Certified Home Health Agencies
New York State Medicaid - Episodic Payment System (EPS)
Nassau, Suffolk and Westchester
| Rate Code | Rate Code Description | 1/1/20 Effective Date - Latest Approved | 4/1/22 Effective Date 1% Enhancement | 10/1/2022 MW Increase 5.25% |
|---|---|---|---|---|
| 4810 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1 | $2,036.63 | $2,057.00 | $2,164.99 |
| 4811 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2 | $2,266.91 | $2,289.58 | $2,409.78 |
| 4812 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3 | $2,266.91 | $2,289.58 | $2,409.78 |
| 4813 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4 | $2,635.34 | $2,661.69 | $2,801.43 |
| 4814 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5 | $2,635.34 | $2,661.69 | $2,801.43 |
| 4815 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6 | $2,777.76 | $2,805.54 | $2,952.83 |
| 4816 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1 | $3,161.71 | $3,193.33 | $3,360.98 |
| 4817 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2 | $3,687.78 | $3,724.66 | $3,920.20 |
| 4818 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3 | $3,687.78 | $3,724.66 | $3,920.20 |
| 4819 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4 | $4,079.96 | $4,120.76 | $4,337.10 |
| 4820 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5 | $4,079.96 | $4,120.76 | $4,337.10 |
| 4821 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6 | $4,533.28 | $4,578.61 | $4,818.99 |
| 4822 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1 | $3,820.52 | $3,858.73 | $4,061.31 |
| 4823 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2 | $4,103.92 | $4,144.96 | $4,362.57 |
| 4824 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3 | $4,103.92 | $4,144.96 | $4,362.57 |
| 4825 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4 | $4,960.44 | $5,010.04 | $5,273.07 |
| 4826 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5 | $4,960.44 | $5,010.04 | $5,273.07 |
| 4827 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6 | $6,360.35 | $6,423.95 | $6,761.21 |
| 4828 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1 | $2,291.03 | $2,313.94 | $2,435.42 |
| 4829 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2 | $2,487.44 | $2,512.31 | $2,644.21 |
| 4830 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3 | $2,487.44 | $2,512.31 | $2,644.21 |
| 4831 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4 | $2,573.06 | $2,598.79 | $2,735.23 |
| 4832 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5 | $2,573.06 | $2,598.79 | $2,735.23 |
| 4833 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6 | $2,800.71 | $2,828.72 | $2,977.22 |
| 4834 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1 | $3,512.24 | $3,547.36 | $3,733.60 |
| 4835 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2 | $3,778.23 | $3,816.01 | $4,016.35 |
| 4836 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3 | $3,778.23 | $3,816.01 | $4,016.35 |
| 4837 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4 | $4,216.11 | $4,258.27 | $4,481.83 |
| 4838 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5 | $4,216.11 | $4,258.27 | $4,481.83 |
| 4839 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6 | $4,627.07 | $4,673.34 | $4,918.69 |
| 4840 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1 | $4,915.44 | $4,964.59 | $5,225.24 |
| 4841 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2 | $5,543.06 | $5,598.49 | $5,892.41 |
| 4842 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3 | $5,543.06 | $5,598.49 | $5,892.41 |
| 4843 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4 | $6,582.34 | $6,648.16 | $6,997.19 |
| 4844 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5 | $6,582.34 | $6,648.16 | $6,997.19 |
| 4845 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6 | $7,187.88 | $7,259.76 | $7,640.90 |
| 4846 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1 | $2,511.16 | $2,536.27 | $2,669.43 |
| 4847 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2 | $2,849.21 | $2,877.70 | $3,028.78 |
| 4848 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3 | $2,849.21 | $2,877.70 | $3,028.78 |
| 4849 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4 | $3,086.25 | $3,117.11 | $3,280.76 |
| 4850 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5 | $3,086.25 | $3,117.11 | $3,280.76 |
| 4851 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6 | $3,782.27 | $3,820.09 | $4,020.65 |
| 4852 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1 | $4,511.25 | $4,556.36 | $4,795.57 |
| 4853 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2 | $5,210.64 | $5,262.75 | $5,539.04 |
| 4854 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3 | $5,210.64 | $5,262.75 | $5,539.04 |
| 4855 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4 | $5,793.68 | $5,851.62 | $6,158.83 |
| 4856 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5 | $5,793.68 | $5,851.62 | $6,158.83 |
| 4857 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6 | $6,089.15 | $6,150.04 | $6,472.92 |
| 4858 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1 | $5,647.17 | $5,703.64 | $6,003.08 |
| 4859 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2 | $7,942.98 | $8,022.41 | $8,443.59 |
| 4860 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3 | $7,942.98 | $8,022.41 | $8,443.59 |
| 4861 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4 | $7,969.83 | $8,049.53 | $8,472.13 |
| 4862 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5 | $7,969.83 | $8,049.53 | $8,472.13 |
| 4863 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6 | $9,236.38 | $9,328.74 | $9,818.50 |
| 4864 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1 | $1,496.68 | $1,511.65 | $1,591.01 |
| 4865 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2 | $1,635.88 | $1,652.24 | $1,738.98 |
| 4866 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3 | $1,635.88 | $1,652.24 | $1,738.98 |
| 4867 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4 | $2,387.46 | $2,411.33 | $2,537.93 |
| 4868 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5 | $2,387.46 | $2,411.33 | $2,537.93 |
| 4869 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6 | $2,531.39 | $2,556.70 | $2,690.93 |
| 4870 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1 | $3,560.28 | $3,595.88 | $3,784.67 |
| 4871 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2 | $3,737.70 | $3,775.08 | $3,973.27 |
| 4872 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3 | $3,737.70 | $3,775.08 | $3,973.27 |
| 4873 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4 | $4,819.60 | $4,867.80 | $5,123.36 |
| 4874 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5 | $4,819.60 | $4,867.80 | $5,123.36 |
| 4875 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6 | $5,304.94 | $5,357.99 | $5,639.28 |
| 4876 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1 | $4,412.54 | $4,456.67 | $4,690.64 |
| 4877 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2 | $4,204.08 | $4,246.12 | $4,469.04 |
| 4878 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3 | $4,204.08 | $4,246.12 | $4,469.04 |
| 4879 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4 | $6,084.43 | $6,145.27 | $6,467.90 |
| 4880 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5 | $6,084.43 | $6,145.27 | $6,467.90 |
| 4881 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6 | $7,595.12 | $7,671.07 | $8,073.80 |
| 4882 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1 | $1,748.99 | $1,766.48 | $1,859.22 |
| 4883 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2 | $1,910.82 | $1,929.93 | $2,031.25 |
| 4884 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3 | $1,910.82 | $1,929.93 | $2,031.25 |
| 4885 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4 | $2,445.08 | $2,469.53 | $2,599.18 |
| 4886 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5 | $2,445.08 | $2,469.53 | $2,599.18 |
| 4887 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6 | $2,720.27 | $2,747.47 | $2,891.72 |
| 4888 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1 | $3,692.48 | $3,729.40 | $3,925.20 |
| 4889 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2 | $4,288.41 | $4,331.29 | $4,558.69 |
| 4890 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3 | $4,288.41 | $4,331.29 | $4,558.69 |
| 4891 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4 | $5,308.99 | $5,362.08 | $5,643.59 |
| 4892 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5 | $5,308.99 | $5,362.08 | $5,643.59 |
| 4893 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6 | $5,780.92 | $5,838.73 | $6,145.26 |
| 4894 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1 | $5,019.77 | $5,069.97 | $5,336.14 |
| 4895 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2 | $6,088.04 | $6,148.92 | $6,471.74 |
| 4896 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3 | $6,088.04 | $6,148.92 | $6,471.74 |
| 4897 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4 | $8,435.56 | $8,519.92 | $8,967.21 |
| 4898 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5 | $8,435.56 | $8,519.92 | $8,967.21 |
| 4899 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6 | $9,258.78 | $9,351.37 | $9,842.31 |
| 4900 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1 | $1,783.87 | $1,801.71 | $1,896.30 |
| 4901 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2 | $2,463.52 | $2,488.16 | $2,618.78 |
| 4902 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3 | $2,463.52 | $2,488.16 | $2,618.78 |
| 4903 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4 | $3,678.18 | $3,714.96 | $3,910.00 |
| 4904 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5 | $3,678.18 | $3,714.96 | $3,910.00 |
| 4905 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6 | $2,997.65 | $3,027.63 | $3,186.58 |
| 4906 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1 | $4,803.16 | $4,851.19 | $5,105.88 |
| 4907 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2 | $6,228.07 | $6,290.35 | $6,620.59 |
| 4908 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3 | $6,228.07 | $6,290.35 | $6,620.59 |
| 4909 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4 | $6,891.58 | $6,960.50 | $7,325.92 |
| 4910 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5 | $6,891.58 | $6,960.50 | $7,325.92 |
| 4911 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6 | $7,928.35 | $8,007.63 | $8,428.03 |
| 4912 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1 | $7,412.10 | $7,486.22 | $7,879.25 |
| 4913 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2 | $11,621.63 | $11,737.85 | $12,354.08 |
| 4914 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3 | $11,621.63 | $11,737.85 | $12,354.08 |
| 4915 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4 | $10,131.57 | $10,232.88 | $10,770.11 |
| 4916 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5 | $10,131.57 | $10,232.88 | $10,770.11 |
| 4917 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6 | $14,053.64 | $14,194.17 | $14,939.37 |
| 4920 | EPS MATERNITY, NO OASIS, 18 AND OLDER | $1,496.68 | $1,511.65 | $1,591.01 |
NYC
| Rate Code | Rate Code Description | 1/1/19 Effective Date Latest Approved | 4/1/22 Effective Date 1% Enhancement | 10/1/2022 MW Increase 5.61% |
|---|---|---|---|---|
| 4810 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1 | $2,321.72 | $2,344.94 | $2,476.49 |
| 4811 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2 | $2,584.22 | $2,610.06 | $2,756.49 |
| 4812 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3 | $2,584.22 | $2,610.06 | $2,756.49 |
| 4813 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4 | $3,004.23 | $3,034.28 | $3,204.50 |
| 4814 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5 | $3,004.23 | $3,034.28 | $3,204.50 |
| 4815 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6 | $3,166.59 | $3,198.26 | $3,377.68 |
| 4816 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1 | $3,604.29 | $3,640.34 | $3,844.56 |
| 4817 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2 | $4,203.99 | $4,246.03 | $4,484.23 |
| 4818 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3 | $4,203.99 | $4,246.03 | $4,484.23 |
| 4819 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4 | $4,651.07 | $4,697.58 | $4,961.12 |
| 4820 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5 | $4,651.07 | $4,697.58 | $4,961.12 |
| 4821 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6 | $5,167.84 | $5,219.52 | $5,512.34 |
| 4822 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1 | $4,355.32 | $4,398.87 | $4,645.65 |
| 4823 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2 | $4,678.38 | $4,725.16 | $4,990.24 |
| 4824 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3 | $4,678.38 | $4,725.16 | $4,990.24 |
| 4825 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4 | $5,654.80 | $5,711.35 | $6,031.75 |
| 4826 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5 | $5,654.80 | $5,711.35 | $6,031.75 |
| 4827 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6 | $7,250.67 | $7,323.17 | $7,734.00 |
| 4828 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1 | $2,611.73 | $2,637.85 | $2,785.83 |
| 4829 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2 | $2,835.63 | $2,863.99 | $3,024.66 |
| 4830 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3 | $2,835.63 | $2,863.99 | $3,024.66 |
| 4831 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4 | $2,933.23 | $2,962.57 | $3,128.76 |
| 4832 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5 | $2,933.23 | $2,962.57 | $3,128.76 |
| 4833 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6 | $3,192.75 | $3,224.68 | $3,405.58 |
| 4834 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1 | $4,003.88 | $4,043.92 | $4,270.79 |
| 4835 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2 | $4,307.11 | $4,350.18 | $4,594.22 |
| 4836 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3 | $4,307.11 | $4,350.18 | $4,594.22 |
| 4837 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4 | $4,806.28 | $4,854.34 | $5,126.67 |
| 4838 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5 | $4,806.28 | $4,854.34 | $5,126.67 |
| 4839 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6 | $5,274.76 | $5,327.51 | $5,626.38 |
| 4840 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1 | $5,603.50 | $5,659.54 | $5,977.04 |
| 4841 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2 | $6,318.97 | $6,382.15 | $6,740.19 |
| 4842 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3 | $6,318.97 | $6,382.15 | $6,740.19 |
| 4843 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4 | $7,503.73 | $7,578.77 | $8,003.94 |
| 4844 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5 | $7,503.73 | $7,578.77 | $8,003.94 |
| 4845 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6 | $8,194.02 | $8,275.96 | $8,740.24 |
| 4846 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1 | $2,862.67 | $2,891.30 | $3,053.50 |
| 4847 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2 | $3,248.05 | $3,280.53 | $3,464.56 |
| 4848 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3 | $3,248.05 | $3,280.53 | $3,464.56 |
| 4849 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4 | $3,518.27 | $3,553.45 | $3,752.80 |
| 4850 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5 | $3,518.27 | $3,553.45 | $3,752.80 |
| 4851 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6 | $4,311.70 | $4,354.82 | $4,599.12 |
| 4852 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1 | $5,142.72 | $5,194.15 | $5,485.54 |
| 4853 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2 | $5,940.02 | $5,999.42 | $6,335.99 |
| 4854 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3 | $5,940.02 | $5,999.42 | $6,335.99 |
| 4855 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4 | $6,604.67 | $6,670.71 | $7,044.94 |
| 4856 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5 | $6,604.67 | $6,670.71 | $7,044.94 |
| 4857 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6 | $6,941.51 | $7,010.92 | $7,404.24 |
| 4858 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1 | $6,437.65 | $6,502.03 | $6,866.79 |
| 4859 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2 | $9,054.85 | $9,145.39 | $9,658.45 |
| 4860 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3 | $9,054.85 | $9,145.39 | $9,658.45 |
| 4861 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4 | $9,085.44 | $9,176.29 | $9,691.08 |
| 4862 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5 | $9,085.44 | $9,176.29 | $9,691.08 |
| 4863 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6 | $10,529.28 | $10,634.57 | $11,231.17 |
| 4864 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1 | $1,706.19 | $1,723.25 | $1,819.92 |
| 4865 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2 | $1,864.87 | $1,883.52 | $1,989.18 |
| 4866 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3 | $1,864.87 | $1,883.52 | $1,989.18 |
| 4867 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4 | $2,721.67 | $2,748.88 | $2,903.09 |
| 4868 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5 | $2,721.67 | $2,748.88 | $2,903.09 |
| 4869 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6 | $2,885.74 | $2,914.60 | $3,078.10 |
| 4870 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1 | $4,058.64 | $4,099.22 | $4,329.19 |
| 4871 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2 | $4,260.90 | $4,303.51 | $4,544.94 |
| 4872 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3 | $4,260.90 | $4,303.51 | $4,544.94 |
| 4873 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4 | $5,494.25 | $5,549.19 | $5,860.50 |
| 4874 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5 | $5,494.25 | $5,549.19 | $5,860.50 |
| 4875 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6 | $6,047.53 | $6,108.01 | $6,450.67 |
| 4876 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1 | $5,030.21 | $5,080.51 | $5,365.53 |
| 4877 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2 | $4,792.57 | $4,840.50 | $5,112.05 |
| 4878 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3 | $4,792.57 | $4,840.50 | $5,112.05 |
| 4879 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4 | $6,936.12 | $7,005.48 | $7,398.49 |
| 4880 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5 | $6,936.12 | $7,005.48 | $7,398.49 |
| 4881 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6 | $8,658.27 | $8,744.86 | $9,235.44 |
| 4882 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1 | $1,993.80 | $2,013.74 | $2,126.71 |
| 4883 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2 | $2,178.29 | $2,200.07 | $2,323.50 |
| 4884 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3 | $2,178.29 | $2,200.07 | $2,323.50 |
| 4885 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4 | $2,787.35 | $2,815.23 | $2,973.16 |
| 4886 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5 | $2,787.35 | $2,815.23 | $2,973.16 |
| 4887 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6 | $3,101.05 | $3,132.07 | $3,307.77 |
| 4888 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1 | $4,209.37 | $4,251.46 | $4,489.97 |
| 4889 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2 | $4,888.70 | $4,937.58 | $5,214.58 |
| 4890 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3 | $4,888.70 | $4,937.58 | $5,214.58 |
| 4891 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4 | $6,052.14 | $6,112.66 | $6,455.58 |
| 4892 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5 | $6,052.14 | $6,112.66 | $6,455.58 |
| 4893 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6 | $6,590.12 | $6,656.02 | $7,029.43 |
| 4894 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1 | $5,722.44 | $5,779.67 | $6,103.90 |
| 4895 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2 | $6,940.23 | $7,009.64 | $7,402.88 |
| 4896 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3 | $6,940.23 | $7,009.64 | $7,402.88 |
| 4897 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4 | $9,616.36 | $9,712.53 | $10,257.40 |
| 4898 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5 | $9,616.36 | $9,712.53 | $10,257.40 |
| 4899 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6 | $10,554.82 | $10,660.37 | $11,258.41 |
| 4900 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1 | $2,033.59 | $2,053.92 | $2,169.15 |
| 4901 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2 | $2,808.36 | $2,836.44 | $2,995.57 |
| 4902 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3 | $2,808.36 | $2,836.44 | $2,995.57 |
| 4903 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4 | $4,193.05 | $4,234.98 | $4,472.57 |
| 4904 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5 | $4,193.05 | $4,234.98 | $4,472.57 |
| 4905 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6 | $3,417.24 | $3,451.42 | $3,645.04 |
| 4906 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1 | $5,475.50 | $5,530.25 | $5,840.50 |
| 4907 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2 | $7,099.86 | $7,170.86 | $7,573.15 |
| 4908 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3 | $7,099.86 | $7,170.86 | $7,573.15 |
| 4909 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4 | $7,856.26 | $7,934.82 | $8,379.96 |
| 4910 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5 | $7,856.26 | $7,934.82 | $8,379.96 |
| 4911 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6 | $9,038.16 | $9,128.54 | $9,640.65 |
| 4912 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1 | $8,449.64 | $8,534.13 | $9,012.90 |
| 4913 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2 | $13,248.41 | $13,380.89 | $14,131.56 |
| 4914 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3 | $13,248.41 | $13,380.89 | $14,131.56 |
| 4915 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4 | $11,549.77 | $11,665.27 | $12,319.69 |
| 4916 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5 | $11,549.77 | $11,665.27 | $12,319.69 |
| 4917 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6 | $16,020.86 | $16,181.07 | $17,088.83 |
| 4920 | EPS MATERNITY, NO OASIS, 18 AND OLDER | $1,706.19 | $1,723.25 | $1,819.92 |
ROS
| Rate Code | Rate Code Description | 10/1/15 Effective Date Latest Approved | 4/1/22 Effective Date 1% Enhancement | 10/1/2022 MW Increase 3.56% |
|---|---|---|---|---|
| 4810 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1 | $1,658.85 | $1,675.44 | $1,735.08 |
| 4811 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2 | $1,846.42 | $1,864.88 | $1,931.27 |
| 4812 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3 | $1,846.42 | $1,864.88 | $1,931.27 |
| 4813 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4 | $2,146.51 | $2,167.98 | $2,245.16 |
| 4814 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5 | $2,146.51 | $2,167.98 | $2,245.16 |
| 4815 | EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6 | $2,262.51 | $2,285.14 | $2,366.49 |
| 4816 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1 | $2,575.24 | $2,600.99 | $2,693.59 |
| 4817 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2 | $3,003.73 | $3,033.77 | $3,141.77 |
| 4818 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3 | $3,003.73 | $3,033.77 | $3,141.77 |
| 4819 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4 | $3,323.16 | $3,356.39 | $3,475.88 |
| 4820 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5 | $3,323.16 | $3,356.39 | $3,475.88 |
| 4821 | EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6 | $3,692.40 | $3,729.32 | $3,862.09 |
| 4822 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1 | $3,111.85 | $3,142.97 | $3,254.86 |
| 4823 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2 | $3,342.68 | $3,376.11 | $3,496.30 |
| 4824 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3 | $3,342.68 | $3,376.11 | $3,496.30 |
| 4825 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4 | $4,040.32 | $4,080.72 | $4,226.00 |
| 4826 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5 | $4,040.32 | $4,080.72 | $4,226.00 |
| 4827 | EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6 | $5,180.56 | $5,232.37 | $5,418.64 |
| 4828 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1 | $1,866.06 | $1,884.72 | $1,951.82 |
| 4829 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2 | $2,026.04 | $2,046.30 | $2,119.15 |
| 4830 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3 | $2,026.04 | $2,046.30 | $2,119.15 |
| 4831 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4 | $2,095.78 | $2,116.74 | $2,192.09 |
| 4832 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5 | $2,095.78 | $2,116.74 | $2,192.09 |
| 4833 | EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6 | $2,281.20 | $2,304.01 | $2,386.03 |
| 4834 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1 | $2,860.75 | $2,889.36 | $2,992.22 |
| 4835 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2 | $3,077.40 | $3,108.17 | $3,218.82 |
| 4836 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3 | $3,077.40 | $3,108.17 | $3,218.82 |
| 4837 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4 | $3,434.06 | $3,468.40 | $3,591.88 |
| 4838 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5 | $3,434.06 | $3,468.40 | $3,591.88 |
| 4839 | EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6 | $3,768.79 | $3,806.48 | $3,941.99 |
| 4840 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1 | $4,003.67 | $4,043.71 | $4,187.66 |
| 4841 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2 | $4,514.87 | $4,560.02 | $4,722.36 |
| 4842 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3 | $4,514.87 | $4,560.02 | $4,722.36 |
| 4843 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4 | $5,361.37 | $5,414.98 | $5,607.76 |
| 4844 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5 | $5,361.37 | $5,414.98 | $5,607.76 |
| 4845 | EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6 | $5,854.59 | $5,913.14 | $6,123.64 |
| 4846 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1 | $2,045.36 | $2,065.81 | $2,139.36 |
| 4847 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2 | $2,320.71 | $2,343.92 | $2,427.36 |
| 4848 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3 | $2,320.71 | $2,343.92 | $2,427.36 |
| 4849 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4 | $2,513.78 | $2,538.92 | $2,629.30 |
| 4850 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5 | $2,513.78 | $2,538.92 | $2,629.30 |
| 4851 | EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6 | $3,080.69 | $3,111.50 | $3,222.27 |
| 4852 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1 | $3,674.45 | $3,711.19 | $3,843.31 |
| 4853 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2 | $4,244.11 | $4,286.55 | $4,439.15 |
| 4854 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3 | $4,244.11 | $4,286.55 | $4,439.15 |
| 4855 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4 | $4,719.00 | $4,766.19 | $4,935.87 |
| 4856 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5 | $4,719.00 | $4,766.19 | $4,935.87 |
| 4857 | EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6 | $4,959.67 | $5,009.27 | $5,187.60 |
| 4858 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1 | $4,599.67 | $4,645.67 | $4,811.05 |
| 4859 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2 | $6,469.63 | $6,534.33 | $6,766.95 |
| 4860 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3 | $6,469.63 | $6,534.33 | $6,766.95 |
| 4861 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4 | $6,491.50 | $6,556.42 | $6,789.82 |
| 4862 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5 | $6,491.50 | $6,556.42 | $6,789.82 |
| 4863 | EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6 | $7,523.11 | $7,598.34 | $7,868.84 |
| 4864 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1 | $1,219.06 | $1,231.25 | $1,275.08 |
| 4865 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2 | $1,332.44 | $1,345.76 | $1,393.67 |
| 4866 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3 | $1,332.44 | $1,345.76 | $1,393.67 |
| 4867 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4 | $1,944.61 | $1,964.06 | $2,033.98 |
| 4868 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5 | $1,944.61 | $1,964.06 | $2,033.98 |
| 4869 | EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6 | $2,061.84 | $2,082.46 | $2,156.59 |
| 4870 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1 | $2,899.88 | $2,928.88 | $3,033.15 |
| 4871 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2 | $3,044.39 | $3,074.83 | $3,184.30 |
| 4872 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3 | $3,044.39 | $3,074.83 | $3,184.30 |
| 4873 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4 | $3,925.61 | $3,964.87 | $4,106.02 |
| 4874 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5 | $3,925.61 | $3,964.87 | $4,106.02 |
| 4875 | EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6 | $4,320.92 | $4,364.13 | $4,519.49 |
| 4876 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1 | $3,594.05 | $3,629.99 | $3,759.22 |
| 4877 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2 | $3,424.26 | $3,458.50 | $3,581.63 |
| 4878 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3 | $3,424.26 | $3,458.50 | $3,581.63 |
| 4879 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4 | $4,955.82 | $5,005.38 | $5,183.57 |
| 4880 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5 | $4,955.82 | $5,005.38 | $5,183.57 |
| 4881 | EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6 | $6,186.29 | $6,248.15 | $6,470.59 |
| 4882 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1 | $1,424.57 | $1,438.82 | $1,490.04 |
| 4883 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2 | $1,556.38 | $1,571.94 | $1,627.90 |
| 4884 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3 | $1,556.38 | $1,571.94 | $1,627.90 |
| 4885 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4 | $1,991.54 | $2,011.46 | $2,083.06 |
| 4886 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5 | $1,991.54 | $2,011.46 | $2,083.06 |
| 4887 | EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6 | $2,215.68 | $2,237.84 | $2,317.50 |
| 4888 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1 | $3,007.56 | $3,037.64 | $3,145.78 |
| 4889 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2 | $3,492.95 | $3,527.88 | $3,653.47 |
| 4890 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3 | $3,492.95 | $3,527.88 | $3,653.47 |
| 4891 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4 | $4,324.22 | $4,367.46 | $4,522.94 |
| 4892 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5 | $4,324.22 | $4,367.46 | $4,522.94 |
| 4893 | EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6 | $4,708.61 | $4,755.70 | $4,925.00 |
| 4894 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1 | $4,088.65 | $4,129.54 | $4,276.55 |
| 4895 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2 | $4,958.76 | $5,008.35 | $5,186.64 |
| 4896 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3 | $4,958.76 | $5,008.35 | $5,186.64 |
| 4897 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4 | $6,870.84 | $6,939.55 | $7,186.60 |
| 4898 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5 | $6,870.84 | $6,939.55 | $7,186.60 |
| 4899 | EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6 | $7,541.36 | $7,616.77 | $7,887.93 |
| 4900 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1 | $1,452.98 | $1,467.51 | $1,519.75 |
| 4901 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2 | $2,006.56 | $2,026.63 | $2,098.77 |
| 4902 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3 | $2,006.56 | $2,026.63 | $2,098.77 |
| 4903 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4 | $2,995.91 | $3,025.87 | $3,133.59 |
| 4904 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5 | $2,995.91 | $3,025.87 | $3,133.59 |
| 4905 | EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6 | $2,441.61 | $2,466.03 | $2,553.82 |
| 4906 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1 | $3,912.22 | $3,951.34 | $4,092.01 |
| 4907 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2 | $5,072.82 | $5,123.55 | $5,305.95 |
| 4908 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3 | $5,072.82 | $5,123.55 | $5,305.95 |
| 4909 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4 | $5,613.25 | $5,669.38 | $5,871.21 |
| 4910 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5 | $5,613.25 | $5,669.38 | $5,871.21 |
| 4911 | EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6 | $6,457.71 | $6,522.29 | $6,754.48 |
| 4912 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1 | $6,037.22 | $6,097.59 | $6,314.67 |
| 4913 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2 | $9,465.92 | $9,560.58 | $9,900.94 |
| 4914 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3 | $9,465.92 | $9,560.58 | $9,900.94 |
| 4915 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4 | $8,252.25 | $8,334.77 | $8,631.49 |
| 4916 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5 | $8,252.25 | $8,334.77 | $8,631.49 |
| 4917 | EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6 | $11,446.81 | $11,561.28 | $11,972.86 |
| 4920 | EPS MATERNITY, NO OASIS, 18 AND OLDER | $1,219.06 | $1,231.25 | $1,275.08 |
