Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
G0493	RN CARE EA 15 MIN HH/HOSPICE	MAXFEE	ORU					10.62	1/1/2022	12/31/2299	N
G0493	RN CARE EA 15 MIN HH/HOSPICE	MAXFEE	NRC					7.45	1/1/2022	12/31/2299	N
G0493	RN CARE EA 15 MIN HH/HOSPICE	MAXFEE	ARC					9.24	1/1/2022	12/31/2299	N
G0493	RN CARE EA 15 MIN HH/HOSPICE	MAXFLT	NRA					NA	NA	NA	N
G0493	RN CARE EA 15 MIN HH/HOSPICE	MAXFLT	ARA					NA	NA	NA	N
G0494	LPN CARE EA 15MIN HH/HOSPICE	MAXFEE	OLU					8.84	1/1/2022	12/31/2299	N
G0494	LPN CARE EA 15MIN HH/HOSPICE	MAXFEE	NLC					6.23	1/1/2022	12/31/2299	N
G0494	LPN CARE EA 15MIN HH/HOSPICE	MAXFEE	ALC					7.81	1/1/2022	12/31/2299	N
T1002	RN SERVICES UP TO 15 MINUTES	HHPDN	NRB					NA	NA	NA	N
T1002	RN SERVICES UP TO 15 MINUTES	MAXFEE	ORU					10.62	11/1/2021	12/31/2299	N
T1002	RN SERVICES UP TO 15 MINUTES	HHPDN	ORB					NA	NA	NA	N
T1002	RN SERVICES UP TO 15 MINUTES	HHPDN	ARB					NA	NA	NA	N
T1003	LPN/LVN SERVICES UP TO 15MIN	MAXFEE	OLU					8.84	11/1/2021	12/31/2299	N
T1003	LPN/LVN SERVICES UP TO 15MIN	HHPDN	ALB					NA	NA	NA	N
T1003	LPN/LVN SERVICES UP TO 15MIN	HHPDN	OLB					NA	NA	NA	N
T1003	LPN/LVN SERVICES UP TO 15MIN	HHPDN	NLB					NA	NA	NA	N