2008 TX - Dallas PPS Payment Rates - Home Care Information ...
2008 TX - Dallas PPS Payment Rates - Home Care Information ...
2008 TX - Dallas PPS Payment Rates - Home Care Information ...
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Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
Early (1 st and 2 nd ) Episodes With 0 to 13 Therapy Visits<br />
1 1AFKS 1AFK1 C1F1S1 0.5827 0 to 5 $ 1,314.25 $ 14.12 $ 1,328.37<br />
1 1AFKT 1AFK2 C1F1S1 0.5827 0 to 5 $ 1,314.25 $ 51.00 $ 1,365.25<br />
1 1AFKU 1AFK3 C1F1S1 0.5827 0 to 5 $ 1,314.25 $ 139.84 $ 1,454.09<br />
1 1AFKV 1AFK4 C1F1S1 0.5827 0 to 5 $ 1,314.25 $ 207.76 $ 1,522.01<br />
1 1AFKW 1AFK5 C1F1S1 0.5827 0 to 5 $ 1,314.25 $ 320.37 $ 1,634.62<br />
1 1AFKX 1AFK6 C1F1S1 0.5827 0 to 5 $ 1,314.25 $ 551.00 $ 1,865.25<br />
1 1AFLS 1AFL1 C1F1S2 0.8507 6 $ 1,918.71 $ 14.12 $ 1,932.83<br />
1 1AFLT 1AFL2 C1F1S2 0.8507 6 $ 1,918.71 $ 51.00 $ 1,969.71<br />
1 1AFLU 1AFL3 C1F1S2 0.8507 6 $ 1,918.71 $ 139.84 $ 2,058.55<br />
1 1AFLV 1AFL4 C1F1S2 0.8507 6 $ 1,918.71 $ 207.76 $ 2,126.47<br />
1 1AFLW 1AFL5 C1F1S2 0.8507 6 $ 1,918.71 $ 320.37 $ 2,239.08<br />
1 1AFLX 1AFL6 C1F1S2 0.8507 6 $ 1,918.71 $ 551.00 $ 2,469.71<br />
1 1AFMS 1AFM1 C1F1S3 1.0599 7 to 9 $ 2,390.55 $ 14.12 $ 2,404.67<br />
1 1AFMT 1AFM2 C1F1S3 1.0599 7 to 9 $ 2,390.55 $ 51.00 $ 2,441.55<br />
1 1AFMU 1AFM3 C1F1S3 1.0599 7 to 9 $ 2,390.55 $ 139.84 $ 2,530.39<br />
1 1AFMV 1AFM4 C1F1S3 1.0599 7 to 9 $ 2,390.55 $ 207.76 $ 2,598.31<br />
1 1AFMW 1AFM5 C1F1S3 1.0599 7 to 9 $ 2,390.55 $ 320.37 $ 2,710.92<br />
1 1AFMX 1AFM6 C1F1S3 1.0599 7 to 9 $ 2,390.55 $ 551.00 $ 2,941.55<br />
1 1AFNS 1AFN1 C1F1S4 1.2744 10 $ 2,874.34 $ 14.12 $ 2,888.46<br />
1 1AFNT 1AFN2 C1F1S4 1.2744 10 $ 2,874.34 $ 51.00 $ 2,925.34<br />
1 1AFNU 1AFN3 C1F1S4 1.2744 10 $ 2,874.34 $ 139.84 $ 3,014.18<br />
1 1AFNV 1AFN4 C1F1S4 1.2744 10 $ 2,874.34 $ 207.76 $ 3,082.10<br />
1 1AFNW 1AFN5 C1F1S4 1.2744 10 $ 2,874.34 $ 320.37 $ 3,194.71<br />
1 1AFNX 1AFN6 C1F1S4 1.2744 10 $ 2,874.34 $ 551.00 $ 3,425.34<br />
1 1AFPS 1AFP1 C1F1S5 1.4506 11 to 13 $ 3,271.75 $ 14.12 $ 3,285.87<br />
1 1AFPT 1AFP2 C1F1S5 1.4506 11 to 13 $ 3,271.75 $ 51.00 $ 3,322.75<br />
1 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1AFPU 1AFP3 C1F1S5 1.4506 11 to 13 $ 3,271.75 $ 139.84 $ 3,411.59<br />
1 1AFPV 1AFP4 C1F1S5 1.4506 11 to 13 $ 3,271.75 $ 207.76 $ 3,479.51<br />
1 1AFPW 1AFP5 C1F1S5 1.4506 11 to 13 $ 3,271.75 $ 320.37 $ 3,592.12<br />
1 1AFPX 1AFP6 C1F1S5 1.4506 11 to 13 $ 3,271.75 $ 551.00 $ 3,822.75<br />
1 1AGKS 1AGK1 C1F2S1 0.6713 0 to 5 $ 1,514.08 $ 14.12 $ 1,528.20<br />
1 1AGKT 1AGK2 C1F2S1 0.6713 0 to 5 $ 1,514.08 $ 51.00 $ 1,565.08<br />
1 1AGKU 1AGK3 C1F2S1 0.6713 0 to 5 $ 1,514.08 $ 139.84 $ 1,653.92<br />
1 1AGKV 1AGK4 C1F2S1 0.6713 0 to 5 $ 1,514.08 $ 207.76 $ 1,721.84<br />
1 1AGKW 1AGK5 C1F2S1 0.6713 0 to 5 $ 1,514.08 $ 320.37 $ 1,834.45<br />
1 1AGKX 1AGK6 C1F2S1 0.6713 0 to 5 $ 1,514.08 $ 551.00 $ 2,065.08<br />
1 1AGLS 1AGL1 C1F2S2 0.9393 6 $ 2,118.54 $ 14.12 $ 2,132.66<br />
1 1AGLT 1AGL2 C1F2S2 0.9393 6 $ 2,118.54 $ 51.00 $ 2,169.54<br />
1 1AGLU 1AGL3 C1F2S2 0.9393 6 $ 2,118.54 $ 139.84 $ 2,258.38<br />
1 1AGLV 1AGL4 C1F2S2 0.9393 6 $ 2,118.54 $ 207.76 $ 2,326.30<br />
1 1AGLW 1AGL5 C1F2S2 0.9393 6 $ 2,118.54 $ 320.37 $ 2,438.91<br />
1 1AGLX 1AGL6 C1F2S2 0.9393 6 $ 2,118.54 $ 551.00 $ 2,669.54<br />
1 1AGMS 1AGM1 C1F2S3 1.1485 7 to 9 $ 2,590.38 $ 14.12 $ 2,604.50<br />
1 1AGMT 1AGM2 C1F2S3 1.1485 7 to 9 $ 2,590.38 $ 51.00 $ 2,641.38<br />
1 1AGMU 1AGM3 C1F2S3 1.1485 7 to 9 $ 2,590.38 $ 139.84 $ 2,730.22<br />
1 1AGMV 1AGM4 C1F2S3 1.1485 7 to 9 $ 2,590.38 $ 207.76 $ 2,798.14<br />
1 1AGMW 1AGM5 C1F2S3 1.1485 7 to 9 $ 2,590.38 $ 320.37 $ 2,910.75<br />
1 1AGMX 1AGM6 C1F2S3 1.1485 7 to 9 $ 2,590.38 $ 551.00 $ 3,141.38<br />
1 1AGNS 1AGN1 C1F2S4 1.3630 10 $ 3,074.17 $ 14.12 $ 3,088.29<br />
1 1AGNT 1AGN2 C1F2S4 1.3630 10 $ 3,074.17 $ 51.00 $ 3,125.17<br />
1 1AGNU 1AGN3 C1F2S4 1.3630 10 $ 3,074.17 $ 139.84 $ 3,214.01<br />
1 1AGNV 1AGN4 C1F2S4 1.3630 10 $ 3,074.17 $ 207.76 $ 3,281.93<br />
1 1AGNW 1AGN5 C1F2S4 1.3630 10 $ 3,074.17 $ 320.37 $ 3,394.54<br />
1 1AGNX 1AGN6 C1F2S4 1.3630 10 $ 3,074.17 $ 551.00 $ 3,625.17<br />
2 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1AGPS 1AGP1 C1F2S5 1.5392 11 to 13 $ 3,471.58 $ 14.12 $ 3,485.70<br />
1 1AGPT 1AGP2 C1F2S5 1.5392 11 to 13 $ 3,471.58 $ 51.00 $ 3,522.58<br />
1 1AGPU 1AGP3 C1F2S5 1.5392 11 to 13 $ 3,471.58 $ 139.84 $ 3,611.42<br />
1 1AGPV 1AGP4 C1F2S5 1.5392 11 to 13 $ 3,471.58 $ 207.76 $ 3,679.34<br />
1 1AGPW 1AGP5 C1F2S5 1.5392 11 to 13 $ 3,471.58 $ 320.37 $ 3,791.95<br />
1 1AGPX 1AGP6 C1F2S5 1.5392 11 to 13 $ 3,471.58 $ 551.00 $ 4,022.58<br />
1 1AHKS 1AHK1 C1F3S1 0.7550 0 to 5 $ 1,702.86 $ 14.12 $ 1,716.98<br />
1 1AHKT 1AHK2 C1F3S1 0.7550 0 to 5 $ 1,702.86 $ 51.00 $ 1,753.86<br />
1 1AHKU 1AHK3 C1F3S1 0.7550 0 to 5 $ 1,702.86 $ 139.84 $ 1,842.70<br />
1 1AHKV 1AHK4 C1F3S1 0.7550 0 to 5 $ 1,702.86 $ 207.76 $ 1,910.62<br />
1 1AHKW 1AHK5 C1F3S1 0.7550 0 to 5 $ 1,702.86 $ 320.37 $ 2,023.23<br />
1 1AHKX 1AHK6 C1F3S1 0.7550 0 to 5 $ 1,702.86 $ 551.00 $ 2,253.86<br />
1 1AHLS 1AHL1 C1F3S2 1.0230 6 $ 2,307.32 $ 14.12 $ 2,321.44<br />
1 1AHLT 1AHL2 C1F3S2 1.0230 6 $ 2,307.32 $ 51.00 $ 2,358.32<br />
1 1AHLU 1AHL3 C1F3S2 1.0230 6 $ 2,307.32 $ 139.84 $ 2,447.16<br />
1 1AHLV 1AHL4 C1F3S2 1.0230 6 $ 2,307.32 $ 207.76 $ 2,515.08<br />
1 1AHLW 1AHL5 C1F3S2 1.0230 6 $ 2,307.32 $ 320.37 $ 2,627.69<br />
1 1AHLX 1AHL6 C1F3S2 1.0230 6 $ 2,307.32 $ 551.00 $ 2,858.32<br />
1 1AHMS 1AHM1 C1F3S3 1.2322 7 to 9 $ 2,779.16 $ 14.12 $ 2,793.28<br />
1 1AHMT 1AHM2 C1F3S3 1.2322 7 to 9 $ 2,779.16 $ 51.00 $ 2,830.16<br />
1 1AHMU 1AHM3 C1F3S3 1.2322 7 to 9 $ 2,779.16 $ 139.84 $ 2,919.00<br />
1 1AHMV 1AHM4 C1F3S3 1.2322 7 to 9 $ 2,779.16 $ 207.76 $ 2,986.92<br />
1 1AHMW 1AHM5 C1F3S3 1.2322 7 to 9 $ 2,779.16 $ 320.37 $ 3,099.53<br />
1 1AHMX 1AHM6 C1F3S3 1.2322 7 to 9 $ 2,779.16 $ 551.00 $ 3,330.16<br />
1 1AHNS 1AHN1 C1F3S4 1.4467 10 $ 3,262.95 $ 14.12 $ 3,277.07<br />
1 1AHNT 1AHN2 C1F3S4 1.4467 10 $ 3,262.95 $ 51.00 $ 3,313.95<br />
1 1AHNU 1AHN3 C1F3S4 1.4467 10 $ 3,262.95 $ 139.84 $ 3,402.79<br />
1 1AHNV 1AHN4 C1F3S4 1.4467 10 $ 3,262.95 $ 207.76 $ 3,470.71<br />
3 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1AHNW 1AHN5 C1F3S4 1.4467 10 $ 3,262.95 $ 320.37 $ 3,583.32<br />
1 1AHNX 1AHN6 C1F3S4 1.4467 10 $ 3,262.95 $ 551.00 $ 3,813.95<br />
1 1AHPS 1AHP1 C1F3S5 1.6229 11 to 13 $ 3,660.36 $ 14.12 $ 3,674.48<br />
1 1AHPT 1AHP2 C1F3S5 1.6229 11 to 13 $ 3,660.36 $ 51.00 $ 3,711.36<br />
1 1AHPU 1AHP3 C1F3S5 1.6229 11 to 13 $ 3,660.36 $ 139.84 $ 3,800.20<br />
1 1AHPV 1AHP4 C1F3S5 1.6229 11 to 13 $ 3,660.36 $ 207.76 $ 3,868.12<br />
1 1AHPW 1AHP5 C1F3S5 1.6229 11 to 13 $ 3,660.36 $ 320.37 $ 3,980.73<br />
1 1AHPX 1AHP6 C1F3S5 1.6229 11 to 13 $ 3,660.36 $ 551.00 $ 4,211.36<br />
1 1BFKS 1BFK1 C2F1S1 0.7335 0 to 5 $ 1,654.37 $ 14.12 $ 1,668.49<br />
1 1BFKT 1BFK2 C2F1S1 0.7335 0 to 5 $ 1,654.37 $ 51.00 $ 1,705.37<br />
1 1BFKU 1BFK3 C2F1S1 0.7335 0 to 5 $ 1,654.37 $ 139.84 $ 1,794.21<br />
1 1BFKV 1BFK4 C2F1S1 0.7335 0 to 5 $ 1,654.37 $ 207.76 $ 1,862.13<br />
1 1BFKW 1BFK5 C2F1S1 0.7335 0 to 5 $ 1,654.37 $ 320.37 $ 1,974.74<br />
1 1BFKX 1BFK6 C2F1S1 0.7335 0 to 5 $ 1,654.37 $ 551.00 $ 2,205.37<br />
1 1BFLS 1BFL1 C2F1S2 1.0015 6 $ 2,258.83 $ 14.12 $ 2,272.95<br />
1 1BFLT 1BFL2 C2F1S2 1.0015 6 $ 2,258.83 $ 51.00 $ 2,309.83<br />
1 1BFLU 1BFL3 C2F1S2 1.0015 6 $ 2,258.83 $ 139.84 $ 2,398.67<br />
1 1BFLV 1BFL4 C2F1S2 1.0015 6 $ 2,258.83 $ 207.76 $ 2,466.59<br />
1 1BFLW 1BFL5 C2F1S2 1.0015 6 $ 2,258.83 $ 320.37 $ 2,579.20<br />
1 1BFLX 1BFL6 C2F1S2 1.0015 6 $ 2,258.83 $ 551.00 $ 2,809.83<br />
1 1BFMS 1BFM1 C2F1S3 1.2107 7 to 9 $ 2,730.67 $ 14.12 $ 2,744.79<br />
1 1BFMT 1BFM2 C2F1S3 1.2107 7 to 9 $ 2,730.67 $ 51.00 $ 2,781.67<br />
1 1BFMU 1BFM3 C2F1S3 1.2107 7 to 9 $ 2,730.67 $ 139.84 $ 2,870.51<br />
1 1BFMV 1BFM4 C2F1S3 1.2107 7 to 9 $ 2,730.67 $ 207.76 $ 2,938.43<br />
1 1BFMW 1BFM5 C2F1S3 1.2107 7 to 9 $ 2,730.67 $ 320.37 $ 3,051.04<br />
1 1BFMX 1BFM6 C2F1S3 1.2107 7 to 9 $ 2,730.67 $ 551.00 $ 3,281.67<br />
1 1BFNS 1BFN1 C2F1S4 1.4252 10 $ 3,214.46 $ 14.12 $ 3,228.58<br />
1 1BFNT 1BFN2 C2F1S4 1.4252 10 $ 3,214.46 $ 51.00 $ 3,265.46<br />
4 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1BFNU 1BFN3 C2F1S4 1.4252 10 $ 3,214.46 $ 139.84 $ 3,354.30<br />
1 1BFNV 1BFN4 C2F1S4 1.4252 10 $ 3,214.46 $ 207.76 $ 3,422.22<br />
1 1BFNW 1BFN5 C2F1S4 1.4252 10 $ 3,214.46 $ 320.37 $ 3,534.83<br />
1 1BFNX 1BFN6 C2F1S4 1.4252 10 $ 3,214.46 $ 551.00 $ 3,765.46<br />
1 1BFPS 1BFP1 C2F1S5 1.6014 11 to 13 $ 3,611.87 $ 14.12 $ 3,625.99<br />
1 1BFPT 1BFP2 C2F1S5 1.6014 11 to 13 $ 3,611.87 $ 51.00 $ 3,662.87<br />
1 1BFPU 1BFP3 C2F1S5 1.6014 11 to 13 $ 3,611.87 $ 139.84 $ 3,751.71<br />
1 1BFPV 1BFP4 C2F1S5 1.6014 11 to 13 $ 3,611.87 $ 207.76 $ 3,819.63<br />
1 1BFPW 1BFP5 C2F1S5 1.6014 11 to 13 $ 3,611.87 $ 320.37 $ 3,932.24<br />
1 1BFPX 1BFP6 C2F1S5 1.6014 11 to 13 $ 3,611.87 $ 551.00 $ 4,162.87<br />
1 1BGKS 1BGK1 C2F2S1 0.8221 0 to 5 $ 1,854.20 $ 14.12 $ 1,868.32<br />
1 1BGKT 1BGK2 C2F2S1 0.8221 0 to 5 $ 1,854.20 $ 51.00 $ 1,905.20<br />
1 1BGKU 1BGK3 C2F2S1 0.8221 0 to 5 $ 1,854.20 $ 139.84 $ 1,994.04<br />
1 1BGKV 1BGK4 C2F2S1 0.8221 0 to 5 $ 1,854.20 $ 207.76 $ 2,061.96<br />
1 1BGKW 1BGK5 C2F2S1 0.8221 0 to 5 $ 1,854.20 $ 320.37 $ 2,174.57<br />
1 1BGKX 1BGK6 C2F2S1 0.8221 0 to 5 $ 1,854.20 $ 551.00 $ 2,405.20<br />
1 1BGLS 1BGL1 C2F2S2 1.0901 6 $ 2,458.66 $ 14.12 $ 2,472.78<br />
1 1BGLT 1BGL2 C2F2S2 1.0901 6 $ 2,458.66 $ 51.00 $ 2,509.66<br />
1 1BGLU 1BGL3 C2F2S2 1.0901 6 $ 2,458.66 $ 139.84 $ 2,598.50<br />
1 1BGLV 1BGL4 C2F2S2 1.0901 6 $ 2,458.66 $ 207.76 $ 2,666.42<br />
1 1BGLW 1BGL5 C2F2S2 1.0901 6 $ 2,458.66 $ 320.37 $ 2,779.03<br />
1 1BGLX 1BGL6 C2F2S2 1.0901 6 $ 2,458.66 $ 551.00 $ 3,009.66<br />
1 1BGMS 1BGM1 C2F2S3 1.2993 7 to 9 $ 2,930.50 $ 14.12 $ 2,944.62<br />
1 1BGMT 1BGM2 C2F2S3 1.2993 7 to 9 $ 2,930.50 $ 51.00 $ 2,981.50<br />
1 1BGMU 1BGM3 C2F2S3 1.2993 7 to 9 $ 2,930.50 $ 139.84 $ 3,070.34<br />
1 1BGMV 1BGM4 C2F2S3 1.2993 7 to 9 $ 2,930.50 $ 207.76 $ 3,138.26<br />
1 1BGMW 1BGM5 C2F2S3 1.2993 7 to 9 $ 2,930.50 $ 320.37 $ 3,250.87<br />
1 1BGMX 1BGM6 C2F2S3 1.2993 7 to 9 $ 2,930.50 $ 551.00 $ 3,481.50<br />
5 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1BGNS 1BGN1 C2F2S4 1.5138 10 $ 3,414.29 $ 14.12 $ 3,428.41<br />
1 1BGNT 1BGN2 C2F2S4 1.5138 10 $ 3,414.29 $ 51.00 $ 3,465.29<br />
1 1BGNU 1BGN3 C2F2S4 1.5138 10 $ 3,414.29 $ 139.84 $ 3,554.13<br />
1 1BGNV 1BGN4 C2F2S4 1.5138 10 $ 3,414.29 $ 207.76 $ 3,622.05<br />
1 1BGNW 1BGN5 C2F2S4 1.5138 10 $ 3,414.29 $ 320.37 $ 3,734.66<br />
1 1BGNX 1BGN6 C2F2S4 1.5138 10 $ 3,414.29 $ 551.00 $ 3,965.29<br />
1 1BGPS 1BGP1 C2F2S5 1.6900 11 to 13 $ 3,811.70 $ 14.12 $ 3,825.82<br />
1 1BGPT 1BGP2 C2F2S5 1.6900 11 to 13 $ 3,811.70 $ 51.00 $ 3,862.70<br />
1 1BGPU 1BGP3 C2F2S5 1.6900 11 to 13 $ 3,811.70 $ 139.84 $ 3,951.54<br />
1 1BGPV 1BGP4 C2F2S5 1.6900 11 to 13 $ 3,811.70 $ 207.76 $ 4,019.46<br />
1 1BGPW 1BGP5 C2F2S5 1.6900 11 to 13 $ 3,811.70 $ 320.37 $ 4,132.07<br />
1 1BGPX 1BGP6 C2F2S5 1.6900 11 to 13 $ 3,811.70 $ 551.00 $ 4,362.70<br />
1 1BHKS 1BHK1 C2F3S1 0.9058 0 to 5 $ 2,042.98 $ 14.12 $ 2,057.10<br />
1 1BHKT 1BHK2 C2F3S1 0.9058 0 to 5 $ 2,042.98 $ 51.00 $ 2,093.98<br />
1 1BHKU 1BHK3 C2F3S1 0.9058 0 to 5 $ 2,042.98 $ 139.84 $ 2,182.82<br />
1 1BHKV 1BHK4 C2F3S1 0.9058 0 to 5 $ 2,042.98 $ 207.76 $ 2,250.74<br />
1 1BHKW 1BHK5 C2F3S1 0.9058 0 to 5 $ 2,042.98 $ 320.37 $ 2,363.35<br />
1 1BHKX 1BHK6 C2F3S1 0.9058 0 to 5 $ 2,042.98 $ 551.00 $ 2,593.98<br />
1 1BHLS 1BHL1 C2F3S2 1.1738 6 $ 2,647.44 $ 14.12 $ 2,661.56<br />
1 1BHLT 1BHL2 C2F3S2 1.1738 6 $ 2,647.44 $ 51.00 $ 2,698.44<br />
1 1BHLU 1BHL3 C2F3S2 1.1738 6 $ 2,647.44 $ 139.84 $ 2,787.28<br />
1 1BHLV 1BHL4 C2F3S2 1.1738 6 $ 2,647.44 $ 207.76 $ 2,855.20<br />
1 1BHLW 1BHL5 C2F3S2 1.1738 6 $ 2,647.44 $ 320.37 $ 2,967.81<br />
1 1BHLX 1BHL6 C2F3S2 1.1738 6 $ 2,647.44 $ 551.00 $ 3,198.44<br />
1 1BHMS 1BHM1 C2F3S3 1.3830 7 to 9 $ 3,119.28 $ 14.12 $ 3,133.40<br />
1 1BHMT 1BHM2 C2F3S3 1.3830 7 to 9 $ 3,119.28 $ 51.00 $ 3,170.28<br />
1 1BHMU 1BHM3 C2F3S3 1.3830 7 to 9 $ 3,119.28 $ 139.84 $ 3,259.12<br />
1 1BHMV 1BHM4 C2F3S3 1.3830 7 to 9 $ 3,119.28 $ 207.76 $ 3,327.04<br />
6 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1BHMW 1BHM5 C2F3S3 1.3830 7 to 9 $ 3,119.28 $ 320.37 $ 3,439.65<br />
1 1BHMX 1BHM6 C2F3S3 1.3830 7 to 9 $ 3,119.28 $ 551.00 $ 3,670.28<br />
1 1BHNS 1BHN1 C2F3S4 1.5975 10 $ 3,603.07 $ 14.12 $ 3,617.19<br />
1 1BHNT 1BHN2 C2F3S4 1.5975 10 $ 3,603.07 $ 51.00 $ 3,654.07<br />
1 1BHNU 1BHN3 C2F3S4 1.5975 10 $ 3,603.07 $ 139.84 $ 3,742.91<br />
1 1BHNV 1BHN4 C2F3S4 1.5975 10 $ 3,603.07 $ 207.76 $ 3,810.83<br />
1 1BHNW 1BHN5 C2F3S4 1.5975 10 $ 3,603.07 $ 320.37 $ 3,923.44<br />
1 1BHNX 1BHN6 C2F3S4 1.5975 10 $ 3,603.07 $ 551.00 $ 4,154.07<br />
1 1BHPS 1BHP1 C2F3S5 1.7737 11 to 13 $ 4,000.48 $ 14.12 $ 4,014.60<br />
1 1BHPT 1BHP2 C2F3S5 1.7737 11 to 13 $ 4,000.48 $ 51.00 $ 4,051.48<br />
1 1BHPU 1BHP3 C2F3S5 1.7737 11 to 13 $ 4,000.48 $ 139.84 $ 4,140.32<br />
1 1BHPV 1BHP4 C2F3S5 1.7737 11 to 13 $ 4,000.48 $ 207.76 $ 4,208.24<br />
1 1BHPW 1BHP5 C2F3S5 1.7737 11 to 13 $ 4,000.48 $ 320.37 $ 4,320.85<br />
1 1BHPX 1BHP6 C2F3S5 1.7737 11 to 13 $ 4,000.48 $ 551.00 $ 4,551.48<br />
1 1CFKS 1CFK1 C3F1S1 0.9010 0 to 5 $ 2,032.16 $ 14.12 $ 2,046.28<br />
1 1CFKT 1CFK2 C3F1S1 0.9010 0 to 5 $ 2,032.16 $ 51.00 $ 2,083.16<br />
1 1CFKU 1CFK3 C3F1S1 0.9010 0 to 5 $ 2,032.16 $ 139.84 $ 2,172.00<br />
1 1CFKV 1CFK4 C3F1S1 0.9010 0 to 5 $ 2,032.16 $ 207.76 $ 2,239.92<br />
1 1CFKW 1CFK5 C3F1S1 0.9010 0 to 5 $ 2,032.16 $ 320.37 $ 2,352.53<br />
1 1CFKX 1CFK6 C3F1S1 0.9010 0 to 5 $ 2,032.16 $ 551.00 $ 2,583.16<br />
1 1CFLS 1CFL1 C3F1S2 1.1691 6 $ 2,636.84 $ 14.12 $ 2,650.96<br />
1 1CFLT 1CFL2 C3F1S2 1.1691 6 $ 2,636.84 $ 51.00 $ 2,687.84<br />
1 1CFLU 1CFL3 C3F1S2 1.1691 6 $ 2,636.84 $ 139.84 $ 2,776.68<br />
1 1CFLV 1CFL4 C3F1S2 1.1691 6 $ 2,636.84 $ 207.76 $ 2,844.60<br />
1 1CFLW 1CFL5 C3F1S2 1.1691 6 $ 2,636.84 $ 320.37 $ 2,957.21<br />
1 1CFLX 1CFL6 C3F1S2 1.1691 6 $ 2,636.84 $ 551.00 $ 3,187.84<br />
1 1CFMS 1CFM1 C3F1S3 1.3783 7 to 9 $ 3,108.68 $ 14.12 $ 3,122.80<br />
1 1CFMT 1CFM2 C3F1S3 1.3783 7 to 9 $ 3,108.68 $ 51.00 $ 3,159.68<br />
7 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1CFMU 1CFM3 C3F1S3 1.3783 7 to 9 $ 3,108.68 $ 139.84 $ 3,248.52<br />
1 1CFMV 1CFM4 C3F1S3 1.3783 7 to 9 $ 3,108.68 $ 207.76 $ 3,316.44<br />
1 1CFMW 1CFM5 C3F1S3 1.3783 7 to 9 $ 3,108.68 $ 320.37 $ 3,429.05<br />
1 1CFMX 1CFM6 C3F1S3 1.3783 7 to 9 $ 3,108.68 $ 551.00 $ 3,659.68<br />
1 1CFNS 1CFN1 C3F1S4 1.5927 10 $ 3,592.25 $ 14.12 $ 3,606.37<br />
1 1CFNT 1CFN2 C3F1S4 1.5927 10 $ 3,592.25 $ 51.00 $ 3,643.25<br />
1 1CFNU 1CFN3 C3F1S4 1.5927 10 $ 3,592.25 $ 139.84 $ 3,732.09<br />
1 1CFNV 1CFN4 C3F1S4 1.5927 10 $ 3,592.25 $ 207.76 $ 3,800.01<br />
1 1CFNW 1CFN5 C3F1S4 1.5927 10 $ 3,592.25 $ 320.37 $ 3,912.62<br />
1 1CFNX 1CFN6 C3F1S4 1.5927 10 $ 3,592.25 $ 551.00 $ 4,143.25<br />
1 1CFPS 1CFP1 C3F1S5 1.7690 11 to 13 $ 3,989.88 $ 14.12 $ 4,004.00<br />
1 1CFPT 1CFP2 C3F1S5 1.7690 11 to 13 $ 3,989.88 $ 51.00 $ 4,040.88<br />
1 1CFPU 1CFP3 C3F1S5 1.7690 11 to 13 $ 3,989.88 $ 139.84 $ 4,129.72<br />
1 1CFPV 1CFP4 C3F1S5 1.7690 11 to 13 $ 3,989.88 $ 207.76 $ 4,197.64<br />
1 1CFPW 1CFP5 C3F1S5 1.7690 11 to 13 $ 3,989.88 $ 320.37 $ 4,310.25<br />
1 1CFPX 1CFP6 C3F1S5 1.7690 11 to 13 $ 3,989.88 $ 551.00 $ 4,540.88<br />
1 1CGKS 1CGK1 C3F2S1 0.9896 0 to 5 $ 2,231.99 $ 14.12 $ 2,246.11<br />
1 1CGKT 1CGK2 C3F2S1 0.9896 0 to 5 $ 2,231.99 $ 51.00 $ 2,282.99<br />
1 1CGKU 1CGK3 C3F2S1 0.9896 0 to 5 $ 2,231.99 $ 139.84 $ 2,371.83<br />
1 1CGKV 1CGK4 C3F2S1 0.9896 0 to 5 $ 2,231.99 $ 207.76 $ 2,439.75<br />
1 1CGKW 1CGK5 C3F2S1 0.9896 0 to 5 $ 2,231.99 $ 320.37 $ 2,552.36<br />
1 1CGKX 1CGK6 C3F2S1 0.9896 0 to 5 $ 2,231.99 $ 551.00 $ 2,782.99<br />
1 1CGLS 1CGL1 C3F2S2 1.2577 6 $ 2,836.67 $ 14.12 $ 2,850.79<br />
1 1CGLT 1CGL2 C3F2S2 1.2577 6 $ 2,836.67 $ 51.00 $ 2,887.67<br />
1 1CGLU 1CGL3 C3F2S2 1.2577 6 $ 2,836.67 $ 139.84 $ 2,976.51<br />
1 1CGLV 1CGL4 C3F2S2 1.2577 6 $ 2,836.67 $ 207.76 $ 3,044.43<br />
1 1CGLW 1CGL5 C3F2S2 1.2577 6 $ 2,836.67 $ 320.37 $ 3,157.04<br />
1 1CGLX 1CGL6 C3F2S2 1.2577 6 $ 2,836.67 $ 551.00 $ 3,387.67<br />
8 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1CGMS 1CGM1 C3F2S3 1.4669 7 to 9 $ 3,308.51 $ 14.12 $ 3,322.63<br />
1 1CGMT 1CGM2 C3F2S3 1.4669 7 to 9 $ 3,308.51 $ 51.00 $ 3,359.51<br />
1 1CGMU 1CGM3 C3F2S3 1.4669 7 to 9 $ 3,308.51 $ 139.84 $ 3,448.35<br />
1 1CGMV 1CGM4 C3F2S3 1.4669 7 to 9 $ 3,308.51 $ 207.76 $ 3,516.27<br />
1 1CGMW 1CGM5 C3F2S3 1.4669 7 to 9 $ 3,308.51 $ 320.37 $ 3,628.88<br />
1 1CGMX 1CGM6 C3F2S3 1.4669 7 to 9 $ 3,308.51 $ 551.00 $ 3,859.51<br />
1 1CGNS 1CGN1 C3F2S4 1.6813 10 $ 3,792.08 $ 14.12 $ 3,806.20<br />
1 1CGNT 1CGN2 C3F2S4 1.6813 10 $ 3,792.08 $ 51.00 $ 3,843.08<br />
1 1CGNU 1CGN3 C3F2S4 1.6813 10 $ 3,792.08 $ 139.84 $ 3,931.92<br />
1 1CGNV 1CGN4 C3F2S4 1.6813 10 $ 3,792.08 $ 207.76 $ 3,999.84<br />
1 1CGNW 1CGN5 C3F2S4 1.6813 10 $ 3,792.08 $ 320.37 $ 4,112.45<br />
1 1CGNX 1CGN6 C3F2S4 1.6813 10 $ 3,792.08 $ 551.00 $ 4,343.08<br />
1 1CGPS 1CGP1 C3F2S5 1.8576 11 to 13 $ 4,189.71 $ 14.12 $ 4,203.83<br />
1 1CGPT 1CGP2 C3F2S5 1.8576 11 to 13 $ 4,189.71 $ 51.00 $ 4,240.71<br />
1 1CGPU 1CGP3 C3F2S5 1.8576 11 to 13 $ 4,189.71 $ 139.84 $ 4,329.55<br />
1 1CGPV 1CGP4 C3F2S5 1.8576 11 to 13 $ 4,189.71 $ 207.76 $ 4,397.47<br />
1 1CGPW 1CGP5 C3F2S5 1.8576 11 to 13 $ 4,189.71 $ 320.37 $ 4,510.08<br />
1 1CGPX 1CGP6 C3F2S5 1.8576 11 to 13 $ 4,189.71 $ 551.00 $ 4,740.71<br />
1 1CHKS 1CHK1 C3F3S1 1.0733 0 to 5 $ 2,420.77 $ 14.12 $ 2,434.89<br />
1 1CHKT 1CHK2 C3F3S1 1.0733 0 to 5 $ 2,420.77 $ 51.00 $ 2,471.77<br />
1 1CHKU 1CHK3 C3F3S1 1.0733 0 to 5 $ 2,420.77 $ 139.84 $ 2,560.61<br />
1 1CHKV 1CHK4 C3F3S1 1.0733 0 to 5 $ 2,420.77 $ 207.76 $ 2,628.53<br />
1 1CHKW 1CHK5 C3F3S1 1.0733 0 to 5 $ 2,420.77 $ 320.37 $ 2,741.14<br />
1 1CHKX 1CHK6 C3F3S1 1.0733 0 to 5 $ 2,420.77 $ 551.00 $ 2,971.77<br />
1 1CHLS 1CHL1 C3F3S2 1.3414 6 $ 3,025.45 $ 14.12 $ 3,039.57<br />
1 1CHLT 1CHL2 C3F3S2 1.3414 6 $ 3,025.45 $ 51.00 $ 3,076.45<br />
1 1CHLU 1CHL3 C3F3S2 1.3414 6 $ 3,025.45 $ 139.84 $ 3,165.29<br />
1 1CHLV 1CHL4 C3F3S2 1.3414 6 $ 3,025.45 $ 207.76 $ 3,233.21<br />
9 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
1 1CHLW 1CHL5 C3F3S2 1.3414 6 $ 3,025.45 $ 320.37 $ 3,345.82<br />
1 1CHLX 1CHL6 C3F3S2 1.3414 6 $ 3,025.45 $ 551.00 $ 3,576.45<br />
1 1CHMS 1CHM1 C3F3S3 1.5506 7 to 9 $ 3,497.29 $ 14.12 $ 3,511.41<br />
1 1CHMT 1CHM2 C3F3S3 1.5506 7 to 9 $ 3,497.29 $ 51.00 $ 3,548.29<br />
1 1CHMU 1CHM3 C3F3S3 1.5506 7 to 9 $ 3,497.29 $ 139.84 $ 3,637.13<br />
1 1CHMV 1CHM4 C3F3S3 1.5506 7 to 9 $ 3,497.29 $ 207.76 $ 3,705.05<br />
1 1CHMW 1CHM5 C3F3S3 1.5506 7 to 9 $ 3,497.29 $ 320.37 $ 3,817.66<br />
1 1CHMX 1CHM6 C3F3S3 1.5506 7 to 9 $ 3,497.29 $ 551.00 $ 4,048.29<br />
1 1CHNS 1CHN1 C3F3S4 1.7650 10 $ 3,980.86 $ 14.12 $ 3,994.98<br />
1 1CHNT 1CHN2 C3F3S4 1.7650 10 $ 3,980.86 $ 51.00 $ 4,031.86<br />
1 1CHNU 1CHN3 C3F3S4 1.7650 10 $ 3,980.86 $ 139.84 $ 4,120.70<br />
1 1CHNV 1CHN4 C3F3S4 1.7650 10 $ 3,980.86 $ 207.76 $ 4,188.62<br />
1 1CHNW 1CHN5 C3F3S4 1.7650 10 $ 3,980.86 $ 320.37 $ 4,301.23<br />
1 1CHNX 1CHN6 C3F3S4 1.7650 10 $ 3,980.86 $ 551.00 $ 4,531.86<br />
1 1CHPS 1CHP1 C3F3S5 1.9413 11 to 13 $ 4,378.50 $ 14.12 $ 4,392.62<br />
1 1CHPT 1CHP2 C3F3S5 1.9413 11 to 13 $ 4,378.50 $ 51.00 $ 4,429.50<br />
1 1CHPU 1CHP3 C3F3S5 1.9413 11 to 13 $ 4,378.50 $ 139.84 $ 4,518.34<br />
1 1CHPV 1CHP4 C3F3S5 1.9413 11 to 13 $ 4,378.50 $ 207.76 $ 4,586.26<br />
1 1CHPW 1CHP5 C3F3S5 1.9413 11 to 13 $ 4,378.50 $ 320.37 $ 4,698.87<br />
1 1CHPX 1CHP6 C3F3S5 1.9413 11 to 13 $ 4,378.50 $ 551.00 $ 4,929.50<br />
Early (1 st and 2 nd ) Episodes With 14 to 19 Therapy Visits<br />
2 2AFKS 2AFK1 C1F1S1 1.6118 14 to 15 $ 3,635.33 $ 14.12 $ 3,649.45<br />
2 2AFKT 2AFK2 C1F1S1 1.6118 14 to 15 $ 3,635.33 $ 51.00 $ 3,686.33<br />
2 2AFKU 2AFK3 C1F1S1 1.6118 14 to 15 $ 3,635.33 $ 139.84 $ 3,775.17<br />
2 2AFKV 2AFK4 C1F1S1 1.6118 14 to 15 $ 3,635.33 $ 207.76 $ 3,843.09<br />
2 2AFKW 2AFK5 C1F1S1 1.6118 14 to 15 $ 3,635.33 $ 320.37 $ 3,955.70<br />
2 2AFKX 2AFK6 C1F1S1 1.6118 14 to 15 $ 3,635.33 $ 551.00 $ 4,186.33<br />
10 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
2 2AFLS 2AFL1 C1F1S2 1.7675 16 to 17 $ 3,986.50 $ 14.12 $ 4,000.62<br />
2 2AFLT 2AFL2 C1F1S2 1.7675 16 to 17 $ 3,986.50 $ 51.00 $ 4,037.50<br />
2 2AFLU 2AFL3 C1F1S2 1.7675 16 to 17 $ 3,986.50 $ 139.84 $ 4,126.34<br />
2 2AFLV 2AFL4 C1F1S2 1.7675 16 to 17 $ 3,986.50 $ 207.76 $ 4,194.26<br />
2 2AFLW 2AFL5 C1F1S2 1.7675 16 to 17 $ 3,986.50 $ 320.37 $ 4,306.87<br />
2 2AFLX 2AFL6 C1F1S2 1.7675 16 to 17 $ 3,986.50 $ 551.00 $ 4,537.50<br />
2 2AFMS 2AFM1 C1F1S3 1.9046 18 to 19 $ 4,295.72 $ 14.12 $ 4,309.84<br />
2 2AFMT 2AFM2 C1F1S3 1.9046 18 to 19 $ 4,295.72 $ 51.00 $ 4,346.72<br />
2 2AFMU 2AFM3 C1F1S3 1.9046 18 to 19 $ 4,295.72 $ 139.84 $ 4,435.56<br />
2 2AFMV 2AFM4 C1F1S3 1.9046 18 to 19 $ 4,295.72 $ 207.76 $ 4,503.48<br />
2 2AFMW 2AFM5 C1F1S3 1.9046 18 to 19 $ 4,295.72 $ 320.37 $ 4,616.09<br />
2 2AFMX 2AFM6 C1F1S3 1.9046 18 to 19 $ 4,295.72 $ 551.00 $ 4,846.72<br />
2 2AGKS 2AGK1 C1F2S1 1.7281 14 to 15 $ 3,897.63 $ 14.12 $ 3,911.75<br />
2 2AGKT 2AGK2 C1F2S1 1.7281 14 to 15 $ 3,897.63 $ 51.00 $ 3,948.63<br />
2 2AGKU 2AGK3 C1F2S1 1.7281 14 to 15 $ 3,897.63 $ 139.84 $ 4,037.47<br />
2 2AGKV 2AGK4 C1F2S1 1.7281 14 to 15 $ 3,897.63 $ 207.76 $ 4,105.39<br />
2 2AGKW 2AGK5 C1F2S1 1.7281 14 to 15 $ 3,897.63 $ 320.37 $ 4,218.00<br />
2 2AGKX 2AGK6 C1F2S1 1.7281 14 to 15 $ 3,897.63 $ 551.00 $ 4,448.63<br />
2 2AGLS 2AGL1 C1F2S2 1.8837 16 to 17 $ 4,248.58 $ 14.12 $ 4,262.70<br />
2 2AGLT 2AGL2 C1F2S2 1.8837 16 to 17 $ 4,248.58 $ 51.00 $ 4,299.58<br />
2 2AGLU 2AGL3 C1F2S2 1.8837 16 to 17 $ 4,248.58 $ 139.84 $ 4,388.42<br />
2 2AGLV 2AGL4 C1F2S2 1.8837 16 to 17 $ 4,248.58 $ 207.76 $ 4,456.34<br />
2 2AGLW 2AGL5 C1F2S2 1.8837 16 to 17 $ 4,248.58 $ 320.37 $ 4,568.95<br />
2 2AGLX 2AGL6 C1F2S2 1.8837 16 to 17 $ 4,248.58 $ 551.00 $ 4,799.58<br />
2 2AGMS 2AGM1 C1F2S3 2.0208 18 to 19 $ 4,557.80 $ 14.12 $ 4,571.92<br />
2 2AGMT 2AGM2 C1F2S3 2.0208 18 to 19 $ 4,557.80 $ 51.00 $ 4,608.80<br />
2 2AGMU 2AGM3 C1F2S3 2.0208 18 to 19 $ 4,557.80 $ 139.84 $ 4,697.64<br />
2 2AGMV 2AGM4 C1F2S3 2.0208 18 to 19 $ 4,557.80 $ 207.76 $ 4,765.56<br />
11 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
2 2AGMW 2AGM5 C1F2S3 2.0208 18 to 19 $ 4,557.80 $ 320.37 $ 4,878.17<br />
2 2AGMX 2AGM6 C1F2S3 2.0208 18 to 19 $ 4,557.80 $ 551.00 $ 5,108.80<br />
2 2AHKS 2AHK1 C1F3S1 1.8010 14 to 15 $ 4,062.06 $ 14.12 $ 4,076.18<br />
2 2AHKT 2AHK2 C1F3S1 1.8010 14 to 15 $ 4,062.06 $ 51.00 $ 4,113.06<br />
2 2AHKU 2AHK3 C1F3S1 1.8010 14 to 15 $ 4,062.06 $ 139.84 $ 4,201.90<br />
2 2AHKV 2AHK4 C1F3S1 1.8010 14 to 15 $ 4,062.06 $ 207.76 $ 4,269.82<br />
2 2AHKW 2AHK5 C1F3S1 1.8010 14 to 15 $ 4,062.06 $ 320.37 $ 4,382.43<br />
2 2AHKX 2AHK6 C1F3S1 1.8010 14 to 15 $ 4,062.06 $ 551.00 $ 4,613.06<br />
2 2AHLS 2AHL1 C1F3S2 1.9566 16 to 17 $ 4,413.00 $ 14.12 $ 4,427.12<br />
2 2AHLT 2AHL2 C1F3S2 1.9566 16 to 17 $ 4,413.00 $ 51.00 $ 4,464.00<br />
2 2AHLU 2AHL3 C1F3S2 1.9566 16 to 17 $ 4,413.00 $ 139.84 $ 4,552.84<br />
2 2AHLV 2AHL4 C1F3S2 1.9566 16 to 17 $ 4,413.00 $ 207.76 $ 4,620.76<br />
2 2AHLW 2AHL5 C1F3S2 1.9566 16 to 17 $ 4,413.00 $ 320.37 $ 4,733.37<br />
2 2AHLX 2AHL6 C1F3S2 1.9566 16 to 17 $ 4,413.00 $ 551.00 $ 4,964.00<br />
2 2AHMS 2AHM1 C1F3S3 2.0937 18 to 19 $ 4,722.23 $ 14.12 $ 4,736.35<br />
2 2AHMT 2AHM2 C1F3S3 2.0937 18 to 19 $ 4,722.23 $ 51.00 $ 4,773.23<br />
2 2AHMU 2AHM3 C1F3S3 2.0937 18 to 19 $ 4,722.23 $ 139.84 $ 4,862.07<br />
2 2AHMV 2AHM4 C1F3S3 2.0937 18 to 19 $ 4,722.23 $ 207.76 $ 4,929.99<br />
2 2AHMW 2AHM5 C1F3S3 2.0937 18 to 19 $ 4,722.23 $ 320.37 $ 5,042.60<br />
2 2AHMX 2AHM6 C1F3S3 2.0937 18 to 19 $ 4,722.23 $ 551.00 $ 5,273.23<br />
2 2BFKS 2BFK1 C2F1S1 1.8626 14 to 15 $ 4,200.99 $ 14.12 $ 4,215.11<br />
2 2BFKT 2BFK2 C2F1S1 1.8626 14 to 15 $ 4,200.99 $ 51.00 $ 4,251.99<br />
2 2BFKU 2BFK3 C2F1S1 1.8626 14 to 15 $ 4,200.99 $ 139.84 $ 4,340.83<br />
2 2BFKV 2BFK4 C2F1S1 1.8626 14 to 15 $ 4,200.99 $ 207.76 $ 4,408.75<br />
2 2BFKW 2BFK5 C2F1S1 1.8626 14 to 15 $ 4,200.99 $ 320.37 $ 4,521.36<br />
2 2BFKX 2BFK6 C2F1S1 1.8626 14 to 15 $ 4,200.99 $ 551.00 $ 4,751.99<br />
2 2BFLS 2BFL1 C2F1S2 2.0183 16 to 17 $ 4,552.16 $ 14.12 $ 4,566.28<br />
2 2BFLT 2BFL2 C2F1S2 2.0183 16 to 17 $ 4,552.16 $ 51.00 $ 4,603.16<br />
12 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
2 2BFLU 2BFL3 C2F1S2 2.0183 16 to 17 $ 4,552.16 $ 139.84 $ 4,692.00<br />
2 2BFLV 2BFL4 C2F1S2 2.0183 16 to 17 $ 4,552.16 $ 207.76 $ 4,759.92<br />
2 2BFLW 2BFL5 C2F1S2 2.0183 16 to 17 $ 4,552.16 $ 320.37 $ 4,872.53<br />
2 2BFLX 2BFL6 C2F1S2 2.0183 16 to 17 $ 4,552.16 $ 551.00 $ 5,103.16<br />
2 2BFMS 2BFM1 C2F1S3 2.1554 18 to 19 $ 4,861.39 $ 14.12 $ 4,875.51<br />
2 2BFMT 2BFM2 C2F1S3 2.1554 18 to 19 $ 4,861.39 $ 51.00 $ 4,912.39<br />
2 2BFMU 2BFM3 C2F1S3 2.1554 18 to 19 $ 4,861.39 $ 139.84 $ 5,001.23<br />
2 2BFMV 2BFM4 C2F1S3 2.1554 18 to 19 $ 4,861.39 $ 207.76 $ 5,069.15<br />
2 2BFMW 2BFM5 C2F1S3 2.1554 18 to 19 $ 4,861.39 $ 320.37 $ 5,181.76<br />
2 2BFMX 2BFM6 C2F1S3 2.1554 18 to 19 $ 4,861.39 $ 551.00 $ 5,412.39<br />
2 2BGKS 2BGK1 C2F2S1 1.9789 14 to 15 $ 4,463.30 $ 14.12 $ 4,477.42<br />
2 2BGKT 2BGK2 C2F2S1 1.9789 14 to 15 $ 4,463.30 $ 51.00 $ 4,514.30<br />
2 2BGKU 2BGK3 C2F2S1 1.9789 14 to 15 $ 4,463.30 $ 139.84 $ 4,603.14<br />
2 2BGKV 2BGK4 C2F2S1 1.9789 14 to 15 $ 4,463.30 $ 207.76 $ 4,671.06<br />
2 2BGKW 2BGK5 C2F2S1 1.9789 14 to 15 $ 4,463.30 $ 320.37 $ 4,783.67<br />
2 2BGKX 2BGK6 C2F2S1 1.9789 14 to 15 $ 4,463.30 $ 551.00 $ 5,014.30<br />
2 2BGLS 2BGL1 C2F2S2 2.1345 16 to 17 $ 4,814.25 $ 14.12 $ 4,828.37<br />
2 2BGLT 2BGL2 C2F2S2 2.1345 16 to 17 $ 4,814.25 $ 51.00 $ 4,865.25<br />
2 2BGLU 2BGL3 C2F2S2 2.1345 16 to 17 $ 4,814.25 $ 139.84 $ 4,954.09<br />
2 2BGLV 2BGL4 C2F2S2 2.1345 16 to 17 $ 4,814.25 $ 207.76 $ 5,022.01<br />
2 2BGLW 2BGL5 C2F2S2 2.1345 16 to 17 $ 4,814.25 $ 320.37 $ 5,134.62<br />
2 2BGLX 2BGL6 C2F2S2 2.1345 16 to 17 $ 4,814.25 $ 551.00 $ 5,365.25<br />
2 2BGMS 2BGM1 C2F2S3 2.2716 18 to 19 $ 5,123.47 $ 14.12 $ 5,137.59<br />
2 2BGMT 2BGM2 C2F2S3 2.2716 18 to 19 $ 5,123.47 $ 51.00 $ 5,174.47<br />
2 2BGMU 2BGM3 C2F2S3 2.2716 18 to 19 $ 5,123.47 $ 139.84 $ 5,263.31<br />
2 2BGMV 2BGM4 C2F2S3 2.2716 18 to 19 $ 5,123.47 $ 207.76 $ 5,331.23<br />
2 2BGMW 2BGM5 C2F2S3 2.2716 18 to 19 $ 5,123.47 $ 320.37 $ 5,443.84<br />
2 2BGMX 2BGM6 C2F2S3 2.2716 18 to 19 $ 5,123.47 $ 551.00 $ 5,674.47<br />
13 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
2 2BHKS 2BHK1 C2F3S1 2.0518 14 to 15 $ 4,627.72 $ 14.12 $ 4,641.84<br />
2 2BHKT 2BHK2 C2F3S1 2.0518 14 to 15 $ 4,627.72 $ 51.00 $ 4,678.72<br />
2 2BHKU 2BHK3 C2F3S1 2.0518 14 to 15 $ 4,627.72 $ 139.84 $ 4,767.56<br />
2 2BHKV 2BHK4 C2F3S1 2.0518 14 to 15 $ 4,627.72 $ 207.76 $ 4,835.48<br />
2 2BHKW 2BHK5 C2F3S1 2.0518 14 to 15 $ 4,627.72 $ 320.37 $ 4,948.09<br />
2 2BHKX 2BHK6 C2F3S1 2.0518 14 to 15 $ 4,627.72 $ 551.00 $ 5,178.72<br />
2 2BHLS 2BHL1 C2F3S2 2.2074 16 to 17 $ 4,978.67 $ 14.12 $ 4,992.79<br />
2 2BHLT 2BHL2 C2F3S2 2.2074 16 to 17 $ 4,978.67 $ 51.00 $ 5,029.67<br />
2 2BHLU 2BHL3 C2F3S2 2.2074 16 to 17 $ 4,978.67 $ 139.84 $ 5,118.51<br />
2 2BHLV 2BHL4 C2F3S2 2.2074 16 to 17 $ 4,978.67 $ 207.76 $ 5,186.43<br />
2 2BHLW 2BHL5 C2F3S2 2.2074 16 to 17 $ 4,978.67 $ 320.37 $ 5,299.04<br />
2 2BHLX 2BHL6 C2F3S2 2.2074 16 to 17 $ 4,978.67 $ 551.00 $ 5,529.67<br />
2 2BHMS 2BHM1 C2F3S3 2.3445 18 to 19 $ 5,287.89 $ 14.12 $ 5,302.01<br />
2 2BHMT 2BHM2 C2F3S3 2.3445 18 to 19 $ 5,287.89 $ 51.00 $ 5,338.89<br />
2 2BHMU 2BHM3 C2F3S3 2.3445 18 to 19 $ 5,287.89 $ 139.84 $ 5,427.73<br />
2 2BHMV 2BHM4 C2F3S3 2.3445 18 to 19 $ 5,287.89 $ 207.76 $ 5,495.65<br />
2 2BHMW 2BHM5 C2F3S3 2.3445 18 to 19 $ 5,287.89 $ 320.37 $ 5,608.26<br />
2 2BHMX 2BHM6 C2F3S3 2.3445 18 to 19 $ 5,287.89 $ 551.00 $ 5,838.89<br />
2 2CFKS 2CFK1 C3F1S1 2.1524 14 to 15 $ 4,854.62 $ 14.12 $ 4,868.74<br />
2 2CFKT 2CFK2 C3F1S1 2.1524 14 to 15 $ 4,854.62 $ 51.00 $ 4,905.62<br />
2 2CFKU 2CFK3 C3F1S1 2.1524 14 to 15 $ 4,854.62 $ 139.84 $ 4,994.46<br />
2 2CFKV 2CFK4 C3F1S1 2.1524 14 to 15 $ 4,854.62 $ 207.76 $ 5,062.38<br />
2 2CFKW 2CFK5 C3F1S1 2.1524 14 to 15 $ 4,854.62 $ 320.37 $ 5,174.99<br />
2 2CFKX 2CFK6 C3F1S1 2.1524 14 to 15 $ 4,854.62 $ 551.00 $ 5,405.62<br />
2 2CFLS 2CFL1 C3F1S2 2.3081 16 to 17 $ 5,205.79 $ 14.12 $ 5,219.91<br />
2 2CFLT 2CFL2 C3F1S2 2.3081 16 to 17 $ 5,205.79 $ 51.00 $ 5,256.79<br />
2 2CFLU 2CFL3 C3F1S2 2.3081 16 to 17 $ 5,205.79 $ 139.84 $ 5,345.63<br />
2 2CFLV 2CFL4 C3F1S2 2.3081 16 to 17 $ 5,205.79 $ 207.76 $ 5,413.55<br />
14 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
2 2CFLW 2CFL5 C3F1S2 2.3081 16 to 17 $ 5,205.79 $ 320.37 $ 5,526.16<br />
2 2CFLX 2CFL6 C3F1S2 2.3081 16 to 17 $ 5,205.79 $ 551.00 $ 5,756.79<br />
2 2CFMS 2CFM1 C3F1S3 2.4451 18 to 19 $ 5,514.79 $ 14.12 $ 5,528.91<br />
2 2CFMT 2CFM2 C3F1S3 2.4451 18 to 19 $ 5,514.79 $ 51.00 $ 5,565.79<br />
2 2CFMU 2CFM3 C3F1S3 2.4451 18 to 19 $ 5,514.79 $ 139.84 $ 5,654.63<br />
2 2CFMV 2CFM4 C3F1S3 2.4451 18 to 19 $ 5,514.79 $ 207.76 $ 5,722.55<br />
2 2CFMW 2CFM5 C3F1S3 2.4451 18 to 19 $ 5,514.79 $ 320.37 $ 5,835.16<br />
2 2CFMX 2CFM6 C3F1S3 2.4451 18 to 19 $ 5,514.79 $ 551.00 $ 6,065.79<br />
2 2CGKS 2CGK1 C3F2S1 2.2686 14 to 15 $ 5,116.70 $ 14.12 $ 5,130.82<br />
2 2CGKT 2CGK2 C3F2S1 2.2686 14 to 15 $ 5,116.70 $ 51.00 $ 5,167.70<br />
2 2CGKU 2CGK3 C3F2S1 2.2686 14 to 15 $ 5,116.70 $ 139.84 $ 5,256.54<br />
2 2CGKV 2CGK4 C3F2S1 2.2686 14 to 15 $ 5,116.70 $ 207.76 $ 5,324.46<br />
2 2CGKW 2CGK5 C3F2S1 2.2686 14 to 15 $ 5,116.70 $ 320.37 $ 5,437.07<br />
2 2CGKX 2CGK6 C3F2S1 2.2686 14 to 15 $ 5,116.70 $ 551.00 $ 5,667.70<br />
2 2CGLS 2CGL1 C3F2S2 2.4243 16 to 17 $ 5,467.88 $ 14.12 $ 5,482.00<br />
2 2CGLT 2CGL2 C3F2S2 2.4243 16 to 17 $ 5,467.88 $ 51.00 $ 5,518.88<br />
2 2CGLU 2CGL3 C3F2S2 2.4243 16 to 17 $ 5,467.88 $ 139.84 $ 5,607.72<br />
2 2CGLV 2CGL4 C3F2S2 2.4243 16 to 17 $ 5,467.88 $ 207.76 $ 5,675.64<br />
2 2CGLW 2CGL5 C3F2S2 2.4243 16 to 17 $ 5,467.88 $ 320.37 $ 5,788.25<br />
2 2CGLX 2CGL6 C3F2S2 2.4243 16 to 17 $ 5,467.88 $ 551.00 $ 6,018.88<br />
2 2CGMS 2CGM1 C3F2S3 2.5613 18 to 19 $ 5,776.87 $ 14.12 $ 5,790.99<br />
2 2CGMT 2CGM2 C3F2S3 2.5613 18 to 19 $ 5,776.87 $ 51.00 $ 5,827.87<br />
2 2CGMU 2CGM3 C3F2S3 2.5613 18 to 19 $ 5,776.87 $ 139.84 $ 5,916.71<br />
2 2CGMV 2CGM4 C3F2S3 2.5613 18 to 19 $ 5,776.87 $ 207.76 $ 5,984.63<br />
2 2CGMW 2CGM5 C3F2S3 2.5613 18 to 19 $ 5,776.87 $ 320.37 $ 6,097.24<br />
2 2CGMX 2CGM6 C3F2S3 2.5613 18 to 19 $ 5,776.87 $ 551.00 $ 6,327.87<br />
2 2CHKS 2CHK1 C3F3S1 2.3415 14 to 15 $ 5,281.12 $ 14.12 $ 5,295.24<br />
2 2CHKT 2CHK2 C3F3S1 2.3415 14 to 15 $ 5,281.12 $ 51.00 $ 5,332.12<br />
15 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
2 2CHKU 2CHK3 C3F3S1 2.3415 14 to 15 $ 5,281.12 $ 139.84 $ 5,420.96<br />
2 2CHKV 2CHK4 C3F3S1 2.3415 14 to 15 $ 5,281.12 $ 207.76 $ 5,488.88<br />
2 2CHKW 2CHK5 C3F3S1 2.3415 14 to 15 $ 5,281.12 $ 320.37 $ 5,601.49<br />
2 2CHKX 2CHK6 C3F3S1 2.3415 14 to 15 $ 5,281.12 $ 551.00 $ 5,832.12<br />
2 2CHLS 2CHL1 C3F3S2 2.4972 16 to 17 $ 5,632.30 $ 14.12 $ 5,646.42<br />
2 2CHLT 2CHL2 C3F3S2 2.4972 16 to 17 $ 5,632.30 $ 51.00 $ 5,683.30<br />
2 2CHLU 2CHL3 C3F3S2 2.4972 16 to 17 $ 5,632.30 $ 139.84 $ 5,772.14<br />
2 2CHLV 2CHL4 C3F3S2 2.4972 16 to 17 $ 5,632.30 $ 207.76 $ 5,840.06<br />
2 2CHLW 2CHL5 C3F3S2 2.4972 16 to 17 $ 5,632.30 $ 320.37 $ 5,952.67<br />
2 2CHLX 2CHL6 C3F3S2 2.4972 16 to 17 $ 5,632.30 $ 551.00 $ 6,183.30<br />
2 2CHMS 2CHM1 C3F3S3 2.6342 18 to 19 $ 5,941.29 $ 14.12 $ 5,955.41<br />
2 2CHMT 2CHM2 C3F3S3 2.6342 18 to 19 $ 5,941.29 $ 51.00 $ 5,992.29<br />
2 2CHMU 2CHM3 C3F3S3 2.6342 18 to 19 $ 5,941.29 $ 139.84 $ 6,081.13<br />
2 2CHMV 2CHM4 C3F3S3 2.6342 18 to 19 $ 5,941.29 $ 207.76 $ 6,149.05<br />
2 2CHMW 2CHM5 C3F3S3 2.6342 18 to 19 $ 5,941.29 $ 320.37 $ 6,261.66<br />
2 2CHMX 2CHM6 C3F3S3 2.6342 18 to 19 $ 5,941.29 $ 551.00 $ 6,492.29<br />
Late (3 rd +) Episodes With 0 to 13 Therapy Visits<br />
3 3AFKS 3AFK1 C1F1S1 0.6543 0 to 5 $ 1,475.74 $ 14.12 $ 1,489.86<br />
3 3AFKT 3AFK2 C1F1S1 0.6543 0 to 5 $ 1,475.74 $ 51.00 $ 1,526.74<br />
3 3AFKU 3AFK3 C1F1S1 0.6543 0 to 5 $ 1,475.74 $ 139.84 $ 1,615.58<br />
3 3AFKV 3AFK4 C1F1S1 0.6543 0 to 5 $ 1,475.74 $ 207.76 $ 1,683.50<br />
3 3AFKW 3AFK5 C1F1S1 0.6543 0 to 5 $ 1,475.74 $ 320.37 $ 1,796.11<br />
3 3AFKX 3AFK6 C1F1S1 0.6543 0 to 5 $ 1,475.74 $ 551.00 $ 2,026.74<br />
3 3AFLS 3AFL1 C1F1S2 1.0041 6 $ 2,264.69 $ 14.12 $ 2,278.81<br />
3 3AFLT 3AFL2 C1F1S2 1.0041 6 $ 2,264.69 $ 51.00 $ 2,315.69<br />
3 3AFLU 3AFL3 C1F1S2 1.0041 6 $ 2,264.69 $ 139.84 $ 2,404.53<br />
3 3AFLV 3AFL4 C1F1S2 1.0041 6 $ 2,264.69 $ 207.76 $ 2,472.45<br />
16 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3AFLW 3AFL5 C1F1S2 1.0041 6 $ 2,264.69 $ 320.37 $ 2,585.06<br />
3 3AFLX 3AFL6 C1F1S2 1.0041 6 $ 2,264.69 $ 551.00 $ 2,815.69<br />
3 3AFMS 3AFM1 C1F1S3 1.2065 7 to 9 $ 2,721.19 $ 14.12 $ 2,735.31<br />
3 3AFMT 3AFM2 C1F1S3 1.2065 7 to 9 $ 2,721.19 $ 51.00 $ 2,772.19<br />
3 3AFMU 3AFM3 C1F1S3 1.2065 7 to 9 $ 2,721.19 $ 139.84 $ 2,861.03<br />
3 3AFMV 3AFM4 C1F1S3 1.2065 7 to 9 $ 2,721.19 $ 207.76 $ 2,928.95<br />
3 3AFMW 3AFM5 C1F1S3 1.2065 7 to 9 $ 2,721.19 $ 320.37 $ 3,041.56<br />
3 3AFMX 3AFM6 C1F1S3 1.2065 7 to 9 $ 2,721.19 $ 551.00 $ 3,272.19<br />
3 3AFNS 3AFN1 C1F1S4 1.4277 10 $ 3,220.10 $ 14.12 $ 3,234.22<br />
3 3AFNT 3AFN2 C1F1S4 1.4277 10 $ 3,220.10 $ 51.00 $ 3,271.10<br />
3 3AFNU 3AFN3 C1F1S4 1.4277 10 $ 3,220.10 $ 139.84 $ 3,359.94<br />
3 3AFNV 3AFN4 C1F1S4 1.4277 10 $ 3,220.10 $ 207.76 $ 3,427.86<br />
3 3AFNW 3AFN5 C1F1S4 1.4277 10 $ 3,220.10 $ 320.37 $ 3,540.47<br />
3 3AFNX 3AFN6 C1F1S4 1.4277 10 $ 3,220.10 $ 551.00 $ 3,771.10<br />
3 3AFPS 3AFP1 C1F1S5 1.6024 11 to 13 $ 3,614.12 $ 14.12 $ 3,628.24<br />
3 3AFPT 3AFP2 C1F1S5 1.6024 11 to 13 $ 3,614.12 $ 51.00 $ 3,665.12<br />
3 3AFPU 3AFP3 C1F1S5 1.6024 11 to 13 $ 3,614.12 $ 139.84 $ 3,753.96<br />
3 3AFPV 3AFP4 C1F1S5 1.6024 11 to 13 $ 3,614.12 $ 207.76 $ 3,821.88<br />
3 3AFPW 3AFP5 C1F1S5 1.6024 11 to 13 $ 3,614.12 $ 320.37 $ 3,934.49<br />
3 3AFPX 3AFP6 C1F1S5 1.6024 11 to 13 $ 3,614.12 $ 551.00 $ 4,165.12<br />
3 3AGKS 3AGK1 C1F2S1 0.7882 0 to 5 $ 1,777.74 $ 14.12 $ 1,791.86<br />
3 3AGKT 3AGK2 C1F2S1 0.7882 0 to 5 $ 1,777.74 $ 51.00 $ 1,828.74<br />
3 3AGKU 3AGK3 C1F2S1 0.7882 0 to 5 $ 1,777.74 $ 139.84 $ 1,917.58<br />
3 3AGKV 3AGK4 C1F2S1 0.7882 0 to 5 $ 1,777.74 $ 207.76 $ 1,985.50<br />
3 3AGKW 3AGK5 C1F2S1 0.7882 0 to 5 $ 1,777.74 $ 320.37 $ 2,098.11<br />
3 3AGKX 3AGK6 C1F2S1 0.7882 0 to 5 $ 1,777.74 $ 551.00 $ 2,328.74<br />
3 3AGLS 3AGL1 C1F2S2 1.1380 6 $ 2,566.70 $ 14.12 $ 2,580.82<br />
3 3AGLT 3AGL2 C1F2S2 1.1380 6 $ 2,566.70 $ 51.00 $ 2,617.70<br />
17 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3AGLU 3AGL3 C1F2S2 1.1380 6 $ 2,566.70 $ 139.84 $ 2,706.54<br />
3 3AGLV 3AGL4 C1F2S2 1.1380 6 $ 2,566.70 $ 207.76 $ 2,774.46<br />
3 3AGLW 3AGL5 C1F2S2 1.1380 6 $ 2,566.70 $ 320.37 $ 2,887.07<br />
3 3AGLX 3AGL6 C1F2S2 1.1380 6 $ 2,566.70 $ 551.00 $ 3,117.70<br />
3 3AGMS 3AGM1 C1F2S3 1.3405 7 to 9 $ 3,023.42 $ 14.12 $ 3,037.54<br />
3 3AGMT 3AGM2 C1F2S3 1.3405 7 to 9 $ 3,023.42 $ 51.00 $ 3,074.42<br />
3 3AGMU 3AGM3 C1F2S3 1.3405 7 to 9 $ 3,023.42 $ 139.84 $ 3,163.26<br />
3 3AGMV 3AGM4 C1F2S3 1.3405 7 to 9 $ 3,023.42 $ 207.76 $ 3,231.18<br />
3 3AGMW 3AGM5 C1F2S3 1.3405 7 to 9 $ 3,023.42 $ 320.37 $ 3,343.79<br />
3 3AGMX 3AGM6 C1F2S3 1.3405 7 to 9 $ 3,023.42 $ 551.00 $ 3,574.42<br />
3 3AGNS 3AGN1 C1F2S4 1.5617 10 $ 3,522.33 $ 14.12 $ 3,536.45<br />
3 3AGNT 3AGN2 C1F2S4 1.5617 10 $ 3,522.33 $ 51.00 $ 3,573.33<br />
3 3AGNU 3AGN3 C1F2S4 1.5617 10 $ 3,522.33 $ 139.84 $ 3,662.17<br />
3 3AGNV 3AGN4 C1F2S4 1.5617 10 $ 3,522.33 $ 207.76 $ 3,730.09<br />
3 3AGNW 3AGN5 C1F2S4 1.5617 10 $ 3,522.33 $ 320.37 $ 3,842.70<br />
3 3AGNX 3AGN6 C1F2S4 1.5617 10 $ 3,522.33 $ 551.00 $ 4,073.33<br />
3 3AGPS 3AGP1 C1F2S5 1.7364 11 to 13 $ 3,916.35 $ 14.12 $ 3,930.47<br />
3 3AGPT 3AGP2 C1F2S5 1.7364 11 to 13 $ 3,916.35 $ 51.00 $ 3,967.35<br />
3 3AGPU 3AGP3 C1F2S5 1.7364 11 to 13 $ 3,916.35 $ 139.84 $ 4,056.19<br />
3 3AGPV 3AGP4 C1F2S5 1.7364 11 to 13 $ 3,916.35 $ 207.76 $ 4,124.11<br />
3 3AGPW 3AGP5 C1F2S5 1.7364 11 to 13 $ 3,916.35 $ 320.37 $ 4,236.72<br />
3 3AGPX 3AGP6 C1F2S5 1.7364 11 to 13 $ 3,916.35 $ 551.00 $ 4,467.35<br />
3 3AHKS 3AHK1 C1F3S1 0.9151 0 to 5 $ 2,063.96 $ 14.12 $ 2,078.08<br />
3 3AHKT 3AHK2 C1F3S1 0.9151 0 to 5 $ 2,063.96 $ 51.00 $ 2,114.96<br />
3 3AHKU 3AHK3 C1F3S1 0.9151 0 to 5 $ 2,063.96 $ 139.84 $ 2,203.80<br />
3 3AHKV 3AHK4 C1F3S1 0.9151 0 to 5 $ 2,063.96 $ 207.76 $ 2,271.72<br />
3 3AHKW 3AHK5 C1F3S1 0.9151 0 to 5 $ 2,063.96 $ 320.37 $ 2,384.33<br />
3 3AHKX 3AHK6 C1F3S1 0.9151 0 to 5 $ 2,063.96 $ 551.00 $ 2,614.96<br />
18 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3AHLS 3AHL1 C1F3S2 1.2649 6 $ 2,852.91 $ 14.12 $ 2,867.03<br />
3 3AHLT 3AHL2 C1F3S2 1.2649 6 $ 2,852.91 $ 51.00 $ 2,903.91<br />
3 3AHLU 3AHL3 C1F3S2 1.2649 6 $ 2,852.91 $ 139.84 $ 2,992.75<br />
3 3AHLV 3AHL4 C1F3S2 1.2649 6 $ 2,852.91 $ 207.76 $ 3,060.67<br />
3 3AHLW 3AHL5 C1F3S2 1.2649 6 $ 2,852.91 $ 320.37 $ 3,173.28<br />
3 3AHLX 3AHL6 C1F3S2 1.2649 6 $ 2,852.91 $ 551.00 $ 3,403.91<br />
3 3AHMS 3AHM1 C1F3S3 1.4674 7 to 9 $ 3,309.64 $ 14.12 $ 3,323.76<br />
3 3AHMT 3AHM2 C1F3S3 1.4674 7 to 9 $ 3,309.64 $ 51.00 $ 3,360.64<br />
3 3AHMU 3AHM3 C1F3S3 1.4674 7 to 9 $ 3,309.64 $ 139.84 $ 3,449.48<br />
3 3AHMV 3AHM4 C1F3S3 1.4674 7 to 9 $ 3,309.64 $ 207.76 $ 3,517.40<br />
3 3AHMW 3AHM5 C1F3S3 1.4674 7 to 9 $ 3,309.64 $ 320.37 $ 3,630.01<br />
3 3AHMX 3AHM6 C1F3S3 1.4674 7 to 9 $ 3,309.64 $ 551.00 $ 3,860.64<br />
3 3AHNS 3AHN1 C1F3S4 1.6886 10 $ 3,808.54 $ 14.12 $ 3,822.66<br />
3 3AHNT 3AHN2 C1F3S4 1.6886 10 $ 3,808.54 $ 51.00 $ 3,859.54<br />
3 3AHNU 3AHN3 C1F3S4 1.6886 10 $ 3,808.54 $ 139.84 $ 3,948.38<br />
3 3AHNV 3AHN4 C1F3S4 1.6886 10 $ 3,808.54 $ 207.76 $ 4,016.30<br />
3 3AHNW 3AHN5 C1F3S4 1.6886 10 $ 3,808.54 $ 320.37 $ 4,128.91<br />
3 3AHNX 3AHN6 C1F3S4 1.6886 10 $ 3,808.54 $ 551.00 $ 4,359.54<br />
3 3AHPS 3AHP1 C1F3S5 1.8632 11 to 13 $ 4,202.34 $ 14.12 $ 4,216.46<br />
3 3AHPT 3AHP2 C1F3S5 1.8632 11 to 13 $ 4,202.34 $ 51.00 $ 4,253.34<br />
3 3AHPU 3AHP3 C1F3S5 1.8632 11 to 13 $ 4,202.34 $ 139.84 $ 4,342.18<br />
3 3AHPV 3AHP4 C1F3S5 1.8632 11 to 13 $ 4,202.34 $ 207.76 $ 4,410.10<br />
3 3AHPW 3AHP5 C1F3S5 1.8632 11 to 13 $ 4,202.34 $ 320.37 $ 4,522.71<br />
3 3AHPX 3AHP6 C1F3S5 1.8632 11 to 13 $ 4,202.34 $ 551.00 $ 4,753.34<br />
3 3BFKS 3BFK1 C2F1S1 0.7124 0 to 5 $ 1,606.78 $ 14.12 $ 1,620.90<br />
3 3BFKT 3BFK2 C2F1S1 0.7124 0 to 5 $ 1,606.78 $ 51.00 $ 1,657.78<br />
3 3BFKU 3BFK3 C2F1S1 0.7124 0 to 5 $ 1,606.78 $ 139.84 $ 1,746.62<br />
3 3BFKV 3BFK4 C2F1S1 0.7124 0 to 5 $ 1,606.78 $ 207.76 $ 1,814.54<br />
19 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3BFKW 3BFK5 C2F1S1 0.7124 0 to 5 $ 1,606.78 $ 320.37 $ 1,927.15<br />
3 3BFKX 3BFK6 C2F1S1 0.7124 0 to 5 $ 1,606.78 $ 551.00 $ 2,157.78<br />
3 3BFLS 3BFL1 C2F1S2 1.0622 6 $ 2,395.73 $ 14.12 $ 2,409.85<br />
3 3BFLT 3BFL2 C2F1S2 1.0622 6 $ 2,395.73 $ 51.00 $ 2,446.73<br />
3 3BFLU 3BFL3 C2F1S2 1.0622 6 $ 2,395.73 $ 139.84 $ 2,535.57<br />
3 3BFLV 3BFL4 C2F1S2 1.0622 6 $ 2,395.73 $ 207.76 $ 2,603.49<br />
3 3BFLW 3BFL5 C2F1S2 1.0622 6 $ 2,395.73 $ 320.37 $ 2,716.10<br />
3 3BFLX 3BFL6 C2F1S2 1.0622 6 $ 2,395.73 $ 551.00 $ 2,946.73<br />
3 3BFMS 3BFM1 C2F1S3 1.2646 7 to 9 $ 2,852.24 $ 14.12 $ 2,866.36<br />
3 3BFMT 3BFM2 C2F1S3 1.2646 7 to 9 $ 2,852.24 $ 51.00 $ 2,903.24<br />
3 3BFMU 3BFM3 C2F1S3 1.2646 7 to 9 $ 2,852.24 $ 139.84 $ 2,992.08<br />
3 3BFMV 3BFM4 C2F1S3 1.2646 7 to 9 $ 2,852.24 $ 207.76 $ 3,060.00<br />
3 3BFMW 3BFM5 C2F1S3 1.2646 7 to 9 $ 2,852.24 $ 320.37 $ 3,172.61<br />
3 3BFMX 3BFM6 C2F1S3 1.2646 7 to 9 $ 2,852.24 $ 551.00 $ 3,403.24<br />
3 3BFNS 3BFN1 C2F1S4 1.4858 10 $ 3,351.14 $ 14.12 $ 3,365.26<br />
3 3BFNT 3BFN2 C2F1S4 1.4858 10 $ 3,351.14 $ 51.00 $ 3,402.14<br />
3 3BFNU 3BFN3 C2F1S4 1.4858 10 $ 3,351.14 $ 139.84 $ 3,490.98<br />
3 3BFNV 3BFN4 C2F1S4 1.4858 10 $ 3,351.14 $ 207.76 $ 3,558.90<br />
3 3BFNW 3BFN5 C2F1S4 1.4858 10 $ 3,351.14 $ 320.37 $ 3,671.51<br />
3 3BFNX 3BFN6 C2F1S4 1.4858 10 $ 3,351.14 $ 551.00 $ 3,902.14<br />
3 3BFPS 3BFP1 C2F1S5 1.6605 11 to 13 $ 3,745.17 $ 14.12 $ 3,759.29<br />
3 3BFPT 3BFP2 C2F1S5 1.6605 11 to 13 $ 3,745.17 $ 51.00 $ 3,796.17<br />
3 3BFPU 3BFP3 C2F1S5 1.6605 11 to 13 $ 3,745.17 $ 139.84 $ 3,885.01<br />
3 3BFPV 3BFP4 C2F1S5 1.6605 11 to 13 $ 3,745.17 $ 207.76 $ 3,952.93<br />
3 3BFPW 3BFP5 C2F1S5 1.6605 11 to 13 $ 3,745.17 $ 320.37 $ 4,065.54<br />
3 3BFPX 3BFP6 C2F1S5 1.6605 11 to 13 $ 3,745.17 $ 551.00 $ 4,296.17<br />
3 3BGKS 3BGK1 C2F2S1 0.8463 0 to 5 $ 1,908.78 $ 14.12 $ 1,922.90<br />
3 3BGKT 3BGK2 C2F2S1 0.8463 0 to 5 $ 1,908.78 $ 51.00 $ 1,959.78<br />
20 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3BGKU 3BGK3 C2F2S1 0.8463 0 to 5 $ 1,908.78 $ 139.84 $ 2,048.62<br />
3 3BGKV 3BGK4 C2F2S1 0.8463 0 to 5 $ 1,908.78 $ 207.76 $ 2,116.54<br />
3 3BGKW 3BGK5 C2F2S1 0.8463 0 to 5 $ 1,908.78 $ 320.37 $ 2,229.15<br />
3 3BGKX 3BGK6 C2F2S1 0.8463 0 to 5 $ 1,908.78 $ 551.00 $ 2,459.78<br />
3 3BGLS 3BGL1 C2F2S2 1.1962 6 $ 2,697.96 $ 14.12 $ 2,712.08<br />
3 3BGLT 3BGL2 C2F2S2 1.1962 6 $ 2,697.96 $ 51.00 $ 2,748.96<br />
3 3BGLU 3BGL3 C2F2S2 1.1962 6 $ 2,697.96 $ 139.84 $ 2,837.80<br />
3 3BGLV 3BGL4 C2F2S2 1.1962 6 $ 2,697.96 $ 207.76 $ 2,905.72<br />
3 3BGLW 3BGL5 C2F2S2 1.1962 6 $ 2,697.96 $ 320.37 $ 3,018.33<br />
3 3BGLX 3BGL6 C2F2S2 1.1962 6 $ 2,697.96 $ 551.00 $ 3,248.96<br />
3 3BGMS 3BGM1 C2F2S3 1.3986 7 to 9 $ 3,154.47 $ 14.12 $ 3,168.59<br />
3 3BGMT 3BGM2 C2F2S3 1.3986 7 to 9 $ 3,154.47 $ 51.00 $ 3,205.47<br />
3 3BGMU 3BGM3 C2F2S3 1.3986 7 to 9 $ 3,154.47 $ 139.84 $ 3,294.31<br />
3 3BGMV 3BGM4 C2F2S3 1.3986 7 to 9 $ 3,154.47 $ 207.76 $ 3,362.23<br />
3 3BGMW 3BGM5 C2F2S3 1.3986 7 to 9 $ 3,154.47 $ 320.37 $ 3,474.84<br />
3 3BGMX 3BGM6 C2F2S3 1.3986 7 to 9 $ 3,154.47 $ 551.00 $ 3,705.47<br />
3 3BGNS 3BGN1 C2F2S4 1.6198 10 $ 3,653.37 $ 14.12 $ 3,667.49<br />
3 3BGNT 3BGN2 C2F2S4 1.6198 10 $ 3,653.37 $ 51.00 $ 3,704.37<br />
3 3BGNU 3BGN3 C2F2S4 1.6198 10 $ 3,653.37 $ 139.84 $ 3,793.21<br />
3 3BGNV 3BGN4 C2F2S4 1.6198 10 $ 3,653.37 $ 207.76 $ 3,861.13<br />
3 3BGNW 3BGN5 C2F2S4 1.6198 10 $ 3,653.37 $ 320.37 $ 3,973.74<br />
3 3BGNX 3BGN6 C2F2S4 1.6198 10 $ 3,653.37 $ 551.00 $ 4,204.37<br />
3 3BGPS 3BGP1 C2F2S5 1.7945 11 to 13 $ 4,047.40 $ 14.12 $ 4,061.52<br />
3 3BGPT 3BGP2 C2F2S5 1.7945 11 to 13 $ 4,047.40 $ 51.00 $ 4,098.40<br />
3 3BGPU 3BGP3 C2F2S5 1.7945 11 to 13 $ 4,047.40 $ 139.84 $ 4,187.24<br />
3 3BGPV 3BGP4 C2F2S5 1.7945 11 to 13 $ 4,047.40 $ 207.76 $ 4,255.16<br />
3 3BGPW 3BGP5 C2F2S5 1.7945 11 to 13 $ 4,047.40 $ 320.37 $ 4,367.77<br />
3 3BGPX 3BGP6 C2F2S5 1.7945 11 to 13 $ 4,047.40 $ 551.00 $ 4,598.40<br />
21 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3BHKS 3BHK1 C2F3S1 0.9732 0 to 5 $ 2,195.00 $ 14.12 $ 2,209.12<br />
3 3BHKT 3BHK2 C2F3S1 0.9732 0 to 5 $ 2,195.00 $ 51.00 $ 2,246.00<br />
3 3BHKU 3BHK3 C2F3S1 0.9732 0 to 5 $ 2,195.00 $ 139.84 $ 2,334.84<br />
3 3BHKV 3BHK4 C2F3S1 0.9732 0 to 5 $ 2,195.00 $ 207.76 $ 2,402.76<br />
3 3BHKW 3BHK5 C2F3S1 0.9732 0 to 5 $ 2,195.00 $ 320.37 $ 2,515.37<br />
3 3BHKX 3BHK6 C2F3S1 0.9732 0 to 5 $ 2,195.00 $ 551.00 $ 2,746.00<br />
3 3BHLS 3BHL1 C2F3S2 1.3230 6 $ 2,983.95 $ 14.12 $ 2,998.07<br />
3 3BHLT 3BHL2 C2F3S2 1.3230 6 $ 2,983.95 $ 51.00 $ 3,034.95<br />
3 3BHLU 3BHL3 C2F3S2 1.3230 6 $ 2,983.95 $ 139.84 $ 3,123.79<br />
3 3BHLV 3BHL4 C2F3S2 1.3230 6 $ 2,983.95 $ 207.76 $ 3,191.71<br />
3 3BHLW 3BHL5 C2F3S2 1.3230 6 $ 2,983.95 $ 320.37 $ 3,304.32<br />
3 3BHLX 3BHL6 C2F3S2 1.3230 6 $ 2,983.95 $ 551.00 $ 3,534.95<br />
3 3BHMS 3BHM1 C2F3S3 1.5255 7 to 9 $ 3,440.68 $ 14.12 $ 3,454.80<br />
3 3BHMT 3BHM2 C2F3S3 1.5255 7 to 9 $ 3,440.68 $ 51.00 $ 3,491.68<br />
3 3BHMU 3BHM3 C2F3S3 1.5255 7 to 9 $ 3,440.68 $ 139.84 $ 3,580.52<br />
3 3BHMV 3BHM4 C2F3S3 1.5255 7 to 9 $ 3,440.68 $ 207.76 $ 3,648.44<br />
3 3BHMW 3BHM5 C2F3S3 1.5255 7 to 9 $ 3,440.68 $ 320.37 $ 3,761.05<br />
3 3BHMX 3BHM6 C2F3S3 1.5255 7 to 9 $ 3,440.68 $ 551.00 $ 3,991.68<br />
3 3BHNS 3BHN1 C2F3S4 1.7467 10 $ 3,939.59 $ 14.12 $ 3,953.71<br />
3 3BHNT 3BHN2 C2F3S4 1.7467 10 $ 3,939.59 $ 51.00 $ 3,990.59<br />
3 3BHNU 3BHN3 C2F3S4 1.7467 10 $ 3,939.59 $ 139.84 $ 4,079.43<br />
3 3BHNV 3BHN4 C2F3S4 1.7467 10 $ 3,939.59 $ 207.76 $ 4,147.35<br />
3 3BHNW 3BHN5 C2F3S4 1.7467 10 $ 3,939.59 $ 320.37 $ 4,259.96<br />
3 3BHNX 3BHN6 C2F3S4 1.7467 10 $ 3,939.59 $ 551.00 $ 4,490.59<br />
3 3BHPS 3BHP1 C2F3S5 1.9213 11 to 13 $ 4,333.39 $ 14.12 $ 4,347.51<br />
3 3BHPT 3BHP2 C2F3S5 1.9213 11 to 13 $ 4,333.39 $ 51.00 $ 4,384.39<br />
3 3BHPU 3BHP3 C2F3S5 1.9213 11 to 13 $ 4,333.39 $ 139.84 $ 4,473.23<br />
3 3BHPV 3BHP4 C2F3S5 1.9213 11 to 13 $ 4,333.39 $ 207.76 $ 4,541.15<br />
22 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3BHPW 3BHP5 C2F3S5 1.9213 11 to 13 $ 4,333.39 $ 320.37 $ 4,653.76<br />
3 3BHPX 3BHP6 C2F3S5 1.9213 11 to 13 $ 4,333.39 $ 551.00 $ 4,884.39<br />
3 3CFKS 3CFK1 C3F1S1 0.9399 0 to 5 $ 2,119.89 $ 14.12 $ 2,134.01<br />
3 3CFKT 3CFK2 C3F1S1 0.9399 0 to 5 $ 2,119.89 $ 51.00 $ 2,170.89<br />
3 3CFKU 3CFK3 C3F1S1 0.9399 0 to 5 $ 2,119.89 $ 139.84 $ 2,259.73<br />
3 3CFKV 3CFK4 C3F1S1 0.9399 0 to 5 $ 2,119.89 $ 207.76 $ 2,327.65<br />
3 3CFKW 3CFK5 C3F1S1 0.9399 0 to 5 $ 2,119.89 $ 320.37 $ 2,440.26<br />
3 3CFKX 3CFK6 C3F1S1 0.9399 0 to 5 $ 2,119.89 $ 551.00 $ 2,670.89<br />
3 3CFLS 3CFL1 C3F1S2 1.2897 6 $ 2,908.85 $ 14.12 $ 2,922.97<br />
3 3CFLT 3CFL2 C3F1S2 1.2897 6 $ 2,908.85 $ 51.00 $ 2,959.85<br />
3 3CFLU 3CFL3 C3F1S2 1.2897 6 $ 2,908.85 $ 139.84 $ 3,048.69<br />
3 3CFLV 3CFL4 C3F1S2 1.2897 6 $ 2,908.85 $ 207.76 $ 3,116.61<br />
3 3CFLW 3CFL5 C3F1S2 1.2897 6 $ 2,908.85 $ 320.37 $ 3,229.22<br />
3 3CFLX 3CFL6 C3F1S2 1.2897 6 $ 2,908.85 $ 551.00 $ 3,459.85<br />
3 3CFMS 3CFM1 C3F1S3 1.4922 7 to 9 $ 3,365.57 $ 14.12 $ 3,379.69<br />
3 3CFMT 3CFM2 C3F1S3 1.4922 7 to 9 $ 3,365.57 $ 51.00 $ 3,416.57<br />
3 3CFMU 3CFM3 C3F1S3 1.4922 7 to 9 $ 3,365.57 $ 139.84 $ 3,505.41<br />
3 3CFMV 3CFM4 C3F1S3 1.4922 7 to 9 $ 3,365.57 $ 207.76 $ 3,573.33<br />
3 3CFMW 3CFM5 C3F1S3 1.4922 7 to 9 $ 3,365.57 $ 320.37 $ 3,685.94<br />
3 3CFMX 3CFM6 C3F1S3 1.4922 7 to 9 $ 3,365.57 $ 551.00 $ 3,916.57<br />
3 3CFNS 3CFN1 C3F1S4 1.7134 10 $ 3,864.48 $ 14.12 $ 3,878.60<br />
3 3CFNT 3CFN2 C3F1S4 1.7134 10 $ 3,864.48 $ 51.00 $ 3,915.48<br />
3 3CFNU 3CFN3 C3F1S4 1.7134 10 $ 3,864.48 $ 139.84 $ 4,004.32<br />
3 3CFNV 3CFN4 C3F1S4 1.7134 10 $ 3,864.48 $ 207.76 $ 4,072.24<br />
3 3CFNW 3CFN5 C3F1S4 1.7134 10 $ 3,864.48 $ 320.37 $ 4,184.85<br />
3 3CFNX 3CFN6 C3F1S4 1.7134 10 $ 3,864.48 $ 551.00 $ 4,415.48<br />
3 3CFPS 3CFP1 C3F1S5 1.8880 11 to 13 $ 4,258.28 $ 14.12 $ 4,272.40<br />
3 3CFPT 3CFP2 C3F1S5 1.8880 11 to 13 $ 4,258.28 $ 51.00 $ 4,309.28<br />
23 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3CFPU 3CFP3 C3F1S5 1.8880 11 to 13 $ 4,258.28 $ 139.84 $ 4,398.12<br />
3 3CFPV 3CFP4 C3F1S5 1.8880 11 to 13 $ 4,258.28 $ 207.76 $ 4,466.04<br />
3 3CFPW 3CFP5 C3F1S5 1.8880 11 to 13 $ 4,258.28 $ 320.37 $ 4,578.65<br />
3 3CFPX 3CFP6 C3F1S5 1.8880 11 to 13 $ 4,258.28 $ 551.00 $ 4,809.28<br />
3 3CGKS 3CGK1 C3F2S1 1.0738 0 to 5 $ 2,421.90 $ 14.12 $ 2,436.02<br />
3 3CGKT 3CGK2 C3F2S1 1.0738 0 to 5 $ 2,421.90 $ 51.00 $ 2,472.90<br />
3 3CGKU 3CGK3 C3F2S1 1.0738 0 to 5 $ 2,421.90 $ 139.84 $ 2,561.74<br />
3 3CGKV 3CGK4 C3F2S1 1.0738 0 to 5 $ 2,421.90 $ 207.76 $ 2,629.66<br />
3 3CGKW 3CGK5 C3F2S1 1.0738 0 to 5 $ 2,421.90 $ 320.37 $ 2,742.27<br />
3 3CGKX 3CGK6 C3F2S1 1.0738 0 to 5 $ 2,421.90 $ 551.00 $ 2,972.90<br />
3 3CGLS 3CGL1 C3F2S2 1.4237 6 $ 3,211.08 $ 14.12 $ 3,225.20<br />
3 3CGLT 3CGL2 C3F2S2 1.4237 6 $ 3,211.08 $ 51.00 $ 3,262.08<br />
3 3CGLU 3CGL3 C3F2S2 1.4237 6 $ 3,211.08 $ 139.84 $ 3,350.92<br />
3 3CGLV 3CGL4 C3F2S2 1.4237 6 $ 3,211.08 $ 207.76 $ 3,418.84<br />
3 3CGLW 3CGL5 C3F2S2 1.4237 6 $ 3,211.08 $ 320.37 $ 3,531.45<br />
3 3CGLX 3CGL6 C3F2S2 1.4237 6 $ 3,211.08 $ 551.00 $ 3,762.08<br />
3 3CGMS 3CGM1 C3F2S3 1.6261 7 to 9 $ 3,667.58 $ 14.12 $ 3,681.70<br />
3 3CGMT 3CGM2 C3F2S3 1.6261 7 to 9 $ 3,667.58 $ 51.00 $ 3,718.58<br />
3 3CGMU 3CGM3 C3F2S3 1.6261 7 to 9 $ 3,667.58 $ 139.84 $ 3,807.42<br />
3 3CGMV 3CGM4 C3F2S3 1.6261 7 to 9 $ 3,667.58 $ 207.76 $ 3,875.34<br />
3 3CGMW 3CGM5 C3F2S3 1.6261 7 to 9 $ 3,667.58 $ 320.37 $ 3,987.95<br />
3 3CGMX 3CGM6 C3F2S3 1.6261 7 to 9 $ 3,667.58 $ 551.00 $ 4,218.58<br />
3 3CGNS 3CGN1 C3F2S4 1.8473 10 $ 4,166.48 $ 14.12 $ 4,180.60<br />
3 3CGNT 3CGN2 C3F2S4 1.8473 10 $ 4,166.48 $ 51.00 $ 4,217.48<br />
3 3CGNU 3CGN3 C3F2S4 1.8473 10 $ 4,166.48 $ 139.84 $ 4,306.32<br />
3 3CGNV 3CGN4 C3F2S4 1.8473 10 $ 4,166.48 $ 207.76 $ 4,374.24<br />
3 3CGNW 3CGN5 C3F2S4 1.8473 10 $ 4,166.48 $ 320.37 $ 4,486.85<br />
3 3CGNX 3CGN6 C3F2S4 1.8473 10 $ 4,166.48 $ 551.00 $ 4,717.48<br />
24 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3CGPS 3CGP1 C3F2S5 2.0220 11 to 13 $ 4,560.51 $ 14.12 $ 4,574.63<br />
3 3CGPT 3CGP2 C3F2S5 2.0220 11 to 13 $ 4,560.51 $ 51.00 $ 4,611.51<br />
3 3CGPU 3CGP3 C3F2S5 2.0220 11 to 13 $ 4,560.51 $ 139.84 $ 4,700.35<br />
3 3CGPV 3CGP4 C3F2S5 2.0220 11 to 13 $ 4,560.51 $ 207.76 $ 4,768.27<br />
3 3CGPW 3CGP5 C3F2S5 2.0220 11 to 13 $ 4,560.51 $ 320.37 $ 4,880.88<br />
3 3CGPX 3CGP6 C3F2S5 2.0220 11 to 13 $ 4,560.51 $ 551.00 $ 5,111.51<br />
3 3CHKS 3CHK1 C3F3S1 1.2007 0 to 5 $ 2,708.11 $ 14.12 $ 2,722.23<br />
3 3CHKT 3CHK2 C3F3S1 1.2007 0 to 5 $ 2,708.11 $ 51.00 $ 2,759.11<br />
3 3CHKU 3CHK3 C3F3S1 1.2007 0 to 5 $ 2,708.11 $ 139.84 $ 2,847.95<br />
3 3CHKV 3CHK4 C3F3S1 1.2007 0 to 5 $ 2,708.11 $ 207.76 $ 2,915.87<br />
3 3CHKW 3CHK5 C3F3S1 1.2007 0 to 5 $ 2,708.11 $ 320.37 $ 3,028.48<br />
3 3CHKX 3CHK6 C3F3S1 1.2007 0 to 5 $ 2,708.11 $ 551.00 $ 3,259.11<br />
3 3CHLS 3CHL1 C3F3S2 1.5506 6 $ 3,497.29 $ 14.12 $ 3,511.41<br />
3 3CHLT 3CHL2 C3F3S2 1.5506 6 $ 3,497.29 $ 51.00 $ 3,548.29<br />
3 3CHLU 3CHL3 C3F3S2 1.5506 6 $ 3,497.29 $ 139.84 $ 3,637.13<br />
3 3CHLV 3CHL4 C3F3S2 1.5506 6 $ 3,497.29 $ 207.76 $ 3,705.05<br />
3 3CHLW 3CHL5 C3F3S2 1.5506 6 $ 3,497.29 $ 320.37 $ 3,817.66<br />
3 3CHLX 3CHL6 C3F3S2 1.5506 6 $ 3,497.29 $ 551.00 $ 4,048.29<br />
3 3CHMS 3CHM1 C3F3S3 1.7530 7 to 9 $ 3,953.79 $ 14.12 $ 3,967.91<br />
3 3CHMT 3CHM2 C3F3S3 1.7530 7 to 9 $ 3,953.79 $ 51.00 $ 4,004.79<br />
3 3CHMU 3CHM3 C3F3S3 1.7530 7 to 9 $ 3,953.79 $ 139.84 $ 4,093.63<br />
3 3CHMV 3CHM4 C3F3S3 1.7530 7 to 9 $ 3,953.79 $ 207.76 $ 4,161.55<br />
3 3CHMW 3CHM5 C3F3S3 1.7530 7 to 9 $ 3,953.79 $ 320.37 $ 4,274.16<br />
3 3CHMX 3CHM6 C3F3S3 1.7530 7 to 9 $ 3,953.79 $ 551.00 $ 4,504.79<br />
3 3CHNS 3CHN1 C3F3S4 1.9742 10 $ 4,452.70 $ 14.12 $ 4,466.82<br />
3 3CHNT 3CHN2 C3F3S4 1.9742 10 $ 4,452.70 $ 51.00 $ 4,503.70<br />
3 3CHNU 3CHN3 C3F3S4 1.9742 10 $ 4,452.70 $ 139.84 $ 4,592.54<br />
3 3CHNV 3CHN4 C3F3S4 1.9742 10 $ 4,452.70 $ 207.76 $ 4,660.46<br />
25 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
3 3CHNW 3CHN5 C3F3S4 1.9742 10 $ 4,452.70 $ 320.37 $ 4,773.07<br />
3 3CHNX 3CHN6 C3F3S4 1.9742 10 $ 4,452.70 $ 551.00 $ 5,003.70<br />
3 3CHPS 3CHP1 C3F3S5 2.1489 11 to 13 $ 4,846.73 $ 14.12 $ 4,860.85<br />
3 3CHPT 3CHP2 C3F3S5 2.1489 11 to 13 $ 4,846.73 $ 51.00 $ 4,897.73<br />
3 3CHPU 3CHP3 C3F3S5 2.1489 11 to 13 $ 4,846.73 $ 139.84 $ 4,986.57<br />
3 3CHPV 3CHP4 C3F3S5 2.1489 11 to 13 $ 4,846.73 $ 207.76 $ 5,054.49<br />
3 3CHPW 3CHP5 C3F3S5 2.1489 11 to 13 $ 4,846.73 $ 320.37 $ 5,167.10<br />
3 3CHPX 3CHP6 C3F3S5 2.1489 11 to 13 $ 4,846.73 $ 551.00 $ 5,397.73<br />
Late (3 rd +) Episodes With 14 to 19 Therapy Visits<br />
4 4AFKS 4AFK1 C1F1S1 1.7530 14 to 15 $ 3,953.79 $ 14.12 $ 3,967.91<br />
4 4AFKT 4AFK2 C1F1S1 1.7530 14 to 15 $ 3,953.79 $ 51.00 $ 4,004.79<br />
4 4AFKU 4AFK3 C1F1S1 1.7530 14 to 15 $ 3,953.79 $ 139.84 $ 4,093.63<br />
4 4AFKV 4AFK4 C1F1S1 1.7530 14 to 15 $ 3,953.79 $ 207.76 $ 4,161.55<br />
4 4AFKW 4AFK5 C1F1S1 1.7530 14 to 15 $ 3,953.79 $ 320.37 $ 4,274.16<br />
4 4AFKX 4AFK6 C1F1S1 1.7530 14 to 15 $ 3,953.79 $ 551.00 $ 4,504.79<br />
4 4AFLS 4AFL1 C1F1S2 1.8689 16 to 17 $ 4,215.20 $ 14.12 $ 4,229.32<br />
4 4AFLT 4AFL2 C1F1S2 1.8689 16 to 17 $ 4,215.20 $ 51.00 $ 4,266.20<br />
4 4AFLU 4AFL3 C1F1S2 1.8689 16 to 17 $ 4,215.20 $ 139.84 $ 4,355.04<br />
4 4AFLV 4AFL4 C1F1S2 1.8689 16 to 17 $ 4,215.20 $ 207.76 $ 4,422.96<br />
4 4AFLW 4AFL5 C1F1S2 1.8689 16 to 17 $ 4,215.20 $ 320.37 $ 4,535.57<br />
4 4AFLX 4AFL6 C1F1S2 1.8689 16 to 17 $ 4,215.20 $ 551.00 $ 4,766.20<br />
4 4AFMS 4AFM1 C1F1S3 2.0252 18 to 19 $ 4,567.73 $ 14.12 $ 4,581.85<br />
4 4AFMT 4AFM2 C1F1S3 2.0252 18 to 19 $ 4,567.73 $ 51.00 $ 4,618.73<br />
4 4AFMU 4AFM3 C1F1S3 2.0252 18 to 19 $ 4,567.73 $ 139.84 $ 4,707.57<br />
4 4AFMV 4AFM4 C1F1S3 2.0252 18 to 19 $ 4,567.73 $ 207.76 $ 4,775.49<br />
4 4AFMW 4AFM5 C1F1S3 2.0252 18 to 19 $ 4,567.73 $ 320.37 $ 4,888.10<br />
4 4AFMX 4AFM6 C1F1S3 2.0252 18 to 19 $ 4,567.73 $ 551.00 $ 5,118.73<br />
26 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
4 4AGKS 4AGK1 C1F2S1 1.8839 14 to 15 $ 4,249.03 $ 14.12 $ 4,263.15<br />
4 4AGKT 4AGK2 C1F2S1 1.8839 14 to 15 $ 4,249.03 $ 51.00 $ 4,300.03<br />
4 4AGKU 4AGK3 C1F2S1 1.8839 14 to 15 $ 4,249.03 $ 139.84 $ 4,388.87<br />
4 4AGKV 4AGK4 C1F2S1 1.8839 14 to 15 $ 4,249.03 $ 207.76 $ 4,456.79<br />
4 4AGKW 4AGK5 C1F2S1 1.8839 14 to 15 $ 4,249.03 $ 320.37 $ 4,569.40<br />
4 4AGKX 4AGK6 C1F2S1 1.8839 14 to 15 $ 4,249.03 $ 551.00 $ 4,800.03<br />
4 4AGLS 4AGL1 C1F2S2 1.9998 16 to 17 $ 4,510.44 $ 14.12 $ 4,524.56<br />
4 4AGLT 4AGL2 C1F2S2 1.9998 16 to 17 $ 4,510.44 $ 51.00 $ 4,561.44<br />
4 4AGLU 4AGL3 C1F2S2 1.9998 16 to 17 $ 4,510.44 $ 139.84 $ 4,650.28<br />
4 4AGLV 4AGL4 C1F2S2 1.9998 16 to 17 $ 4,510.44 $ 207.76 $ 4,718.20<br />
4 4AGLW 4AGL5 C1F2S2 1.9998 16 to 17 $ 4,510.44 $ 320.37 $ 4,830.81<br />
4 4AGLX 4AGL6 C1F2S2 1.9998 16 to 17 $ 4,510.44 $ 551.00 $ 5,061.44<br />
4 4AGMS 4AGM1 C1F2S3 2.1560 18 to 19 $ 4,862.74 $ 14.12 $ 4,876.86<br />
4 4AGMT 4AGM2 C1F2S3 2.1560 18 to 19 $ 4,862.74 $ 51.00 $ 4,913.74<br />
4 4AGMU 4AGM3 C1F2S3 2.1560 18 to 19 $ 4,862.74 $ 139.84 $ 5,002.58<br />
4 4AGMV 4AGM4 C1F2S3 2.1560 18 to 19 $ 4,862.74 $ 207.76 $ 5,070.50<br />
4 4AGMW 4AGM5 C1F2S3 2.1560 18 to 19 $ 4,862.74 $ 320.37 $ 5,183.11<br />
4 4AGMX 4AGM6 C1F2S3 2.1560 18 to 19 $ 4,862.74 $ 551.00 $ 5,413.74<br />
4 4AHKS 4AHK1 C1F3S1 2.0531 14 to 15 $ 4,630.65 $ 14.12 $ 4,644.77<br />
4 4AHKT 4AHK2 C1F3S1 2.0531 14 to 15 $ 4,630.65 $ 51.00 $ 4,681.65<br />
4 4AHKU 4AHK3 C1F3S1 2.0531 14 to 15 $ 4,630.65 $ 139.84 $ 4,770.49<br />
4 4AHKV 4AHK4 C1F3S1 2.0531 14 to 15 $ 4,630.65 $ 207.76 $ 4,838.41<br />
4 4AHKW 4AHK5 C1F3S1 2.0531 14 to 15 $ 4,630.65 $ 320.37 $ 4,951.02<br />
4 4AHKX 4AHK6 C1F3S1 2.0531 14 to 15 $ 4,630.65 $ 551.00 $ 5,181.65<br />
4 4AHLS 4AHL1 C1F3S2 2.1690 16 to 17 $ 4,892.06 $ 14.12 $ 4,906.18<br />
4 4AHLT 4AHL2 C1F3S2 2.1690 16 to 17 $ 4,892.06 $ 51.00 $ 4,943.06<br />
4 4AHLU 4AHL3 C1F3S2 2.1690 16 to 17 $ 4,892.06 $ 139.84 $ 5,031.90<br />
4 4AHLV 4AHL4 C1F3S2 2.1690 16 to 17 $ 4,892.06 $ 207.76 $ 5,099.82<br />
27 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
4 4AHLW 4AHL5 C1F3S2 2.1690 16 to 17 $ 4,892.06 $ 320.37 $ 5,212.43<br />
4 4AHLX 4AHL6 C1F3S2 2.1690 16 to 17 $ 4,892.06 $ 551.00 $ 5,443.06<br />
4 4AHMS 4AHM1 C1F3S3 2.3252 18 to 19 $ 5,244.36 $ 14.12 $ 5,258.48<br />
4 4AHMT 4AHM2 C1F3S3 2.3252 18 to 19 $ 5,244.36 $ 51.00 $ 5,295.36<br />
4 4AHMU 4AHM3 C1F3S3 2.3252 18 to 19 $ 5,244.36 $ 139.84 $ 5,384.20<br />
4 4AHMV 4AHM4 C1F3S3 2.3252 18 to 19 $ 5,244.36 $ 207.76 $ 5,452.12<br />
4 4AHMW 4AHM5 C1F3S3 2.3252 18 to 19 $ 5,244.36 $ 320.37 $ 5,564.73<br />
4 4AHMX 4AHM6 C1F3S3 2.3252 18 to 19 $ 5,244.36 $ 551.00 $ 5,795.36<br />
4 4BFKS 4BFK1 C2F1S1 2.0276 14 to 15 $ 4,573.14 $ 14.12 $ 4,587.26<br />
4 4BFKT 4BFK2 C2F1S1 2.0276 14 to 15 $ 4,573.14 $ 51.00 $ 4,624.14<br />
4 4BFKU 4BFK3 C2F1S1 2.0276 14 to 15 $ 4,573.14 $ 139.84 $ 4,712.98<br />
4 4BFKV 4BFK4 C2F1S1 2.0276 14 to 15 $ 4,573.14 $ 207.76 $ 4,780.90<br />
4 4BFKW 4BFK5 C2F1S1 2.0276 14 to 15 $ 4,573.14 $ 320.37 $ 4,893.51<br />
4 4BFKX 4BFK6 C2F1S1 2.0276 14 to 15 $ 4,573.14 $ 551.00 $ 5,124.14<br />
4 4BFLS 4BFL1 C2F1S2 2.1435 16 to 17 $ 4,834.55 $ 14.12 $ 4,848.67<br />
4 4BFLT 4BFL2 C2F1S2 2.1435 16 to 17 $ 4,834.55 $ 51.00 $ 4,885.55<br />
4 4BFLU 4BFL3 C2F1S2 2.1435 16 to 17 $ 4,834.55 $ 139.84 $ 4,974.39<br />
4 4BFLV 4BFL4 C2F1S2 2.1435 16 to 17 $ 4,834.55 $ 207.76 $ 5,042.31<br />
4 4BFLW 4BFL5 C2F1S2 2.1435 16 to 17 $ 4,834.55 $ 320.37 $ 5,154.92<br />
4 4BFLX 4BFL6 C2F1S2 2.1435 16 to 17 $ 4,834.55 $ 551.00 $ 5,385.55<br />
4 4BFMS 4BFM1 C2F1S3 2.2998 18 to 19 $ 5,187.07 $ 14.12 $ 5,201.19<br />
4 4BFMT 4BFM2 C2F1S3 2.2998 18 to 19 $ 5,187.07 $ 51.00 $ 5,238.07<br />
4 4BFMU 4BFM3 C2F1S3 2.2998 18 to 19 $ 5,187.07 $ 139.84 $ 5,326.91<br />
4 4BFMV 4BFM4 C2F1S3 2.2998 18 to 19 $ 5,187.07 $ 207.76 $ 5,394.83<br />
4 4BFMW 4BFM5 C2F1S3 2.2998 18 to 19 $ 5,187.07 $ 320.37 $ 5,507.44<br />
4 4BFMX 4BFM6 C2F1S3 2.2998 18 to 19 $ 5,187.07 $ 551.00 $ 5,738.07<br />
4 4BGKS 4BGK1 C2F2S1 2.1585 14 to 15 $ 4,868.38 $ 14.12 $ 4,882.50<br />
4 4BGKT 4BGK2 C2F2S1 2.1585 14 to 15 $ 4,868.38 $ 51.00 $ 4,919.38<br />
28 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
4 4BGKU 4BGK3 C2F2S1 2.1585 14 to 15 $ 4,868.38 $ 139.84 $ 5,008.22<br />
4 4BGKV 4BGK4 C2F2S1 2.1585 14 to 15 $ 4,868.38 $ 207.76 $ 5,076.14<br />
4 4BGKW 4BGK5 C2F2S1 2.1585 14 to 15 $ 4,868.38 $ 320.37 $ 5,188.75<br />
4 4BGKX 4BGK6 C2F2S1 2.1585 14 to 15 $ 4,868.38 $ 551.00 $ 5,419.38<br />
4 4BGLS 4BGL1 C2F2S2 2.2744 16 to 17 $ 5,129.78 $ 14.12 $ 5,143.90<br />
4 4BGLT 4BGL2 C2F2S2 2.2744 16 to 17 $ 5,129.78 $ 51.00 $ 5,180.78<br />
4 4BGLU 4BGL3 C2F2S2 2.2744 16 to 17 $ 5,129.78 $ 139.84 $ 5,269.62<br />
4 4BGLV 4BGL4 C2F2S2 2.2744 16 to 17 $ 5,129.78 $ 207.76 $ 5,337.54<br />
4 4BGLW 4BGL5 C2F2S2 2.2744 16 to 17 $ 5,129.78 $ 320.37 $ 5,450.15<br />
4 4BGLX 4BGL6 C2F2S2 2.2744 16 to 17 $ 5,129.78 $ 551.00 $ 5,680.78<br />
4 4BGMS 4BGM1 C2F2S3 2.4306 18 to 19 $ 5,482.08 $ 14.12 $ 5,496.20<br />
4 4BGMT 4BGM2 C2F2S3 2.4306 18 to 19 $ 5,482.08 $ 51.00 $ 5,533.08<br />
4 4BGMU 4BGM3 C2F2S3 2.4306 18 to 19 $ 5,482.08 $ 139.84 $ 5,621.92<br />
4 4BGMV 4BGM4 C2F2S3 2.4306 18 to 19 $ 5,482.08 $ 207.76 $ 5,689.84<br />
4 4BGMW 4BGM5 C2F2S3 2.4306 18 to 19 $ 5,482.08 $ 320.37 $ 5,802.45<br />
4 4BGMX 4BGM6 C2F2S3 2.4306 18 to 19 $ 5,482.08 $ 551.00 $ 6,033.08<br />
4 4BHKS 4BHK1 C2F3S1 2.3277 14 to 15 $ 5,250.00 $ 14.12 $ 5,264.12<br />
4 4BHKT 4BHK2 C2F3S1 2.3277 14 to 15 $ 5,250.00 $ 51.00 $ 5,301.00<br />
4 4BHKU 4BHK3 C2F3S1 2.3277 14 to 15 $ 5,250.00 $ 139.84 $ 5,389.84<br />
4 4BHKV 4BHK4 C2F3S1 2.3277 14 to 15 $ 5,250.00 $ 207.76 $ 5,457.76<br />
4 4BHKW 4BHK5 C2F3S1 2.3277 14 to 15 $ 5,250.00 $ 320.37 $ 5,570.37<br />
4 4BHKX 4BHK6 C2F3S1 2.3277 14 to 15 $ 5,250.00 $ 551.00 $ 5,801.00<br />
4 4BHLS 4BHL1 C2F3S2 2.4436 16 to 17 $ 5,511.41 $ 14.12 $ 5,525.53<br />
4 4BHLT 4BHL2 C2F3S2 2.4436 16 to 17 $ 5,511.41 $ 51.00 $ 5,562.41<br />
4 4BHLU 4BHL3 C2F3S2 2.4436 16 to 17 $ 5,511.41 $ 139.84 $ 5,651.25<br />
4 4BHLV 4BHL4 C2F3S2 2.4436 16 to 17 $ 5,511.41 $ 207.76 $ 5,719.17<br />
4 4BHLW 4BHL5 C2F3S2 2.4436 16 to 17 $ 5,511.41 $ 320.37 $ 5,831.78<br />
4 4BHLX 4BHL6 C2F3S2 2.4436 16 to 17 $ 5,511.41 $ 551.00 $ 6,062.41<br />
29 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
4 4BHMS 4BHM1 C2F3S3 2.5998 18 to 19 $ 5,863.71 $ 14.12 $ 5,877.83<br />
4 4BHMT 4BHM2 C2F3S3 2.5998 18 to 19 $ 5,863.71 $ 51.00 $ 5,914.71<br />
4 4BHMU 4BHM3 C2F3S3 2.5998 18 to 19 $ 5,863.71 $ 139.84 $ 6,003.55<br />
4 4BHMV 4BHM4 C2F3S3 2.5998 18 to 19 $ 5,863.71 $ 207.76 $ 6,071.47<br />
4 4BHMW 4BHM5 C2F3S3 2.5998 18 to 19 $ 5,863.71 $ 320.37 $ 6,184.08<br />
4 4BHMX 4BHM6 C2F3S3 2.5998 18 to 19 $ 5,863.71 $ 551.00 $ 6,414.71<br />
4 4CFKS 4CFK1 C3F1S1 2.3479 14 to 15 $ 5,295.56 $ 14.12 $ 5,309.68<br />
4 4CFKT 4CFK2 C3F1S1 2.3479 14 to 15 $ 5,295.56 $ 51.00 $ 5,346.56<br />
4 4CFKU 4CFK3 C3F1S1 2.3479 14 to 15 $ 5,295.56 $ 139.84 $ 5,435.40<br />
4 4CFKV 4CFK4 C3F1S1 2.3479 14 to 15 $ 5,295.56 $ 207.76 $ 5,503.32<br />
4 4CFKW 4CFK5 C3F1S1 2.3479 14 to 15 $ 5,295.56 $ 320.37 $ 5,615.93<br />
4 4CFKX 4CFK6 C3F1S1 2.3479 14 to 15 $ 5,295.56 $ 551.00 $ 5,846.56<br />
4 4CFLS 4CFL1 C3F1S2 2.4637 16 to 17 $ 5,556.74 $ 14.12 $ 5,570.86<br />
4 4CFLT 4CFL2 C3F1S2 2.4637 16 to 17 $ 5,556.74 $ 51.00 $ 5,607.74<br />
4 4CFLU 4CFL3 C3F1S2 2.4637 16 to 17 $ 5,556.74 $ 139.84 $ 5,696.58<br />
4 4CFLV 4CFL4 C3F1S2 2.4637 16 to 17 $ 5,556.74 $ 207.76 $ 5,764.50<br />
4 4CFLW 4CFL5 C3F1S2 2.4637 16 to 17 $ 5,556.74 $ 320.37 $ 5,877.11<br />
4 4CFLX 4CFL6 C3F1S2 2.4637 16 to 17 $ 5,556.74 $ 551.00 $ 6,107.74<br />
4 4CFMS 4CFM1 C3F1S3 2.6200 18 to 19 $ 5,909.27 $ 14.12 $ 5,923.39<br />
4 4CFMT 4CFM2 C3F1S3 2.6200 18 to 19 $ 5,909.27 $ 51.00 $ 5,960.27<br />
4 4CFMU 4CFM3 C3F1S3 2.6200 18 to 19 $ 5,909.27 $ 139.84 $ 6,049.11<br />
4 4CFMV 4CFM4 C3F1S3 2.6200 18 to 19 $ 5,909.27 $ 207.76 $ 6,117.03<br />
4 4CFMW 4CFM5 C3F1S3 2.6200 18 to 19 $ 5,909.27 $ 320.37 $ 6,229.64<br />
4 4CFMX 4CFM6 C3F1S3 2.6200 18 to 19 $ 5,909.27 $ 551.00 $ 6,460.27<br />
4 4CGKS 4CGK1 C3F2S1 2.4787 14 to 15 $ 5,590.57 $ 14.12 $ 5,604.69<br />
4 4CGKT 4CGK2 C3F2S1 2.4787 14 to 15 $ 5,590.57 $ 51.00 $ 5,641.57<br />
4 4CGKU 4CGK3 C3F2S1 2.4787 14 to 15 $ 5,590.57 $ 139.84 $ 5,730.41<br />
4 4CGKV 4CGK4 C3F2S1 2.4787 14 to 15 $ 5,590.57 $ 207.76 $ 5,798.33<br />
30 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
4 4CGKW 4CGK5 C3F2S1 2.4787 14 to 15 $ 5,590.57 $ 320.37 $ 5,910.94<br />
4 4CGKX 4CGK6 C3F2S1 2.4787 14 to 15 $ 5,590.57 $ 551.00 $ 6,141.57<br />
4 4CGLS 4CGL1 C3F2S2 2.5946 16 to 17 $ 5,851.98 $ 14.12 $ 5,866.10<br />
4 4CGLT 4CGL2 C3F2S2 2.5946 16 to 17 $ 5,851.98 $ 51.00 $ 5,902.98<br />
4 4CGLU 4CGL3 C3F2S2 2.5946 16 to 17 $ 5,851.98 $ 139.84 $ 5,991.82<br />
4 4CGLV 4CGL4 C3F2S2 2.5946 16 to 17 $ 5,851.98 $ 207.76 $ 6,059.74<br />
4 4CGLW 4CGL5 C3F2S2 2.5946 16 to 17 $ 5,851.98 $ 320.37 $ 6,172.35<br />
4 4CGLX 4CGL6 C3F2S2 2.5946 16 to 17 $ 5,851.98 $ 551.00 $ 6,402.98<br />
4 4CGMS 4CGM1 C3F2S3 2.7509 18 to 19 $ 6,204.50 $ 14.12 $ 6,218.62<br />
4 4CGMT 4CGM2 C3F2S3 2.7509 18 to 19 $ 6,204.50 $ 51.00 $ 6,255.50<br />
4 4CGMU 4CGM3 C3F2S3 2.7509 18 to 19 $ 6,204.50 $ 139.84 $ 6,344.34<br />
4 4CGMV 4CGM4 C3F2S3 2.7509 18 to 19 $ 6,204.50 $ 207.76 $ 6,412.26<br />
4 4CGMW 4CGM5 C3F2S3 2.7509 18 to 19 $ 6,204.50 $ 320.37 $ 6,524.87<br />
4 4CGMX 4CGM6 C3F2S3 2.7509 18 to 19 $ 6,204.50 $ 551.00 $ 6,755.50<br />
4 4CHKS 4CHK1 C3F3S1 2.6479 14 to 15 $ 5,972.19 $ 14.12 $ 5,986.31<br />
4 4CHKT 4CHK2 C3F3S1 2.6479 14 to 15 $ 5,972.19 $ 51.00 $ 6,023.19<br />
4 4CHKU 4CHK3 C3F3S1 2.6479 14 to 15 $ 5,972.19 $ 139.84 $ 6,112.03<br />
4 4CHKV 4CHK4 C3F3S1 2.6479 14 to 15 $ 5,972.19 $ 207.76 $ 6,179.95<br />
4 4CHKW 4CHK5 C3F3S1 2.6479 14 to 15 $ 5,972.19 $ 320.37 $ 6,292.56<br />
4 4CHKX 4CHK6 C3F3S1 2.6479 14 to 15 $ 5,972.19 $ 551.00 $ 6,523.19<br />
4 4CHLS 4CHL1 C3F3S2 2.7638 16 to 17 $ 6,233.60 $ 14.12 $ 6,247.72<br />
4 4CHLT 4CHL2 C3F3S2 2.7638 16 to 17 $ 6,233.60 $ 51.00 $ 6,284.60<br />
4 4CHLU 4CHL3 C3F3S2 2.7638 16 to 17 $ 6,233.60 $ 139.84 $ 6,373.44<br />
4 4CHLV 4CHL4 C3F3S2 2.7638 16 to 17 $ 6,233.60 $ 207.76 $ 6,441.36<br />
4 4CHLW 4CHL5 C3F3S2 2.7638 16 to 17 $ 6,233.60 $ 320.37 $ 6,553.97<br />
4 4CHLX 4CHL6 C3F3S2 2.7638 16 to 17 $ 6,233.60 $ 551.00 $ 6,784.60<br />
4 4CHMS 4CHM1 C3F3S3 2.9201 18 to 19 $ 6,586.12 $ 14.12 $ 6,600.24<br />
4 4CHMT 4CHM2 C3F3S3 2.9201 18 to 19 $ 6,586.12 $ 51.00 $ 6,637.12<br />
31 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
4 4CHMU 4CHM3 C3F3S3 2.9201 18 to 19 $ 6,586.12 $ 139.84 $ 6,725.96<br />
4 4CHMV 4CHM4 C3F3S3 2.9201 18 to 19 $ 6,586.12 $ 207.76 $ 6,793.88<br />
4 4CHMW 4CHM5 C3F3S3 2.9201 18 to 19 $ 6,586.12 $ 320.37 $ 6,906.49<br />
4 4CHMX 4CHM6 C3F3S3 2.9201 18 to 19 $ 6,586.12 $ 551.00 $ 7,137.12<br />
All Episodes With 20 or More Therapy Visits<br />
5 5AFKS 5AFK1 C1F1S1 2.5495 20+ $ 5,750.26 $ 14.12 $ 5,764.38<br />
5 5AFKT 5AFK2 C1F1S1 2.5495 20+ $ 5,750.26 $ 51.00 $ 5,801.26<br />
5 5AFKU 5AFK3 C1F1S1 2.5495 20+ $ 5,750.26 $ 139.84 $ 5,890.10<br />
5 5AFKV 5AFK4 C1F1S1 2.5495 20+ $ 5,750.26 $ 207.76 $ 5,958.02<br />
5 5AFKW 5AFK5 C1F1S1 2.5495 20+ $ 5,750.26 $ 320.37 $ 6,070.63<br />
5 5AFKX 5AFK6 C1F1S1 2.5495 20+ $ 5,750.26 $ 551.00 $ 6,301.26<br />
5 5AGKS 5AGK1 C1F2S1 2.7390 20+ $ 6,177.66 $ 14.12 $ 6,191.78<br />
5 5AGKT 5AGK2 C1F2S1 2.7390 20+ $ 6,177.66 $ 51.00 $ 6,228.66<br />
5 5AGKU 5AGK3 C1F2S1 2.7390 20+ $ 6,177.66 $ 139.84 $ 6,317.50<br />
5 5AGKV 5AGK4 C1F2S1 2.7390 20+ $ 6,177.66 $ 207.76 $ 6,385.42<br />
5 5AGKW 5AGK5 C1F2S1 2.7390 20+ $ 6,177.66 $ 320.37 $ 6,498.03<br />
5 5AGKX 5AGK6 C1F2S1 2.7390 20+ $ 6,177.66 $ 551.00 $ 6,728.66<br />
5 5AHKS 5AHK1 C1F3S1 2.9532 20+ $ 6,660.78 $ 14.12 $ 6,674.90<br />
5 5AHKT 5AHK2 C1F3S1 2.9532 20+ $ 6,660.78 $ 51.00 $ 6,711.78<br />
5 5AHKU 5AHK3 C1F3S1 2.9532 20+ $ 6,660.78 $ 139.84 $ 6,800.62<br />
5 5AHKV 5AHK4 C1F3S1 2.9532 20+ $ 6,660.78 $ 207.76 $ 6,868.54<br />
5 5AHKW 5AHK5 C1F3S1 2.9532 20+ $ 6,660.78 $ 320.37 $ 6,981.15<br />
5 5AHKX 5AHK6 C1F3S1 2.9532 20+ $ 6,660.78 $ 551.00 $ 7,211.78<br />
5 5BFKS 5BFK1 C2F1S1 2.7632 20+ $ 6,232.25 $ 14.12 $ 6,246.37<br />
5 5BFKT 5BFK2 C2F1S1 2.7632 20+ $ 6,232.25 $ 51.00 $ 6,283.25<br />
5 5BFKU 5BFK3 C2F1S1 2.7632 20+ $ 6,232.25 $ 139.84 $ 6,372.09<br />
5 5BFKV 5BFK4 C2F1S1 2.7632 20+ $ 6,232.25 $ 207.76 $ 6,440.01<br />
5 5BFKW 5BFK5 C2F1S1 2.7632 20+ $ 6,232.25 $ 320.37 $ 6,552.62<br />
32 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
5 5BFKX 5BFK6 C2F1S1 2.7632 20+ $ 6,232.25 $ 551.00 $ 6,783.25<br />
5 5BGKS 5BGK1 C2F2S1 2.9527 20+ $ 6,659.65 $ 14.12 $ 6,673.77<br />
5 5BGKT 5BGK2 C2F2S1 2.9527 20+ $ 6,659.65 $ 51.00 $ 6,710.65<br />
5 5BGKU 5BGK3 C2F2S1 2.9527 20+ $ 6,659.65 $ 139.84 $ 6,799.49<br />
5 5BGKV 5BGK4 C2F2S1 2.9527 20+ $ 6,659.65 $ 207.76 $ 6,867.41<br />
5 5BGKW 5BGK5 C2F2S1 2.9527 20+ $ 6,659.65 $ 320.37 $ 6,980.02<br />
5 5BGKX 5BGK6 C2F2S1 2.9527 20+ $ 6,659.65 $ 551.00 $ 7,210.65<br />
5 5BHKS 5BHK1 C2F3S1 3.1669 20+ $ 7,142.77 $ 14.12 $ 7,156.89<br />
5 5BHKT 5BHK2 C2F3S1 3.1669 20+ $ 7,142.77 $ 51.00 $ 7,193.77<br />
5 5BHKU 5BHK3 C2F3S1 3.1669 20+ $ 7,142.77 $ 139.84 $ 7,282.61<br />
5 5BHKV 5BHK4 C2F3S1 3.1669 20+ $ 7,142.77 $ 207.76 $ 7,350.53<br />
5 5BHKW 5BHK5 C2F3S1 3.1669 20+ $ 7,142.77 $ 320.37 $ 7,463.14<br />
5 5BHKX 5BHK6 C2F3S1 3.1669 20+ $ 7,142.77 $ 551.00 $ 7,693.77<br />
5 5CFKS 5CFK1 C3F1S1 3.0835 20+ $ 6,954.66 $ 14.12 $ 6,968.78<br />
5 5CFKT 5CFK2 C3F1S1 3.0835 20+ $ 6,954.66 $ 51.00 $ 7,005.66<br />
5 5CFKU 5CFK3 C3F1S1 3.0835 20+ $ 6,954.66 $ 139.84 $ 7,094.50<br />
5 5CFKV 5CFK4 C3F1S1 3.0835 20+ $ 6,954.66 $ 207.76 $ 7,162.42<br />
5 5CFKW 5CFK5 C3F1S1 3.0835 20+ $ 6,954.66 $ 320.37 $ 7,275.03<br />
5 5CFKX 5CFK6 C3F1S1 3.0835 20+ $ 6,954.66 $ 551.00 $ 7,505.66<br />
5 5CGKS 5CGK1 C3F2S1 3.2730 20+ $ 7,382.07 $ 14.12 $ 7,396.19<br />
5 5CGKT 5CGK2 C3F2S1 3.2730 20+ $ 7,382.07 $ 51.00 $ 7,433.07<br />
5 5CGKU 5CGK3 C3F2S1 3.2730 20+ $ 7,382.07 $ 139.84 $ 7,521.91<br />
5 5CGKV 5CGK4 C3F2S1 3.2730 20+ $ 7,382.07 $ 207.76 $ 7,589.83<br />
5 5CGKW 5CGK5 C3F2S1 3.2730 20+ $ 7,382.07 $ 320.37 $ 7,702.44<br />
5 5CGKX 5CGK6 C3F2S1 3.2730 20+ $ 7,382.07 $ 551.00 $ 7,933.07<br />
5 5CHKS 5CHK1 C3F3S1 3.4872 20+ $ 7,865.19 $ 14.12 $ 7,879.31<br />
5 5CHKT 5CHK2 C3F3S1 3.4872 20+ $ 7,865.19 $ 51.00 $ 7,916.19<br />
5 5CHKU 5CHK3 C3F3S1 3.4872 20+ $ 7,865.19 $ 139.84 $ 8,005.03<br />
33 of 34
Medicare <strong>Home</strong> Health <strong>PPS</strong> <strong>Payment</strong> <strong>Rates</strong><br />
Effective for Episodes Beginning and Ending in <strong>2008</strong><br />
CBSA<br />
Code<br />
19124 <strong>Dallas</strong>, Texas CBSA<br />
Service Area<br />
Urban or Rural Area<br />
<strong>Payment</strong> <strong>Rates</strong><br />
HI<strong>PPS</strong> Code<br />
<strong>Payment</strong><br />
No Case- Total<br />
<strong>Payment</strong> Supplies Supplies HHRG Mix Therapy HHRG NRS Total<br />
Grouping Billed Billed Code Weight Visits Portion Portion Episode<br />
5 5CHKV 5CHK4 C3F3S1 3.4872 20+ $ 7,865.19 $ 207.76 $ 8,072.95<br />
5 5CHKW 5CHK5 C3F3S1 3.4872 20+ $ 7,865.19 $ 320.37 $ 8,185.56<br />
5 5CHKX 5CHK6 C3F3S1 3.4872 20+ $ 7,865.19 $ 551.00 $ 8,416.19<br />
LUPA Per-Visit <strong>Payment</strong> <strong>Rates</strong><br />
Skilled nursing $ 104.22<br />
Physical therapy $ 113.96<br />
Occupational therapy $ 114.72<br />
Speech therapy $ 123.72<br />
Medical social worker $ 167.07<br />
<strong>Home</strong> health aide $ 47.20<br />
LUPA Episode Add-On <strong>Payment</strong> Amount<br />
Initial episodes $ 87.35<br />
All rates are effective for episodes beginning January 1, <strong>2008</strong>, and are based on the Federal<br />
Register, dated August 29, 2007, and the Centers for Medicare and Medicaid Services Transmittal<br />
1348, Change Request 5746 , dated October 5, 2007.<br />
BKD Health <strong>Care</strong> Group provides financial, billing, clinical and operational consulting services for<br />
home health and hospice agencies throughout the nation. Contact Mark Sharp at 417 865-8701 or<br />
msharp@bkd.com with questions regarding this information or browse the BKD website to learn<br />
more about our services.<br />
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