Private duty nursing services copayments

Effective June 19, 2004

CODE
DESCRIPTION
FEE/ VISIT
PLUS
COPAYMENT
(Per visit,
effective 1/1/03)

STANDARD COPAYMENT
(Eliminated
6/19/04
)

T1030 RN Visit $16.59
$3.00
none
T1031 LPN Visit $14.79
$3.00
none
S9123 RN Shift $34.90
$3.00
none
S9124 LPN Shift $29.66
$3.00
none

Figure the price for the prior authorization according to the requested amount, agreed upon fee, or fee schedule; the MMIS will figure out the copayment.