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pdfCY 2024 PBP Data Entry System Pages
11a - Durable Medical Equipment (DME) -Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 250
CY 2024 PBP Data Entry System Pages
11a - Durable Medical Equipment (DME) -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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CY 2024 PBP Data Entry System Pages
11a - Durable Medical Equipment (DME) -Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 250
CY 2024 PBP Data Entry System Pages
11a - Durable Medical Equipment (DME) Non Medicare -Page 1
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01/13/2023
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Page 4 of 250
CY 2024 PBP Data Entry System Pages
11a - Durable Medical Equipment (DME) Non Medicare -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 250
CY 2024 PBP Data Entry System Pages
11a1 - Durable Medical Equipment for use outside the home
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2024 PBP Data Entry System Pages
11a2 - Other 1 for Durable Medical Equipement
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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CY 2024 PBP Data Entry System Pages
11a3 - Other 2 for Durable Medical Equipment
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01/13/2023
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11b - Prosthetics /Medical Supplies-Page 1
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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11b - Prosthetics /Medical Supplies-Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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CY 2024 PBP Data Entry System Pages
11b – Non-Medicare Prosthetics Medical Supplies -Page 1
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01/13/2023
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11b – Non-Medicare Prosthetics Medical Supplies -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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11b1 - Prosthetic Devices
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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11b2 - Medical Supplies
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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11c - Diabetic Supplies and Services -Page 1
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01/13/2023
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11c - Diabetic Supplies and Services-Page 2
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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11c - Diabetic Supplies and Services-Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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11c1 - Diabetic Supplies
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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11c2 - Diabetic Therapeutic Shoes /Inserts
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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12 - Dialysis Services -Page 1
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CY2024 PBP – Benefit Service Categories 11-20
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12 - Dialysis Services - Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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12 - Dialysis Services-Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 250
13a - Acupuncture -Page 1
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 250
13a - Acupuncture -Page 2
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13a - Acupuncture -Page 3
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 250
CY 2024 PBP Data Entry System Pages
13b - Over-the-Counter (OTC) items -Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2024 PBP Data Entry System Pages
13b - Over-the-Counter (OTC) items -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13b - Over-the-Counter (OTC) items -Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13b - Over-the-Counter (OTC) items -Page 4
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01/13/2023
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13c - Meal Benefits -Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13c - Meal Benefits -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13c - Meal Benefits -Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13d - Other 1 -Page 1
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13d - Other 1 -Page 2
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13d - Other 1 -Page 3
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13e - Other 2 -Page 1
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13e - Other 2 -Page 2
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13e - Other 2 -Page 3
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13f - Other 3 -Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13f - Other 3 -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13f - Other 3 -Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13g - Dual Eligible SNPs with Highly Integrated Services -Page 1
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01/13/2023
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13g - Dual Eligible SNPs with Highly Integrated Services -Page 2
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01/13/2023
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13g - Dual Eligible SNPs with Highly Integrated Services -Page 3
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01/13/2023
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13h - Additional Services (MMP) -Page 1
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CY 2024 PBP Data Entry System Pages
CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h - Additional Services (MMP) -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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CY 2024 PBP Data Entry System Pages
13h1 - Early and Peroidic Screening, Diagnostic, and Treatment (EPSDT) Services -Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2024 PBP Data Entry System Pages
13h1 - Early and Peroidic Screening ,Diagnostic , and Treatment (EPSDT) Services -Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2024 PBP Data Entry System Pages
13h1 - Early and Peroidic Screening, Diagnostic, and Treatment (EPSDT) Services -Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2024 PBP Data Entry System Pages
13h2 - Tobacco Cessation Counseling for Pregnant Women - Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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CY 2024 PBP Data Entry System Pages
13h2 - Tobacco Cessation Counseling for Pregnant Women – Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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CY 2024 PBP Data Entry System Pages
13h2 - Tobacco Cessation Counseling for Pregnant Women – Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h3 - Freestanding Birth Center Services – Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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13h3 - Freestanding Birth Center Services – Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h3 - Freestanding Birth Center Services – Page 3
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01/13/2023
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13h4 - Respiratory Care Services – Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h4 - Respiratory Care Services – Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h4 - Respiratory Care Services – Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h5 - Family Planning Services – Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h5 - Family Planning Services – Page 2
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h5 - Family Planning Services – Page 3
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h6 - Nursing Home Services – Page 1
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CY2024 PBP – Benefit Service Categories 11-20
01/13/2023
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13h6 - Nursing Home Services – Page 2
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13h6 - Nursing Home Services – Page 3
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CY2024 PBP – Benefit Service Categories 11-20
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13h7 - Home and Community Based Services – Page 1
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01/13/2023
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13h7 - Home and Community Based Services – Page 2
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13h7 - Home and Community Based Services – Page 3
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13h8 – Personal Care Services – Page 1
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13h8 – Personal Care Services – Page 2
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13h8 – Personal Care Services – Page 3
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13h9 - Self-Directed Personal Assistance Services – Page 1
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01/13/2023
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13h9 - Self-Directed Personal Assistance Services – Page 2
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13h9 - Self-Directed Personal Assistance Services – Page 3
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13h10 - Private Duty Nursing Services – Page 1
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13h10 - Private Duty Nursing Services – Page 2
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13h10 - Private Duty Nursing Services – Page 3
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13h11 - Case Management (Long Term Care) – Page 1
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13h11 - Case Management (Long Term Care) – Page 2
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13h11 - Case Management (Long Term Care) – Page 3
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13h12 - Institution for Mental Disease Services for Individuals 65 or older – Page 1
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13h12 - Institution for Mental Disease Services for Individuals 65 or older – Page 2
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13h12 - Institution for Mental Disease Services for Individuals 65 or older – Page 3
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13h13 - Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities – Page 1
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13h13 - Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities – Page 2
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13h13 - Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities – Page 3
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13h14 - Case Management – Page 1
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13h14 - Case Management – Page 2
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13h14 - Case Management – Page 3
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13h15 - Other 1 – Page 1
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14a – Medicare-covered Zero Dollar Preventive Services – Page 1
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14a – Medicare-covered Zero Dollar Preventive Services – Page 2
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14b – Annual Physical Exam – Page 1
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14c – Other Defined Supplemental Benefits
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14c1 – Health Education – Page 1
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14c1 – Health Education – Page 2
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14c2 – Nutritional/Dietary Benefit – Page 1
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14c3 – Additional Sessions of Smoking and Tobacco Cessation Counseling – Page 1
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18b1 – Hearing Aids (all types)
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20 – Outpatient Drug Groups
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| File Type | application/pdf |
| File Title | CY 2024 PBP Data Entry System Pages |
| Author | Michelle Hsu |
| File Modified | 2023-01-11 |
| File Created | 2023-01-10 |