Traumatic Brain Injury (TBI) Waiver Approved Rates

Rate Summary effective 1/1/2020

Below is a list of the approved rates for the Traumatic Brain Injury (TBI) waiver program. The definitions of services are more fully presented in the TBI Program Manual. For a complete understanding of the policies and procedures for payment of these rates, please consult with the TBI Program Manual.

Rate Code Rate Code Description Billing Unit Upstate Downstate
9850 Service Coordination, Initial 1 time $ 537.99 $ 699.39
9851 Service Coordination, Monthly monthly $ 393.92 $ 512.11
9854 TBI Waiver Assistive Technology - $1.00 per unit fee hourly $ 1.00 $ 1.00
9855 TBI Waiver Assistive Technology - $10.00 per unit fee hourly $ 10.00 $ 10.00
9856 TBI Waiver Assistive Technology - $100.00 per unit fee hourly $ 100.00 $ 100.00
9857 TBI Waiver Assistive Technology - total charges charges 100% of approved cost 100% of approved cost
9858 Independent Living Skills Training hourly $ 36.02 $ 46.82
9859 Substance Abuse Program hourly $ 34.00 $ 34.00
9860 Intensive Behavior Program hourly $ 54.02 $ 70.24
9861 Community Integration Counseling hourly $ 72.03 $ 93.64
9867 Community Transitional Services charges 100% of approved cost 100% of approved cost
9870 Structured Day Program hourly $ 17.56 $ 22.84
9871 Environmental Modifications - $1.00 per unit fee hourly $ 1.00 $ 1.00
9872 Environmental Modifications - $10.00 per unit fee hourly $ 10.00 $ 10.00
9873 Environmental Modifications - $100.00 per unit fee hourly $ 100.00 $ 100.00
9874 Environmental Modifications - $1000.00 per unit fee charges 100% of approved cost 100% of approved cost
9875 Respite per diem $ 334.37 $ 334.37

Rate Code HCSS Rate Code Description Billing Unit 1/1/2018 1/1/2019 Rural Adj.
8/1/2019
1/1/2020 1/1/2021 1/1/2022
9879 NYC (Bronx, Kings, NY, Queens, Richmond) hourly $ 25.23 $ 27.79 - $ 27.79 $ 27.79 $ 27.79
9880 Long Island/Westchester (Nassau, Suffolk, Westchester) hourly $ 22.67 $ 23.95 - $ 25.23 $ 26.51 $ 27.79
9881 Rockland hourly $ 23.57 $ 24.46 - $ 25.36 $ 26.26 $ 26.26
9882 Rest of State hourly $ 24.65 $ 25.54 - $ 26.44 $ 27.34 $ 27.34
9883 Rural (Alleghany, Clinton, Delaware, Essex, Franklin, Hamilton, St Lawrence) hourly Pending Approval