Traumatic Brain Injury (TBI) Waiver Approved Rates

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 Summary effective 1/1/2022
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
9857 TBI Waiver Assistive Technology total 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 total charges 100% of approved cost 100% of approved cost
9870 Structured Day Program hourly $ 17.56 $ 22.84
9874 Environmental Modifications total 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.
9/1/2019
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 $ 27.16
9882 Rest of State hourly $ 24.65 $ 25.54 - $ 26.44 $ 27.34 $ 28.24
9883 Rural (Alleghany, Clinton, Delaware, Essex, Franklin, Hamilton, St Lawrence) hourly $ - $ - $ 33.54 $ 34.44 $ 35.34 $ 36.24