOR (CHANNELING)5051 CHORE SERVICES: LABOR (CHANNELING)5052 CHORE SERVICES: LABOR (CHANNELING)5053 CHORE SERVICES: LABOR (CHANNELING)5054 HOMEMAKER/PERS CARE-HOLIDAY (CHANNELING)5055 RESPITE: IN-HOME (CHANNELING)5056 RESPITE: IN-HOME (CHANNELING)5057 RESPITE: SNF (CHANNELING)5058 RESPITE: SNF (CHANNELING)5059 RESPITE: HRF (CHANNELING)5060 RESPITE: HRF (CHANNELING)5061 RESPITE: ADULT FOSTER CARE (CHANNELING)5062 RESPITE: ADULT FOSTER CARE (CHANNELING)5063 HOUSING ASSISTANCE: SUBSIDY (CHANNELING)5064 HOUSING MAINTENANCE: MOVING (CHANNELING)5065 HOMEMAKER/PERS CARE-TRANS (CHANNELING)5066 HOMEMAKER/PERS CARE-TRANS (CHANNELING)5067 HOMEMAKER/PERS CARE-TRANS (CHANNELING)5068 ADULT FOSTER CARE (CHANNELING)5069 ADULT FOSTER CARE (CHANNELING)5070 ADULT FOSTER CARE (CHANNELING)5071 HOMEMAKER/PERS CARE-HOLIDAY (CHANNELING)5072 CHANNELING SERVICES - $.01 PER UNIT5073 CHANNELING SERVICES - $1.00 PER UNIT5074 CHANNELING SERVICES - $100.00 PER UNIT5161 SYSTEM GENERATED FROM MEMBER PA5200 OMH-ICM5201 INITIAL HEALTH CARE COORDINATION ASSESS PLAN5202 ONGOING HEALTH CARE COORDINATION5203 OMH-ICM-STATE5204 OMH-SCM-STATE 205205 OMH-SCM-COMMUNITY 205206 OMH-SCM-COMMUNITY 305207 OMH-SCM-STATE 305210 OMR SERVICE COORD STATE5211 OMR SERVICE COORD-BASIC VOLUNTARY5212 OMR SERVICE COORD-INTERMEDIATE VOLUNTARY5213 OMR SERVICE COORD-ENHANCED VOLUNTARY5214 OMR SERVICE COORD-WILLOWBROOK VOLUNTARY5215 RESERVED FOR FUTURE PROGRAMS5216 RESERVED FOR FUTURE PROGRAMS5217 RESERVED FOR FUTURE PROGRAMS5220 TASA5221 OMR/DD-CMCM5222 ENRICHED HOUSING5223 AIDS/CASE MANAGEMENT5224 CONNECT CASE MANAGEMENT 1/4 HOUR5225 SYRACUSE COMMUNITY HLTH PERINATAL 1/4 HOUR5226 COMMUNITY HEALTH WORKER 1/4 HR5227 NYC HEALTH DEPT. PERINATAL - VISIT5228 OMR STATE OPERATED CMCM5229 SPECIAL NEEDS CHILDREN 1/4 HR UPST CMCM5230 SPECIAL NEEDS CHILDREN 1/4 HR DWNST CMCM5231 CMCM/ICM INDIV. LESS THAN 30 MINUTES5232 CMCM/ICM GROUP. LESS THAN 30 MINUTES5233 CMCM/ICM INDIV. 31 TO 60 MINUTES5234 CMCM/ICM GROUP. 31 TO 60 MINUTES5235 CMCM/ICM INDIV. 61 TO 90 MINUTES5236 CMCM/ICM GROUP. 61 TO 90 MINUTES5237 CMCM/ICM INDIV. 91 TO 120 MINUTES5238 CMCM/ICM GROUP. 91 TO 120 MINUTES5239 CMCM/ICM INDIV. 121 TO 150 MINUTES5240 CMCM/ICM GROUP. 121 TO 150 MINUTES5241 CMCM/ICM INDIV. 151 TO 180 MINUTES5242 CMCM/ICM GROUP. 151 TO 180 MINUTES5243 CMCM/NBA5244 CMCM/EARLY INTERVENTION SERVICES5246 COLLABORATIVE CARE MONTHLY CASE PAYMENT - YEAR 15247 COLLABORATIVE CARE MONTHLY CASE PAYMENT - YEAR 25248 COLLABORATIVE CARE RETAINAGE - YEAR 15249 COLLABORATIVE CARE RETAINAGE - YEAR 25250 OMH - ICM TEAM5251 OMH - 1ICM/1SCM5252 OMH - 1ICM/2SCM5253 OMH - 2ICM/1SCM5254 OMH - SCM STEPDOWN5255 OMH- ICM STEPDOWN5256 OMH - 1ICM/1SCM STEMDOWN5257 OMH - 1ICM/2SCM STEPDOWN5258 OMH - 2ICM/1SCM STEPDOWN5259 OMH - SCH STEPDOWN 1:305260 NFP TARGETED CASE MANAGEMENT5301 MEDICAL EVALUATION SSHSP5302 MEDICAL EVALUATION-SPECIALIST SSHP5303 AUDIOLOGICAL EVALUATION SSHP5304 NURSING SERVICES SSHSP5305 PSYCHOLOGICAL EVAL WITH SOCIAL HISTORY SSHSP5306 PSYCHOLOGICAL SERVICES INDIVIDUAL PSSHSP5307 PSYCHOLOGICAL SVCES CENTER-BASED PSSHSP5308 PSYCHOLOGICAL EVALUATION PSSHS

5309 PSYCH. EVAL. WITH SOCIAL HISTORY PSSHSP5310 MEDICAL EVALUATION PSSHSP5311 MEDICAL EVALUATION-SPECIALIST PSSHSP5312 TB/DIRECTLY OBSERVED THERAPY-DNST LEVEL 15313 TB/DIRECTLY OBSERVED THERAPY-DNST LEVEL 25314 TB/DIRECTLY OBSERVED THERAPY-DNST LEVEL 35315 TB/DIRECTLY OBSERVED THERAPY-DNST LEVEL 45316 TB/DIRECTLY OBSERVED THERAPY-DNST LEVEL 55317 TB/DIRECTLY OBSERVED THERAPY-UPST LEVEL 15318 TB/DIRECTLY OBSERVED THERAPY-UPST LEVEL 25319 TB/DIRECTLY OBSERVED THERAPY-UPST LEVEL 35320 TB/DIRECTLY OBSERVED THERAPY-UPST LEVEL 45321 TB/DIRECTLY OBSERVED THERAPY-UPST LEVEL 55322 PSYCHOLOGICAL EVALUATION SSHSP5323 SPEECH PATHOLOGY CENTER-BASED PSSHSP5324 PHYSICAL THERAPY CENTER-BASED PSSHSP5325 OCCUPATIONAL THERAPY CENTER-BASED PSSHSP5326 SPEECH PATHOLOGY SERVICES SSHSP5327 PRE-SCHOOL TRANSPORTATION PSSHSP5328 PHYSICAL THERAPY SERVICES SSHSP5329 PSYCHOLOGICAL COUNSELING SERVICE SSHSP5330 OCCUPATIONAL THERAPY SERVICES SSHSP5331 SPEECH PATHOLOGY INDIVIDUAL PSSHSP5332 PHYSICAL THERAPY INDIV PSSHSP5333 OCCUPATIONAL THERAPY INDIVIDUAL PSSHSP5334 EPSDT METRO-UPS TRANSPORTATION SSHSP5335 EPSDT NYC TRANSPORTATION5336 EPSDT NYC OCCUPATIONAL THERAPY5337 EPSDT NYC SPEECH PATHOLOGY5338 EPSDT NYC PHYSICAL THERAPY5339 EPSDT UPSTATE OCCUPATIONAL THERAPY5340 EPSDT UPSTATE SPEECH PATHOLOGY5341 EPSDT UPSTATE PHYSICAL THERAPY5342 EARLY INTERVENTION SCREENING5343 EARLY INTERVENTION CORE EVALUATION5344 EARLY INTERVENTION PHYSICIAN EVALUATION5345 EARLY INTRVEN NON-PHYSICIAN EVALUATION5346 EI BASIC HOME AND COMMUNITY BASED IND/COLL VISIT5347 EI OFFICE/FAC BSD INVIV/COLLATERAL VISIT5348 EI PARENT-CHILD GROUP VISIT5349 EI BASIC GRP DEVMNTL INVERVENTION VISIT5350 EI BASIC GRP DEV. INTER VISIT WITH 1:1 AIDE5351 EI ENHANCED GRP DVLPMNTL INTERVENTION VISIT5352 EI ENHNCD GRP DEV INTER VISIT WITH 1:1 AIDE5353 EI FAMILY/CAREGIVER SUPPORT GROUP VISIT5354 EI EXTENDED HOME AND COMMUNITY BASED IND/COLL VST5355 EI BILINGUAL CORE EVALUATION5356 EI BILINGUAL PHYSICIAN EVALUATION5357 EARLY INTERVENTION HEARING AIDS PER $100.005358 EARLY INTERVENTION HEARING AIDS PER $1.005359 EARLY INTERVENTION EYE CARE PER $100.005360 EARLY INTERVENTION EYE CARE PER $1.005361 EARLY INTERVENTION SERVICES5362 EI APPLIED BEHAV ANALYSIS 10 TO 19 HRS/WK5363 EI APPLIED BEHAV ANALYSIS 20 TO 29 HRS/WK5364 EI APPLIED BEHAV ANALYSIS 30 OR MORE HRS/WK5365 EI APPLIED BEHAV ANALYSIS (FOR FUTURE USE)5366 EI APPLIED BEHAV ANALYSIS (FOR FUTURE USE)5369 INITIAL EI SERVICE COORDINATION5370 ON-GOING EI SERVICE COORDINATION5371 PSHSP-EPSDT-INDIV. SPEECH THERAPY5372 PSSHSP NURSING SERVICES-INDIVIDUAL5373 PSSHSP NURSING SERVICES-CENTERBASED5374 PSHSP-EPSDT-CENTERBASED SPEECH THERAPY5375 PSHSP-EPSDT CENTERBASED PHYSICAL THERAPY5376 PSHSP-EPSDT-CENTERBASED OCCUP. THERAPY5377 PSHSP-EPSDT-NYC-TRANSPORTATION5378 PSHSP-EPSDT-UPSTATE-TRANSPORTATION5379 PSHSP-INDIV. SPEECH THERAPY5380 PSHSP-INDIV. PHYSICAL THERAPY5381 PSHSP-INDIV. OCCUP. THERAPY5382 PSHSP-CENTERBASED SPEECH THERAPY5383 PSHSP-CENTERBASED PHYSICAL THERAPY5384 PSHSP-CENTERBASED OCCUP. THERAPY5385 SUPPORTIVE HEALTH SERVICES5386 SUPPORTIVE HEALTH SERVICES5387 SUPPORTIVE HEALTH SERVICES5388 PRESCHOOL SUPPORTIVE HEALTH PROGRAM - IEP5389 SCHOOL-AGE SUPPORTIVE HEALTH PROGRAM - IEP5390 SUPPORTIVE HEALTH SERVICES5391 SUPPORTIVE HEALTH SERVICES5392 SUPPORTIVE HEALTH SERVICES5393 SUPPORTIVE HEALTH SERVICES5394 SUPPORTIVE HEALTH SERVICES5395 SUPPORTIVE HEALTH SERVICES5396 SUPPORTIVE HEALTH SERVICES5397 SUPPORTIVE HEALTH SERVICES5398 SUPPORTIVE HEALTH SERVICES5399 SUPPORTIVE HEALTH SERVICES5400 SUPPORTIVE HEALTH SERVICES5401 EARLY INTERVENTION SCREENING5402 EARLY INTERVENTION CORE EVALUATION5403 EARLY INTERVENTION PHYSICIAN EVALUATION5404 E I PHYSICIAN EVAL ADDITIONAL SAME DAY5405 EI ASSISTIVE TECHNOLOGY EVALUATION5406 EI AUDIOLOGY EVALUATION5407 EI NURSING EVALUATION5408 EI NUTRITION EVALUATION5409 EI OCCUPATIONAL THERAPY EVALUATION

5410 EI PHYSICAL THERAPY EVALUATION5411 EI PSYCHOLOGICAL EVALUATION5412 EI SOCIAL WORK EVALUATION5413 EI SPECIAL INSTRUCTION EVALUATION5414 EI SPEECH PATHOLOGY EVALUATION5415 EI VISION EVALUATION5416 EI BI-LINGUAL CORE EVALUATION ADD ON5417 EI BI-LINGUAL PHYSICIAN EVALUATION ADD-ON5418 EI BI-LINGUAL NON-PHYSICIAN EVALUATION ADD-ON5419 EI SERVICES (RESERVED FOR FUTURE USE)5420 EI BASIC ASSISTIVE TECH HOME/COMM BASED IND/COL5421 EI BASIC AUDIOLOGY TECH HOME/COMM BASED IND/COL5422 EI BASIC FAMILY TECH HOME/COMM BASED IND/COL5423 EI BASIC FAMILY SUPPORT HOME/COMM BASED IND/COL5424 EI BASIC FAMILY TRAINING HOME/COMM BASED IND/COL5425 EI BASIC HEALTH SRVS HOME/COMM BASED IND/COL5426 EI BASIC NURSING SRVS HOME/COMM BASED IND/COL5427 E I/COMM BASED INDIV/COLLATERAL VISIT SAME DAY5428 EI BASIC NUTRITION HOME/COMM BASED IND/COL VISIT5429 EI BASIC OCC THRPY HOME/COMM BASED IND-COL VISIT5430 EI BASIC PHYSICAL THRPY HOME/COMM BASED IND/COL VS5431 EI BASIC PSYCH HOME/COMM BASED IND/COL VISIT5432 EI BASIC SOCIAL WRK HOME/COMM BASED IND/COL VISIT5433 EI BASIC SPECIAL INST HOME/COMM BASED IND/COL VST5434 EI BASIC SPEECH LANG HOME/COMM BASED COLL VISIT5435 EI BASIC CISION HOME/COMM BASED IND/COL VISIT5436 EI BASIC OTHER HOME/COMM BASED IND/COL VISIT5437 EI SERVICES (RESERVED FOR FUTURE USE)5438 EI SERVICES (RESERVED FOR FUTURE USE)5439 EI EXTENDED ASSISTIVE TECH HOME/COMM BASED IND/COL5440 EI EXTENDED AUDIOLOGY HOME/COMM BASED IND/COL5441 EI EXTENDED FAMILY COUNS HOME/COMM BASED IND/COL5442 EI EXTENDED FAMILY SUPP HOME/COMM BASED IND/COL5443 EI EXTENDED FAMILY TRAIN HOME/COMM BASED IND/COL5444 EI EXTENDED HEALTH SRVS HOME/COMM BASED IND/COL5445 EI EXTENDED NURSING SRV HOME/COMM BASED IND/COL5446 EI EXTENDED NURSING SRV HOME/COMM BASED IND/COL5447 EI EXTENDED NUTRITION HOME/COMM BASED IND/COL5448 EI EXTENDED OCC THRPY HOME/COMM BASED IND/COL5449 EI EXTENDED PHYSICAL THRPY HOME/COMM BASED IND/COL5450 EI EXTENDED PSYCH HOME/COMM BASED IND/COL5451 EI EXTENDED SOCIAL WORK HOME/COMM BASED IND/COL5452 EI EXTENDED SPECIAL INST HOME/COMM BASED IND/COL5453 EI EXTENDED SPEECH LANG HOME/COMM BASED IND/COL5454 EI EXTENDED VISION HOME/COMM BASED IND/COL5455 EI EXTENDED OTHER EI HOME/COMM BASED IND/COL5456 EI SERVICES - ABA AIDE HOURLY RATE5457 EI SERVICES (RESERVED FOR FUTURE USE)5458 EI ASSISTIVE TECH OFFICE/FAC BASED IND/COL5459 EI AUDIOLOGY OFFICE/FAC BASED IND/COL VISIT5460 EI FAMILY COUNSELING OFFICE/FAC BASED IND/COL5461 EI FAMILY SUPPORT OFFICE/FAC BASED IND/COL5462 EI FAMILY TRAINING OFFICE/FAC BASED IND/COL5463 EI HEALTH SERVICES OFFICE/FAC BASED IND/COL5464 EI NURSING OFFICE/FAC BASED IND/COL VISIT5465 EI NUTRITION OFFICE/FAC BASED IND/COL VISIT5466 EI OCCUPATIONAL THERAPY OFFICE/FAC BASED IND/COL5467 EI PHYSICAL THERAPY OFFICE/FAC BASED IND/COL5468 EI PSYCHOLOGICAL OFFICE/FAC BASED IND/COL5469 EI SOCIAL WORK OFFICE/FAC BASED IND/COL5470 EI SPECIAL INSTRUCTION OFFICE/FAC BASED IND/COL5471 EI SPEECH AND LANGUAGE OFFICE/FAC BASED IND/COL5472 EI VISION OFFICE/FAC BASED IND/COL VISIT5473 EI OTHER OFFICE/FAC BASED IND/COL VISIT5474 EI SERVICES (RESERVED FOR FUTURE USE)5475 EI SERVICES (RESERVED FOR FUTURE USE)5476 EI PARENT/CHILD GROUP VISIT5477 EI BASIC GRP DEVLPMNT INTERVENTION VISIT5478 EI SERVICES (RESERVED FOR FUTURE USE)5479 EI BASIC GRP DVLPMNTL INTERVENTION VISIT5480 EI BASIC GRP DVLPMNTL INTERVENTION VISIT WITH 1:15481 EARLY INTERVENTION SERVICES5482 EI ENHNCD GRP DEVEL INTERVENTION VISIT5483 EI ENHNCD GRP DEVEL VISIT WITH 1:1 AIDE5484 EI SERVICES (RESERVED FOR FUTURE USE)5485 EI FAMILY/CAREGIVER SUPPORT GROUP VISIT5486 EI SIBLING SUPPORT GROUP VISIT5487 EI SERVICES DME/PROSTHETICS/ORTHOTICS PER $100.005488 EI SERVICES DME/PROSTHETICS/ORTHOTICS PER $1.005489 EI SERVICES OTHER ASSISTIVE TECHNOLOGY PER $100.005490 EI SERVICES OTHER ASSISTIVE TECHNOLOGY PER $1.005491 CMCM INITIAL IEP REVIEW5492 CMCM ANNUAL IEP REVIEW5493 CMCM TRIENNIAL IEP REVIEW5494 CMCM REQUESTED IEP REVIEW5495 CMCM ONGOING SERVICE COORDINATION5496 SSHSP SPECIAL TRANSPORTATION6001 MPA ADJUSTMENT TO 2852 (LOCAL SHARE)6002 MPA ADJUSTMENT TO 2852 (STATE SHARE)6003 SLIP ADJUSTMENT TO 2852 (LOCAL SHARE)6004 SLIP ADJUSTMENT TO 2852 (STATE SHARE)6005 MPA ADJUSTMENT TO 2853 (LOCAL SHARE)6006 MPA ADJUSTMENT TO 2853 (STATE SHARE)6007 SLIP ADJUSTMENT TO 2853 (LOCAL SHARE)6008 SLIP ADJUSTMENT TO 2853 (STATE SHARE)6009 MPA ADJUSTMENT TO 2946 (LOCAL SHARE)6010 MPA ADJUSTMENT TO 2946 (STATE SHARE)6011 SLIP ADJUSTMENT TO 2946 (LOCAL SHARE)6012 SLIP ADJUSTMENT TO 2946 (STATE SHARE)

6013 MPA ADJUSTMENT TO 2947 (LOCAL SHARE)6014 MPA ADJUSTMENT TO 2947 (STATE SHARE)6015 MPA ADJUSTMENT TO 2959 (LOCAL SHARE)6016 MPA ADJUSTMENT TO 2959 (STATE SHARE)6017 SLIP ADJUSTMENT TO 2948 (LOCAL SHARE)6018 SLIP ADJUSTMENT TO 2948 (STATE SHARE)6019 MPA ADJUSTMENT TO 2957 (LOCAL SHARE)6020 MPA ADJUSTMENT TO 2957 (STATE SHARE)6021 SLIP ADJUSTMENT TO 2957 (LOCAL SHARE)6022 SLIP ADJUSTMENT TO 2957 (STATE SHARE)6023 MPA ADJUSTMENT TO 2948 (LOCAL SHARE)6024 MPA ADJUSTMENT TO 2948 (STATE SHARE)6025 SLIP ADJUSTMENT TO 2949 (LOCAL SHARE)6026 SLIP ADJUSTMENT TO 2949 (STATE SHARE)6027 SLIP ADJUSTMENT TO 2993 (LOCAL SHARE)6028 SLIP ADJUSTMENT TO 2993 (STATE SHARE)6368 SYSTEM GENERATED FROM CLAIM6501 PAC 1 DIAG INVESTIGATION EXAMS NEC6502 PAC 2 DIAG INVEST WITH NUCL IMAGING6503 PAC 3 DIAG INVEST WITH CAT IMAAGING6504 PAC 4 DIAG INVEST WITH MRI6505 PAC 5 MANAGEMENT EXAM NEC6506 PAC 6 MEDICATION ADMINISTRATION6507 PAC 7 PED ANUAL WELCARE EXAM (AGE 3-17)6508 PAC 8 ADLT ANUAL WELLCARE EXAM (AGE >17)6509 PAC 9 FIRST PRENATAL-ROUTINE6510 PAC 10 FIRST PRENATAL-COMPLICATED6511 PAC 11 PRENATAL MGMNT REVIST-COMPLICATED6512 PAC 12 POST PARTUM MGMNT-COMPLICATED6513 PAC 13 PRENATAL REVST WELL CARE-NORMAL6514 PAC 14 POST PARTUM MGMNT-NORMAL6515 PAC 15 NEONATAL & CONGENITAL DIAG INVEST6516 PAC 16 MGMNT OF NEONTL & CONGENITL PROB6517 PAC 17 PEDIATRIC WELLCARE EXAM (AGE <3)6518 PAC 18 FEMALE REPRO DIAG INVEST6519 PAC 19 MGMNT OF FEMALE REPRODUCTIVE PROB6520 PAC 20 ANNUAL GYNECOLOGICAL EXAM6521 PAC 21 CONTRACEPTIVE WELL CARE EXAM6522 PAC 22 ENT DIAG INVEST-ADULT (AGE >17)6523 PAC 23 ENT DIAG INVEST-PEDIA (AGE 0-17)6524 PAC 24 MGMT OF ENT PRBL-ADULT (AGE >17)6525 PAC 25 MGMT OF ENT PROB-PEDIA (AGE 0-17)6526 PAC 26 OPTHALMOLOGICAL SERVICES6527 PAC 27 RESPTRY DIAG INVST-ADULT (AGE >17)6528 PAC 28 RESP DIAG INVST-PEDIA (AGE 0-17)6529 PAC 29 MGMT OF RESP PBL-ADULT (AGE >17)6530 PAC 30 MGMT OF RESP PLB-PEDIA (AGE 0-17)6531 PAC 31 SYSTEMIC INFECT DIAG INVEST6532 PAC 32 MGMT OF SYSTEMIC INFECTIONS6533 PAC 33 GASTROINTESTINAL DIAG INVEST6534 PAC 34 MGMT GASTINT PROB-ADULT (AGE >17)6535 PAC 35 MGMT GASTINT PROB-PED (AGE 0-17)6536 PAC 36 HEPATOBILIARY DIAG INVESTIGATION6537 PAC 37 MGMT OF HEPATOBILIARY PROB6538 PAC 38 GENITO-URO DIAG INVEST6539 PAC 39 MGMT OF GENITO-UROLOGICAL PROB6540 PAC 40 CARDIAC DIAG INVESTIGATION6541 PAC 41 MGMT OF CARDIAC PROB6542 PAC 42 ENDOCRINAL DIAG INVESTIGATION6543 PAC 43 MGMT OF OTHER ENDOCRINAL PROB6544 PAC 44 MGMT OF DIABETES-PEDIATRIC (AGE 0-17)6545 PAC 45 MGMT OF DIABETES-ADULT (AGE >17)6546 PAC 46 SKIN & SOFT TISSUE DIAG INVEST6547 PAC 47 INFLAM MUSC/SKEL DIAG INVEST6548 PAC 48 OTHER MUSC/SKEL DIAG INVESTIGATION6549 PAC 49 REHABILITATION THERAPY6550 PAC 50 MGMT SKIN & SOFT TISSUE PROB6551 PAC 51 MANAGEMENT OF POISONING6552 PAC 52 MGMT OF INFLAM MUSC/SKEL PROB6553 PAC 53 MGMT OTH MUSC/SKEL PROB6554 PAC 54 ONCOLOGICAL DIAG INVESTIGATION6555 PAC 55 AIDS DIAG INVESTIGATION6556 PAC 56 OTH HEMATOLOGICAL DIAG INVEST6557 PAC 57 THERAPY IV PUSH & CHEMO INJECT6558 PAC 58 THERAPY INFUSIONS6559 PAC 59 THERAPY RADIOTHERAPY6560 PAC 60 ONCOLOGICAL MANAGEMENT6561 PAC 61 MGMT OF ANEMIAA-PEDIATRIC (AGE 0-17)6562 PAC 62 MGMT OF ANEMIAS-ADULT (AGE >17)6563 PAC 63 MGMT OF AIDS-PEDIATRIC (AGE 0-17)6564 PAC 64 MGMT OF AIDS-ADULT (AGE >17)6565 PAC 65 MGMT OF OTHER HEMATOLOGICAL PROB6566 PAC 66 NEURO & PSYCHO/SOCIAL DIAG INVEST6567 PAC 67 SPEECH & HEARING SVCS-ADULT (AGE >17)6568 PAC 68 SPEECH & HEARING SVCS-PEDIA (AGE 0-17)6569 PAC 69 NEUROLOGICAL & PSYCHO/SOCIAL MGMNT6570 PAC 70 COUNSELING6571 PAC 71 DIAG INVST OF VASCULAR SYSTEMS7501 PAC 1 MEDICARE CLAIM7502 PAC 2 MEDICARE CLAIM7503 PAC 3 MEDICARE CLAIM7504 PAC 4 MEDICARE CLAIM7505 PAC 5 MEDICARE CLAIM7506 PAC 6 MEDICARE CLAIM7507 PAC 7 MEDICARE CLAIM7508 PAC 8 MEDICARE CLAIM7509 PAC 9 MEDICARE CLAIM7510 PAC 10 MEDICARE CLAIM7511 PAC 11 MEDICARE CLAIM

7512 PAC 12 MEDICARE CLAIM7513 PAC 13 MEDICARE CLAIM7514 PAC 14 MEDICARE CLAIM7515 PAC 15 MEDICARE CLAIM7516 PAC 16 MEDICARE CLAIM7517 PAC 17 MEDICARE CLAIM7518 PAC 18 MEDICARE CLAIM7519 PAC 19 MEDICARE CLAIM7520 PAC 20 MEDICARE CLAIM7521 PAC 21 MEDICARE CLAIM7522 PAC 22 MEDICARE CLAIM7523 PAC 23 MEDICARE CLAIM7524 PAC 24 MEDICARE CLAIM7525 PAC 25 MEDICARE CLAIM7526 PAC 26 MEDICARE CLAIM7527 PAC 27 MEDICARE CLAIM7528 PAC 28 MEDICARE CLAIM7529 PAC 29 MEDICARE CLAIM7530 PAC 30 MEDICARE CLAIM7531 PAC 31 MEDICARE CLAIM7532 PAC 32 MEDICARE CLAIM7533 PAC 33 MEDICARE CLAIM7534 PAC 34 MEDICARE CLAIM7535 PAC 35 MEDICARE CLAIM7536 PAC 36 MEDICARE CLAIM7537 PAC 37 MEDICARE CLAIM7538 PAC 38 MEDICARE CLAIM7539 PAC 39 MEDICARE CLAIM7540 PAC 40 MEDICARE CLAIM7541 PAC 41 MEDICARE CLAIM7542 PAC 42 MEDICARE CLAIM7543 PAC 43 MEDICARE CLAIM7544 PAC 44 MEDICARE CLAIM7545 PAC 45 MEDICARE CLAIM7546 PAC 46 MEDICARE CLAIM7547 PAC 47 MEDICARE CLAIM7548 PAC 48 MEDICARE CLAIM7549 PAC 49 MEDICARE CLAIM7550 PAC 50 MEDICARE CLAIM7551 PAC 51 MEDICARE CLAIM7552 PAC 52 MEDICARE CLAIM7553 PAC 53 MEDICARE CLAIM7554 PAC 54 MEDICARE CLAIM7555 PAC 55 MEDICARE CLAIM7556 PAC 56 MEDICARE CLAIM7557 PAC 57 MEDICARE CLAIM7558 PAC 58 MEDICARE CLAIM7559 PAC 59 MEDICARE CLAIM7560 PAC 60 MEDICARE CLAIM7561 PAC 61 MEDICARE CLAIM7562 PAC 62 MEDICARE CLAIM7563 PAC 63 MEDICARE CLAIM7564 PAC 64 MEDICARE CLAIM7565 PAC 65 MEDICARE CLAIM7566 PAC 66 MEDICARE CLAIM7567 PAC 67 MEDICARE CLAIM7568 PAC 68 MEDICARE CLAIM7569 PAC 69 MEDICARE CLAIM7570 PAC 70 MEDICARE CLAIM7571 PAC 71 MEDICARE CLAIM7580 HARP TANF/SN/SSI 21+ M/F7581 RES FOR HARP FUTURE USE7582 RES FOR HARP FUTURE USE7583 RES FOR HARP FUTURE USE7584 OFF-SITE SERVICES (PRIMARY MEDICAL CARE)7680 SYSTEM GENERATED FROM CLAIM7777 NO RATE CODE FOUND ON CONVERSION TABLE7778 HARP HCBS BRIEF ASSESSMENT7779 HARP HCBS FULL ASSESSMENT7780 PLAN OF CARE DEVELOPMENT - INITIAL7781 PLAN OF CARE DEVELOPMENT - ONGOING7782 HARP CARE MANAGEMENT - OUTREACH7783 HARP CARE MANAGEMENT - ACTIVE7784 HARP HCBS PSYCHOSOCIAL REHAB - INDV - ON-SITE7785 HARP HCBS PSYCHOSOCIAL REHAB - INDV - OFF-SITE7786 HARP HCBS PSYCHOSOCIAL REHAB - GROUP 2-37787 HARP HCBS PSYCHOSOCIAL REHAB - GROUP 4-57788 HARP HCBS PSYCHOSOCIAL REHAB - GROUP 6-107789 HARP HCBS PSYCHOSOCIAL REHAB - INDV - PER DIEM7790 HARP HCBS CPST (PHYSICIAN)7791 HARP HCBS CPST (NP, PSYCHOLOGIST)7792 HARP HCBS CPST (RN, LMHC, LMFT, LCSW, LMSW)7793 HARP HCBS CPST (ALL OTHER ALLOWABLE PROFESSIONS)7794 HARP HCBS PEER SUPPORTS - BY CREDENTIALED STAFF7795 HARP HCBS RESIDENTIAL SUPPORTS SERVICES7796 HARP SHORT-TERM CRISIS RESPITE (DEDICATED FACL)7797 HARP SHORT-TERM CRISIS RESP (NON-DEDICATED FACL)7798 HARP INTENSIVE CRISIS RESPITE7799 HARP HCBS FAMILY SUPPORT / TRAINING (INDIVIDUAL)7800 HARP HCBS FAMILY SUPPORT / TRN (GROUP OF 2 OR 3)7801 HARP HCBS PRE-VOCATIONAL7802 HARP HCBS TRANSITIONAL EMPLOYMENT7803 HARP HCBS INTENSIVE SUPPORTED EMPLOYMENT7804 HARP HCBS ON-GOING SUPPORTED EMPLOYMENT7805 HARP HCBS EDUCATION SUPPORT SERVICES7806 HARP HCBS PROVIDER TRAVEL SUPPLEMENT (PER MILE)7807 HARP HCBS PROVIDER TRAVEL SUPPLEMENT (SUBWAY)7808 RES FOR HARP FUTURE USE7809 RES FOR HARP FUTURE USE

7810 RES FOR HARP FUTURE USE7811 RES FOR HARP FUTURE USE7812 RES FOR HARP FUTURE USE7813 RES FOR HARP FUTURE USE7814 RES FOR HARP FUTURE USE7815 RES FOR HARP FUTURE USE7816 RES FOR HARP FUTURE USE7817 RES FOR HARP FUTURE USE8514 SYSTEM GENERATED FROM MEMBER PA8720 SYSTEM GENERATED FROM CLAIM8888 9'S LINE WAS ENTERED INSTEAD OF R-LINE9045 SYSTEM GENERATED FROM MEMBER PA9170 SYSTEM GENERATED FROM CLAIM9221 LT HOME CARE RESPIRATORY CARE9327 SYSTEM GENERATED FROM MEMBER PA9457 SYSTEM GENERATED FROM CLAIM9508 SYSTEM GENERATED FROM MEMBER PA9750 NHTDWVR VEHICLE ADAPTATION9751 NHTDWVR RRDC INTERIM SERVICE COORDINATION9752 NHTDWVR ASSIST TECH TOTAL CHARGES9753 NHTDWVR ASSIST TECH $10.009754 NHTDWVR ASSIST TECH $1009755 NHTDWVR COMM INTEGRAT COUNSEL9756 NHTDWVR INDEP LIV SKILL-HOURLY9757 NHTDWVR POS BEHAV INTERV & SUP9758 NHTDWVR COM TRANSIT SVR TOT CHARGE9759 NHTDWVR COM TRANSIT SVR-$10.009760 NHTDWVR COM TRANSIT SVR-$1009761 NHTDWVR COM TRANSIT SVR-$10009762 NHTDWVR ENVIRON MOD TOT CHARGES9763 NHTDWVR NUT CONSUL ED LEVEL I9764 NHTDWVR NUT CONSUL ED LEV II9765 NHTDWVR NUT CONSUL ED LEV III9766 NHTDWVR NUT CONCUL ED-LEV I9767 NHTDWVR NUT CONCUL ED-LEV II9768 NHTDWVR RESPITE/DIEM IN HOME9769 NHTDWVR HOM RESP CARE-LEV I9770 NHTDWVR HOM RESP CARE-LEV II9771 NHTDWVR HOM RESP CARE-LEV III9772 NHTDWVR INIT SRV COORD/TRANS L19773 NHTDWVR INIT SRV COORD/TRANS L29774 NHTDWVR INIT SRV COORD/DIVER9775 NHTDWVR ONGO SVR COORD-LEV I9776 NHTDWVR ONGO SVR COORD-LEV II9777 NHTDWVR ONGO STRUCT DAY PROG-LEV I9778 NHTDWVR ONGO STRUCT DAY PROG-LEV II9779 NHTDWVR ONGO STRUCT DAY PROG-LEV III9780 NHTDWVR PEER MENTOR SRV9781 NHTDWVR CONG/HOME MEALS TOT CHARGE9782 NHTDWVR CONG/HOME MEALS $10.009783 NHTDWVR CONG/HOME MEALS $1009784 NHTDWVR CONG/HOME MEALS $10009785 NHTDWVR NURSE/WELLNESS COUNSEL9786 NHTDWVR MEDICAL HOME VISIT9787 NHTDWVR MOV ASS'T PROG TOTAL CHARGE9788 NHTDWVR MOV ASS'T PROG $10.009789 NHTDWVR MOV ASS'T PROG $1009790 NHTDWVR MOV ASS'T PROG $10009791 NHTDWVR TELEMED SRV LEV I9792 NHTDWVR TELEMED SRV LEV II9793 NHTDWVR TELEMED SRV LEV III9794 NHTDWVR TELEMED SRV LEV IV9795 NHTDWVR HOME/COM SUPSRV LEV I9796 NHTDWVR HOME/COM SUPSRV LEV II9797 NHTDWVR HOME/COM SUPSRV LEV III9798 NHTDWVR HOME/COM SUPSRV LEV IV9799 NHTDWVR HOME/COM SUP'T NURSUPER9800 INTAKE SESSION9801 CLINIC VISIT9802 CLINIC VISIT WITH PSYCHIATRIST9803 GROUP THERAPY SESSION9804 PSYCHIATRIC DAY CARE-5+ HOURS9805 PSYCHIATRIC DAY CARE (+3 AND -5 HOURS)9806 PSYCHIATRIC EVENING CARE - 5+ HOURS9807 PSYCHIATRIC NIGHT CARE9809 CLINIC HOME VISIT9810 PRE-ADMISSION CLINICAL DIAGNOSTIC EVALUATION9850 SERVICE COORDINATION, INITIAL9851 SERVICE COORDINATION, MONTHLY9852 THERAPEUTIC FOSTER CARE, PARTIAL DAY9853 THERAPEUTIC FOSTER CARE, FULL DAY9854 TBI WAIVER ASSISTIVE TECHNOLOGY $1.00 PER UNIT FEE9855 TBI WAIVER ASSISTIVE TECHNOLOGY $10.00 PER UNIT FE9856 TBI WAIVER ASSISTIVE TECHNOLOGY $100.00 PER UNIT F9857 TBI WAIVER ASSISTIVE TECHNOLOGY - TOTAL CHARGES9858 INDPNDNT LVNG SKILLS/TRNG/DVLPMNT, HOURLY9859 SUBSTANCE ABUSE PROGRAM HOURLY - LIMITED TO 5 HRS9860 INTENSIVE BEHAVIOR PROGRAM, HOURLY9861 COMMUNITY INTEGRATION COUNSELING, HOURLY9862 TRANSITIONAL LIVING PROGRAM, FULL DAY9863 HOME & COMMUNITY SUPPORT SERVICES, HOURLY9864 TBI WAIVER COMM TRANS RATE CD 16 - $1.00 PER UNIT9865 TBI WAIVER COMM TRANS RATE CD 16 - $10.00 PER UNIT9866 TBI WAIVER COMM TRANS RATE CD 16 - $100.00 PER UNI9867 TBI WAIVER COMM TRANS RATE CD 20 - $1000.00 PER UN9868 TBI WAIVER TRANS. INDIVIDUAL $100.00 PER UNIT FEE9869 RESPITE, HOURLY, IN-HOME9870 STRUCTURED DAY PROGRAM HOURLY - LIMITED TO 8 HRS9871 TBI WVR ENVIRON. MODIFICATIONS $1.00 PER UNIT FEE

9872 TBI WVR ENVIRON MODIFICATIONS $10.00 PER UNIT FEE9873 TBI WVR ENVIRON MODIFICATIONS $100.00 PER UNIT FEE9874 TBI WVR ENVIRON MODS $1000.00 PER UNIT FEE9875 TBI WAIVER RESPITE, PER DIEM, IN-HOME9876 RESPITE, PER DIEM, HOSPITAL9877 RESPITE, PER DIEM, NURSING FACILITY9878 RESPITE, PER DIEM, OMRDD APPROVED FACILITY9900 CAH 1 LONGTERM HOME HOUSING IMPRVMNT COMM BASED9901 CAH 2 LONGTERM HOME HOUSING IMPRVMNT COMM BASED9902 CAH 1 LONGTERM HOME HOUSING IMPRVMNT HSP BASED9903 CAH 2 LONGTERM HOME HOUSING IMPRVMNT HSP BASED9904 CAH 1 LONG TERM HOUSING IMPROVMNT NURSING HOME9905 CAH 2 LONG TERM HOUSING IMPROVMNT NURSING HOME9906 CAH 1 LONG TERM HOME CARE RESPIRATORY CARE9907 CAH 2 LONG TERM HOME CARE RESPIRATORY CARE9908 CAH 1 LONG TERM HOME CARE MEDICAL SOCIAL SERVICES9909 CAH 2 LONG TERM HOME CARE MEDICAL SOCIAL SERVICES9910 CAH 1 LTHC NUTRITION COUNSELING/EDUCATIONAL SRV9911 CAH 1 LTHC NUTRITION COUNSELING/EDUCATIONAL SRV9912 ENVIRON MODIFICATIONS; $1.00 PER UNIT FEE - STATE9913 ENVIRON MODIFICATIONS; $10.00 PER UNIT FEE - STATE9914 ENVIRON MODIFICATIONS; $100.00 PER UNIT FEE - ST9915 ENVIRON MODIFICATIONS; $1000.00 PER UNIT FEE - ST9916 LONGTERM HOME CARE MEDICAL/SOCIAL SERVICES9917 LTHC NUTRITION COUNSELING/EDUCATIONAL SERVICES9918 ENVIRON MODIFICATIONS; $1.00 PER UNIT FEE - STATE9919 ENVIRON MODIFICATIONS; $10.00 PER UNIT FEE - STATE9920 ENVIRON MODIFICATIONS; $100.00 PER UNIT FEE - ST9921 ENVIRON MODIFICATIONS; $1000.00 PER UNIT FEE - ST9922 ADAPTIVE TECH; $1.00 PER UNIT FEE - STATE9923 ADAPTIVE TECH; $10.00 PER UNIT FEE - STATE9924 LT HOME HOUSING IMPRV COMM BASED9925 LT HOME HOUSING IMPRV HOSPITAL BASED9926 LT HOME HOUSING IMPRV NURSING HOME9927 LT HOME CARE RESPIRATORY CARE9928 LT HOME CARE MEDICAL SOCIAL SRVS9929 LTHC NUTRITION COUNSEL/EDUCATIONAL SERVICES9930 ENVIRON MODIFICATIONS; $1.00 PER UNIT FEE - STATE9931 ENVIRON MODIFICATIONS; $10.00 PER UNIT FEE - STATE9932 ENVIRON MODIFICATIONS; $100.00 PER UNIT FEE - ST9933 ENVIRON MODIFICATIONS; $1000.00 PER UNIT FEE - ST9934 LT HOME CARE MEDICAL SOCIAL SERVICES9935 LTHC NUTRITION COUNSEL/ED SERVICES9936 LT HOME HOUSING IMPRV COMM BASED9937 LT HOME HOUSING IMPRV HSP BASED9938 LT HOME HOUSING IMPRV NURSING HOME9939 LT HOME CARE RESPIRATORY CARE9940 LT HOME CARE MEDICAL/SOCIAL SERVICES9941 LTHC NUTRITION COUNSL/ED SERVICES9942 LT HOME HOUSING IMPRV COMM BASED9943 LT HOME HOUSING IMPRV HSP BASED9944 LT HOME HOUSING IMPRV NURSING HOME9945 LT HOME CARE RESPIRATORY CARE9946 LT HOME CARE MEDICAL/SOCIAL SERVICES9947 LTHC NUTRITION COUNSL/ED SERVICES9948 LT HOME HOUSING IMPRV COMM BASED9949 LT HOME HOUSING IMPRV HSP BASED9950 LT HOME HOUSING IMPRV NURSING HOME9951 LT HOME CARE RESPIRATORY CARE9952 LT HOME CARE MEDICAL SOCIAL SERVICES9953 LTHC NUTRITION COUNSL/ED SERVICES9954 LT HOME HOUSING IMPROV COMM BASED9955 LT HOME HOUSING IMPROV HSP BASED9956 LT HOME HOUSING IMPROV NURSING HOME9957 LT HOME CARE RESPIRATORY CARE9958 LT HOME CARE MEDICAL/SOCIAL SERVICES9959 LTHC NUTRITION COUNSL/ED SERVICES9960 OMR/CAHIII ADAPTIVE TECH; $1.00 PER UNIT FEE - ST9961 OMR/CAHIII ADAPTIVE TECH; $10.00 PER UNIT FEE - ST9962 OMR/CAHIII ADAPT TECH; $100.00 PER UNIT FEE - ST9963 OMR/CAHIII ADAPT TECH; $1000.00 PER UNIT FEE - ST9964 OMR/CAHIV - ADAPTIVE TECH; $100.00 PER UNTI FEE9965 OMR/CAHIV - ADAPTIVE TECH; $1000.00 PER UNTI FEE9966 HOME CARE MEDICAL/SOCIAL SERVICES - DDSO9967 NUTRITION COUNCL/ED SERVICES - DDSO9970 ADAPTIVE TECH; $1.00 PER UNIT FEE - STATE9971 ADAPTIVE TECH; $10.00 PER UNIT FEE - STATE9972 ADAPTIVE TECH; $100.00 PER UNIT FEE - STATE9973 ADAPTIVE TECH; $1000.00 PER UNIT FEE - STATE9980 HOSPITAL, LTHHC, PRE + SCREEN9981 HOSPITAL, LTHHC, PERS9982 PCA II 1 CLIENT HRLY WEEKEND & EVENING STAFF9983 PCA II 1 CLIENT HRLY DIFFCULT TO SERVICE DIFF9987 LTHHCP E-MODS (VEHICLE) COMM BASED9988 LTHHCP E-MODS (VEHICLE) HOSPITAL BASED9989 LTHHCP E-MODS (VEHICLE) NURSING HOME9990 LTERM MAIN TASK-OTHER COMM BASED9991 LTERM HOME TRANS COMM BASED9992 LTHHCP E-MODS (HOME) COMM BASED9993 LTERM HOME MAINT-OTH HOSP BASED9994 LTERM HOME TRANS HOSP BASED9995 LTHHCP E-MODS (HOME) HOSPITAL BASED9996 LTERM HOME MAINT TASK-OTHER NURSING HOME9997 LTERM HOME TRANSPORTATION NURSING HOME9998 LTHHCP E-MODS (HOME) NURSING HOMEA010 SYSTEM GENERATED FROM MEMBER PAAB94 SYSTEM GENERATED FROM MEMBER PAAC70 SYSTEM GENERATED FROM MEMBER PAAE95 SYSTEM GENERATED FROM MEMBER PA

AO10 SYSTEM GENERATED FROM MEMBER PAAU76 SYSTEM GENERATED FROM MEMBER PAAX01 SYSTEM GENERATED FROM MEMBER PAAX15 SYSTEM GENERATED FROM MEMBER PACR04 SYSTEM GENERATED FROM MEMBER PACY83 SYSTEM GENERATED FROM MEMBER PADV90 SYSTEM GENERATED FROM MEMBER PALIFE SYSTEM GENERATED FROM MEMBER PAT101 SYSTEM GENERATED FROM MEMBER PAZZZZ INSTITUTIONAL CMS MEDICARE CROSSOVER

SPEC_CD THER_CLASS_FORMULARY_CDCode Value Code Description Code Value Code Description007 ALCOHOLISM/SUBSTANCE ABUSE INPATIENT- MC PNDS ONLY 04040 CARDIAC GLYCOSIDES010 PSC: ALLERGY AND IMMUNOLOGY 04080 CENTRAL ACTING ANTIADRENERGIC AHT011 GENERAL HOSPITAL (ARTICLE 28) - MC PNDS ONLY 04081 PERIPHERAL ACTING ANTIADRENERGIC AHT017 OMH PSYCH CTR/OASAS ASA INPATIENT - MC PNDS ONLY 04082 ALPHA/BETA BLOCKING ANTIADRENERGIC AHT018 PRIVATE PSYCH & ASA INPATIENT - MC PNDS ONLY 04083 BETA BLOCKING ANTIADRENERGIC AHT020 PSC: ANESTHESIOLOGY 04084 VASODILATING AHT030 PSC: COLON AND RECTAL SURGERY 04085 CALCIUM CHANNEL BLOCKERS031 INCREASED PRIMARY CARE FEE 04086 ANGIOTENSIN CONVERT ENZYME INHIBITORS AC040 PSC DERM: DERMATOLOGY 04087 COMBINATION AHT041 PSC DERM: DERMATOPATHOLOGY 04088 MISC. AHT050 PSC: FAMILY PRACTICE 04089 ARB ANGIOTENSIN II RECEPTOR ANTAGONISTS055 ADOLESCENT MEDICINE: FAMILY MEDICINE (MC USE ONLY) 04090 DIRECT RENIN INHIBITOR056 ADOLESCENT MEDICINE: PEDIATRICS (MC USE ONLY) 04091 SYSTEM GENERATED FROM CLAIM057 DEVELOPMENT: BEHAVIORAL PEDIATRICS (MC USE ONLY) 04120 ANTIANGINALS058 INTERNAL MEDICINE AND PEDIATRICS (MC USE ONLY) 04160 ANTIARRHYTHMICS059 MC:PEDIATRIC RHEUMATOLOGY (MC ONLY) 04200 ANTIHYPERLIPIDEMICS060 PSC INT MED: INTERNAL MEDICINE 04201 ANTIHYPERLIPIDEMICS-(VIT B)-MED-WRAP061 PEDIATRIC INFECTIOUS DISEASE (MC USE ONLY) 04220 COMBINATION ANTIHYPERLIPIDEMICS062 PSC INT MED: CARDIOVASCULAR DISEASE 04240 THIAZIDE/RELATED DIURETICS063 PSC INT MED: ENDOCRINOLOGY AND METABOLISM 04242 CARBONIC ANHYDRASE INHIBITORS064 PSC INT MED: GASTROENTEROLOGY 04243 LOOP DIURETICS065 PSC INT MED: HEMATOLOGY 04244 K SPARING/COMBINATION DIURETICS066 PSC INT MED: INFECTIOUS DISEASES 04249 MISC. DIURETICS, NOC067 PSC INT MED: NEPHROLOGY 04300 ER DRUGS & ANTI-SHOCK DRUGS068 PSC INT MED: PULMONARY DISEASES 04320 PERIPHERAL VASCULAR DISEASE AGENTS069 PSC INT MED: RHEUMATOLOGY 04400 PERIPHERAL VASODILATORS070 PSC NEURO SUR: NEUROLOGICAL SURGERY 04401 SYSTEM GENERATED FROM CLAIM071 SPINAL CORD INJURY MEDICINE (MC USE ONLY) 04500 AGENTS USED FOR PULMONARY HYPERTENSION072 PEDIATRIC NEUROSURGERY (MC USE ONLY) 04575 SYSTEM GENERATED FROM CLAIM073 MC:PEDIATRIC DERMATOLOGY (MC ONLY) 04600 VASODILATORS-PROSTAGLANDIN074 MC:MEDICAL TOXICOLOGY (MC ONLY) 04633 SYSTEM GENERATED FROM CLAIM075 MC:UNDERSEA & HYPERBARIC MEDICINE (MC ONLY) 04681 SYSTEM GENERATED FROM CLAIM076 MC:PEDIATRIC REHABILITATION (MC ONLY) 04900 MISC. CARDIO/RENAL AGENT, NOC080 PSC NUC MED: NUCLEAR MEDICINE 07220 SYSTEM GENERATED FROM ENCOUNTER081 PSC RAD: MEDICAL NUCLEAR PHYSICS - INACTIVE 08041 IRON PRODUCTS083 NEUROMUSCULAR MEDICINE - MC PNDS ONLY 08042 IRON COMBINATIONS084 NEURORADIOLOGY - MC PNDS ONLY 08043 IRON REPLACEMENT-MEDICARE WRAP085 NEUROTOLOGY - MC PNDS ONLY 08080 MEGALOBLASTIC ANEMIAS089 PSC OB GYN: OBSTETRICS AND GYNECOLOGY 08081 FOLIC ACID AND B12 MEDICARE WRAP092 PSC OB GYN: MATERNAL AND FETAL MEDICINE 08120 PAREN. ANTICOAGULANTS/ANTAGONISTS093 PSC OB GYN: REPRODUCTIVE ENDOCRINOLOGY 08121 PAREN. ANTICOAGULANTS/ANTAGONISTS-MED-WRAP095 CERTIFIED DIABETES EDUCATOR (MC USE ONLY) 08160 ORAL ANTICOAGULANTS100 PSC OPHTHAL: OPHTHALMOLOGY 08200 HEMOSTATICS101 PEDIATRIC OPHTHALMOLOGY (MC USE ONLY) 08240 BLOOD/COMPONENTS/SUBSTITUTES102 CAE: CERTIFIED ASTHMA EDUCATOR 08280 ANTI-FIBRINOLYTICS103 CDE: CERTIFIED DIABETES EDUCATOR 08300 BLOOD COLONY STIMULATING FACTORS110 PSC ORTHO SUR: ORTHOPEDIC SURGERY 08400 RECOMB. HUMAN ERYTHROPOITIN111 HAND SURGERY - ORTHOPEDIC SURGERY (MC USE ONLY) 08900 MISC. BLOOD MODIFIERS, NOC112 HAND SURGERY - PLASTIC SURGERY (MC USE ONLY) 12040 VITAMIN A113 HAND SURGERY - SURGERY (MC USE ONLY) 12080 VITAMIN B COMPLEX114 MC:PLASTIC SURGERY WITH THE HEAD & NECK (MC ONLY) 12120 VITAMIN C120 PSC OTOLARYN: OTOLARYNGOLOGY 12130 SYSTEM GENERATED FROM CLAIM121 PEDIATRIC OTOLARYNGOLOGY (MC USE ONLY) 12136 SYSTEM GENERATED FROM CLAIM127 PSC: CLIA REGISTRATION/COMPLIANCE/ACCREDITATION 12160 VITAMIN D128 PSC: CLIA WAIVER 12161 VITAMIN D-MEDICARE COV129 PSC: CLIA PHYSICIAN PERFORMED MICROSCOPY PROCEDURE 12200 VITAMIN A/D COMBOS.130 PSC: CLIA WAIVER/REGISTRATION (OBSOLETE 10/12/99) 12220 VITAMIN A/D/C WITH/WITHOUT IRON131 PSC PATH: BLOOD BANKING 12240 MISC. VITAMIN B PREPS.135 PSC PATH: CLINICAL PATHOLOGY 12241 VITAMIN B1 AND B6 INJ - MEDICARE WRAP136 PSC PATH: FORENSIC PATHOLOGY 12242 SYSTEM GENERATED FROM CLAIM137 PSC PATH: HEMATOLOGY 12280 VITAMIN E138 PSC PATH: CHEMICAL PATHOLOGY 12320 VITAMIN K139 PSC PATH: MEDICAL MICROBIOLOGY 12321 VITAMIN K-MEDICARE COV WO PA140 MC:PATHOLOGY WITH MOLECULAR GENETIC SPEC (MC ONLY) 12360 MULTI-VITAMINS WITH-WITHOUT MINERALS141 PSC PATH: NEUROPATHOLOGY 12400 MISC. MINERAL PREPS.142 PSC PATH: ANATOMIC PATHOLOGY 12440 MISC. NUTRITIONAL AGENTS143 PSC PATH: DERMATOPATHOLOGY 12480 FLUID/ELECTROLYTE/ACID/BASE BALANCERS144 TRANSPLANT HEPATOLOGY - MC PNDS ONLY 12520 MISC. HEMOSTATIC AGENTS145 PEDIATRIC TRANSPLANT HEPATOLOGY - MC PNDS ONLY 14852 SYSTEM GENERATED FROM CLAIM146 PSC PATH: ANATOMIC AND CLINICAL PATHOLOGY 16040 NARCOTIC AGONIST ANALGESICS147 PEDIATRIC PATHOLOGY - MC PNDS ONLY 16080 ANTIPYRETIC NSAIDS OTHER THAN COXII INHIBIT148 PSC PATH: RADIOISOTOPIC PATHOLOGY 16081 COX II INHIBITORS149 MC:PEDIATRIC EMERGENCY MEDICINE (MC ONLY) 16082 ANTIRHEUMATICS150 PSC PEDIATRICS 16083 ANTIRHEUMATICS- IMMUNMODULATORS151 PSC PEDIATRICS: CARDIOLOGY 16120 NARCOTIC AGONIST/ANTAGONISTS152 PSC PEDIATRICS: HEMATOLOGY - ONCOLOGY 16140 NON-NARCOTIC/NARCOTIC COMBOS.153 PSC PEDIATRICS: SURGERY 16141 BARB/ANALGESIC COMBOS.-MEDICARE WRAPPED154 PSC PEDIATRICS: NEPHROLOGY 16160 URICOSURICS155 PSC PEDIATRICS: NEONATAL - PERINATAL MEDICINE 16200 MISC. GOUT AGENTS156 PSC PEDIATRICS: ENDOCRINOLOGY 16240 ANTI-MIGRAINE AGENTS157 PSC PEDIATRICS: PULMONOLOGY 16280 MISC. SALICYLATES158 PSC PPAC: PREFERRED PHYSICIANS AND CHILDREN PROG 16400 ANALGESICS, NOC159 PSC MOMS: MEDICAID OBSTETRICAL & MATERNAL SVC PROG 17350 SYSTEM GENERATED FROM CLAIM160 PSC PM & REHAB: PHYSICAL MEDICINE & REHABILITATION 18040 LOCAL ANESTHETICS161 PCP PEDIATRICS: PEDIATRIC CRITICAL CARE 18080 GENERAL ANESTHETICS162 PSC PM & REHAB: OSTEOPATHIC MANIPULATIVE MEDICINE 18120 ANALGESIC ADJUNCTS163 PSC PEDIATRICS: GASTROENTOLOGY 20028 SYSTEM GENERATED FROM CLAIM164 CRITICAL CARE MED - ANESTHESIOLOGIST (MC USE ONLY) 20041 NON-BARB/NON-BENZO SEDATIVE HYPNOTICS165 CRITICAL CARE MEDICINE - INTERNAL (MC USE ONLY) 20042 BENZO. SEDATIVE HYPONOTICS ON TRIPLICATE166 CRITICAL CARE MEDICINE - OBSTETRICS (MC USE ONLY) 20043 BARBITURATE SEDATIVE HYPNOTICS167 CRITICAL CARE MEDICINE - SURGERY (MC USE ONLY) 20045 BENZO. SEDATIVE HYPONOTICS NOT TRIPLICATE169 PSC MOMS: HEALTH SUPPORTIVE SERVICES 20046 BENZO. SEDATIVE HYPONOTICS -COV MED D170 PSC PLASTIC SUR: PLASTIC SURGERY 20047 BARBITURATE SEDATIVE HYPNOTICS-COV MED D171 CLINICAL MOLECULAR GENETICS - MC PNDS ONLY 20080 BARB. ANTICONVULSANTS -COV MED D180 CLINICAL BIOCHEMICAL GENETICS - MC PNDS ONLY 20081 BARBITURATE ANTICONVULSANTS181 AEROSPACE 20082 HYDANTOIN ANTICONVULSANTS182 PSC PREV MED: GENERAL PREVENTIVE MEDICINE 20083 SUCCINIMIDE ANTICONVULSANTS

183 PSC PREV MED: OCCUPATIONAL MEDICINE 20084 OXAZOLIDINEDIONE ANTICONVULSANTS184 PSC PREV MED: PUBLIC HEALTH 20085 BENZODIAZEPINE ANTICONVULSANTS185 PSC PREV MED: AEROSPACE MEDICINE 20086 MISC. ANTICONVULSANTS186 T.B. DIRECTLY OBSERVED THERAPY/PHYSICIAN 20087 MISC AGENTS FOR POSTHERPETIC NEURALGIA187 PSY SP CD: MEDICAL GENETICS 20088 BENZO. ANTICONVULSANTS-COV MED D188 MC:CLINICAL GENETICS (MC ONLY) 20122 BENZODIAZEPINE ANXIOLYTICS189 MC:MOLECULAR GENETIC PATHOLOGY (MC ONLY) 20123 BENZODIAZEPINE ANXIOLYTICS-COV MED D190 MC:PAIN MANAGEMENT-PSYCHIATRY & NEUROLOGY (MC ONLY 20133 MISC. NON-CONTROLLED ANXIOLYTICS191 PSC PSY & NEURO: CHILD PSYCHIATRY 20144 MISC. CONTROLLED ANXIOLYTICS192 PSC PSY & NEURO: PSYCHIATRY (NOT CHILD) 20162 TRICYCLIC TERT. AMINES ANTIDEPRESSANTS193 PSC PSY & NEURO: CHILD NEUROLOGY 20163 TRICYCLIC SECOND.AMINES ANTIDEPRESSANTS194 PSC PSY & NEURO: NEUROLOGY (NOT CHILD) 20164 TETRACYCLIC ANTIDEPRESSANTS195 PSC PSY & NEURO: PSYCHIATRY & NEUROLOGY 20165 MONOAMINE OXIDASE INHIBITORS196 PSC PSY & NEURO: CLOZAPINE CASE MANAGER 20166 ANTIDEPRESSANTS NOC197 GERIATRIC PSYCHIATRY (MC USE ONLY) 20167 SSRI198 ADDICTION PSYCHIATRY (MC USE ONLY) 20170 SNRI199 MC:NERODEVELOPMENTAL DISABILITIES (MC ONLY) 20180 SNRI-FOR FIBROMYALGIA200 PSC RAD: PSC RADIOLOGY 20190 ANTIDEPRESSANTS OTHER INDICATIONS201 PSC RAD: DIAGNOSTIC RADIOLOGY 20201 ANTIPSYCH. PHENOTHIAZINES-ALIPHATIC202 PSC RAD: DIAGNOSTIC ROENTGENOLOGY 20202 ANTIPSYCH. PHENOTHIAZINES-PIPERIDINE205 PSC RAD: THERAPEUTIC RADIOLOGY 20203 ANTIPSYCH. PHENOTHIAZINES-PIPERAZINE206 PSC RAD: RADIOLOGICAL PHYSICS - INACTIVE 20204 ANTIPSYCH. THIOXANTHINES207 PSC RAD: THERAPEUTIC RADIOLOGICAL PHYSICS - INACT 20205 ANTIPSYCH. BUTYROPHENONES208 PSC RAD: DIAGNOSTIC RADIOLOGICAL PHYSICS - INACT 20206 ANTIPSYCH. DIHYDROINDOLONES210 PSC: GENERAL SURGERY 20207 ANTIPSYCH. DIBENZOXAZEPINE211 HOSPITALIST (MC USE ONLY) 20208 MISC. ANTIPSYCHOTICS220 PSC THOR SUR: THORACIC SURGERY 20210 ANTIPSYCHOTICS- OTHER THAN ATYPICAL230 PSC: UROLOGY 20240 SYSTEM GENERATED FROM CLAIM231 PEDIATRIC UROLOGY (MC USE ONLY) 20250 ATYPICAL ANTIPSYCHOTICS240 VASCULAR NEUROLOGY - MC PNDS ONLY 20300 ANTIDEPRESSANT/ANTIPSYCHOTICS COMBOS.241 PSC INT MED: ONCOLOGY 20310 ANTIDEPRESSANT/ANTIPSYCH.- OTHER COMBOS.242 PSC OB GYN: GYNECOLOGIC ONCOLOGY 20320 ANTIDEPRESSANT/ATYPICAL ANTIPSYCH. COMBOS.243 VASCULAR MEDICINE - MC PNDS ONLY 20330 ANTIDEPRESSANT/ANTIANXIETY COMBOS.244 RADIOLOGIST ONCOLOGY (MC USE ONLY) 20350 SYSTEM GENERATED FROM CLAIM245 MC:PEDIATRIC RADIOLOGY (MC ONLY) 20400 CNS STIMULANTS246 MC:VASCULAR&INTERVENTIONAL RADIOLOGY (MC ONLY) 20410 TRANSDERMAL CNS STIMULANTS247 MANAGED CARE - PHYSICIAN ENHANCED FEE 20440 ANALEPTICS248 MANAGED CARE - DENTAL ENHANCED FEE 20480 ANTI-ALCOHOLISM AGENTS249 PSC: HIV PRIMARY CARE SERVICES (CONFIDENTIAL) 20500 MISC. PSYCHTHERAPEUTIC AGENTS250 PSC EMER MED: EMERGENCY MEDICINE 20510 MISC. ADHD AGENTS252 PSC: PRIMARY CARE INITIATIVE IN UNDERSERVED AREAS 20888 SYSTEM GENERATED FROM CLAIM253 PSC: SPECIALSTS PRIMARY CARE INIT - UNDERSRVD AREA 24028 SYSTEM GENERATED FROM CLAIM254 PCMPS: SPECIALISTS IN PHYSICIANS CASE MGMT PROGRAM 24040 ACTH/CORTICOSTEROIDS270 PSC CHAP: CHILD HEALTH ASSURANCE PROGRAM 24082 ANDROGENS280 CHIROPRACTIC (OBSOLETE) 24084 ANABOLIC STEROIDS281 PSC: CLINICAL SOCIAL WORKER (OBSOLETE) 24086 MISC. ANDROGEN/ANABOLIC STEROIDS282 CERTIFIED DRUG & ALCOHOL COUNSELOR (MC USE ONLY) 24120 GROWTH HORMONES283 COUNSELOR (MC USE ONLY) 24122 GROWTH HORMONE RECEPTOR ANTAGONIST290 ACUPUNCTURIST (MC USE ONLY) 24161 ORAL ESTROGENS300 PSC: PHYSICAL THERAPY - LONG TERM MAINTENANCE 24162 VAGINAL ESTROGENS301 PSC: OCCUPATIONAL THERAPY - LONG TERM MAINTENANCE 24163 TRANSDERMAL ESTROGENS302 PSC: SPEECH THERAPY - LONG TERM MAINTENANCE 24164 PARENTERAL ESTROGENS303 PSC: AIDS/HIV SERVICES 24180 ANDROGEN/ESTROGEN COMBOS.304 PSC: MEDICAL REHAB - LONG TERM MAINTENANCE 24182 SYSTEM GENERATED FROM CLAIM305 PSC: PEDIATRIC SPECIALTY - ALL EXCEPT PRIMARY CARE 24201 PARENTERAL PROGESTINS306 PSC: SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM 24202 ORAL PROGESTINS307 PSC: DURABLE MEDICAL EQUIPMENT (EMEVS USE ONLY) 24203 PROGESTINS-USED IN COMPOUNDING-BULK308 CLN SP CD: HIV PRIMARY CARE SERVICES 24230 PROGESTIN/ESTROGEN COMBOS (NON OC)309 CLN SP CD: MEDICALLY SUPERVISED SUBSTANCE ABUSE 24240 ORAL CONTRACEPTIVES310 CLN SP CD: OMH ADULT CLINIC (STATE OPERATED) 24242 ORAL CONTRACEPTIVES- MEDICARE D WRAP311 CLN SP CD: OMH CHILD CLINIC (STATE OPERATED) 24245 CONTRACEPTIVE PATCHES312 CLN SP CD: OMH CONTINUING DAY TRTMT (STATE OPR) 24247 CONTRACEPTIVE- VAGINAL HORMONE313 CLN SP CD: OMH PARTIAL HOSPITALIZATION (STATE OPR) 24250 INJECTABLE CONTRACEPTIVES314 CLN SP CD: OMH INTEN PSYCH REHAB TRTMT (STATE OPR) 24270 PROSTOGLANDINS315 CLN SP CD: OMH ADULT CLINIC 24280 OVULATORY AGENTS316 CLN SP CD: OMH CHILD CLINIC 24310 POSTERIOR PITUITARY HORMONES317 CLN SP CD: OMH CONTINUING DAY TREATMENT 24340 ANTI-HYPERGLYCEMICS318 CLN SP CD: OMH PARTIAL HOSPITALIZATION 24341 ANTIHYPERGLYCEMICS/ANTIHYPERLYPIDEMIC COMBO319 CLN SP CD: OMH INTENSIVE PSYCH REHAB TREATMENT 24345 INHALED INSULIN320 CLN SP CD: CLOZAPINE CASE MANAGER 24360 ANTI-HYPERTHYROID AGENTS321 COMPREHENSIVE SPECIALTY CLINIC SERVICES 24400 THYROID AGENTS322 OMH COMPREHENSIVE OUTPATIENT PROGRAM (COPS) CLINIC 24480 UTERINE STIMULANTS/RELAXANTS323 OMH COMP OUTPAT PROG (COPS) CONTINUING DAY TRTMT 24520 GONADOTROPINS324 PRE-SCHOOL SUPPORTIVE HEALTH CARE 24540 GONADOTROPIN RELEASING HORMONE ANALOG325 CLN SP CD: EARLY INTERVENTION 24560 ANTI-HYPOGLYCEMICS326 OMH/CR ADULT (VOLUNTARY) 24900 MISC. HORMONES327 OMH/CR CHILDREN (VOLUNTARY) 28041 SYMPATHOMIMETIC-ORAL328 OMH FAMILY BASED TREATMENT 28042 LONG ACTING BETA AGONIST-INHALED329 OMH/CR ADULT (STATE OPERATED) 28043 SHORT ACTING BETA AGONIST- INHALER330 OMH/CR CHILDREN (STATE OPERATED) 28045 SHORT ACTING BETA AGONIST- NEBULIZER331 OMH TEACHING FAMILY HOME 28046 SYMPATHOMIMETIC-INJECTABLE332 OMR/DD CR (STATE OPERATED) 28080 MISC ANTI-ASTHMA INCL THEOPHYLLINES333 OMH CERTIFIED PHYSICIAN 28081 INHALED ANTICHOLINERGICS350 PPCP ASSOCIATED DENTAL CLINIC - ORAL SURGERY 28082 LEUKOTRIENE RECEPTOR INHIBITORS/ANTAGONI351 PPCP ASSOCIATED DENTAL CLINIC - GENERAL DENTISTRY 28083 INHALED STEROIDS352 PPCP ASSOCIATED COPS 28084 INHALED NONSTEROIDAL ANTIINFLAMATORY353 PPCP ASSOCIATED OMH CLINICS 28085 NONSTEROIDAL ANTIINFLAMATORY-NEBULIZER354 PPCP ASSOCIATED PSYCHIATRY, GENERAL (DOH CERT) 28120 ANTIHISTAMINES-outdated see 28122 OR 28125355 CLN SP CD: AIDS DAY HEALTH CARE SERVICES 28122 ANTIHISTAMINES - OTHER THAN NON-SEDATING**356 HCBS/TBI WAIVER 28125 ANTIHISTAMINES - NON-SEDATING**357 CLN SP CD:OUTPATIENT CHEMICAL DEPENDENCE WITHDRAWL 28140 ANTIHIST/DECONG. COMBOS.OD- 28142 OR 28145358 MC:TBI SERVICES (MC ONLY) 28142 ANTIHIST OTHER THAN NON-SEDATING/DECON COMB365 MH RESIDENTIAL (NONINPATIENT) - MC PNDS ONLY 28145 ANTIHIST**NON-SEDATING/DECONG. COMBO371 CASE MANAGEMENT - MC PNDS ONLY 28160 NARCOTIC ANTITUSSIVE COMBOS.375 MH OUTPATIENT (NON-RESIDENTIAL) - MC PNDS ONLY 28161 ANTITUSSIVE & ANTITUSSIVE COMBOS.-MED. WRP376 MENTAL HEALTH PRACTITIONER - MC PNDS ONLY 28180 NON-NARCOTIC ANTITUSSIVE COMBOS.400 MICROBIOLOGY 28200 EXPECTORANTS401 FQ OUT-OF-STATE (NON-CMMA) 28201 EXPECTORANTS-MEDICARE WRAPPED402 FQ PRIMARY 28240 MUCOLYTIC AGENTS

403 FQ SECONDARY 28280 DECONGESTANTS404 FQ AUTHORIZED 28290 SYSTEM GENERATED FROM CLAIM410 BACTERIOLOGY 28320 MISC. INTRANASAL AGENTS411 LSC: BACTERIOLOGY - GENERAL 28400 MISC. RESPIRATORY/ALLERGIC AGENTS412 LSC: BACTERIOLOGY - LIMITED 28500 AGENTS FOR PULMONARY FIBROSIS NOC413 LSC: BACTERIOLOGY - AEROBES ONLY 32040 PEN.V/PEN.G414 LSC: BACTERIOLOGY - NEISSERIA GONORRHOEAE SCREENG 32080 PENICILLINASE RESIST. PENICILLIN415 LSC: BACTEROLOGY - GC SMEARS ONLY 32100 EXTENDED SPECTRUM PENICILLIN416 LSC: BACTERIOLOGY-RESTRICTED (DENTAL) 32160 TETRACYCLINES419 LSC: MYCOBACTERIOLOGY - SMEARS AND CULTURE 32167 SYSTEM GENERATED FROM CLAIM420 LSC: MYCOBACTERIOLOGY - GENERAL 32200 CHLORAMPHENICOLS421 LSC: MYCOBACTERIOLOGY - LIMITED 32230 SYSTEM GENERATED FROM CLAIM422 LSC: MYCOBACTERIOLOGY - SMEARS ONLY 32240 1ST GENERATION CEPHALOSPORINS423 LSC: DIAGNOSTIC IMMUNOLOGY - COMPREHENSIVE 32244 2ND GENERATION CEPHALOSPORINS424 LSC: DIAGNOSTIC IMMUNOLOGY - OTHER 32246 3RD GENERATION CEPHALOSPORINS427 LSC: DIAGNOSTIC IMMUNOLOGY - GENERAL/LIMITED 32247 4TH GENERATION CEPHALOSPORINS429 LSC: DIAGNOSTIC IMMUNOLOGY - SPECIAL 32248 5TH GENERATION CEPHALOSPORINS430 HUMAN IMMUNODEFICIENCY VIRUS - RESTRICTED A 32280 MACROLIDES/LINCOSAMIDES431 HUMAN IMMUNODEFICIENCY VIRUS - RESTRICTED B 32320 AMINOGLYCOSIDES432 HUMAN IMMUNODEFICIENCY VIRUS - COMPREHENSIVE 32340 SYSTEM GENERATED FROM CLAIM433 SEROLOGY - ROUTINE 32360 SULFONAMIDES434 SEROLOGY - LIMITED 32380 FLUROQUINOLONES435 LSC: CELLULAR IMMUNOLOGY - LIMITED I 32400 MISC. ANTIBACTERIALS436 LSC: CELLULAR IMMUNOLOGY - LIMITED II 32420 OXAZOLIDINONE ANTIBIOTICS437 SEROLGY - OTHER 32440 ANTIFUNGALS438 LSC: CELLULAR IMMUNOLOGY - GENERAL 32458 SYSTEM GENERATED FROM CLAIM439 LSC: CELLULAR IMMUNOLOGY - LIMITED III 32480 ANTIVIRALS-OTHER THAN FOR HIV440 LSC: VIROLOGY - GENERAL I OR GENERAL II 32485 ANTIVIRALS-VS HIV SPECIFICALLY441 LSC: VIROLOGY - LIMITED 32486 ADJUNCTS FOR HIV THERAPY442 LSC: VIROLOGY - RESTRICTED 32520 ANTIMYCOBACTERIALS450 LSC: MYCOLOGY - GENERAL 32560 LEPROSTATICS451 LSC: MYCOLOGY - LIMITED(YEAST ONLY) 32600 URINARY ANTI-INFECTIVES460 LSC: PARASITOLOGY 34291 SYSTEM GENERATED FROM ENCOUNTER461 LSC: PARASITOLOGY - STOOL 36040 ANTIMALARIALS462 LSC: PARASITOLOGY - OTHER 36080 AMEBICIDES463 LSC: PARASITOLOGY - BLOOD 36120 ANTIHELMINTICS470 LSC: URINE PREGNANCY TESTING 36160 ANTI-TRICHOMONAL/TRYPANOSOMALS480 LSC: HEMATOLOGY 36200 SCABICIDES/PEDICULICIDES481 LSC: HEMATOLOGY - COMPREHENSIVE 40040 ANTISEPTIC/DISINFECTANT - TOPICAL482 LSC: HEMATOLOGY - GENERAL 40081 ANTIBIOTICS - TOPICAL483 LSC: HEMATOLOGY - COAGULATION ONLY 40082 ANTIVIRALS - TOPICAL484 LSC: HEMATOLOGY - LIMITED 40083 ANTIFUNGALS - TOPICAL485 LSC: HEMATOLOGY - OTHER 40084 ANTI-MICROBIAL/INFLAMMATORY TOPICAL COMB486 LSC: CYTOHEMATOLOGY - LIMITED/DIAGNOSTIC 40085 MISC. ANTI-INFECTIVE TOPICAL COMBOS.490 LSC: IMMUNOHEMATOLOGY 40120 ANTI-INFLAMMATORY - TOPICAL obsolete491 LSC: BLOOD SERVICES - DIAGNOSTIC IMMUNOHEMATOLOGY 40121 STEROIDAL ANTI-INFLAMMATORY TOPICAL492 LSC: IMMUNOHEMATOLOGY SPC 492 40122 NONSTEROIDAL ANIT-INFLAMMATORY- TOPICAL493 LSC: IMMUNOHEMATOLOGY SPC 493 40160 LOCAL ANESTHETICS - TOPICAL510 LSC: CLINICAL CHEMISTRY - GENERAL 40200 ANTI-SEBORRHEA/PSORIATIC - TOPICAL511 LSC: CLINICAL CHEMISTRY - LIMITED 40220 ANTI-KERATOSIS - TOPICAL512 LSC: TOXICOLOGY - ERYTHROCYTE PROTOPORPHYRIN-HEMAT 40230 ACNE PREPARAIONS - TOPICAL513 LSC: TOXICOLOGY - ERYTHROCYTE PROTOPORHYRIN-EXTRCT 40235 TOPICAL ANTI-CANCER514 LSC: TOXICOLOGY - DRUG ANALYSIS-QUAL (OR FORENSIC) 40240 MISC. TOPICALS515 LSC: TOXICOLOGY - BLOOD LEAD 40280 CERVICAL ANTISEPTICS516 LSC: ENDOCRINOLOGY 40320 VAGINAL ANTI-INFLAMMATORY/SEPTICS517 LSC: CHEMLIMIT 40360 VAGINAL ANTI-TRICHOMONAL/MONILIAL AGENTS518 LSC: QUALITATIVE TOXICOLOGY - REHABILITATION PROGS 40400 OTC FAMILY PLANNING - TOPICAL519 LSC: CHEM RESERV 40485 SYSTEM GENERATED FROM CLAIM520 CHEM ALL 40500 MISC. IRRIGATING SOLUTIONS521 LSC: BLOOD PH AND GASES 40610 SYSTEM GENERATED FROM CLAIM522 CHEM IMD 44042 OCULAR GLAUCOMA BETA-ADRENERGICS523 LSC: THERAPEUTIC SUBSTANCE MONITORING/QUAN TOXICOL 44044 OCULAR GLAUCOMA SYMPATHOMIMETICS524 LSC: URINALYSIS 44046 OCULAR GLAUCOMA MITOICS530 LSC: PATHOLOGY SPC 530 44048 OCULAR GLAUCOMA COMBINATIONS531 LSC: HISTOPATHOLOGY - GENERAL/ORAL/DERMATOPATHALGY 44049 MISC. GLAUCOMA OPHTHALMICS532 LSC: PATHOLOGY SPC 532 44080 OCCULAR CYCLOPLEGIC/MYDRIATIC533 LSC: PATHOLOGY SPC 533 44162 OCULAR ANTIBACTERIALS540 LSC: CYTOPATHOLOGY 44164 OCULAR ANTIVIRALS550 LSC: ONCOFETAL ANTIGEN - GENERAL 44166 OCULAR ANTIFUNGLS551 LSC: ONCOFETAL ANTIGEN - LIMITED 44180 OCULAR ANTI-INFLAMMATORY AGENTS552 LSC: ONCOFETAL ANTIGEN - GENERAL, SERA ONLY 44220 OCULAR ANTI-INFECTIVE/INFLAMMATORY AGENT553 LSC: ONCOFETAL ANTIGEN - GENL, AMNIOTIC FLUID ONLY 44240 OCULAR LOCAL ANESTHETICS560 LSC: GENETIC TESTING 44260 OCULAR LUBRICANTS561 BLOOD TRANSFUSION COLLECTION 44280 MISC.OPHTHS.562 BLOOD TRANSFUSION 48040 OTIC ANTI-INFECTIVES570 MISCELLANEOUS 48080 OTIC ANTI-INFLAMMATORY AGENTS571 LSC: CYTOGENETICS - GENERAL 48120 OTIC ANESTHETIC/IRRIGANTS572 LSC: CYTOGENETICS - LIMITED 48160 OTIC ANTIBIOTIC/STEROID COMBOS.573 LSC: CYTOGENETICS - HEMATOLOGICAL DISORDERS 48180 MISC. OTIC AGENTS574 MISCELLANEOUS HIS 50010 SYSTEM GENERATED FROM CLAIM575 MISCELLANEOUS LIMITED HIS 50036 SYSTEM GENERATED FROM CLAIM576 MISCELLANEOUS MISCELLANEOUS 50040 ANTI-PARKINSON AGENTS579 NURSE SP CD: MEDICALLY FRAGILE CHILDREN 50080 ANTI-MYASTHENIA AGENTS580 LSC: HISTOCOMPATIBILITY - LIMITED 50120 SKELETAL MUSCLE RELAXANTS585 MISCELLANEOUS CLINIC CHEM 50150 SKELETAL MUSCLE RELAXANTS AND ANALGESIC590 MISCELLANEOUS SPECIALTY TEST 50160 TETANY599 LSC: ALL LABS (PROCEDURE FILE & EMEVS USE ONLY) 50242 SYSTEM GENERATED FROM CLAIM600 SPORTS MEDICINE - EMERGENCY (MC USE ONLY) 50400 SYSTEM GENERATED FROM CLAIM601 SPORTS MEDICINE - FAMILY MEDICINE (MC USE ONLY) 50458 SYSTEM GENERATED FROM ENCOUNTER602 SPORTS MEDICINE - INTERNAL (MC USE ONLY) 50900 MISC. NEUROMUSCULAR AGENTS603 SPORTS MEDICINE - PEDIATRICS (MC USE ONLY) 51552 SYSTEM GENERATED FROM CLAIM604 SPORTS MEDICINE -ORTHOPEDIC - MC PNDS ONLY 52040 ANTACIDS615 PERSONAL EMERGENCY RESPONSE SYSTEM - MC PNDS ONLY 52080 ANTI-CHOLINERGIC/SPASMODIC AGENTS616 MENTAL HEALTH INPATIENT - MC PNDS ONLY 52122 HISTAMINE H 2 ANTAGONISTS620 GERIATRICS - FAMILY MEDICINE (MC USE ONLY) 52123 PROTON PUMP INHIBITORS621 GERIATRICS - INTERNAL (MC USE ONLY) 52124 PROSTOGLANDINS - ANTISECRETORY630 PAIN MANAGEMENT (MC USE ONLY) 52129 MISC. ANTIULCER AGENTS640 AUDIOLOGIST (MC USE ONLY) 52160 ANTI-DIARRHEALS650 GENERAL VASCULARY SURGERY (MC USE ONLY) 52200 LAXATIVES/SOFTENERS/EVACUANTS

651 CARDIO-THORACIC (MC USE ONLY) 52210 SYSTEM GENERATED FROM CLAIM652 MC:INTERVENTION CARDIOLOGY (MC ONLY) 52240 ANTI-EMETIC/VERTIGO/NAUSEANTS653 CLINICAL CARDIAC ELECTROPHYSIOLOGY - MC PNDS ONLY 52260 EMETICS655 AIDS SKILLED NURSING FACILITY-REPORTING ONLY 52280 MISC. G.I. AGENTS656 HEAD INJURY/TBI INJURY SNF-REPORTING ONLY 52300 AGENTS FOR CROHNS DISEASE657 NEURO SKILLED NURSING FACILITY-REPORTING ONLY 52400 BILE/LIVER/PANCREATIC AGENTS658 PEDIATRIC SKILLED NURSING FACILITY-REPORTING ONLY 52440 ANORECTAL AGENTS659 VENT SKILLED NURSING FACILITY-REPORTING ONLY 54040 SYSTEM GENERATED FROM ENCOUNTER660 MC:INSTITUTIONAL LTC (MC ONLY) 56040 ALKYLATING AGENTS661 SOCIAL AND ENVIRONMENTAL SUPPORTS 56080 ANTIMETABOLITES662 SOCIAL DAY CARE 56120 ONCOLYTIC HORMONES/ANTAGONISTS663 NURSING HOME CARE 56160 ONCOLYTIC ANTIBIOTICS664 ADULT DAY HEALTH CARE 56200 MITOTIC INHIBITORS665 MC:NON INSTITUTIONAL LTC (MC ONLY) 56240 MISC. ONCOLYTIC AGENTS666 ASSISTED LIVING PROGRAM 56300 ANTINEOPLASTIC/CYTOPROTECTIVE AGENTS667 HOME DELIVERED MEALS 60040 BACTERIAL VACCINES668 HOME CARE - HOME HEALTH AIDE 60080 VIRAL VACCINES669 MC:HOSPICE CARE (MC ONLY) 60160 IMMUNOGLOBULINS670 MC:AMBULANCE (MC ONLY) 60200 IMMUNOLOGICALS, NOC671 MC:OTHER TRANSPORTATION (MC ONLY) 60240 IMMUNOSUPPRESSIVES672 PARAPROFESSIONAL SERVICES: LEVEL 1 HMMAKER/HOUSKPR 60242 SYSTEM GENERATED FROM CLAIM673 PARAPROFESSIONAL SERVICES: LEVEL 2 PERSONAL CARE 64040 HEAVY METAL CHELATES674 RESPIRATORY THERAPY 64120 MISC. ANTIDOTES/ANTAGONISTS675 CONSUMER DIRECTED PERSONAL ASSISTANT LEVEL 1 68080 RADIOPAQUE MEDIA676 CONSUMER DIRECTED PERSONAL ASSISTANT LEVEL 2 68090 MISC. DIAGNOSTICS680 MC:NURSING (MC ONLY) 72040 ENZYMES711 PRESCRIPTION FOOTWEAR 72045 ACNE PREPARATION-ORAL714 E S & O S C: LOW VISION SPECIALIST 72051 ANITPSORATIC AGENTS ORAL715 E S & O S C: CONTACT LENS PRIVILGE 72052 ANITPSORATIC AGENTS INJECTABLE716 E S & O S C: OPTOMETRIST/DIAGNOSTIC PHARMEUTICALS 72120 URINARY RELAXANTS/STIMULANTS/ANTISPASMOD730 MISC SP CD: PHC INBORN METABOLIC DISEASE CENTER 72140 AGENTS FOR IMPOTENCE738 MISC SP CD: PORTABLE X-RAY COMPANIES (MC) 72142 SMOKING CESSATION AGENTS739 MISC SP CD: INDEPENDENT PHYSIOLOGICAL LABS (MC) 72143 SMOKING CESSATION -NICOTINE INHALERS740 MISC SP CD: REGIONAL PERINATAL TRANSPORTATION PROV 72144 SMOKING CESSATION -NICOTINE NASAL SP741 TRANSPLANT SURGERY (MC USE ONLY) 72145 SMOKING CESSATION -NICOTINE GUM749 ASA GENERAL OUTPATIENT - MC PNDS ONLY 72146 SMOKING CESSATION -NICOTINE LOZ750 MISC SP CD: METHADONE MAINTENANCE (PHYSICIAN) 72147 SMOKING CESSATION -NICOTINE PATCHES 7/10mg751 MISC SP CD: METHADONE MAINTENANCE PREFERRED PROV 72148 SMOKING CESSATION -NICOTINE PATCHES 14/15mg754 ASA MEDICALLY MONITORED WITHDRAWAL - MC PNDS ONLY 72149 SMOKING CESSATION -NICOTINE PATCHES 21/22mg760 MISC SP CD: CLINIC PHARMACY (EMEVS USE ONLY) 72151 SYSTEM GENERATED FROM CLAIM762 HOME CARE SERVICES AGENCY LIMITED LICENSE 72160 URINARY ANALGESICS775 MISC SP CD: ALL SPECIALITIES (PROCEDURE FILE ONLY) 72180 URINARY pH AGENTS776 MISC SP CD: G/P ONLY - NO SPEC (PROC FILE ONLY) 72190 SALIVA SUBSTITUTES777 MISC SP CD: ALL PHYSICIAN (PROC FILE & EMEVS ONLY) 72200 TREATMENT OF TOOTH CARIES778 MISC SP CD: ALL PODIATRIST (CLM PROC ONLY) 72210 SALINE FLUSHES -MEDICARE WRAP779 MISC SP CD: ALL NURSE PRAC (CLM PROC ONLY) 72220 BLADDER IRRIGANTS780 MISC SP CD: ALL CLINICAL PSYCHLG (CLMS PROC ONLY) 72240 AGENTS NOT OTHERWISE CLASSIFIED781 MISC SP CD: ALL CERT SOCIAL WKRS (CLMS PROC ONLY) 7240 SYSTEM GENERATED FROM CLAIM782 MISC SP CD: ALL NURSE MIDWIVES (CLMS PROC ONLY) 88888 MANAGED CARE-UNCLASSIFIED790 MISC SP CD: RESPITE (K. BECKETT DEMO) 99100 BLOOD GLUCOSE TEST STRIPS-BILLED BY NDC791 MISC SP CD: S/HMO (ELDERPLAN) 99200 GLUCOMETERS- BILLED BY NDC798 MISC SP CD: LONG TERM HOME HEALTH 99990 ADMINISTRATION VACCINE799 MISC SP CD: NO SPECIALTY REQUIRED 99999 MISC AGENTS AND SUPPLIES800 DENT SP CD: GENERAL DENTIST (PROCEDURE FILE)801 DENT SP CD: ORTHODONTURE802 DENT SP CD: ENDODONTIST803 DENT SP CD: ORAL PATHOLOGIST804 DENT SP CD: PEDODONTIST805 DENT SP CD: PROSTHODONTIST806 DENT SP CD: PERIODONTIST807 DENT SP CD: PUBLIC HEALTH808 DENT SP CD: ORAL SURGEON809 DENT SP CD: DENTAL ANESTHESIOLOGIST810 DENT SP CD: PARENTERAL CONSCIOUS SEDATION811 MAXILLOFACIAL SURGERY (MC USE ONLY)815 DENT SP CD: ALL DENTISTS (PROCEDURE FILE ONLY)816 ASSERTIVE COMMUNITY TREATMENT817 ASSISTIVE TECHNOLOGY818 COMMUNITY INTEGRATION COUNSELING819 COMMUNITY TRANSITIONAL SERVICE PROVIDER820 ENVIRONMENTAL MODIFICATIONS SERVICES821 FREESTANDING BIRTH CENTER822 INDEPENDENT LIVING SKILLS TRAINING PROVIDER823 URGENT CARE824 MOBILE MENTAL HEALTH TREATMENT PROVIDER825 MOVING ASSISTANCE PROVIDER826 PALLIATIVE CARE PROVIDER827 PEER DELIVERED SERVICES828 PEER MENTORING PROVIDER829 PERSONALIZED RECOVERY ORIENTED SERVICES830 POSITIVE BEHAVIORAL INTERVENTIONS AND SUPPORTS831 SOCIAL DAY CARE TRANSPORTATION832 STRUCTURED DAY PROGRAM833 TELEHEALTH834 HOME AND COMMUNITY SUPPORT SERVICES835 HCBS PROVIDER TRAVEL836 HCBS PSYCHOSOCIAL REHAB837 HCBS PEER SUPPORT838 OMH OTHER LICENSED PRACTITIONERS839 HCBS COMMUNITY PSYCHIATRIC SUPPORTS AND TREATMENT851 MC:OTHER VISION CARE (MC ONLY)852 PCCM ENHANCEMENT853 PCCM QUALITY ENHANCEMENT854 HABILITATION SUPPORT SERVICES855 FAMILY SUPPORT AND TRAINING856 SHORT-TERM CRISIS RESPITE857 INTENSIVE CRISIS RESPITE858 PRE-VOCATIONAL SERVICES859 TRANSITIONAL EMPLOYMENT

860 INTENSIVE SUPPORTED EMPLOYMENT861 ONGOING SUPPORTED EMPLOYMENT862 EDUCATION SUPPORT SERVICES899 HOSP INP SP CD: HOSPITAL INPATIENT - EMEVS ONLY900 CLN SP CD: HMO CO-PAYMENT901 CLN SP CD: EMERGENCY ROOM902 CLN SP CD: ENDOCRINE903 CLN SP CD: DIABETES904 CLN SP CD: OBSTETRICS905 CLN SP CD: GYNECOLOGY906 CLN SP CD: FAMILY PLANNING907 CLN SP CD: ABORTION908 CLN SP CD: CHILD HEALTH ASSURANCE PROGRAM (CHAP)909 CLN SP CD: NUTRITION910 CLN SP CD: ORAL SURGERY911 CLN SP CD: GENERAL DENTISTRY912 CLN SP CD: ORTHODONTICS913 CLN SP CD: HEMODIALYSIS914 CLN SP CD: GENERAL MEDICINE915 CLN SP CD: ALLERGY916 CLN SP CD: ARTHRITIS917 CLN SP CD: RHEUMATOLOGY918 CLN SP CD: PODIATRY919 CLN SP CD: EYE920 CLN SP CD: PHYSICAL THERAPY921 CLN SP CD: SPEECH THERAPY922 CLN SP CD: METHADONE MAINTENANCE TREATMENT PROGRAM923 CLN SP CD: OCCUPATIONAL THERAPY924 CLN SP CD: REHABILITATION MEDICINE925 CLN SP CD: HYPERTENSION926 CLN SP CD: CLN SP CD HEMATOLOGY927 CLN SP CD: CARDIOLOGY928 CLN SP CD: CARDIOVASCULAR929 CLN SP CD: PULMONARY930 CLN SP CD: GASTROENTEROLOGY931 CLN SP CD: NEUROLOGY932 CLN SP CD: NEUROSURGERY933 CLN SP CD: CANCER DETECTION934 CLN SP CD: ONCOLOGY - THERAPY (RADIATION OR CHEMO)935 CLN SP CD: EAR NOSE & THROAT936 CLN SP CD: PEDIATRIC GENERAL MEDICINE937 CLN SP CD: PEDIATRIC ALLERGY938 CLN SP CD: PEDIATRIC NEUROLOGY939 CLN SP CD: PEDIATRIC HEMATOLOGY940 CLN SP CD: PEDIATRIC CARDIAC941 CLN SP CD: PEDIATRIC RENAL942 CLN SP CD: PEDIATRIC PULMONARY943 CLN SP CD: PEDIATRIC ORTHOPEDIC944 CLN SP CD: PEDIATRIC ENDOCRINE945 CLN SP CD: PSYCHIATRY - INDIVIDUAL946 CLN SP CD: PSYCHIATRY - GROUP947 CLN SP CD: PSYCHIATRY - HALF DAY CARE948 CLN SP CD: PSYCHIATRY - FULL DAY CARE949 CLN SP CD: ALCOHOLISM TREATMENT PROGRAM950 CLN SP CD: ORTHOPEDIC951 CLN SP CD: SURGICAL, MINOR952 CLN SP CD: SURGICAL, GENERAL953 CLN SP CD: UROLOGY954 CLN SP CD: NEPHROLOGY955 CLN SP CD: GENITO-URINARY956 CLN SP CD: DERMATOLOGY957 CLN SP CD: CONTRACT CARRIER958 CLN SP CD: OPTHALMOLOGY959 CLN SP CD: OUTPAT CHEM DEPENDENCY PROG FOR YOUTH960 CLN SP CD: PEDIATRIC DERMATOLOGY961 CLN SP CD: PEDIATRIC DIABETES962 CLN SP CD: PEDIATRIC SURGERY963 CLN SP CD: CHILD PSYCHIATRY964 CLN SP CD: PSYCHIATRY-GENERAL965 CLN SP CD: TUBERCULOSIS966 CLN SP CD: INFECTIOUS DISEASES967 CLN SP CD: PHC SPEECH & HEARING968 CLN SP CD: PHC APPROVED AMPUTEE CENTER969 CLN SP CD: HOSP DME/ORTHOTIC/PROSTH APPLNC VENDOR970 CLN SP CD:NURSING HOME HOSPITAL DAYCARE (NO CLAIM)971 CLN SP CD: MH CLINIC TREATMENT (STATE OPERATED)972 CLN SP CD: MH DAY TREATMENT (STATE OPERATED)973 CLN SP CD: MH CONTINUING TREATMENT (STATE OPR)974 CLN SP CD: MENTAL HEALTH CLINIC TREATMENT975 CLN SP CD: MENTAL HEALTH DAY TREATMENT976 CLN SP CD: MENTAL HEALTH CONTINUING TREATMENT977 CLN SP CD: MR/DD CLINIC TREATMENT (STATE OPERATED)978 CLN SP CD: PREFERRED PRIMARY CARE CLINIC979 CLN SP CD: MR/DD CLINIC TREATMENT980 T.B. DIRECTLY OBSERVED THERAPY/CLINIC981 CLN SP CD: DIAG AND RESEARCH CLINIC MR (STATE OPR)982 PHCP APNEA CTR: PCP APNEA CENTER983 CLN SP CD: SPECIALTY CLINIC - MENTAL RETARDATION984 CLN SP CD: ALCOHOLISM CLINIC TREATMENT (STATE OPR)985 CLN SP CD: ALCOHOLISM DAY REHAB (STATE OPERATED)986 CLN SP CD: ALCOHOLISM CLINIC TREATMENT987 CLN SP CD: ALCOHOLISM DAY REHABILIATION988 CLN SP CD: COMPREHENSIVE ALCOHOLISM CARE989 MEDICALLY SUPERVISED WITHDRAWAL-OUTPATIENT990 CLN SP CD: COMP PHYSICAL EXAM (SCHOOL HEALTH PROJ)991 CLN SP CD: ROUTINE VISIT (SCHOOL HEALTH PROJECT)992 OMH COMPREHENSIVE PSYCHIATRIC EMERGENCY PROG993 CLN SP CD: HOSP-BASED/FREESTANDING AMBULAT SURGERY994 CLN SP CD: BLOOD PRODUCTS (ORDERED AMBULATORY)

995 CLN SP CD: GENETIC COUNSELING (ORDERED AMBULATORY)996 CLN SP CD: HEARING SERVICES (ORDERED AMBULATORY)997 CLN SP CD: OPERATING ROOM (ORDERED AMBULATORY)998 CLN SP CD: RADIOLOGY (ORDERED AMBULATORY)999 CLN SP CD: OTHER

These advisories are intended to provide user guidance and to identify common problems/known issues with the data

member_idUse this recipient ID to identify patients across multiple claims and encountersWe have identified patients with "duplicate" or changing IDs over time and member_id is the de-duped ID for the patient

MBR_ID is the original ID on a claim for patients who have been de-dupedmember_dupe_flag identifies with possible duplicate IDs that have not been resolved (1 = possible unresolved dupe)

A crosswalk of duplicate IDs and a list of names are available upon request

clm_tpAnalysis files include both fee-for-service "claims" and Medicaid Managed Care "encounters"Note that "A" are denied encounter claims

These encounter claims should not be included with examing expenditures (e.g., medicaid_pd)However these claims may be included in counting "visits" or looking at presence of diagnoses

Denied fee-for-service claims are not in the data set

new_tcnUnique claim/encounter identifier for a "transaction""Transaction" is defined as a claim/encounter for the same patient on the same day with the same provider

The patient ID is original MBR_IDThis variable can be used to link claims/encounters across all analysis filesIn the All Claims File, for cos_final categories that are rolled up into month totals, this variable is missingBut new_tcn variable is available for individual claims in Pharmacy File and Unrolled Files

Medicare patients (dual eligibles)We recommend exluding patients who are on Medicare (see Eligibility File - mcare_Start_dt and mcare_Start_mo)

We assume patients remain on Medicare after first start date/monthClaims and encounters include both "medicaid_pd" and "medicare_pd", but we do not believe they are reliable for duals

Analysis has documented a drop in utilization following Medicare enrollment even for claims where a co-pay or deductible is expected

MBR_RACE_CD (and ethnicity)This code as provided by Medicaid has limitations - we create a new race/ethnicity codeApproach 1 - Race/Ethnicity

Black/African American - mbr_race_cd = 2White - mbr_race_cd = 1Asian - mbr_race_cd = 3Other - mbr_race_cd = 4 or 9Unknown - mbr_race_cd = 0Hispanic/Latino - hispanic_or_latino_ethnic_cd = "Y" or MBR_RACE_CD = 5

Note order of operationsApproach 2 - RaceEthnicity - includes "mixed" race

Black/African American:if (BLK_OR_AF_AMER_ETHNIC_CD = "Y" and ((AMER_IND_OR_AK_NAT_ETHNIC_CD = "N" and ASIAN_ETHNIC_CD = "N" and NATIVE_HI_OR_OPI_ETHNIC_CD = "N" and WHITE_ETHNIC_CD = "N") or (AMER_IND_OR_AK_NAT_ETHNIC_CD = "U" and ASIAN_ETHNIC_CD = "U" and NATIVE_HI_OR_OPI_ETHNIC_CD = "U" and WHITE_ETHNIC_CD = "U") or (AMER_IND_OR_AK_NAT_ETHNIC_CD = "" and BLK_OR_AF_AMER_ETHNIC_CD = "" and NATIVE_HI_OR_OPI_ETHNIC_CD = "" and WHITE_ETHNIC_CD = ""))) RaceEth = "Black".

White:if (WHITE_ETHNIC_CD = "Y" and ((AMER_IND_OR_AK_NAT_ETHNIC_CD = "N" and ASIAN_ETHNIC_CD = "N" and BLK_OR_AF_AMER_ETHNIC_CD = "N" and NATIVE_HI_OR_OPI_ETHNIC_CD = "N") or (AMER_IND_OR_AK_NAT_ETHNIC_CD = "N" and ASIAN_ETHNIC_CD = "N" and BLK_OR_AF_AMER_ETHNIC_CD = "N" and NATIVE_HI_OR_OPI_ETHNIC_CD = "N") or (AMER_IND_OR_AK_NAT_ETHNIC_CD = "" and ASIAN_ETHNIC_CD = "" and BLK_OR_AF_AMER_ETHNIC_CD = "" and NATIVE_HI_OR_OPI_ETHNIC_CD = ""))) RaceEth = "White".

Asian:if (ASIAN_ETHNIC_CD = "Y" and ((AMER_IND_OR_AK_NAT_ETHNIC_CD = "N" and BLK_OR_AF_AMER_ETHNIC_CD = "N" and NATIVE_HI_OR_OPI_ETHNIC_CD = "N" and WHITE_ETHNIC_CD = "N") or(AMER_IND_OR_AK_NAT_ETHNIC_CD = "U" and BLK_OR_AF_AMER_ETHNIC_CD = "U" and NATIVE_HI_OR_OPI_ETHNIC_CD = "U" and WHITE_ETHNIC_CD = "U") or(AMER_IND_OR_AK_NAT_ETHNIC_CD = "" and BLK_OR_AF_AMER_ETHNIC_CD = "" and NATIVE_HI_OR_OPI_ETHNIC_CD = "" and WHITE_ETHNIC_CD = ""))) RaceEth = "Asian".if (NATIVE_HI_OR_OPI_ETHNIC_CD = "Y" and ((AMER_IND_OR_AK_NAT_ETHNIC_CD = "N" and ASIAN_ETHNIC_CD = "N" and BLK_OR_AF_AMER_ETHNIC_CD = "N" and WHITE_ETHNIC_CD = "N") or (AMER_IND_OR_AK_NAT_ETHNIC_CD = "U" and ASIAN_ETHNIC_CD = "U" and NATIVE_HI_OR_OPI_ETHNIC_CD = "U" and WHITE_ETHNIC_CD = "U") or(AMER_IND_OR_AK_NAT_ETHNIC_CD = "" and ASIAN_ETHNIC_CD = "" and NATIVE_HI_OR_OPI_ETHNIC_CD = "" and WHITE_ETHNIC_CD = ""))) RaceEth = "Asian".

Native American:if (AMER_IND_OR_AK_NAT_ETHNIC_CD = "Y" and ((ASIAN_ETHNIC_CD = "N" and BLK_OR_AF_AMER_ETHNIC_CD = "N" and NATIVE_HI_OR_OPI_ETHNIC_CD = "N" and WHITE_ETHNIC_CD = "N") or(ASIAN_ETHNIC_CD = "U" and BLK_OR_AF_AMER_ETHNIC_CD = "U" and NATIVE_HI_OR_OPI_ETHNIC_CD = "U" and WHITE_ETHNIC_CD = "U") or (ASIAN_ETHNIC_CD = "" and BLK_OR_AF_AMER_ETHNIC_CD = "" and NATIVE_HI_OR_OPI_ETHNIC_CD = "" and WHITE_ETHNIC_CD = ""))) RaceEth = "NatAm".

Mixed:if (AMER_IND_OR_AK_NAT_ETHNIC_CD = "Y" and (ASIAN_ETHNIC_CD = "Y" or BLK_OR_AF_AMER_ETHNIC_CD = "Y" or NATIVE_HI_OR_OPI_ETHNIC_CD = "Y" or WHITE_ETHNIC_CD = "Y")) RaceEth = "Mixed".if (ASIAN_ETHNIC_CD = "Y" and (AMER_IND_OR_AK_NAT_ETHNIC_CD = "Y" or BLK_OR_AF_AMER_ETHNIC_CD = "Y" or NATIVE_HI_OR_OPI_ETHNIC_CD = "Y" or WHITE_ETHNIC_CD = "Y")) RaceEth = "Mixed".if (NATIVE_HI_OR_OPI_ETHNIC_CD = "Y" and (AMER_IND_OR_AK_NAT_ETHNIC_CD = "Y" or ASIAN_ETHNIC_CD = "Y" or BLK_OR_AF_AMER_ETHNIC_CD = "Y" or WHITE_ETHNIC_CD = "Y")) RaceEth = "Mixed".if (WHITE_ETHNIC_CD = "Y" and (AMER_IND_OR_AK_NAT_ETHNIC_CD = "Y" or ASIAN_ETHNIC_CD = "Y" or BLK_OR_AF_AMER_ETHNIC_CD = "Y" or NATIVE_HI_OR_OPI_ETHNIC_CD = "Y")) RaceEth = "Mixed".if (BLK_OR_AF_AMER_ETHNIC_CD = "Y" and (AMER_IND_OR_AK_NAT_ETHNIC_CD = "Y" or ASIAN_ETHNIC_CD = "Y" or NATIVE_HI_OR_OPI_ETHNIC_CD = "Y" or WHITE_ETHNIC_CD = "Y")) RaceEth = "Mixed".

Hispanic/Latino:if (HISPANIC_OR_LATINO_ETHNIC_CD = "Y") RaceEth = "Hisp".

Unknown:recode RaceEth ("" = "UnKwn").

Note order of operations

National Drug Codes (NDC)Note that NDC codes in "drugs" file are 11-digit NDC "billing" codes (which differ from 10-digit NDC codes from FDA)

See https://www.idmedicaid.com/Reference/NDC Format for Billing PAD.pdf fpr conversion of 10-digit codes to 11-digits"Drug Info File from MDW - NCD9 - Trimmed.xls" provides current and historic 9-digit billing codes in the NY Medicaid formulary

To match 11-digit "billing" codes to the list, trim the last 2 digits (package code)

county_cd73-198County fiscally responsible for patient (not necessarily county of residence)NYC counties not identified separately (66 = New York City, all counties/boroughs)NYC counties can be identified by residential zip

cos_final = 42 and cos_final = 43These claims are premium payments to managed care plans

Cos_final = 43 is for Family Health Plus which ended 1/1/14 with implementation of the Affordable Care Act Medicaid expansionThese claims should be excluded examining total patient costs or expenditureHowever, because premiums are risk adjusted, they can provide useful information

DX_Obese and DX_Overweight in DX FileThese diagnoses are believed to be under-coded (as are some substance use and mental health codes)Also these flags are missing some ICD9 and ICD10 codes which should have been includedDX_Obese:

V85ICD9 BMI 30.0-30.9 (Begin 2005)V85ICD9 BMI 31.0-31.9 (Begin 2005)V85ICD9 BMI 32.0-32.9 (Begin 2005)V85ICD9 BMI 33.0-33.9 (Begin 2005)V85ICD9 BMI 34.0-34.9 (Begin 2005)V85ICD9 BMI 35.0-35.9 (Begin 2005)V85ICD9 BMI 36.0-36.9 (Begin 2005)V85ICD9 BMI 37.0-37.9 (Begin 2005)V85ICD9 BMI 38.0-38.9 (Begin 2005)V85ICD9 BMI 39.0-39.9 (Begin 2005)V85ICD9 BMI 40 AND OVER (Begin 2005) (end 2010)V85ICD9 BMI 40.0-44.9 adult (Begin 2010)V85ICD9 BMI 45.0-49.9 adult (Begin 2010)V85ICD9 BMI 50.0-59.9 adult (Begin 2010)V85ICD9 BMI 60.0-69.9 adult (Begin 2010)V85ICD9 BMI 70 and over adult (Begin 2010)V85ICD9 BMI above 95th for age - pediatricZ68ICD10 Body mass index (BMI) 30.0-30.9, adultZ68ICD10 Body mass index (BMI) 31.0-31.9, adultZ68ICD10 Body mass index (BMI) 32.0-32.9, adultZ68ICD10 Body mass index (BMI) 33.0-33.9, adultZ68ICD10 Body mass index (BMI) 34.0-34.9, adultZ68ICD10 Body mass index (BMI) 35.0-35.9, adultZ68ICD10 Body mass index (BMI) 36.0-36.9, adultZ68ICD10 Body mass index (BMI) 37.0-37.9, adultZ68ICD10 Body mass index (BMI) 38.0-38.9, adultZ68ICD10 Body mass index (BMI) 39.0-39.9, adultZ68ICD10 Body mass index (BMI) 40.0-44.9, adultZ68ICD10 Body mass index (BMI) 45.0-49.9, adultZ68ICD10 Body mass index (BMI) 50-59.9 , adultZ68ICD10 Body mass index (BMI) 60.0-69.9, adultZ68ICD10 Body mass index (BMI) 70 or greater, adultZ68ICD10 BMI pediatric, greater than or equal to 95% for ageO9 ICD10 Obesity complicating pregnancy, unspecified trimestO9 ICD10 Obesity complicating pregnancy, first trimesterO9 ICD10 Obesity complicating pregnancy, second trimesterO9 ICD10 Obesity complicating pregnancy, third trimesterO9 ICD10 Obesity complicating childbirthO9 ICD10 Obesity complicating the puerperium

DX_Overweight:V85ICD9 BMI 25.0-25.9 (Begin 2005)V85ICD9 BMI 26.0-26.9 (Begin 2005)V85ICD9 BMI 27.0-27.9 (Begin 2005)V85ICD9 BMI 28.0-28.9 (Begin 2005)V85ICD9 BMI 29.0-29.9 (Begin 2005)Z68ICD10 BMI pediatric, 85% to less than 95th percentile for ageZ68ICD10 Body mass index (BMI) 25.0-25.9, adultZ68ICD10 Body mass index (BMI) 26.0-26.9, adultZ68ICD10 Body mass index (BMI) 27.0-27.9, adultZ68ICD10 Body mass index (BMI) 28.0-28.9, adultZ68ICD10 Body mass index (BMI) 29.0-29.9, adult

trueadm and truedisch, srv_dt_adj and serv_end_dt_adj, and date_mo_start_adj and date_mo_endFor admissions on the same day or next day are condsidered a single admission/dischargeService start and end dates and date month variables are similarly adjusted

2/7/2017