APG Rate Code Matrix

Revised July 1, 2016.

Article 28 Rate Codes by DTC Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
DTC AMBULATORY SURGERY 1408  
DTC DENTAL SCHOOL 1428 1459
DTC DOH DTC APG ART 28 INTEGRATED SVC (DUAL LIC)   1597
DTC DOH DTC APG ART 28 INTEGRATED SVC (SINGLE LIC)   1102
DTC GENERAL CLINIC 1407 1422
DTC GENERAL CLINIC APG MR/DD (EDIT EXEMPT) 1498 1495
DTC GENERAL CLINIC MR/DD/TBI 1435* 1425*
DTC MA CVRD NON-CARE CVRD SRVC FOR DUAL-DTC-APG MRDD/TBI 1057  
DTC MA CVRD NON-MEDICARE CVRD SRVCS FOR DUALS-DTC-APG 1128  
DTC RENAL 1438 1456
DTC SCHOOL BASED HEALTH PROJECT 1447 1453

* rate codes 1435 & 1425 are to be used for those Medicaid Members with recipient restriction codes 81 or 95


Article 32 Rate Codes by DTC Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
DTC OASAS - ARTICLE 32 CLINIC MEDICAL 1540 1468
DTC OASAS - ARTICLE 32 OP REHAB MEDICAL 1573 1570
DTC OASAS - FREE-STANDING MMTP (WEEKLY) 1564 1543
DTC OASAS - MMTP CLINIC MEDICAL VISIT   1471
DTC OASAS DTC APG ART 32 INTEGRATED SVC (DUAL LIC) 1486  
DTC OASAS DTC APG ART 32 INTEGRATED SVC (SINGLE LIC) 1114  
DTC OASAS DTC APG MMTP INTEGRATED SVC (DUAL LIC) 1130  
DTC OASAS DTC APG MMTP INTEGRATED SVC (SINGLE LIC) 1116  

Article 31 Rate Codes by DTC Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
DTC OMH - ARTICLE 31 MEDICAL VISIT TYPE A   1474
DTC OMH - ARTICLE 31 MEDICAL VISIT TYPE A (SED)   1477
DTC OMH - DTC ARTICLE 31 CLINIC (SED) (UT EXEMPT) APG 1138  
DTC OMH - DTC ARTICLE 31 CLINIC (UT EXEMPT) APG 1136  
DTC OMH - FREE-STANDING ARTICLE 31 CLINIC 1504  
DTC OMH - FREE-STANDING ARTICLE 31 CLINIC - OFF-SITE 1507  
DTC OMH - FREE-STANDING ARTICLE 31 CLINIC - OFF-SITE (SED) 1513  
DTC OMH - FREE-STANDING ARTICLE 31 CLINIC (CRISIS) 1579  
DTC OMH - FREE-STANDING ARTICLE 31 CLINIC (CRISIS) (SED) 1585  
DTC OMH - FREE-STANDING ARTICLE 31 CLINIC (SED) 1510  
DTC OMH DTC APG ART 31 INTEGRATED SVC (DUAL LIC) 1480  
DTC OMH DTC APG ART 31 INTEGRATED SVC (SINGLE LIC) 1106  
DTC OMH DTC APG ART 31 INTEGRATED SVC-SED (DUAL LIC) 1483  
DTC OMH DTC APG ART 31 INTEGRATED SVC-SED (SINGLE LIC) 1108  

Article 16 Rate Codes by DTC Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
DTC OMRDD - FREE-STANDING ARTICLE 16 CLINIC 1546  
DTC OMRDD - FREE-STANDING ARTICLE 16 CLINIC - OFF SITE 1549