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 – FREE–STANDING ARTICLE 32 CLINIC |
1540 |
|
| DTC |
OASAS – ARTICLE 32 CLINIC MEDICAL VISIT |
1468 |
|
| DTC |
OASAS – ARTICLE 32 OUTPATIENT REHAB |
1573 |
|
| DTC |
OASAS – ARTICLE 32 OP REHAB MEDICAL VISIT |
1570 |
|
| DTC |
OASAS – FREE–STANDING OPIOID TREATMENT PROGRAMS (OTP) |
1564 |
|
| DTC |
OASAS – OTP 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 OTP INTEGRATED SVC (DUAL LIC) |
1130 |
|
| DTC |
OASAS DTC APG OTP 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 |
|
