| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
301,070 |
55,380 |
$14.12M |
| V2799 |
Vision item or service, miscellaneous |
3,486 |
3,089 |
$1.68M |
| T2028 |
Specialized supply, not otherwise specified, waiver |
15,360 |
14,749 |
$992K |
| S5150 |
Unskilled respite care, not hospice; per 15 minutes |
956 |
660 |
$457K |
| T2004 |
Non-emergency transport; commercial carrier, multi-pass |
4,513 |
4,265 |
$188K |
| T2021 |
Day habilitation, waiver; per 15 minutes |
262 |
220 |
$159K |
| S5130 |
Homemaker service, nos; per 15 minutes |
842 |
535 |
$151K |
| T1016 |
Case management, each 15 minutes |
9,505 |
2,180 |
$135K |
| T2003 |
Non-emergency transportation; encounter/trip |
944 |
723 |
$126K |
| H2021 |
Community-based wrap-around services, per 15 minutes |
393 |
301 |
$111K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
428 |
340 |
$92K |
| 97124 |
|
122 |
116 |
$54K |
| S5151 |
Unskilled respite care, not hospice; per diem |
127 |
97 |
$54K |
| T1019 |
Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) |
192 |
169 |
$45K |
| G0176 |
Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
119 |
97 |
$30K |
| T2036 |
Therapeutic camping, overnight, waiver; each session |
17 |
15 |
$9K |
| T2035 |
Utility services to support medical equipment and assistive technology/devices, waiver |
14 |
12 |
$4K |