Crosswalk - Valid Value List
T-MSIS Valid Value Lists Crosswalk v2.4.0 - v4.0.0 508.xlsx
[Medicaid] Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)
Crosswalk - Valid Value List
OMB: 0938-0345
Document [xlsx]
Download: xlsx | pdf
VVL Change Log
Overview
Cover SheetVVL Change Log
Sheet 1: Cover Sheet
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| Centers for Medicaid and CHIP Services (CMCS) | ||||
| Transformed Medicaid Statistical Information System (T-MSIS) | ||||
| T-MSIS Valid Value Lists (VVLs) Crosswalk (Change Log) - Version 2.4.0 Through Version 4.0.0 | ||||
| PRA Disclosure Statement: The Transformed Medicaid Statistical Information System (T-MSIS) is used to assist the Centers for Medicare & Medicaid Services (CMS) with monitoring and oversight of Medicaid and CHIP programs, to enable evaluation of demonstrations under section 1115 of the Social Security Act | ||||
| and to calculate quality measures and other metrics, including those reported through the new Medicaid and CHIP Scoreboard. Section 4735 of the Balanced Budget Act of 1997 included a statutory requirement for states to submit claims data, enrollee encounter data, and supporting information. Section 6504 of the Affordable Care Act strengthened | ||||
| this provision by requiring states to include data elements the Secretary determines necessary for program integrity, program oversight, and administration. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law. According to the Paperwork Reduction Act of 1995, no persons are | ||||
| required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0345 (Expires: 03/31/2026). The time required to complete this information collection is estimated to average 10 hours per response, including the time to review instructions, | ||||
| search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. | ||||
Sheet 2: VVL Change Log
| T-MSIS Valid Value Lists (VVLs) Crosswalk (Change Log) - Version 2.4.0 Through Version 4.0.0 | |||||
| Date |
Valid Value Code Set Name |
Action |
Field(s) |
Before |
After |
| 2021-01-27 | PROCEDURE-CODE-FLAG | UPDATE | Valid Value Attibutes as Shown | ICD-10 - CM PCS | ICD-10 - PCS |
| 2021-02-05 | ACCREDITATION-ORGANIZATION | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Valid Vlaue ID|Effective Date|End Date|Value|Description||ACCREDITATION-ORGANIZATION|00010101|99991231|16|JCAHO (Joint Commission on Accreditation of Healthcare Organizations)| |
| 2021-02-05 | PATIENT-STATUS | UPDATE | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
Added valid values '69'-'95'effective date: 10/1/2013 |
| 2021-02-26 | AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR|00010101|99991231|0|Not applicable| ||CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR|00010101|99991231|1|No, Individual does not have CDIB| ||CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR|00010101|20200214|2|Yes, Individual does have CDIB| | | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR|00010101|99991231|0|Individual does not meet the definition of an American Indian/Alaska Native.| ||CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR|00010101|99991231|1|Individual meets the definition of an American Indian/Alaska Native.| |No update is required for value '2'. This value is end dated on 2/24/2020. |
| 2021-02-26 | CITIZENSHIP-VERIFICATION-FLAG | UPDATE | Valid Value Attibutes as Shown | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CITIZENSHIP-VERIFICATION-FLAG|00010101|99991231|0|No| ||CITIZENSHIP-VERIFICATION-FLAG|00010101|99991231|1|Yes| | | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CITIZENSHIP-VERIFICATION-FLAG|00010101|99991231|0|Citizenship Verified| ||CITIZENSHIP-VERIFICATION-FLAG|00010101|99991231|1|Enrolled in Medicaid pending citizenship verification| | |
| 2021-02-26 | IMMIGRATION-VERIFICATION-FLAG | UPDATE | Valid Value Attibutes as Shown | |Value ID|Value|Description||IMMIGRATION-VERIFICATION-FLAG|0|No||IMMIGRATION-VERIFICATION-FLAG|1|Yes| | |Value ID|Value|Description||IMMIGRATION-VERIFICATION-FLAG|0|Immigration Status Verified||IMMIGRATION-VERIFICATION-FLAG|1|Enrolled in Medicaid pending immigration verification| |
| 2021-02-26 | RECORD-ID | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION||RECORD-ID|00010101|99991231|ELG00022|ELG-IDENTIFIERS| |
| 2021-02-26 | TYPE-OF-HOSPITAL | UPDATE | Valid Value Attibutes as Shown | |Value ID|Effective Date|End Date|Value|Description||TYPE-OF-HOSPITAL|0010101|99991231|99|Unknown| | *End date valid value '99'* |
| 2021-02-26 | XIX-MBESCBES-CATEGORY-OF-SERVICE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Valid Value ID|Effective Date|End Date|Value|Description||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46|OUD Medicaid Assisted Treatment – Drugs||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46A1| OUD MAT DRUG REBATE/National Agreement||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46A2|OUD MAT DRUG REBATE/State Sidebar||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46A3| OUD MAT DRUG REBATE MCO /National Agreement||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46A4| OUD MAT DRUG REBATE MCO /State Sidebar||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46A5| OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46A6| OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%||XIX-MBESCBES-CATEGORY-OF-SERVICE|20201001|99991231|46B| OUD Medicaid Assisted Treatment Services| |
| 2021-03-19 | ELIGIBILITY-GROUP | UPDATE | Valid Value Attibutes as Shown | |Data Element|Effective Date|End Date|Value|Name||ELIGIBILITY-GROUP|00010101|99991231|10|Non-pregnant individuals aged 19 through 64, not otherwise mandatorily eligible, with income at or below 133% FPL.| | N/A |
| 2021-03-19 | TYPE-OF-SERVICE | UPDATE | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Data Element|Effective Date|End Date|Value|Name||TYPE-OF-SERVICE|00010101|99991231|146|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)| |
| 2021-03-19 | XIX-MBESCBES-CATEGORY-OF-SERVICE | UPDATE | Valid Value Attibutes as Shown | |Data Element|Effective Date|End Date|Value|Name||XIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|50|Total| | N/A |
| 2021-03-19 | XXI-MBESCBES-CATEGORY-OF-SERVICE | UPDATE | Valid Value Attibutes as Shown | |Data Element|Effective Date|End Date|Value|Name||XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|48|Balance||XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|49|Less: Collections||XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|50|Total| | N/A |
| 2021-04-09 | DIAGNOSIS-CODE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONDIAGNOSIS-CODE|20210101|99991231|J1282|Pneumonia due to coronavirus disease 2019|DIAGNOSIS-CODE|20210101|99991231| Z1152|Encounter for screening for COVID-19|DIAGNOSIS-CODE|20210101|99991231| Z20822|Contact with and (suspected) exposure to COVID-19|DIAGNOSIS-CODE|20210101|99991231|Z8616|Personal history of COVID-19DIAGNOSIS-CODE|20210101|99991231|M3581|Multisystem inflammatory syndromeDIAGNOSIS-CODE|20210101|99991231|M3589|Other specified systemic involvement of connective tissue| |
| 2021-04-09 | MEDICAID-BASIS-OF-ELIGIBILITY | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONMEDICAID-BASIS-OF-ELIGIBILITY|00010101|99991231|00|Individual was not eligible for Medicaid at any time during the month| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONMEDICAID-BASIS-OF-ELIGIBILITY|00010101|99991231|00|Individual was not eligible for Medicaid (or Medicaid-expansion CHIP) at any time during the month, and Individual was eligible for separate CHIP| |
| 2021-04-30 | DIAGNOSIS-POA-FLAG | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONDIAGNOSIS-POA-FLAG|00010101|99991231|N|Diagnosis was not present at time of inpatient admission|DIAGNOSIS-POA-FLAG|00010101|99991231|U|Documentation insufficient to determine if condition was present at the time of inpatient admission|DIAGNOSIS-POA-FLAG|00010101|99991231|W|Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.|DIAGNOSIS-POA-FLAG|00010101|99991231|Y|Diagnosis was present at time of inpatient admission| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|DIAGNOSIS-POA-FLAG|00010101|99991231|N|Diagnosis was not present at time of inpatient admission|DIAGNOSIS-POA-FLAG|00010101|99991231|U|Documentation insufficient to determine if condition was present at the time of inpatient admission|DIAGNOSIS-POA-FLAG|00010101|99991231|W|Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.|DIAGNOSIS-POA-FLAG|00010101|99991231|Y|Diagnosis was present at time of inpatient admission|DIAGNOSIS-POA-FLAG|00010101|99991231|1|Unreported/Not used. Exempt from POA reporting.| |
| 2021-04-30 | DRUG-UTILIZATION-CODE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|DRUG-UTILIZATION-CODE-E4|00010101|99991231|SC|Suboptimal Compliance|DRUG-UTILIZATION-CODE-E4|00010101|99991231|SD|Suboptimal Drug/Indication|DRUG-UTILIZATION-CODE-E4|00010101|99991231|SE|Side Effect|DRUG-UTILIZATION-CODE-E4|00010101|99991231|SF|Suboptimal Dosage Form|DRUG-UTILIZATION-CODE-E4|00010101|99991231|SX|Drug-Gender|DRUG-UTILIZATION-CODE-E4|00010101|99991231|TN|Laboratory Test Needed|DRUG-UTILIZATION-CODE-E4|00010101|99991231|TP|Payer/Processor Question| |
| 2021-04-30 | PROCEDURE-CODE-FLAG | UPDATE | Valid Value Attibutes as Shown | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||PROCEDURE-CODE-FLAG|00010101|99991231|06|HCPCS (Both National and Regional HCPCS)| | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||PROCEDURE-CODE-FLAG|00010101|99991231|06|HCPCS Level II and CDT| |
| 2021-04-30 | XIX-MBESCBES-CATEGORY-OF-SERVICE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Valid Value|Effective Date|End Date|Name||2C|00010101|99991231|Certified Community Behavior Health Clinic Payments||18A5|00010101|99991231|Medicaid MCO - Certified Community Behavior Health Clinic Payments||18B1e|00010101|99991231|Medicaid PAHP - Certified Community Behavior Health Clinic Payments||18B2e|00010101|99991231|Medicaid PIHP - Certified Community Behavior Health Clinic Payments||46|00010101|99991231|OUD Medicaid Assisted Treatment – Drugs||46A1|00010101|99991231|OUD MAT DRUG REBATE/National Agreement||46A2|00010101|99991231|OUD MAT DRUG REBATE/State Sidebar||46A3|00010101|99991231|OUD MAT DRUG REBATE MCO /National Agreement||46A4|00010101|99991231|OUD MAT DRUG REBATE MCO /State Sidebar||46A5|00010101|99991231|OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%||46A6|00010101|99991231|OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%||46B|00010101|99991231|OUD Medicaid Assisted Treatment Services| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||DD|20210101|99991231|FROM Diagnostic or therapeutic site TO Diagnostic or therapeutic site||DE|20210101|99991231|FROM Diagnostic or therapeutic site TO Residential, domiciliary, custodial facility (other than 1819 facility)||DG|20210101|99991231|FROM Diagnostic or therapeutic site TO Hospital based ESRD facility||DH|20210101|99991231|FROM Diagnostic or therapeutic site TO Hospital||DI|20210101|99991231|FROM Diagnostic or therapeutic site TO Site of transfer||DJ|20210101|99991231|FROM Diagnostic or therapeutic site TO Freestanding ESRD facility||DN|20210101|99991231|FROM Diagnostic or therapeutic site TO Skilled nursing facility||DP|20210101|99991231|FROM Diagnostic or therapeutic site TO Physician’s office||DR|20210101|99991231|FROM Diagnostic or therapeutic site TO Residence||DS|20210101|99991231|FROM Diagnostic or therapeutic site TO Scene of accident or acute event||DX|20210101|99991231|FROM Diagnostic or therapeutic site TO Intermediate stop at Physician’s office on way to Hospital||ED|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Diagnostic or therapeutic site| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||EE|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Residential, domiciliary, custodial facility (other than 1819 facility)||EG|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital based ESRD facility||EH|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital||EI|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Site of transfer||EJ|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Freestanding ESRD facility||EN|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Skilled nursing facility||EP|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Physician’s office||ER|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Residence||ES|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Scene of accident or acute event||EX|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Intermediate stop at Physician’s office on way to Hospital| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||GD|20210101|99991231|FROM Hospital based ESRD facility TO Diagnostic or therapeutic site||GE|20210101|99991231|FROM Hospital based ESRD facility TO Residential, domiciliary, custodial facility (other than 1819 facility)||GG|20210101|99991231|FROM Hospital based ESRD facility TO Hospital based ESRD facility||GH|20210101|99991231|FROM Hospital based ESRD facility TO Hospital||GI|20210101|99991231|FROM Hospital based ESRD facility TO Site of transfer||GJ|20210101|99991231|FROM Hospital based ESRD facility TO Freestanding ESRD facility||GN|20210101|99991231|FROM Hospital based ESRD facility TO Skilled nursing facility||GP|20210101|99991231|FROM Hospital based ESRD facility TO Physician’s office||GR|20210101|99991231|FROM Hospital based ESRD facility TO Residence||GS|20210101|99991231|FROM Hospital based ESRD facility TO Scene of accident or acute event||GX|20210101|99991231|FROM Hospital based ESRD facility TO Intermediate stop at Physician’s office on way to Hospital||HD|20210101|99991231|FROM Hospital TO Diagnostic or therapeutic site||HE|20210101|99991231|FROM Hospital TO Residential, domiciliary, custodial facility (other than 1819 facility)||HG|20210101|99991231|FROM Hospital TO Hospital based ESRD facility||HH|20210101|99991231|FROM Hospital TO Hospital||HI|20210101|99991231|FROM Hospital TO Site of transfer| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||HJ|20210101|99991231|FROM Hospital TO Freestanding ESRD facility||HN|20210101|99991231|FROM Hospital TO Skilled nursing facility||HP|20210101|99991231|FROM Hospital TO Physician’s office||HR|20210101|99991231|FROM Hospital TO Residence||HS|20210101|99991231|FROM Hospital TO Scene of accident or acute event||HX|20210101|99991231|FROM Hospital TO Intermediate stop at Physician’s office on way to Hospital||ID|20210101|99991231|FROM Site of transfer TO Diagnostic or therapeutic site||IE|20210101|99991231|FROM Site of transfer TO Residential, domiciliary, custodial facility (other than 1819 facility)||IG|20210101|99991231|FROM Site of transfer TO Hospital based ESRD facility||IH|20210101|99991231|FROM Site of transfer TO Hospital||II|20210101|99991231|FROM Site of transfer TO Site of transfer||IJ|20210101|99991231|FROM Site of transfer TO Freestanding ESRD facility||IN|20210101|99991231|FROM Site of transfer TO Skilled nursing facility||IP|20210101|99991231|FROM Site of transfer TO Physician’s office| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||IR|20210101|99991231|FROM Site of transfer TO Residence||IS|20210101|99991231|FROM Site of transfer TO Scene of accident or acute event||IX|20210101|99991231|FROM Site of transfer TO Intermediate stop at Physician’s office on way to Hospital||JD|20210101|99991231|FROM Freestanding ESRD facility TO Diagnostic or therapeutic site||JE|20210101|99991231|FROM Freestanding ESRD facility TO Residential, domiciliary, custodial facility (other than 1819 facility)||JG|20210101|99991231|FROM Freestanding ESRD facility TO Hospital based ESRD facility||JH|20210101|99991231|FROM Freestanding ESRD facility TO Hospital||JI|20210101|99991231|FROM Freestanding ESRD facility TO Site of transfer||JJ|20210101|99991231|FROM Freestanding ESRD facility TO Freestanding ESRD facility||JN|20210101|99991231|FROM Freestanding ESRD facility TO Skilled nursing facility||JP|20210101|99991231|FROM Freestanding ESRD facility TO Physician’s office||JR|20210101|99991231|FROM Freestanding ESRD facility TO Residence||JS|20210101|99991231|FROM Freestanding ESRD facility TO Scene of accident or acute event||JX|20210101|99991231|FROM Freestanding ESRD facility TO Intermediate stop at Physician’s office on way to Hospital||ND|20210101|99991231|FROM Skilled nursing facility TO Diagnostic or therapeutic site||NE|20210101|99991231|FROM Skilled nursing facility TO Residential, domiciliary, custodial facility (other than 1819 facility)||NG|20210101|99991231|FROM Skilled nursing facility TO Hospital based ESRD facility| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||NH|20210101|99991231|FROM Skilled nursing facility TO Hospital||NI|20210101|99991231|FROM Skilled nursing facility TO Site of transfer||NJ|20210101|99991231|FROM Skilled nursing facility TO Freestanding ESRD facility||NN|20210101|99991231|FROM Skilled nursing facility TO Skilled nursing facility||NP|20210101|99991231|FROM Skilled nursing facility TO Physician’s office||NR|20210101|99991231|FROM Skilled nursing facility TO Residence||NS|20210101|99991231|FROM Skilled nursing facility TO Scene of accident or acute event||NX|20210101|99991231|FROM Skilled nursing facility TO Intermediate stop at Physician’s office on way to Hospital||PD|20210101|99991231|FROM Physician’s office TO Diagnostic or therapeutic site||PE|20210101|99991231|FROM Physician’s office TO Residential, domiciliary, custodial facility (other than 1819 facility)||PG|20210101|99991231|FROM Physician’s office TO Hospital based ESRD facility||PH|20210101|99991231|FROM Physician’s office TO Hospital||PI|20210101|99991231|FROM Physician’s office TO Site of transfer||PJ|20210101|99991231|FROM Physician’s office TO Freestanding ESRD facility||PN|20210101|99991231|FROM Physician’s office TO Skilled nursing facility||PP|20210101|99991231|FROM Physician’s office TO Physician’s office||PR|20210101|99991231|FROM Physician’s office TO Residence||PS|20210101|99991231|FROM Physician’s office TO Scene of accident or acute event||PX|20210101|99991231|FROM Physician’s office TO Intermediate stop at Physician’s office on way to Hospital|RD|20210101|99991231|FROM Residence TO Diagnostic or therapeutic site||RE|20210101|99991231|FROM Residence TO Residential, domiciliary, custodial facility (other than 1819 facility)||RG|20210101|99991231|FROM Residence TO Hospital based ESRD facility |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|Modifier|Effective Date|End Date|Description||RH|20210101|99991231|FROM Residence TO Hospital||RI|20210101|99991231|FROM Residence TO Site of transfer||RJ|20210101|99991231|FROM Residence TO Freestanding ESRD facility||RN|20210101|99991231|FROM Residence TO Skilled nursing facility||RP|20210101|99991231|FROM Residence TO Physician’s office||RR|20210101|99991231|FROM Residence TO Residence||RS|20210101|99991231|FROM Residence TO Scene of accident or acute event||RX|20210101|99991231|FROM Residence TO Intermediate stop at Physician’s office on way to Hospital||SD|20210101|99991231|FROM Scene of accident or acute event TO Diagnostic or therapeutic site||SE|20210101|99991231|FROM Scene of accident or acute event TO Residential, domiciliary, custodial facility (other than 1819 facility)||SG|20210101|99991231|FROM Scene of accident or acute event TO Hospital based ESRD facility||SH|20210101|99991231|FROM Scene of accident or acute event TO Hospital||SI|20210101|99991231|FROM Scene of accident or acute event TO Site of transfer||SJ|20210101|99991231|FROM Scene of accident or acute event TO Freestanding ESRD facility||SN|20210101|99991231|FROM Scene of accident or acute event TO Skilled nursing facility||SP|20210101|99991231|FROM Scene of accident or acute event TO Physician’s office||SR|20210101|99991231|FROM Scene of accident or acute event TO Residence||SS|20210101|99991231|FROM Scene of accident or acute event TO Scene of accident or acute event||SX|20210101|99991231|FROM Scene of accident or acute event TO Intermediate stop at Physician’s office on way to Hospital| |
| 2021-05-21 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | |EFFECTIVE_DATE|END_DATE|VALUE|NAME||20100701|99991231|V6|Arteriovenous graft|20100701|99991231|V7|Arteriovenous fistula||20120401|20120331|V8|Infection present||20120401|20120331|V9|No infection present||20180401|99991231|VM|Mdpp virtual make-up session||19970101|99991231|VP|Aphakic patient||20180101|99991231|X1|Continuous/broad services||20180101|99991231|X2|Continuous/focused services||20180101|99991231|X3|Episodic/broad services||20180101|99991231|X4|Episodic/focused services||20180101|99991231|X5|Svc req by another clinician||20150101|99991231|XE|Separate encounter||20150101|99991231|XP|Separate practitioner||20150101|99991231|XS|Separate organ/structure||20150101|99991231|XU|Unusual separate service|20180401|20180331|ZA|Novartis/sandoz||20180401|20180331|ZB|Pfizer/hospira||20180401|20180331|ZC| Merck/samsung bioepis| | N/A |
| 2021-07-02 | AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR (ELG215) | UPDATE | Valid Value Attibutes as Shown | Valid Value '0' Description: Individual does not meet the definition of an American Indian/Alaskan Native.Valid Value '1' Description: Individual meets the definition of an American Indian/Alaskan Native. | Valid Value '0' Description: Individual does not meet the definition of an American Indian/Alaska Native.Valid Value '1' Description: Individual meets the definition of an American Indian/Alaska Native. |
| 2021-07-02 | RACE (ELG213) | UPDATE | Valid Value Attibutes as Shown | Valid Value '003' Description: American Indian or Alaskan Native | Valid Value '003' Description: American Indian or Alaska Native |
| 2021-08-13 | OPERATING-AUTHORITY (MCR067) | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||OPERATING-AUTHORITY|00010101|99991231|16|Concurrent 1915(a)/1915(j) - programs, or portions thereof, operating under both 1915(a) and 1915(j) authorities||OPERATING-AUTHORITY|00010101|99991231|17|Concurrent 1932(a)/1915(j) - programs, or portions thereof, operating under both 1932(a) and 1915(j) authorities||OPERATING-AUTHORITY|00010101|99991231|18|Concurrent 1915(b)/1915(j) - programs, or portions thereof, operating under both 1915(b) and 1915(j) authorities||OPERATING-AUTHORITY|00010101|99991231|19|Concurrent 1115/1915(j) - programs, or portions thereof, operating under both 1115 and 1915(j) authorities||OPERATING-AUTHORITY|00010101|99991231|20|Concurrent 1915(a)/1915(k) - programs, or portions thereof, operating under both 1915(a) and 1915(k) authorities||OPERATING-AUTHORITY|00010101|99991231|21|Concurrent 1932(a)/1915(k) - programs, or portions thereof, operating under both 1932(a) and 1915(k) authorities||OPERATING-AUTHORITY|00010101|99991231|22|Concurrent 1915(b)/1915(k) - programs, or portions thereof, operating under both 1915(b) and 1915(k) authorities||OPERATING-AUTHORITY|00010101|99991231|23|Concurrent 1115/1915(k) - programs, or portions thereof, operating under both 1115 and 1915(k) authorities| |
| 2021-08-13 | TYPE-OF-BILL-2-FACILITY-TYPE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|1|Hospital||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|2|Skilled Nursing||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|3|Home Health||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|4|Religious Nonmedical (Hospital)||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|20051001|5|Reserved for national assignment (discontinued effective 10/1/05).||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|6|Intermediate Care||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|7|Clinic or Hospital Based Renal Dialysis Facility (requires special information in second digit below).||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|8|Special facility or hospital ASC surgery (requires special information in second digit below).||TYPE-OF-BILL-2-FACILITY-TYPE|00010101|99991231|9|Reserved for National Assignment| |
| 2021-08-13 | TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|1|Rural Health Clinic (RHC)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|2|Hospital Based or Independent Renal Dialysis Facility||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|3|Free Standing Provider-Based Federally Qualified Health Center (FQHC)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|4|Other Rehabilitation Facility (ORF)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|5|Comprehensive Outpatient Rehabilitation Facility (CORF)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|6|Community Mental Health Center (CMHC)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|20100401|99991231|7|Federally Qualified Health Center (FQHC) (Effective 4/1/10)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|20120401|99991231|8|Licensed Freestanding Emergency Medical Facility (Effective 4/1/12)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS|00010101|99991231|9|OTHER| |
| 2021-08-13 | TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|1|Hospice (Nonhospital Based)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|2|Hospice (Hospital Based)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|3|Ambulatory Surgical Center Services to Hospital Outpatients||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|4|Free Standing Birthing Center||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|5|Critical Access Hospital||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|6|Residential Facility||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|20210101|99991231|7|Freestanding Non-residential Opioid Treatment Program (Effective 1/1/21)||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|8|Reserved for National Assignment||TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY|00010101|99991231|9|OTHER| |
| 2021-08-13 | TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|1|Inpatient||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|2|Inpatient||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|3|Outpatient||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|4|Other||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|5|Intermediate Care - Level I||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|6|Intermediate Care - Level II||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|20051001|7|Reserved for national assignment (discontinued effective 10/1/05).||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|8|Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement).||TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER|00010101|99991231|9|Reserved for National Assignment| |
| 2021-08-13 | TYPE-OF-BILL-4-FREQUENCY | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|0|Nonpayment/Zero Claims||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|1|Admit Through Discharge Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|2|Interim-First Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|3|Interim-Continuing Claims (Not valid for PPS Bills)||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|A|Admission/Election Notice||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|B|Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Termination/Revocation Notice||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|C|Hospice Change of Provider Notice||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|D|Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Void/Cancel||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|E|Hospice Change of Ownership||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|F|Beneficiary Initiated Adjustment Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|G|CWF Initiated Adjustment Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|H|CMS Initiated Adjustment Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|I|FI Adjustment Claim (Other than QIO or Provider||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|J|Initiated Adjustment Claim-Other||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|K|OIG Initiated Adjustment Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|M|MSP Initiated Adjustment Claim||TYPE-OF-BILL-4-FREQUENCY|00010101|99991231|P|QIO Adjustment Claim| |
| 2021-08-13 | TYPE-OF-SERVICE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-SERVICE|00010101|99991231|147|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.| |
| 2021-09-03 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||HCPCS|06032021|99991231|Q0244|Casirivi and imdevi 1200 mg |Injection, casirivimab and imdevimab, 1200 mg||HCPCS|05062021|99991231|M0244|Casirivi and imdevi inj hm|Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|06242021|99991231|Q0249|Tocilizumab for COVID-19|Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg||HCPCS|06242021|99991231|M0249|Adm Tocilizu COVID-19 1st|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or ext|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||HCPCS|06032021|99991231|Q0244|Casirivi and imdevi 1200 mg |Injection, casirivimab and imdevimab, 1200 mg||HCPCS|05062021|99991231|M0244|Casirivi and imdevi inj hm|Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|06242021|99991231|Q0249|Tocilizumab for COVID-19|Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg||HCPCS|06242021|99991231|M0249|Adm Tocilizu COVID-19 1st|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose||HCPCS|06242021|99991231|M0250|Adm Tocilizu COVID-19 2nd|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose||HCPCS|05062021|99991231|M0246|Bamlan and etesev infus home|Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|05262021|99991231|Q0247|Sotrovimab|Injection, sotrovimab, 500 mg||HCPCS|05262021|99991231|M0247|Sotrovimab infusion|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring||HCPCS|05262021|99991231|M0248|Sotrovimab inf, home admin|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|06082021|99991231|M0201|Covid-19 vaccine home admin|Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home|racorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose||HCPCS|06242021|99991231|M0250|Adm Tocilizu COVID-19 2nd|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose||HCPCS|05062021|99991231|M0246|Bamlan and etesev infus home|Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|05262021|99991231|Q0247|Sotrovimab|Injection, sotrovimab, 500 mg||HCPCS|05262021|99991231|M0247|Sotrovimab infusion|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring||HCPCS|05262021|99991231|M0248|Sotrovimab inf, home admin|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|06082021|99991231|M0201|Covid-19 vaccine home admin|Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home| |
| 2021-09-03 | TYPE-OF-SERVICE | UPDATE | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||TYPE-OF-SERVICE|00010101|99991231|147|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.| |
| 2021-10-15 | CITIZENSHIP-IND | UPDATE | Valid Value Attibutes as Shown | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CITIZENSHIP-IND|00010101|99991231|1|U.S. Citizen||CITIZENSHIP-IND|00010101|99991231|2|U.S. National| | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CITIZENSHIP-IND|00010101|99991231|1|U.S. Citizen (If the state’s eligibility determination system does not distinguish between U.S. citizens and U.S. nationals who are not U.S. citizens, then use this value for all U.S. citizens and U.S. nationals (see 42 CFR 435 and 436.).)||CITIZENSHIP-IND|00010101|99991231|2|U.S. National (If the state’s eligibility determination system does distinguish between U.S. citizens and U.S. nationals who are not U.S. citizens, then use this value for U.S. nationals who are not U.S. citizens (see 42 CFR 435 and 436.).)| |
| 2021-10-15 | HCPCS | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||HCPCS|20210603|99991231|Q0244|Casirivi and imdevi 1200 mg |Injection, casirivimab and imdevimab, 1200 mg||HCPCS|20210506|99991231|M0244|Casirivi and imdevi inj hm|Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|20210624|99991231|Q0249|Tocilizumab for COVID-19|Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg||HCPCS|20210624|99991231|M0249|Adm Tocilizu COVID-19 1st|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose||HCPCS|20210624|99991231|M0250|Adm Tocilizu COVID-19 2nd|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose||HCPCS|20210506|99991231|M0246|Bamlan and etesev infus home|Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|20210506|99991231|Q0247|Sotrovimab|Injection, sotrovimab, 500 mg||HCPCS|20210506|99991231|M0247|Sotrovimab infusion|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring||HCPCS|20210506|99991231|M0248|Sotrovimab inf, home admin|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency||HCPCS|20210506|999912311|M0201|Covid-19 vaccine home admin|Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home||HCPCS|20201109|20210416|Q0239|Bamlanivimab-xxxx|Injection, bamlanivimab, 700 mg||HCPCS|20201109|20210416|M0239|Bamlanivimab-xxxx infusion|Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring||HCPCS|20210730|99991231|Q0240|Casirivi and imdevi 600mg|Injection, casirivimab and imdevimab, 600 mg||HCPCS|20210730|99991231|M0240|Casiri and imdev repeat|Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses||HCPCS|20210730|99991231|M0241|Casiri and imdev repeat hm|Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses||HCPCS|20201121|99991231|Q0243|Casirivimab and imdevimab|Injection, casirivimab and imdevimab, 2400 mg||HCPCS|20201121|99991231|M0243|Casirivi and imdevi inj|Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring||HCPCS|20210209|99991231|M0245|Bamlan and etesev infusion|Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring||HCPCS|20210209|99991231|Q0245|Bamlanivimab and etesevima|Injection, bamlanivimab and etesevimab, 2100 mg| |
| 2021-10-15 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||CPT|20201211|99991231|91300|SARSCOV2 VAC 30MCG/0.3ML IM|Pfizer-Biontech Covid-19 Vaccine||CPT|20201211|99991231|0001A|ADM SARSCOV2 30MCG/0.3ML 1ST|Pfizer-Biontech Covid-19 Vaccine Administration – First Dose||CPT|20201211|99991231|0002A|ADM SARSCOV2 30MCG/0.3ML 2ND|Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose||CPT|20210812|99991231|0003A|ADM SARSCOV2 30MCG/0.3ML 3RD|Pfizer-Biontech Covid-19 Vaccine Administration – Third Dose||CPT|20201218|99991231|91301|SARSCOV2 VAC 100MCG/0.5ML IM|Moderna Covid-19 Vaccine||CPT|20201218|99991231|0011A|ADM SARSCOV2 100MCG/0.5ML1ST|Moderna Covid-19 Vaccine Administration – First Dose||CPT|20201218|99991231|0012A|ADM SARSCOV2 100MCG/0.5ML2ND|Moderna Covid-19 Vaccine Administration – Second Dose||CPT|20210812|99991231|0013A|ADM SARSCOV2 100MCG/0.5ML3RD|Moderna Covid-19 Vaccine Administration – Third Dose||CPT|2021027|99991231|91303|SARSCOV2 VAC AD26 .5ML IM|Janssen Covid-19 Vaccine[3]***||CPT|2021027|99991231|0031A|ADM SARSCOV2 VAC AD26 .5ML|Janssen Covid-19 Vaccine Administration[3]***| |
| 2021-10-15 | PROV-IDENTIFIER-TYPE (PRV077) | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||PROV-IDENTIFIER-TYPE|00010101|99991231|9|Old State Provider ID |
| 2021-11-05 | PROV-CLASSIFICATION-TYPE = 4 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|89|Disposable medical supplies||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|90|Critical access hospital services - IP||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|91|Skilled care - hospital residing||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|92|Exceptional care - hospital residing||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|93|Non-acute care - hospital residing||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|120|Capitated payments for primary care case management (PCCM)||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|123|Disproportionate share hospital (DSH) payments||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|127|Indian Health Service (IHS) - Family Plan||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|132|Supplemental payment - inpatient||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|133|Supplemental payment - nursing||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|134|Supplemental payment - outpatient||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|135|EHR payments to provider||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|136|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|137|COVID–19 testing-related services||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|138|Per member per month (PMPM) payments for health home services||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|143|Per member per month (PMPM) payments for other payments||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|144|Payments to individuals for personal assistance services under 1915(j)||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|145|Medication Assisted Treatment (MAT) services and drugs for evidenced-based treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the Social Security Act||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|146|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)||PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)|00010101|99991231|147|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.| |
| 2021-12-03 | DIAGNOSIS-CODE | UPDATE | Valid Value Attibutes as Shown | Update DIAGNOSIS-CODE.psv reference file - all end dates currently on or before 20210930 | These ICD-10 diagnosis codes END-DATE is updated to 20220930 |
| 2021-12-03 | ELIGIBILITY-CHANGE-REASON | UPDATE | Valid Value Attibutes as Shown | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||ELIGIBILITY-CHANGE-REASON|00010101|99991231|09|No longer in need of long-term care services resides| | |VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||ELIGIBILITY-CHANGE-REASON|00010101|99991231|09|No longer in need of long-term care services| |
| 2021-12-03 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | Update PROCEDURE-CODE.psv reference file - all end dates currently on or before 20210930 | These ICD-10 procedure codes END-DATE is updated to 20220930 |
| 2021-12-03 | PROV-CLASSIFICATION-TYPE = 3 (Provider Type Code) | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||PROV-CLASSIFICATION-TYPE = 3 (Provider Type Code)|00010101|99991231|58|Institutions for Mental Disease| |
| 2021-12-03 | RACE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||RACE|00010101|99991231|018|Other| |
| 2021-12-03 | XIX-MBESCBES-CATEGORY-OF-SERVICE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||XIX-MBESCBES-CATEGORY-OF-SERVICE|20210311|99991231|47|ARP Section 9811 COVID Vaccine/Vaccine Administration| |
| 2021-12-03 | XXI-MBESCBES-CATEGORY-OF-SERVICE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
|VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION||XXI-MBESCBES-CATEGORY-OF-SERVICE|20210311|99991231|26|ARP Section 9821 COVID Vaccine/Vaccine Administration| |
| 2021-12-17 | PROCEDURE-CODE-MOD | ADD | Valid Value Attibutes as Shown | add values to the PROCEDURE-CODE-MOD.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|PROCEDURE-CODE-MOD|20070701|99991231|1P|Performance Measure Exclusion Modifier due to Medical Reasons|PROCEDURE-CODE-MOD|20070701|99991231|2P|Performance Measure Exclusion Modifier due to Patient Reasons|PROCEDURE-CODE-MOD|20070701|99991231|3P|Performance Measure Exclusion Modifier due to System Reasons | |
| 2021-12-17 | PROCEDURE-CODE-MOD | UPDATE | Valid Value Attibutes as Shown | |Modifier|Effective Date|End Date|Description||DD|20210101|99991231|FROM Diagnostic or therapeutic site TO Diagnostic or therapeutic site||DE|20210101|99991231|FROM Diagnostic or therapeutic site TO Residential, domiciliary, custodial facility (other than 1819 facility)||DG|20210101|99991231|FROM Diagnostic or therapeutic site TO Hospital based ESRD facility||DH|20210101|99991231|FROM Diagnostic or therapeutic site TO Hospital||DI|20210101|99991231|FROM Diagnostic or therapeutic site TO Site of transfer||DJ|20210101|99991231|FROM Diagnostic or therapeutic site TO Freestanding ESRD facility||DN|20210101|99991231|FROM Diagnostic or therapeutic site TO Skilled nursing facility||DP|20210101|99991231|FROM Diagnostic or therapeutic site TO Physician’s office||DR|20210101|99991231|FROM Diagnostic or therapeutic site TO Residence||DS|20210101|99991231|FROM Diagnostic or therapeutic site TO Scene of accident or acute event||DX|20210101|99991231|FROM Diagnostic or therapeutic site TO Intermediate stop at Physician’s office on way to Hospital| | |Modifier|Effective Date|End Date|Description||DD|00010101|99991231|FROM Diagnostic or therapeutic site TO Diagnostic or therapeutic site||DE|00010101|99991231|FROM Diagnostic or therapeutic site TO Residential, domiciliary, custodial facility (other than 1819 facility)||DG|00010101|99991231|FROM Diagnostic or therapeutic site TO Hospital based ESRD facility||DH|00010101|99991231|FROM Diagnostic or therapeutic site TO Hospital||DI|00010101|99991231|FROM Diagnostic or therapeutic site TO Site of transfer||DJ|00010101|99991231|FROM Diagnostic or therapeutic site TO Freestanding ESRD facility||DN|00010101|99991231|FROM Diagnostic or therapeutic site TO Skilled nursing facility||DP|00010101|99991231|FROM Diagnostic or therapeutic site TO Physician’s office||DR|00010101|99991231|FROM Diagnostic or therapeutic site TO Residence||DS|00010101|99991231|FROM Diagnostic or therapeutic site TO Scene of accident or acute event||DX|00010101|99991231|FROM Diagnostic or therapeutic site TO Intermediate stop at Physician’s office on way to Hospital| |
| 2021-12-17 | PROCEDURE-CODE-MOD | UPDATE | Valid Value Attibutes as Shown | |Modifier|Effective Date|End Date|Description||EG|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital based ESRD facility||EH|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital||EI|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Site of transfer||EN|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Skilled nursing facility||ES|20210101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Scene of accident or acute event||GI|20210101|99991231|FROM Hospital based ESRD facility TO Site of transfer||ID|20210101|99991231|FROM Site of transfer TO Diagnostic or therapeutic site||IE|20210101|99991231|FROM Site of transfer TO Residential, domiciliary, custodial facility (other than 1819 facility)||IG|20210101|99991231|FROM Site of transfer TO Hospital based ESRD facility||IH|20210101|99991231|FROM Site of transfer TO Hospital||II|20210101|99991231|FROM Site of transfer TO Site of transfer||IJ|20210101|99991231|FROM Site of transfer TO Freestanding ESRD facility||IN|20210101|99991231|FROM Site of transfer TO Skilled nursing facility||IP|20210101|99991231|FROM Site of transfer TO Physician’s office| | |Modifier|Effective Date|End Date|Description||EG|00010101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital based ESRD facility||EH|00010101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital||EI|00010101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Site of transfer||EN|00010101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Skilled nursing facility||ES|00010101|99991231|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Scene of accident or acute event||GI|00010101|99991231|FROM Hospital based ESRD facility TO Site of transfer||ID|00010101|99991231|FROM Site of transfer TO Diagnostic or therapeutic site||IE|00010101|99991231|FROM Site of transfer TO Residential, domiciliary, custodial facility (other than 1819 facility)||IG|00010101|99991231|FROM Site of transfer TO Hospital based ESRD facility||IH|00010101|99991231|FROM Site of transfer TO Hospital||II|00010101|99991231|FROM Site of transfer TO Site of transfer||IJ|00010101|99991231|FROM Site of transfer TO Freestanding ESRD facility||IN|00010101|99991231|FROM Site of transfer TO Skilled nursing facility||IP|00010101|99991231|FROM Site of transfer TO Physician’s office| |
| 2021-12-17 | PROCEDURE-CODE-MOD | UPDATE | Valid Value Attibutes as Shown | |Modifier|Effective Date|End Date|Description||IR|20210101|99991231|FROM Site of transfer TO Residence||IS|20210101|99991231|FROM Site of transfer TO Scene of accident or acute event||IX|20210101|99991231|FROM Site of transfer TO Intermediate stop at Physician’s office on way to Hospital||JH|20210101|99991231|FROM Freestanding ESRD facility TO Hospital||JI|20210101|99991231|FROM Freestanding ESRD facility TO Site of transfer||JJ|20210101|99991231|FROM Freestanding ESRD facility TO Freestanding ESRD facility||JN|20210101|99991231|FROM Freestanding ESRD facility TO Skilled nursing facility||JP|20210101|99991231|FROM Freestanding ESRD facility TO Physician’s office||JR|20210101|99991231|FROM Freestanding ESRD facility TO Residence||JS|20210101|99991231|FROM Freestanding ESRD facility TO Scene of accident or acute event||JX|20210101|99991231|FROM Freestanding ESRD facility TO Intermediate stop at Physician’s office on way to Hospital||ND|20210101|99991231|FROM Skilled nursing facility TO Diagnostic or therapeutic site||NE|20210101|99991231|FROM Skilled nursing facility TO Residential, domiciliary, custodial facility (other than 1819 facility)||NG|20210101|99991231|FROM Skilled nursing facility TO Hospital based ESRD facility| | |Modifier|Effective Date|End Date|Description||IR|00010101|99991231|FROM Site of transfer TO Residence||IS|00010101|99991231|FROM Site of transfer TO Scene of accident or acute event||IX|00010101|99991231|FROM Site of transfer TO Intermediate stop at Physician’s office on way to Hospital||JH|00010101|99991231|FROM Freestanding ESRD facility TO Hospital||JI|00010101|99991231|FROM Freestanding ESRD facility TO Site of transfer||JJ|00010101|99991231|FROM Freestanding ESRD facility TO Freestanding ESRD facility||JN|00010101|99991231|FROM Freestanding ESRD facility TO Skilled nursing facility||JP|00010101|99991231|FROM Freestanding ESRD facility TO Physician’s office||JR|00010101|99991231|FROM Freestanding ESRD facility TO Residence||JS|00010101|99991231|FROM Freestanding ESRD facility TO Scene of accident or acute event||JX|00010101|99991231|FROM Freestanding ESRD facility TO Intermediate stop at Physician’s office on way to Hospital||ND|00010101|99991231|FROM Skilled nursing facility TO Diagnostic or therapeutic site||NE|00010101|99991231|FROM Skilled nursing facility TO Residential, domiciliary, custodial facility (other than 1819 facility)||NG|00010101|99991231|FROM Skilled nursing facility TO Hospital based ESRD facility| |
| 2021-12-17 | PROCEDURE-CODE-MOD | UPDATE | Valid Value Attibutes as Shown | |Modifier|Effective Date|End Date|Description||NH|20210101|99991231|FROM Skilled nursing facility TO Hospital||NI|20210101|99991231|FROM Skilled nursing facility TO Site of transfer||NJ|20210101|99991231|FROM Skilled nursing facility TO Freestanding ESRD facility||NN|20210101|99991231|FROM Skilled nursing facility TO Skilled nursing facility||NP|20210101|99991231|FROM Skilled nursing facility TO Physician’s office||NS|20210101|99991231|FROM Skilled nursing facility TO Scene of accident or acute event||NX|20210101|99991231|FROM Skilled nursing facility TO Intermediate stop at Physician’s office on way to Hospital||PD|20210101|99991231|FROM Physician’s office TO Diagnostic or therapeutic site||PE|20210101|99991231|FROM Physician’s office TO Residential, domiciliary, custodial facility (other than 1819 facility)||PG|20210101|99991231|FROM Physician’s office TO Hospital based ESRD facility||PH|20210101|99991231|FROM Physician’s office TO Hospital||PI|20210101|99991231|FROM Physician’s office TO Site of transfer||PJ|20210101|99991231|FROM Physician’s office TO Freestanding ESRD facility||PN|20210101|99991231|FROM Physician’s office TO Skilled nursing facility||PP|20210101|99991231|FROM Physician’s office TO Physician’s office||PR|20210101|99991231|FROM Physician’s office TO Residence||PX|20210101|99991231|FROM Physician’s office TO Intermediate stop at Physician’s office on way to Hospital|RG|20210101|99991231|FROM Residence TO Hospital based ESRD facility | |Modifier|Effective Date|End Date|Description||NH|00010101|99991231|FROM Skilled nursing facility TO Hospital||NI|00010101|99991231|FROM Skilled nursing facility TO Site of transfer||NJ|00010101|99991231|FROM Skilled nursing facility TO Freestanding ESRD facility||NN|00010101|99991231|FROM Skilled nursing facility TO Skilled nursing facility||NP|00010101|99991231|FROM Skilled nursing facility TO Physician’s office||NS|00010101|99991231|FROM Skilled nursing facility TO Scene of accident or acute event||NX|00010101|99991231|FROM Skilled nursing facility TO Intermediate stop at Physician’s office on way to Hospital||PD|00010101|99991231|FROM Physician’s office TO Diagnostic or therapeutic site||PE|00010101|99991231|FROM Physician’s office TO Residential, domiciliary, custodial facility (other than 1819 facility)||PG|00010101|99991231|FROM Physician’s office TO Hospital based ESRD facility||PH|00010101|99991231|FROM Physician’s office TO Hospital||PI|00010101|99991231|FROM Physician’s office TO Site of transfer||PJ|00010101|99991231|FROM Physician’s office TO Freestanding ESRD facility||PN|00010101|99991231|FROM Physician’s office TO Skilled nursing facility||PP|00010101|99991231|FROM Physician’s office TO Physician’s office||PR|00010101|99991231|FROM Physician’s office TO Residence||PX|00010101|99991231|FROM Physician’s office TO Intermediate stop at Physician’s office on way to Hospital|RG|00010101|99991231|FROM Residence TO Hospital based ESRD facility |
| 2021-12-17 | PROCEDURE-CODE-MOD | UPDATE | Valid Value Attibutes as Shown | |Modifier|Effective Date|End Date|Description||RN|20210101|99991231|FROM Residence TO Skilled nursing facility||RS|20210101|99991231|FROM Residence TO Scene of accident or acute event||RX|20210101|99991231|FROM Residence TO Intermediate stop at Physician’s office on way to Hospital||SI|20210101|99991231|FROM Scene of accident or acute event TO Site of transfer||SP|20210101|99991231|FROM Scene of accident or acute event TO Physician’s office||SR|20210101|99991231|FROM Scene of accident or acute event TO Residence||SX|20210101|99991231|FROM Scene of accident or acute event TO Intermediate stop at Physician’s office on way to Hospital| | |Modifier|Effective Date|End Date|Description||RN|00010101|99991231|FROM Residence TO Skilled nursing facility||RS|00010101|99991231|FROM Residence TO Scene of accident or acute event||RX|00010101|99991231|FROM Residence TO Intermediate stop at Physician’s office on way to Hospital||SI|00010101|99991231|FROM Scene of accident or acute event TO Site of transfer||SP|00010101|99991231|FROM Scene of accident or acute event TO Physician’s office||SR|00010101|99991231|FROM Scene of accident or acute event TO Residence||SX|00010101|99991231|FROM Scene of accident or acute event TO Intermediate stop at Physician’s office on way to Hospital| |
| 2021-12-17 | PROV-SPECIALTY | ADD | Valid Value Attibutes as Shown | add valid value to file PROV-SPECIALTY.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONPROV-SPECIALTY|00010101|99991231|88|Unknown Supplier/Provider Specialty| |
| 2021-12-17 | XXI-MBESCBES-CATEGORY-OF-SERVICE | ADD | Valid Value Attibutes as Shown | add values to XXI-MBESCBES-CATEGORY-OF-SERVICE.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|2A|Inpatient Hospital Services - DSH|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|3A|Inpatient Mental Health - DSH|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|3B|Certified Community Behavior Health Clinic Payments|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|8A2|Drug Rebate - State|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|8A3|MCO - National Agreement|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|8A4|MCO - State Sidebar Agreement|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|8A5|Increased ACA OFFSET - Fee for Service - 100%|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|8A6|Increased ACA OFFSET - MCO - 100%|XXI-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|21A|Home and Community-Based Services - Regular Payment (WAIVER)| |
| 2022-01-07 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | add values to PROCEDURE-CODE.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION|PROCEDURE-CODE|20210701|99991231|J1951|INJ FENSOLVI 0.25 MG|PROCEDURE-CODE|20210701|99991231|Q5123|INJ. RIABNI, 10 MG| |
| 2022-01-07 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | add values to CPT.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION|CPT|20190701|99991231|0097U|GI PATHOGEN 22 TARGETS|CPT|20190701|99991231|0107U|C DIFF TOX AG DETCJ IA STOOL|CPT|20190701|99991231|0117U|PAIN MGMT 11 ENDOGENOUS ANAL|CPT|20201001|99991231|0204U|ONC THYR MRNA XPRSN ALYS 593|CPT|20201001|99991231|0208U|ONC MTC MRNA XPRSN ALYS 108 | |
| 2022-01-28 | N/A | UPDATE | Valid Value Attibutes as Shown | PROV-TAXONOMY.psv v20.1 07/01/2020 | PROV-TAXONOMY.psv v22.0 - 01/01/2022 |
| 2022-01-28 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION||CPT|20211020|99991231|0034A|ADM SARSCOV2 VAC AD26 .5ML B||CPT|00010101|99991231|0053A|ADM SARSCV2 30MCG TRS-SUCR 3||CPT|20211029|99991231|91307|SARSCOV2 VAC 10 MCG TRS-SUCR||CPT|20210922|99991231|0004A|ADM SARSCOV2 30MCG/0.3ML BST||CPT|00010101|99991231|0052A|ADM SARSCV2 30MCG TRS-SUCR 2||CPT|20211020|99991231|0064A|ADM SARSCOV2 50MCG/0.25MLBST||CPT|20130608|99991231|M0201|Covid-19 vaccine home admin||CPT|00010101|99991231|0051A|ADM SARSCV2 30MCG TRS-SUCR 1||CPT|20211020|99991231|91306|SARSCOV2 VAC 50MCG/0.25ML IM||CPT|20211029|99991231|0072A|ADM SARSCV2 10MCG TRS-SUCR 2||CPT|00010101|99991231|91305|SARSCOV2 VAC 30 MCG TRS-SUCR||CPT|00010101|99991231|0054A|ADM SARSCV2 30MCG TRS-SUCR B||CPT|20211029|99991231|0071A|ADM SARSCV2 10MCG TRS-SUCR 1| |
| 2022-01-28 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION||HCPCS|20211208|99991231|M0221|Tixagev and cilgav inj hm||HCPCS|20211208|99991231|Q0220|Tixagev and cilgav, 300mg||HCPCS|20211208|99991231|M0220|Tixagev and cilgav inj| |
| 2022-02-18 | REVENUE-CODE | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION|REVENUE-CODE|00010101|99991231|0000|RESERVED FOR NATIONAL ASSIGNMENT|All Revenue Codes with the description 'RESERVED FOR NATIONAL ASSIGNMENT' and 'RESERVED FOR NATIONAL ASSIGNMENT - ' | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION|All Revenue Codes with the description 'RESERVED FOR NATIONAL ASSIGNMENT' and 'RESERVED FOR NATIONAL ASSIGNMENT - ' were removed from the REVENUE-CODE.psv file |
| 2022-03-11 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|END_DATE|CPT|20211231| | VALUE_SET_ID|END_DATE|CPT|99991231| |
| 2022-03-11 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|END_DATE|CDT|20211231| | VALUE_SET_ID|END_DATE|CDT|99991231| |
| 2022-04-01 | ELG215 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|END_DATE|VALUE|NAME|DESCRIPTIONAMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR|20200214|2|Yes, Individual does have CDIB | VALUE_SET_ID|END_DATE|VALUE|NAME|DESCRIPTIONAMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR|20171201|2|Yes, Individual does have CDIB |
| 2022-04-01 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONELIGIBILTY-GROUP|20220401|20270330|77|Medicaid - Women who are pregnant or postpartum, 12-month extended postpartum coverageELIGIBILTY-GROUP|20220401|20270330|78|CHIP - Women who are pregnant or postpartum, 12-month extended postpartum coverage |
| 2022-04-01 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
Update 2022 CDT Code Set End date |
| 2022-04-22 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONELIGIBILTY-GROUP|20220401|20270330|77|Medicaid - Women who are pregnant or postpartum, 12-month extended postpartum coverageELIGIBILTY-GROUP|20220401|20270330|78|CHIP - Women who are pregnant or postpartum, 12-month extended postpartum coverage | N/A |
| 2022-05-13 | COT123 | UPDATE | Valid Value Attibutes as Shown | Replace VVL.178 - Place of Service Code List | https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set |
| 2022-05-13 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONPROCEDURE-CODE-MOD|20080101|20201231|ED|Hct>39% or hgb>13g>=3 cycle|Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cyclePROCEDURE-CODE-MOD|20210101|99991231|ED|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Diagnostic or therapeutic site|PROCEDURE-CODE-MOD|20080101|20201231|EE|Hct>39% or hgb>13g<3 cycle|Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cyclePROCEDURE-CODE-MOD|20210101|99991231|EE|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Residential, domiciliary, custodial facility (other than 1819 facility)| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONPROCEDURE-CODE-MOD|00010101|20201231|ED|Hct>39% or hgb>13g>=3 cycle|Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cyclePROCEDURE-CODE-MOD|20210101|99991231|ED|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Diagnostic or therapeutic site|PROCEDURE-CODE-MOD|00010101|20201231|EE|Hct>39% or hgb>13g<3 cycle|Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cyclePROCEDURE-CODE-MOD|20210101|99991231|EE|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Residential, domiciliary, custodial facility (other than 1819 facility)| |
| 2022-05-13 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONXIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|10|Clinic Services|10. Clinic Services (See 42 CFR 440.90.).--These are preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that:Are provided to outpatients;• Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. For reporting purposes, consider a group of physicians who share, only for mutual convenience, space, services of supporting staff, etc., as physicians, rather than a clinic, even though they practice under the name of a clinic; and• Except in the case of nurse-midwife services (see 42 CFR 440.165), are furnished by, or under, the direction of a physician. NOTE: Place dental clinics under Dental Services. Report any services not included above under Other Care Services. A clinic staff may include practitioners with different specialties.|XIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|49|Other Care Services|49 -- Other Care Services --These are any medical or remedial care services recognized under State law and authorized by the approved Medicaid State Plan. Such services do not meet the definition of, and are not classified under, any category of service included on Lines 1 through 41. |XIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|50|Total|Total| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONXIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|20210930|10|XIX-MBESCBES-CATEGORY-OF-SERVICE|20211001|99991231|10A|Clinic Services - Reg. Payments|10A. Clinic Services - Reg. Payments (See 42 CFR 440.90.).--These are preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that: o Are provided to outpatients; o Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. For reporting purposes, consider a group of physicians who share, only for mutual convenience, space, services of supporting staff, etc., as physicians, rather than a clinic, even though they practice under the name of a clinic; and o Except in the case of nurse-midwife services (see 42 CFR 440.165), are furnished by, or under, the direction of a physician. NOTE: Place dental clinics under Dental Services. Report any services not included above under Other Care Services. A clinic staff may include practitioners with different specialties.|XIX-MBESCBES-CATEGORY-OF-SERVICE|20211001|99991231|10B|Clinic Services - Sup. Payments|10B. Clinic Services - Sup. Payments (See 42 CFR 440.90.).--These are preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that: o Are provided to outpatients; o Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. For reporting purposes, consider a group of physicians who share, only for mutual convenience, space, services of supporting staff, etc., as physicians, rather than a clinic, even though they practice under the name of a clinic; and o Except in the case of nurse-midwife services (see 42 CFR 440.165), are furnished by, or under, the direction of a physician. NOTE: Place dental clinics under Dental Services. Report any services not included above under Other Care Services. A clinic staff may include practitioners with different specialties.|XIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|20211231|49|XIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|99991231|69|Other Care Services|69 - Other Care Services --These are any medical or remedial care services recognized under State law and authorized by the approved Medicaid State Plan. Such services do not meet the definition of, and are not classified under, any category of service included on Lines 1 through 41.|XIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|99991231|70|Total|Line 70 - TOTAL.--The MBES automatically enters the total of Columns (a)- (e).|XIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|20211231|50| |
| 2022-05-13 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONXIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|29|Non-Emergency Medical TransportationXIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|99991231|37|Critical Access Hospitals | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONXIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|20211231|29|Non-Emergency Medical TransportationXIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|20211231|37|Critical Access HospitalsXIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|99991231|29A|Non-Emergency Medical Transportation - Reg. Payments|29A. -Non-Emergency Medical Transportation - Reg. Payments|XIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|99991231|29B|Non-Emergency Medical Transportation - Sup. Payments|XIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|99991231|37A|Critical Access Hospitals - Reg. Payments|37A. -Critical Access Hospitals - Reg. Payments|XIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|9991231|37B|Critical Access Hospitals - Sup. Payments|37B. -Critical Access Hospitals Inpatient - Sup. Payments|XIX-MBESCBES-CATEGORY-OF-SERVICE|20220101|9991231|37C|Critical Access Hospitals Outpatient - Sup. Payments|37C. -Critical Access Hospitals Outpatient - Sup. Payments| |
| 2022-05-13 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|END_DATE|VALUE|CPT|20201231|99072|CPT|20211231|87636|CPT|20201231|87637|CPT|20201231|87811|CPT|20211231|87428| | VALUE_SET_ID|END_DATE|VALUE|CPT|99991231|99072|CPT|99991231|87636|CPT|99991231|87637|CPT|99991231|87811|CPT|99991231|87428| |
| 2022-06-24 | CRX162 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|DESCRIPTION|PRESCRIPTION-ORIGIN-CODE|20220624|99991231|1|WrittenPRESCRIPTION-ORIGIN-CODE|20220624|99991231|2|TelephonePRESCRIPTION-ORIGIN-CODE|20220624|99991231|3|ElectronicPRESCRIPTION-ORIGIN-CODE|20220624|99991231|4|Fax |
| 2022-06-24 | N/A | ADD | Valid Value Attibutes as Shown | add values to TYPE-OF-CLAIM.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONTYPE-OF-CLAIM|00010101|99991231|6|Medicaid or Medicaid-expansion CHIP financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agencyTYPE-OF-CLAIM|00010101|99991231|F|Separate CHIP (Title XXI) financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency |
| 2022-06-24 | N/A | ADD | Valid Value Attibutes as Shown | add values to SOURCE-LOCATION.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONSOURCE-LOCATION|00010101|99991231|99991231|22|Sub-contracted entitySOURCE-LOCATION|00010101|99991231|99991231|23|Sub-capitated network provider |
| 2022-06-24 | N/A | ADD | Valid Value Attibutes as Shown | add values to AFFILIATED-PROGRAM-TYPE.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONAFFILIATED-PROGRAM-TYPE|00010101|99991231|6||Sub-capitated Network provider – The value in the AFFILIATED-PROGRAM-ID data element contains the state-assigned health plan identifier with which the network provider has a sub-capitated contract to provide services for managed care plan enrollees. |
| 2022-07-15 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
add new valid value file DATA-DICTIONARY-VERSION.psv |
| 2022-07-15 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONBED-TYPE-CODE|00010101|99991231|5|Intermediate Care Facility for the Intellectually Disabled bed in an Institution for Mental Disease|BED-TYPE-CODE|00010101|99991231|6|Inpatient bed in an Institution for Mental Disease|BED-TYPE-CODE|00010101|99991231|7|Nursing Facility bed in an Institution for Mental Disease| |
| 2022-07-15 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONPAYMENT-LEVEL-IND|00010101|99991231|3|Payment/allowed amount is determined for each individual line (e.g., RBRVS) but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only |
| 2022-07-15 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONBED-TYPE-CODE|00010101|99991231|1|Intermediate Care Facility for the Intellectually Disabled|BED-TYPE-CODE|00010101|99991231|2|Inpatient|BED-TYPE-CODE|00010101|99991231|3|Nursing Facility|BED-TYPE-CODE|00010101|99991231|4|Title 18 Skilled Nursing Facility (T18 SNF)| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONBED-TYPE-CODE|00010101|99991231|1|Intermediate Care Facility for the Intellectually Disabled bed not in an Institution for Mental Disease|BED-TYPE-CODE|00010101|99991231|2|Inpatient bed not in an Institution for Mental Disease|BED-TYPE-CODE|00010101|99991231|3|Nursing Facility bed not in an Institution for Mental Disease|BED-TYPE-CODE|00010101|99991231|4|Title 18 Skilled Nursing Facility (T18 SNF) bed not in an Institution for Mental Disease| |
| 2022-07-15 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONPAYMENT-LEVEL-IND|00010101|99991231|1|Claim Header - Sum of Line Item paymentsPAYMENT-LEVEL-IND|00010101|99991231|2|Claim Detail - Individual Line Item payments | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE||DESCRIPTIONPAYMENT-LEVEL-IND|00010101|99991231|1|Payment/allowed amount is not determined at the individual line level (e.g., DRG or outpatient PPS)PAYMENT-LEVEL-IND|00010101|99991231|2|Payment/allowed amount is determined at the individual line level (e.g., RBRVS) and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amount(s) |
| 2022-08-26 | N/A | ADD | Valid Value Attibutes as Shown | PRESCRIPTION-ORIGIN-CODE.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONPRESCRIPTION-ORIGIN-CODE|00010101|99991231|0|Not Known||PRESCRIPTION-ORIGIN-CODE|00010101|99991231|1|Written|Prescription obtained via paper.|PRESCRIPTION-ORIGIN-CODE|00010101|99991231|2|Telephone|Prescription obtained via oral instructions or interactive voice response using a phone.|PRESCRIPTION-ORIGIN-CODE|00010101|99991231|3|Electronic|Prescription obtained via SCRIPT or HL7 Standard transactions, or electronically within closed systems.|PRESCRIPTION-ORIGIN-CODE|00010101|99991231|4|Facsimile|Prescription obtained via transmission using a fax machine.|PRESCRIPTION-ORIGIN-CODE|00010101|99991231|5|Pharmacy|This value is used to cover any situation where a new Rx number needs to be created from an existing valid prescription such as traditional transfers, intrachain transfers, file buys, software upgrades/migrations, and any reason necessary to give it a new number. This value is also the appropriate value for Pharmacy dispensing when applicable such as BTC (behind the counter), Plan B, established protocols, pharmacists authority to prescribe, etc.| |
| 2022-08-26 | PLACE-OF-SERVICE | ADD | Valid Value Attibutes as Shown | PLACE-OF-SERVICE.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONPLACE-OF-SERVICE|20220101|99991231|10|Telehealth Provided in Patient’s Home|The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. |
| 2022-08-26 | PROV-CLASSIFICATION-CODE | ADD | Valid Value Attibutes as Shown | PROV-CLASSIFICATION-CODE-TYPE-1.psv | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONPROV-CLASSIFICATION-CODE-TYPE-1|00010101|99991231|106S00000X|Behavior Technician|PROV-CLASSIFICATION-CODE-TYPE-1|00010101|99991231|106E00000X|Assistant Behavior Analyst| |
| 2022-09-26 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTIONRESTRICTED-BENEFITS-CODE|20230101|99991231|G|Individual is eligible for Medicaid but only entitled to restricted benefits based on Medicare dual-eligibility status Medicare Part B-ID ESRD Benefit. |
| 2022-09-26 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME| PROV-SPECIALTY|00010101|99991231|C0|Sleep Medicine| PROV-SPECIALTY|00010101|99991231|C1|Centralized Flu| PROV-SPECIALTY|00010101|99991231|C2|Indirect Payment Procedure| PROV-SPECIALTY|00010101|99991231|C3|Interventional Cardiology| PROV-SPECIALTY|00010101|99991231|C4|Restricted Use| PROV-SPECIALTY|00010101|99991231|C5|Dentist| PROV-SPECIALTY|00010101|99991231|C6|Hospitalist|PROV-SPECIALTY|00010101|99991231|C7|Advanced Heart Failure and Transplant Cardiology|PROV-SPECIALTY|00010101|99991231|C8|Medical Toxicology|PROV-SPECIALTY|00010101|99991231|C9|Hematopoietic Cell Transplantation and Cellular Therapy|PROV-SPECIALTY|00010101|99991231|D1|Medicare Diabetes Preventive Program|PROV-SPECIALTY|00010101|99991231|D2|Restricted Use|PROV-SPECIALTY|00010101|99991231|D3|Medical Genetics and Genomics|PROV-SPECIALTY|00010101|99991231|D4|Undersea and Hyperbaric Medicine|PROV-SPECIALTY|00010101|99991231|D5|Opioid Treatment Program|PROV-SPECIALTY|00010101|99991231|D6|Home Infusion Therapy Services|PROV-SPECIALTY|00010101|99991231|D7|Micrographic Dermatologic Surgery|PROV-SPECIALTY|00010101|99991231|D8|Adult Congenital Heart Disease| |
| 2022-09-26 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|XIX-MBESCBES-CATEGORY-OF-SERVICE|20221001|99991231|7A7|Drug Rebate Offset - Value Based Purchasing| |
| 2022-09-26 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|XXI-MBESCBES-CATEGORY-OF-SERVICE|20221001|99991231|8A7|Drug Rebate Offset - Value Based Purchasing| |
| 2022-09-26 | N/A | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION IHS-SERVICE-IND|20220624|99991231|0|NoIHS-SERVICE-IND|20220624|99991231|1|Yes |
| 2022-09-26 | N/A | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|XIX-MBESCBES-CATEGORY-OF-SERVICE|00010101|20211231|49|Other Care Services| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|XIX-MBESCBES-CATEGORY-OF-SERVICE|20221001|99991231|49|Health Homes For Children With Medically Complex Conditions| |
| 2022-09-26 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | Update Latest ICD10 PROCEDURE-CODE | https://www.cms.gov/medicare/icd-10/2023-icd-10-pcs |
| 2022-09-26 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | Update Latest ICD10 DIAGNOSIS-CODE | https://www.cms.gov/medicare/icd-10/2023-icd-10-cm |
| 2022-11-18 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | Update latest HCPCS Valid Values | https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update |
| 2022-12-09 | IHS-SERVICE-IND (CIP296, CLT243, COT234, CRX172) | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|IHS-SERVICE-IND|20220624|99991231|0|NoIHS-SERVICE-IND|20220624|99991231|1|Yes | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|IHS-SERVICE-IND|00010101|99991231|0|NoIHS-SERVICE-IND|00010101|99991231|1|Yes |
| 2022-12-30 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | Update quarterly HCPCS file | https://www.cms.gov/files/zip/january-2023-alpha-numeric-hcpcs-file.zip |
| 2022-12-30 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | UPDATE | Valid Value Attibutes as Shown | Update quarterly CPT and CDT 2023 files | https://tmsis2.atlassian.net/wiki/spaces/RTD/pages/855998590/Code+Sets+from+CMS |
| 2023-01-27 | PROCEDURE-CODE-1, PROCEDURE-CODE-2, PROCEDURE-CODE-3, PROCEDURE-CODE-4, PROCEDURE-CODE-5, PROCEDURE-CODE-6 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME PROCEDURE-CODE-MOD|20220101|99991231|FS|Split or shared e/m visit PROCEDURE-CODE-MOD|20220101|99991231|FT|Separate, unrelated e/m |
| 2023-01-27 | REVENUE-CODE | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME REVENUE-CODE|00010101|99991231|0815|Allogeneic Stem Cell Acquisition/Donor Services |
| 2023-02-17 | N/A | UPDATE | Valid Value Attibutes as Shown | Update the latest OCCURRENCE-CODE | Code Sets from CMSUB_04_Data_Files___ALL_CODES_as_of_07_01_2022_FIN__3_.xlsx |
| 2023-03-10 | ELG034 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MARITAL-STATUS|00010101|99991231|15|Legally Married (to opposite sex)|MARITAL-STATUS|00010101|99991231|16|Legally Married (to same sex)|MARITAL-STATUS|00010101|99991231|17|Legally Married, spouse present|MARITAL-STATUS|00010101|99991231|18|Legally Married, spouse absent|MARITAL-STATUS|00010101|99991231|19|Legally Married|MARITAL-STATUS|00010101|99991231|20|Partnered or in Civil Union (to opposite sex)|MARITAL-STATUS|00010101|99991231|21|Partnered (Registered Domestic Partner) or in Civil Union (to same sex)|MARITAL-STATUS|00010101|99991231|22|Partnered (Registered Domestic Partner) or in Civil Union, spouse present|MARITAL-STATUS|00010101|99991231|23|Partnered (Registered Domestic Partner) or in Civil Union, spouse absent|MARITAL-STATUS|00010101|99991231|24|Partnered (Registered Domestic Partner) or in Civil Union|MARITAL-STATUS|00010101|99991231|25|Partnered (Registered Domestic Partner)|MARITAL-STATUS|00010101|99991231|26|Civil Union|MARITAL-STATUS|00010101|99991231|27|Legally Married, Partnered, or in Civil Union|MARITAL-STATUS|00010101|99991231|28|Legally separated (and still legally married)|MARITAL-STATUS|00010101|99991231|29|Legally separated|MARITAL-STATUS|00010101|99991231|30|Annulled (and not currently married or partnered)|MARITAL-STATUS|00010101|99991231|31|Separated (and currently married or partnered)|MARITAL-STATUS|00010101|99991231|32|Separated|MARITAL-STATUS|00010101|99991231|33|Single, widowed, or divorced| |
| 2023-03-10 | ELG095 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-CHANGE-REASON|00010101|99991231|23|Terminated due to Incorrect Granting of Eligibility (e.g., someone is given eligibility in error and then eligibility has to be retracted/terminated)| ELIGIBILITY-CHANGE-REASON|00010101|99991231|24|Household or family composition criteria not met (e.g., someone was incorrectly included or excluded from the household or family composition) - do not use for changes in income| ELIGIBILITY-CHANGE-REASON|00010101|99991231|25|Non-financial program requirements not met (e.g. child support not paid, failure of drug tests, failure to apply for SSN, etc.)| ELIGIBILITY-CHANGE-REASON|00010101|99991231|26|No longer meets categorical eligibility requirements.| ELIGIBILITY-CHANGE-REASON|00010101|99991231|27|End of pregnancy/postpartum coverage period - should only be used if the beneficiary did not obtain coverage through another coverage group like parent/caretaker relative| ELIGIBILITY-CHANGE-REASON|00010101|99991231|28|Time limited eligibility expired (e.g., Transitional Medical Assistance (TMA)|ELIGIBILITY-CHANGE-REASON|00010101|99991231|29|Closed as duplicate| ELIGIBILITY-CHANGE-REASON|00010101|99991231|30|Medical/health status or condition or level of care requirements no longer met - for reasons other than no longer being institutionalized or no longer meeting disability requirements (e.g., completed breast and/or cervical cancer treatment, incarcerated individual no longer requires temporary inpatient level of care)| ELIGIBILITY-CHANGE-REASON|00010101|99991231|31|Change in federal or state law or policy (e.g., a state or federal program is completely discontinued and not replaced by an equivalent or transitional program; unwinding of the Families First Coronavirus Response Act coverage of COVID testing for otherwise uninsured individuals who would have otherwise continued to be eligible if they had been re-determined eligible for at least the same program had the program not been terminated)| |
| 2023-03-10 | ELG095 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-CHANGE-REASON|00010101|99991231|01|Excess income| ELIGIBILITY-CHANGE-REASON|00010101|99991231|02|Excess assets| ELIGIBILITY-CHANGE-REASON|00010101|99991231|03|Income reduced| ELIGIBILITY-CHANGE-REASON|00010101|99991231|05|No longer in the foster care system| ELIGIBILITY-CHANGE-REASON|00010101|99991231|15|Moved to a different state| ELIGIBILITY-CHANGE-REASON|00010101|99991231|17|Lack of verifications|ELIGIBILITY-CHANGE-REASON|00010101|99991231|19|Suspension due to incarceration| ELIGIBILITY-CHANGE-REASON|00010101|99991231|20|Residence in an Institution for Mental Disease (IMD)| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-CHANGE-REASON|00010101|99991231|01|Income Requirement not met - do not use for changes in household composition| ELIGIBILITY-CHANGE-REASON|00010101|99991231|02|Asset requirement not met - do not use for changes in household composition| ELIGIBILITY-CHANGE-REASON|00010101|99991231|03|Income reduced - (typically not a reason for termination)| ELIGIBILITY-CHANGE-REASON|00010101|99991231|05|N/A| ELIGIBILITY-CHANGE-REASON|00010101|99991231|15|Residency requirement not met (e.g., individual moved to a different state, individual has entered or been discharged from an otherwise unspecified facility or institution)| ELIGIBILITY-CHANGE-REASON|00010101|99991231|17|Lack of verifications (e.g., unable to successfully verify citizenship status, immigration status, income, or other information from an application; if unverifiable due to non-response, document as "Failure to respond)|ELIGIBILITY-CHANGE-REASON|00010101|99991231|19|Suspension/termination due to incarceration - use when the state is able to distinguish a more granular reason than just residency requirement not met| ELIGIBILITY-CHANGE-REASON|00010101|99991231|20|Disqualification for residence in an Institution for Mental Disease (IMD) - use when the state is able to distinguish a more granular reason than just residency requirement not met| |
| 2023-03-31 | ELG095 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-CHANGE-REASON|00010101|99991231|05|No longer in the foster care system - (do not use - typically not a reason for termination)| |
| 2023-03-31 | ELG095 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-CHANGE-REASON|00010101|99991231|03|Income reduced - (typically not a reason for termination)| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-CHANGE-REASON|00010101|99991231|03|Income reduced - (do not use - typically not a reason for termination)| |
| 2023-03-31 | N/A | UPDATE | Valid Value Attibutes as Shown | Update Quarterly HCPCS valid values | HCPCS Quarterly Update | CMS |
| 2023-04-21 | N/A | ADD | Valid Value Attibutes as Shown | Update the latest CPT file | https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies |
| 2023-05-12 | N/A | ADD | Valid Value Attibutes as Shown | ADD Zip-Code valid value file | https://www.unitedstateszipcodes.org/zip-code-database/ |
| 2023-05-12 | N/A | UPDATE | Valid Value Attibutes as Shown | Update latest Provider Taxonomy Codes valid value file | https://x12.org/codes |
| 2023-05-12 | N/A | UPDATE | Valid Value Attibutes as Shown | Update latest ADJUSTMENT-REASON-CODE valid value file | https://x12.org/codes |
| 2023-05-12 | N/A | UPDATE | Valid Value Attibutes as Shown | Update latest Claim Status Codes valid value file | https://x12.org/codes |
| 2023-05-12 | N/A | UPDATE | Valid Value Attibutes as Shown | Update latest Claim Status Category Codes valid value file | https://x12.org/codes |
| 2023-05-12 | N/A | UPDATE | Valid Value Attibutes as Shown | Update latest CPT valid value file | https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies |
| 2023-06-02 | PRV119 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION AFFILIATED-PROGRAM-TYPE|00010101|99991231|7|Fee-For-Service - (This value is used to identify providers that are affiliated directly with the state’s Medicaid or CHIP agency (or their fiscal intermediary) and reimbursed by the Medicaid or CHIP agency on a FFS basis. The value in the AFFILIATED-PROGRAM-ID data element contains the ANSI state code of the state in which the provider is enrolled to provide services including through the state plan and a waiver.) |
| 2023-07-14 | N/A | ADD | Valid Value Attibutes as Shown | Update latest HCPCS Valid Value file | https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update |
| 2023-09-08 | CIP004, CLT004, COT004, CRX004, ELG004, MCR004, PRV004, TPL004 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION FILE-ENCODING-SPECIFICATION|00010101|99991231|FIX|The file follows a fixed length format. | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION|||||| |
| 2023-09-08 | CIP004, CLT004, COT004, CRX004, ELG004, MCR004, PRV004, TPL004 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION FILE-ENCODING-SPECIFICATION|00010101|99991231|PSV|The file follows a pipe-delimited format. | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION FILE-ENCODING-SPECIFICATION|00010101|99991231|PSV|The file follows a pipe-separated value format. |
| 2023-09-08 | CIP257, CLT211, COT186, CRX134 | UPDATE | Valid Value Attibutes as Shown | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION TYPE-OF-SERVICE|00010101|99991231|005|Professional laboratory services, Technical laboratory services| | VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION TYPE-OF-SERVICE|00010101|99991231|005|Professional laboratory services| |
| 2023-09-08 | COT123 | ADD | Valid Value Attibutes as Shown | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION PLACE-OF-SERVICE|20231001|99991231|27|Outreach Site/ Street| A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals. |
| 2023-09-08 | N/A | UPDATE | Valid Value Attibutes as Shown | Update latest ICD-10-procedure-code Valid Value file | PROCEDURE-CODE.psv |
| 2023-09-08 | N/A | UPDATE | Valid Value Attibutes as Shown | Update Latest ICD-10-diagnosis-code Valid Values file | DIAGNOSIS-CODE.psv |
| 2024-02-01 | N/A | UPDATE | Valid Value Attibutes as Shown | HCPCS Code Set PROCEDURE-CODE.psv as of 08/23/2023 | HCPCS Code Set Update PROCEDURE-CODE.psv as of 01/26/2024 |
| 2024-03-01 | ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026 | UPDATE | Valid Value Attibutes as Shown | Original Claim/Encounter | Original Claim/Encounter/Payment - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also). |
| 2024-03-01 | ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026 | UPDATE | Valid Value Attibutes as Shown | Void of a prior submission | Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment where the claim/encounter/payment is not being replaced by a new paid/approved version of the claim/encounter/payment. Typically, this would be the last claim/encounter/payment that would ever be associated with a given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being voided/reversed/cancelled. |
| 2024-03-01 | ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026 | UPDATE | Valid Value Attibutes as Shown | Debit Adjustment (positive supplemental) | Replacement/Resubmission of a previously paid/approved claim/encounter/payment - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment with a new paid/approved version of the claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being replaced/resubmitted. |
| 2024-03-01 | ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026 | UPDATE | Valid Value Attibutes as Shown | Credit Gross Adjustment | Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction. |
| 2024-03-01 | ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026 | UPDATE | Valid Value Attibutes as Shown | Debit Gross Adjustment | Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction. |
| 2024-03-01 | LINE-ADJUSTMENT-IND CIP239 | UPDATE | Valid Value Attibutes as Shown | Original Claim/Encounter | Original Claim/Encounter/Payment - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also). |
| 2024-03-01 | LINE-ADJUSTMENT-IND CIP239 | UPDATE | Valid Value Attibutes as Shown | Void of a prior submission | Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment where the claim/encounter/payment is not being replaced by a new paid/approved version of the claim/encounter/payment. Typically, this would be the last claim/encounter/payment that would ever be associated with a given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being voided/reversed/cancelled. |
| 2024-03-01 | LINE-ADJUSTMENT-IND CIP239 | UPDATE | Valid Value Attibutes as Shown | Debit Adjustment (positive supplemental) | Replacement/Resubmission of a previously paid/approved claim/encounter/payment - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment with a new paid/approved version of the claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being replaced/resubmitted. |
| 2024-03-01 | LINE-ADJUSTMENT-IND CIP239 | UPDATE | Valid Value Attibutes as Shown | Credit Gross Adjustment | Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction. |
| 2024-03-01 | LINE-ADJUSTMENT-IND CIP239 | UPDATE | Valid Value Attibutes as Shown | Debit Gross Adjustment | Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction. |
| 2024-03-15 | PROV-CLASSIFICATION-CODE-TYPE-1 | UPDATE | Valid Value Attibutes as Shown | reference files containing provider taxonomy are out of sync | Valid Values updated |
| 2024-03-15 | PROV-TAXONOMY | UPDATE | Valid Value Attibutes as Shown | reference files containing provider taxonomy are out of sync | Valid Values updated |
| 2024-03-15 | REBATE-ELIGIBLE-INDICATOR - 0 | UPDATE | Valid Value Attibutes as Shown | NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate agreement.) | NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate agreement.) Drug meets the definition of a covered outpatient drug (COD), but manufacturer does not participate in the rebate program. |
| 2024-03-15 | REBATE-ELIGIBLE-INDICATOR - 1 | UPDATE | Valid Value Attibutes as Shown | NDC is eligible for drug rebate program | NDC is eligible for drug rebate program NDC is listed on the MDP |
| 2024-03-15 | REBATE-ELIGIBLE-INDICATOR - 2 | UPDATE | Valid Value Attibutes as Shown | NDC is exempt from the drug rebate program (biological and medical devices) | NDC is exempt from the drug rebate program (biological and medical devices) these are prescribed drugs that do not meet the definition of a COD. There are several examples, the easiest is insect repellant. State release 178 provides more details. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/rx-releases/state-releases/state-rel-178.pdf |
| 2024-03-15 | Rule-1378 | UPDATE | Valid Value Attibutes as Shown | not a valid value within CMS | CLAIM-PYMT-REM-CODE |
| 2024-04-17 | VV End-Dates for WAIVER-TYPE | UPDATE | Valid Value Attibutes as Shown | VV End-Dates for WAIVER-TYPE was 12/31/9999 for the following WAIVER-TYPE Valid Values: 02-19 & 21. | VV End-Dates for WAIVER-TYPE has been updated with ‘10/31/2028’ for the following WAIVER-TYPE Valid Values: 02-19 & 21. |
| 2023-09-28 | ADJUSTMENT-IND | UPDATE | Valid Value Code Description | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 0|Original Claim / Encounter|01/01/0001|12/31/9999 1|Void of a prior submission|01/01/0001|12/31/9999 4|Debit Adjustment (positive supplemental)|01/01/0001|12/31/9999 5|Credit Gross Adjustment|01/01/0001|12/31/9999 6|Debit Gross Adjustment|01/01/0001|12/31/9999 |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 0|Original Claim/Encounter/Payment/Financial Transaction - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim/encounter/payment/financial transaction family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also).|01/01/0001|12/31/9999 1|Void/Reversal/Cancel of a prior submission - Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment/financial transaction where the claim/encounter/payment/financial transaction is not being replaced by a new paid/approved version of the claim/encounter/payment/financial transaction. Typically, this would be the last claim/encounter/payment/financial transaction that would ever be associated with a given claim/encounter/payment/financial transaction family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter/financial transaction being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment/financial transaction being voided/reversed/cancelled.|01/01/0001|12/31/9999 4|Replacement/Resubmission of a previously paid/approved claim/encounter/payment/financial transaction - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment/financial transaction with a new paid/approved version of the claim/encounter/payment/financial transaction. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter/payment/financial transaction being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment/financial transaction being replaced/resubmitted.|01/01/0001|12/31/9999 5|Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication/transaction date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction.|01/01/0001|12/31/9999 6|Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication/transaction date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction.|01/01/0001|12/31/9999 |
| 2023-09-28 | ATYPICAL-PROV-IND | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 0|No, the State does not this to be an atypical provider|01/01/0001|12/31/9999 1|Yes, the State considers this to be an atypical provider|01/01/0001|12/31/9999 |
| 2023-09-28 | BENEFIT-TYPE | DELETE | All Valid Value Attributes | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 001|Inpatient Hospital Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 002|Outpatient Hospital Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 003|Rural health clinic services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 004|FQHC services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 005|Other Laboratory and X-Ray Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 006|Nursing Facility Services for 21 and over,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 007|EPSDT,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 008|Family Planning Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 009|Mandatory tobacco cessation counseling for pregnant women under 1905(a)(4)(D),Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 010|Physicians' Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 011|Medical and Surgical Services Furnished by a Dentist,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 012|Nurse-midwife services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 013|Certified pediatric or family nurse practitioners' services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 014|Free Standing Birth Center Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 015|Home Health Services - Intermittent or part-time nursing services provided by a home health agency,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 016|Home Health Services - Home Health Aide Services Provided by a Home Health Agency,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 017|Home Health Services - Medical supplies, equipment, and appliances suitable for use in the home,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals|01/01/0001|12/31/9999 018|Medical care and any type of remedial care recognized under State law - Podiatrists' Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 019|Medical care and any type of remedial care recognized under State law - Optometrists' Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 020|Medical care and any type of remedial care recognized under State law - Chiropractors' Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 021|Medical care and any type of remedial care recognized under State law - Other Practitioners' Services within scope of practice as defined by State law,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 022|Home Health Services - Physical therapy; occupational therapy; speech pathology; audiology provided by a home health agency,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 023|Private Duty Nursing,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 024|Clinic Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 025|Dental Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 026|Physical Therapy and Related Services - Physical Therapy,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 027|Physical Therapy and Related Services - Occupational Therapy,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 028|Physical Therapy and Related Services - Services for individuals with speech, hearing and language disorders,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 029|Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Prescribed Drugs,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 030|Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Dentures,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 031|Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Prosthetic Devices,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 032|Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Eyeglasses,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 033|Other diagnostic, screening, preventive, and rehabilitative services - Diagnostic Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 034|Other diagnostic, screening, preventive, and rehabilitative services - Screening Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 035|Other diagnostic, screening, preventive, and rehabilitative services - Preventive Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 036|Other diagnostic, screening, preventive, and rehabilitative services - Rehabilitative Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 037|Services for individuals over age 65 in IMDs - Inpatient hospital services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 038|Services for individuals over age 65 in IMDs - Nursing facility services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 039|Intermediate Care Facility Services for individuals with intellectual disabilities or persons with related conditions,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 040|Inpatient psychiatric facility services for under 21,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 041|Hospice Care,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 042|Case Management Services and TB related services - Case management services as defined in the State Plan in accordance with section 1905(a)(19) or 1915(g),Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 043|Case Management Services and TB related services - Special TB related services under section 1902(z)(2),Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 044|Respiratory care services under 1902(e)9)(A) through (C),Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 045|Personal care services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 046|Primary care case management services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 047|Special sickle-cell anemia-related services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 048|Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Transportation,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 049|Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Services provided in religious non-medical health care facilities,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 050|Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Nursing facility services for patients under 21,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 051|Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Emergency hospital services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 052|Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Critical Access Hospitals,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 053|Extended services for pregnant women - Additional Services for any other medical conditions that may complicate pregnancy,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 054|Community First Choice,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 055|Health Home Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals|01/01/0001|12/31/9999 056|Limited Pregnancy-Related Services for Pregnant Women with Income Above the Applicable Income Limit,Special Benefit Provisions|01/01/0001|12/31/9999 057|Ambulatory prenatal care for pregnant women furnished during a presumptive eligibility period,Special Benefit Provisions|01/01/0001|12/31/9999 058|Benefits for Families Receiving Transitional Medical Assistance,Special Benefit Provisions|01/01/0001|12/31/9999 059|Standards for Coverage of Transplant Services,Special Benefit Provisions|01/01/0001|12/31/9999 060|School-Based Services Payment Methodologies,Special Benefit Provisions|01/01/0001|12/31/9999 061|Indian Health Services and Tribal Health Facilities,Special Benefit Provisions|01/01/0001|12/31/9999 062|Methods and Standards to Assure High Quality Care,Special Benefit Provisions|01/01/0001|12/31/9999 063|Medicare Premium Payments,Coordination of Medicaid with Medicare and Other Insurance|01/01/0001|12/31/9999 064|Medicare Coinsurance and Deductibles,Coordination of Medicaid with Medicare and Other Insurance|01/01/0001|12/31/9999 065|Other Medical Insurance Premium Payments,Coordination of Medicaid with Medicare and Other Insurance|01/01/0001|12/31/9999 066|Programs for Distribution of Pediatric Vaccines,Special Benefit Programs|01/01/0001|12/31/9999 067|Laboratory and x-ray services,Home and Community-Based Services|01/01/0001|12/31/9999 068|Home Health Services - Home health aide services provided by a home health agency,Home and Community-Based Services|01/01/0001|12/31/9999 069|Private duty nursing services,Home and Community-Based Services|01/01/0001|12/31/9999 070|Physical Therapy and Related Services - Audiology services,Home and Community-Based Services|01/01/0001|12/31/9999 071|Extended services for pregnant women - Additional Pregnancy-related and postpartum services for a 60-day period after the pregnancy ends and any remaining days in the month in which the 60th day falls.,Home and Community-Based Services|01/01/0001|12/31/9999 072|Home and Community Care for Functionally Disabled Elderly individuals as defined and described in the State Plan,Home and Community-Based Services|01/01/0001|12/31/9999 073|Emergency services for certain legalized aliens and undocumented aliens,Home and Community-Based Services|01/01/0001|12/31/9999 074|Licensed or Otherwise State-Approved Free-Standing Birthing Center and other ambulatory services that are offered by a freestanding birth center,Home and Community-Based Services|01/01/0001|12/31/9999 075|Homemaker,Home and Community-Based Services|01/01/0001|12/31/9999 076|Home Health Aide,Home and Community-Based Services|01/01/0001|12/31/9999 077|Adult Day Health services,Home and Community-Based Services|01/01/0001|12/31/9999 078|Habilitation,Home and Community-Based Services|01/01/0001|12/31/9999 079|Habilitation: Residential Habilitation,Home and Community-Based Services|01/01/0001|12/31/9999 080|Habilitation: Supported Employment,Home and Community-Based Services|01/01/0001|12/31/9999 081|Habilitation: Education (non IDEA available),Home and Community-Based Services|01/01/0001|12/31/9999 082|Habilitation: Day Habilitation,Home and Community-Based Services|01/01/0001|12/31/9999 083|Habilitation: Pre-Vocational,Home and Community-Based Services|01/01/0001|12/31/9999 084|Habilitation: Other Habilitative Services,Home and Community-Based Services|01/01/0001|12/31/9999 085|Respite,Home and Community-Based Services|01/01/0001|12/31/9999 086|Day Treatment (mental health service),Home and Community-Based Services|01/01/0001|12/31/9999 087|Psychosocial rehabilitation,Home and Community-Based Services|01/01/0001|12/31/9999 088|Environmental Modifications (Home Accessibility Adaptations),Home and Community-Based Services|01/01/0001|12/31/9999 089|Vehicle Modifications,Home and Community-Based Services|01/01/0001|12/31/9999 090|Non-Medical Transportation,Home and Community-Based Services|01/01/0001|12/31/9999 091|Special Medical Equipment (minor assistive Devices),Home and Community-Based Services|01/01/0001|12/31/9999 092|Home Delivered meals,Home and Community-Based Services|01/01/0001|12/31/9999 093|Assistive Technology (i.e., communication devices),Home and Community-Based Services|01/01/0001|12/31/9999 094|Personal Emergency Response (PERS),Home and Community-Based Services|01/01/0001|12/31/9999 095|Nursing Services,Home and Community-Based Services|01/01/0001|12/31/9999 096|Community Transition Services,Home and Community-Based Services|01/01/0001|12/31/9999 097|Adult Foster Care,Home and Community-Based Services|01/01/0001|12/31/9999 098|Day Supports (non-habilitative),Home and Community-Based Services|01/01/0001|12/31/9999 099|Supported Employment,Home and Community-Based Services|01/01/0001|12/31/9999 100|Supported Living Arrangements,Home and Community-Based Services|01/01/0001|12/31/9999 101|Supports for Consumer Direction (Supports Facilitation),Home and Community-Based Services|01/01/0001|12/31/9999 102|Participant Directed Goods and Services,Home and Community-Based Services|01/01/0001|12/31/9999 103|Senior Companion (Adult Companion Services),Home and Community-Based Services|01/01/0001|12/31/9999 104|Assisted Living,Home and Community-Based Services|01/01/0001|12/31/9999 105|Program for All-inclusive Care for the Elderly (PACE) Services,Other|01/01/0001|12/31/9999 106|Self-directed Personal Assistance Services under 1915(j),Other|01/01/0001|12/31/9999 107|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products|03/18/2020|12/31/9999 108|COVID–19 testing-related services|03/18/2020|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2023-09-28 | CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT | UPDATE | Valid Value Code Set Name | CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT | CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
| 2023-09-28 | CONTINUOUS-ELIGIBILITY-CODE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 001| continuous eligibility for children (optional per SSA 1902(e)(12) or 2105(a)(4)(A))|01/01/0001|12/31/9999 002| 1115 waiver for continuous eligibility|01/01/0001|12/31/9999 995| Other|01/01/0001|12/31/9999 |
| 2023-09-28 | DATA-DICTIONARY-VERSION | UPDATE | Valid Value Code; Valid Value Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date v4.0.0||45555|12/31/9999 |
| 2023-09-28 | DIAGNOSIS-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date A|Admitting (from 837I or UB-04 claim for IP and LT)|01/01/0001|12/31/9999 D|Diagnosis Code #1-5 (from NCPDP claim for RX) or #1-12 (from 837P, CMS-1500, 837D, or ADA claim for OT)|01/01/0001|12/31/9999 E|External Cause of Injury #1-12 (from 837I claim for IP, LT, and OT)|01/01/0001|12/31/9999 O|Other Diagnosis #1-24 (for IP, LT) or #1-12 (from 837I or UB-04 claim for OT)|01/01/0001|12/31/9999 P|Principal (from 837I or UB-04 claim for IP, LT, and OT)|01/01/0001|12/31/9999 R|Reason for Visit #1-3 (from 837I claim for OT)|01/01/0001|12/31/9999 |
| 2023-09-28 | ELIGIBILITY-CHANGE-REASON | UPDATE | Valid Value Code Set Name | ELIGIBILITY-CHANGE-REASON | ELIGIBILITY-TERMINATION-REASON |
| 2023-09-28 | ELIGIBILITY-EXTENSION-CODE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 001| 60-day extended postpartum coverage (mandatory per SSA 1902(e)(5) and 2112(d)(2)(A))|01/01/0001|12/31/9999 002| 12-month extended postpartum coverage (optional per SSA 1902(e)(16) or 2107(e)(1)(J))|01/01/0001|12/31/9999 003| 1115 waiver for extended postpartum coverage|01/01/0001|12/31/9999 995| Other|01/01/0001|12/31/9999 |
| 2023-09-28 | EXPENDITURE-AUTHORITY-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|1115|01/01/0001|12/31/9999 95|Other|01/01/0001|12/31/9999 |
| 2023-09-28 | FILE-NAME | UPDATE | Valid Value Code; Valid Value Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FINTRANS|Financial Transactions File|01/01/0001|12/31/9999 |
| 2023-09-28 | FILE-SUBMISSION-METHOD | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|True Full File Refresh (TFFR)|01/01/0001|12/31/9999 02|Rolling Historial File Refresh (RHFR)|01/01/0001|12/31/9999 03|Incremental Timespan (IT) - One month incremental Create files|01/01/0001|12/31/9999 04|Change-Segment Only (CSO)|01/01/0001|12/31/9999 05|Incremental Timespan (IT) - Multi-month incremental Create files|01/01/0001|12/31/9999 |
| 2023-09-28 | IMMUNIZATION-TYPE | DELETE | All Valid Value Attributes | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 00|None|01/01/0001|12/31/9999 01|Anthrax|01/01/0001|12/31/9999 02|Cervical Cancer)|01/01/0001|12/31/9999 03|Diphtheria|01/01/0001|12/31/9999 04|Hepatitis A|01/01/0001|12/31/9999 05|Hepatitis B|01/01/0001|12/31/9999 06|Haemophilus influenza type b (Hib)|01/01/0001|12/31/9999 07|Human Papillomavirus (HPV)|01/01/0001|12/31/9999 08|H1N1 Flu|01/01/0001|12/31/9999 09|Seasonal Flu|01/01/0001|12/31/9999 10|Japanese Encephalitis|01/01/0001|12/31/9999 11|Lyme Disease|01/01/0001|12/31/9999 12|Measles|01/01/0001|12/31/9999 13|Meningococcal|01/01/0001|12/31/9999 14|Monkey pox|01/01/0001|12/31/9999 15|Mumps|01/01/0001|12/31/9999 16|Pertussis|01/01/0001|12/31/9999 17|Pneumococcal|01/01/0001|12/31/9999 18|Poliomyelitis|01/01/0001|12/31/9999 19|Rabies|01/01/0001|12/31/9999 20|Rotavirus|01/01/0001|12/31/9999 21|Rubella|01/01/0001|12/31/9999 22|Shingles|01/01/0001|12/31/9999 23|Smallpox|01/01/0001|12/31/9999 24|Tetanus|01/01/0001|12/31/9999 25|Tuberculosis|01/01/0001|12/31/9999 26|Typhoid Fever|01/01/0001|12/31/9999 27|Varicella|01/01/0001|12/31/9999 28|Yellow Fever|01/01/0001|12/31/9999 29|Other|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2023-09-28 | INCOME-STANDARD-CODE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|MAGI|01/01/0001|12/31/9999 02|Non-MAGI|01/01/0001|12/31/9999 95|Other|01/01/0001|12/31/9999 |
| 2023-09-28 | LINE-ADJUSTMENT-IND | UPDATE | Valid Value Code Description | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 0|Original Claim/Encounter|01/01/0001|12/31/9999 1|Void of a prior submission|01/01/0001|12/31/9999 4|Debit Adjustment (positive supplemental)|01/01/0001|12/31/9999 5|Credit Gross Adjustment.|01/01/0001|12/31/9999 6|Debit Gross Adjustment|01/01/0001|12/31/9999 |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 0|Original Claim/Encounter/Payment - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also).|01/01/0001|12/31/9999 1|Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment where the claim/encounter/payment is not being replaced by a new paid/approved version of the claim/encounter/payment. Typically, this would be the last claim/encounter/payment that would ever be associated with a given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being voided/reversed/cancelled.|01/01/0001|12/31/9999 4|Replacement/Resubmission of a previously paid/approved claim/encounter/payment - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment with a new paid/approved version of the claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being replaced/resubmitted.|01/01/0001|12/31/9999 5|Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction.|01/01/0001|12/31/9999 6|Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction.|01/01/0001|12/31/9999 |
| 2023-09-28 | MANAGED-CARE-PLAN-ID-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|Federal Tax ID|01/01/0001|12/31/9999 02|State Tax ID|01/01/0001|12/31/9999 |
| 2023-09-28 | MBESCBES-FORM | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21|Child Health Expenditures by Type of Service|01/01/0001|12/31/9999 21.11|Summary Total of Receipts from Form CMS 21.11A|01/01/0001|12/31/9999 64.1|Summary Sheet|01/01/0001|12/31/9999 64.11|Summary Total of Receipts from Form CMS 64.11a|01/01/0001|12/31/9999 64.21|Quarterly MAP Payments for CHIP Categories|01/01/0001|12/31/9999 21.11A|Actual Receipts by Plan Name|01/01/0001|12/31/9999 21AD|21 REMAP Waiver|01/01/0001|12/31/9999 21BASE|Children's Health Expenditures By Type of Service|01/01/0001|12/31/9999 21C|CHIP Fiscal Year Allotment|01/01/0001|12/31/9999 21L|Calculation of 10% Limit|01/01/0001|12/31/9999 21LSUB|Form CMS-21L Outreach Allowance|01/01/0001|12/31/9999 21NARR|Narrative Form|01/01/0001|12/31/9999 21O|Children's Health Expenditures For the Title XXI Program Overpayment Adjustments|01/01/0001|12/31/9999 21OMEQC|Children's Health Expenditures For the Title XXI Program Overpayment Adjustments|01/01/0001|12/31/9999 21P|Child Health Expenditures by Type of Service for Title XXI Program|01/01/0001|12/31/9999 21PAD|21 REMAP Waiver P|01/01/0001|12/31/9999 21PERM|Child Health Expenditures by Type of Service|01/01/0001|12/31/9999 21PWAIVER|Child Health Waivers by Type of Service for Title XXI Program|01/01/0001|12/31/9999 21Summary|Summary of CMS 21|01/01/0001|12/31/9999 21T.TRACK|20% Medicaid Allowance|01/01/0001|12/31/9999 21WAIVER|Child Health Waivers by Type Of Service|01/01/0001|12/31/9999 64.10200K|Quarterly Expenditures for State & Local Administration - 200K|01/01/0001|12/31/9999 64.10BASE|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 64.10I|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 64.10P|Prior Period Adjustments for Lines 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.10P200K|Prior Period Adjustments for Lines 7, 8, 10A, 10B - 200K|01/01/0001|12/31/9999 64.10PI|Prior Period Adjustments for Lines 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.10WAIV|64.10 Waivers|01/01/0001|12/31/9999 64.10WAIVP|Waiver Prior Period Adjustments for Lines 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.1108CAP|Quarterly Medicaid Statement of Expenditures For the Medical Assistance Program Summary Sheet|01/01/0001|12/31/9999 64.11A|Actual Receipts by Plan Name|01/01/0001|12/31/9999 64.21P|Prior Period MAP Adjustments for CHIP Categories|01/01/0001|12/31/9999 64.21U|Child Health Expenditures by Service|01/01/0001|12/31/9999 64.21U114|Child Health Expenditures by Service|01/01/0001|12/31/9999 64.21U115|Child Health Expenditures by Service|01/01/0001|12/31/9999 64.21U200K|Child Health Expenditures by Service|01/01/0001|12/31/9999 64.21UP|Child Health Expenditures by Service - Prior Period|01/01/0001|12/31/9999 64.21UP114|Child Health Expenditures by Service - Prior Period|01/01/0001|12/31/9999 64.21UP115|Child Health Expenditures by Service - Prior Period|01/01/0001|12/31/9999 64.21UP200K|Child Health Expenditures by Service|01/01/0001|12/31/9999 64.21UPWAV|Child Health Expenditures by Service - Prior Period Waiver|01/01/0001|12/31/9999 64.21UPWAV114|Child Health Expenditures by Service - Prior Period Waiver|01/01/0001|12/31/9999 64.21UPWAV115|Child Health Expenditures by Service - Prior Period Waiver|01/01/0001|12/31/9999 64.21UWAIV|Child Health Expenditures by Service - Waiver|01/01/0001|12/31/9999 64.21UWAIV114|Child Health Expenditures by Service - Waiver|01/01/0001|12/31/9999 64.21UWAIV115|Child Health Expenditures by Service - Waiver|01/01/0001|12/31/9999 64.21WAIV|Waiver Quarterly MAP Payments for CHIP Categories|01/01/0001|12/31/9999 64.21WAIVP|Waiver Prior Period MAP Adjustments for CHIP Categories|01/01/0001|12/31/9999 64.9200K|Medical Assistance Expenditures by Type of Service 200K|01/01/0001|12/31/9999 64.9200KP|Medical Assistance Expenditures by Type of Service 200KP|01/01/0001|12/31/9999 64.9A|Third Party Liability Collections and Cost Avoidance|01/01/0001|12/31/9999 64.9ARPSection9817|ARP 9817 HCBS|01/01/0001|12/31/9999 64.9BASE|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 64.9C1|Fraud, Waste & Abuse Recoveries From State Medicaid Program Integrity Activities|01/01/0001|12/31/9999 64.9C1F|Fraud, Waste & Abuse Recoveries From State Medicaid Program Integrity Activities|01/01/0001|12/31/9999 64.9C2|Recoveries From OIG State Compliant Fraud Claims Act|01/01/0001|12/31/9999 64.9D|DSH Form|01/01/0001|12/31/9999 64.9E|Medical Assistance Expenditures Eligibility Form|01/01/0001|12/31/9999 64.9EP|Medical Assistance Expenditures Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 64.9EPWAIV|Waiver for Medical Assistance Expenditures Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 64.9EWAIV|Waiver for Medical Assistance Expenditures Eligibility Form|01/01/0001|12/31/9999 64.9I|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 64.9I.DSHDIV.WAIV|DSH Diversion Waiver for Medical Assistance Payments by Type of Service|01/01/0001|12/31/9999 64.9I.VIII|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 64.9O|Medicaid Overpayment Adjustments|01/01/0001|12/31/9999 64.9OARRA|Medicaid Overpayment Adjustments - ARRA Portion|01/01/0001|12/31/9999 64.9OFWA|Fraud, Waste & Abuse Amounts Overpayments|01/01/0001|12/31/9999 64.9OMEQC|Medicaid Eligibility Quality Control Collections and Overpayment|01/01/0001|12/31/9999 64.9OPerm|Medicaid Overpayment Adjustments|01/01/0001|12/31/9999 64.9ORAC|Medicaid Overpayment Adjustments for RAC|01/01/0001|12/31/9999 64.9P|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.9PE|Medical Assistance Expenditures PE Eligibility Form|01/01/0001|12/31/9999 64.9PEP|Medical Assistance Expenditures PE Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 64.9PEPWAIV|Waiver for Medical Assistance Expenditures PE Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 64.9PEWAIV|Waiver for Medical Assistance Expenditures PE Eligibility Form|01/01/0001|12/31/9999 64.9PI|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.9PI.DSHDIV.WAIV|DSH Diversion Waiver for MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.9PI.VIII|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 64.9QI|QI Form|01/01/0001|12/31/9999 64.9R|Drug Rebate Schedule|01/01/0001|12/31/9999 64.9SAP|Support Act Section 1003 Payment|01/01/0001|12/31/9999 64.9T|Medical Assistance Expenditures by Type of Service Applied Against the CHIP Amount|01/01/0001|12/31/9999 64.9TP|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B Applied Against the CHIP Amount|01/01/0001|12/31/9999 64.9TPWAIV|Line 7, 8, 10A, 10B Waiver MAP Prior Period Adjustments Applied Against the CHIP Amount|01/01/0001|12/31/9999 64.9TWAIV|Waivers for Medical Assistance Payments by Type of Service Applied Against the CHIP Amount|01/01/0001|12/31/9999 64.9VIII|Medical Assistance Expenditures Newly Eligibility Form|01/01/0001|12/31/9999 64.9VIII.P|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B Newly Eligibility Form|01/01/0001|12/31/9999 64.9VIII.WAIV|Waivers for Medical Assistance Expenditures Newly Eligibility Form|01/01/0001|12/31/9999 64.9VIII.WAIV.P|Waiver for Prior Period Adjustments for Line 7, 8, 10A, 10B Newly Eligibility Form|01/01/0001|12/31/9999 64.9VIIIARPSection9817|ARP Section 9817 - VIII Group|01/01/0001|12/31/9999 64.9WAIV|Waivers for Medical Assistance Payments by Type of Service|01/01/0001|12/31/9999 64.9WAIV.DSH|Waivers for Medical Assistance Payments by Type of Service|01/01/0001|12/31/9999 64.9WAIV.P|Line 7, 8, 10A, 10B Waiver MAP Prior Period Adjustments|01/01/0001|12/31/9999 64.9WAIV.P.DSH|Line 7, 8, 10A, 10B DHS Diversion Waiver MAP Prior Period Adjustments|01/01/0001|12/31/9999 64.ENROLL|Medicaid Enrollees|01/01/0001|12/31/9999 64.F|Medicaid Statement of Expenditures Summary Sheet|01/01/0001|12/31/9999 64.REH|Midical Assistance Expenditures by Type of Service for Rehabilitation Services|01/01/0001|12/31/9999 64.S9RAC|RAC Collection|01/01/0001|12/31/9999 64.SCH|Midical Assistance Expenditures by Type of Service for School-Based Services|01/01/0001|12/31/9999 64.SPV.NARR|Supplemental Payment Validation Narrative|01/01/0001|12/31/9999 64.SPV.PAYMENTS|Supplemental Payment Validation Payments|01/01/0001|12/31/9999 64.SPV.PROVIDERSUBMISSION|Supplemental Payment Validation Providers|01/01/0001|12/31/9999 HCBS.1915c|Midical Assistance Expenditures by Type of Service for 1915(c) HCBS Waiver|01/01/0001|12/31/9999 HCBS.1915i|Midical Assistance Expenditures by Type of Service for 1915(i) HCBS Supplemental Benefit Package|01/01/0001|12/31/9999 HCBS.1915j|Midical Assistance Expenditures by Type of Service for 1915(j) Self-Directed Personal Assistance Services State Plan Option|01/01/0001|12/31/9999 |
| 2023-09-28 | MBESCBES-FORM-GROUP | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1|The MBES/CBES form that this expenditure was or will be reported to is a form for Medicaid (but not Medicaid-expansion CHIP) expenditures or adjustments.|01/01/0001|12/31/9999 2|The MBES/CBES form that this expenditure was or will be reported to is a form for Medicaid-expansion CHIP expenditures or adjustments.|01/01/0001|12/31/9999 3|The MBES/CBES form that this expenditure was or will be reported to is a form for separate CHIP expenditures or adjustments.|01/01/0001|12/31/9999 |
| 2023-09-28 | OFFSET-TRANS-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1|Capitation|01/01/0001|12/31/9999 2|Individual Premium|01/01/0001|12/31/9999 3|Group Premium|01/01/0001|12/31/9999 |
| 2023-09-28 | PAYEE-ID-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|State|01/01/0001|12/31/9999 02|Capitated plan ID|01/01/0001|12/31/9999 03|Sub-capitated plan ID|01/01/0001|12/31/9999 04|Sub-capitated network provider ID|01/01/0001|12/31/9999 05|State contracted FFS provider ID assigned by state|01/01/0001|12/31/9999 06|State contracted FFS provider NPI|01/01/0001|12/31/9999 07|Insurance carrier|01/01/0001|12/31/9999 08|Beneficiary|01/01/0001|12/31/9999 09|Non-Medicaid eligible guardian|01/01/0001|12/31/9999 95|Other|01/01/0001|12/31/9999 |
| 2023-09-28 | PAYEE-TAX-ID-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|SSN|01/01/0001|12/31/9999 02|EIN|01/01/0001|12/31/9999 03|ITIN|01/01/0001|12/31/9999 04|State Tax ID|01/01/0001|12/31/9999 95|Other|01/01/0001|12/31/9999 |
| 2023-09-28 | PAYER-ID-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|State|01/01/0001|12/31/9999 02|Capitated plan ID|01/01/0001|12/31/9999 03 |Sub-capitated entity ID|01/01/0001|12/31/9999 04|Sub-capitated network provider ID|01/01/0001|12/31/9999 95 |Other|01/01/0001|12/31/9999 |
| 2023-09-28 | PAYMENT-PERIOD-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01 |Bene coverage period|01/01/0001|12/31/9999 02|Service coverage period|01/01/0001|12/31/9999 03 |Provider coverage period|01/01/0001|12/31/9999 04|Fiscal period|01/01/0001|12/31/9999 05 |Episode of care|01/01/0001|12/31/9999 95 |Other|01/01/0001|12/31/9999 |
| 2023-09-28 | PRIMARY-LANGUAGE-CODE | UPDATE | Valid Value Code Set Name | PRIMARY-LANGUAGE-CODE | PREFERRED-LANGUAGE-CODE |
| 2023-09-28 | PROVIDER-CLAIM-FORM-CODE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|Institutional claim - any (837I format or UB-04 form)|01/01/0001|12/31/9999 02|Institutional claim - electronic (837I format)|01/01/0001|12/31/9999 03|Institutional claim (UB-04 form)|01/01/0001|12/31/9999 11|Professional claim - any (837P format or CMS-1500 form)|01/01/0001|12/31/9999 12|Professional claim - electronic (837P format)|01/01/0001|12/31/9999 13|Professional claim - paper (CMS-1500 form)|01/01/0001|12/31/9999 21|Dental claim - any (837D format or ADA Dental Claim Form)|01/01/0001|12/31/9999 22|Dental claim - electronic (837D format)|01/01/0001|12/31/9999 23|Dental claim - paper (ADA Dental Claim Form)|01/01/0001|12/31/9999 31|Pharmacy claim (NCPDP format)|01/01/0001|12/31/9999 95|Other claim form or format not listed above|01/01/0001|12/31/9999 |
| 2023-09-28 | RECORD-ID | UPDATE | Valid Value Code; Valid Value Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CIP00004|CLAIM-DX-IP|01/01/0001|12/31/9999 CLT00004|CLAIM-DX-LT|01/01/0001|12/31/9999 COT00004|CLAIM-DX-OT|01/01/0001|12/31/9999 CRX00004|CLAIM-DX-RX|01/01/0001|12/31/9999 MCR00010|MANAGED-CARE-ID|01/01/0001|12/31/9999 FTX00001|FILE-HEADER-RECORD-FTX|01/01/0001|12/31/9999 FTX00002|INDIVIDUAL-CAPITATION-PMPM|01/01/0001|12/31/9999 FTX00003|INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT|01/01/0001|12/31/9999 FTX00004|GROUP-INSURANCE-PREMIUM-PAYMENT|01/01/0001|12/31/9999 FTX00005|COST-SHARING-OFFSET|01/01/0001|12/31/9999 FTX00006|VALUE-BASED-PAYMENT|01/01/0001|12/31/9999 FTX00007|STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM|01/01/0001|12/31/9999 FTX00008|COST-SETTLEMENT-PAYMENT|01/01/0001|12/31/9999 FTX00009| FQHC-WRAP-PAYMENT|01/01/0001|12/31/9999 FTX00095 |MISCELLANEOUS-PAYMENT|01/01/0001|12/31/9999 |
| 2023-09-28 | SDP-IND | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 0|No, not an SDP|01/01/0001|12/31/9999 1|Yes, SDP|01/01/0001|12/31/9999 |
| 2023-09-28 | SERVICE-TRACKING-TYPE | DELETE | All Valid Value Attributes | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 00|Not a Service Tracking Claim|01/01/0001|12/31/9999 01|Drug Rebate|01/01/0001|12/31/9999 02|DSH Payment|01/01/0001|12/31/9999 03|Lump Sum Payment|01/01/0001|12/31/9999 04|Cost Settlement|01/01/0001|12/31/9999 05|Supplemental|01/01/0001|12/31/9999 06|Other|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2023-09-28 | SUBCAPITATION-IND | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1|No, transaction is not a sub-capitation payment or recoupment|01/01/0001|12/31/9999 2 |Yes, transaction is a sub-capitation or recoupment|01/01/0001|12/31/9999 |
| 2023-09-28 | TRANSACTION-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 01|Kick payment|01/01/0001|12/31/9999 02|Provider retainer payment|01/01/0001|12/31/9999 03 |Direct reimbursement to Bene for retroactive period cost (e.g. 42 CFR 447.25)|01/01/0001|12/31/9999 04|Direct reimbursement to Bene for non-emergency transportation|01/01/0001|12/31/9999 95 |Other|01/01/0001|12/31/9999 |
| 2023-09-28 | TYPE-OF-CLAIM | UPDATE | Effective End Date | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 2|Medicaid or Medicaid-expansion Capitated Payment| |00010101|99991231| 4|Medicaid or Medicaid-expansion Service Tracking Claim| |00010101|99991231| 5|Medicaid or Medicaid-expansion Supplemental Payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement)| |00010101|99991231| 6|Medicaid or Medicaid-expansion CHIP financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency| |00010101|99991231| B|Separate CHIP (Title XXI) claim: Capitated Payment| |00010101|99991231| D|Separate CHIP (Title XXI) Service Tracking Claim| |00010101|99991231| E|Separate CHIP (Title XXI) claim for a supplemental payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement)| |00010101|99991231| F|Separate CHIP (Title XXI) financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency| |00010101|99991231| V|Other Capitated Payment| |00010101|99991231| X|Non-Medicaid/CHIP service tracking claims| |00010101|99991231| Y|Other Supplemental Payment| |00010101|99991231| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 2|Medicaid or Medicaid-expansion Capitated Payment| |00010101|20250930| 4|Medicaid or Medicaid-expansion Service Tracking Claim| |00010101|20250930| 5|Medicaid or Medicaid-expansion Supplemental Payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement)| |00010101|20250930| 6|Medicaid or Medicaid-expansion CHIP financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency| |00010101|20250930| B|Separate CHIP (Title XXI) claim: Capitated Payment| |00010101|20250930| D|Separate CHIP (Title XXI) Service Tracking Claim| |00010101|20250930| E|Separate CHIP (Title XXI) claim for a supplemental payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement)| |00010101|20250930| F|Separate CHIP (Title XXI) financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency| |00010101|20250930| V|Other Capitated Payment| |00010101|20250930| X|Non-Medicaid/CHIP service tracking claims| |00010101|20250930| Y|Other Supplemental Payment| |00010101|20250930| |
| 2023-09-28 | TYPE-OF-SERVICE | UPDATE | Effective End Date | VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 119|Capitated payments to HMOs, HIOs, or PACE plans| |00010101|99991231| 120|Capitated payments for primary care case management (PCCM)| |00010101|99991231| 121|Premium payments for private health insurance| |00010101|99991231| 122|Capitated payments to prepaid health plans (PHPs)| |00010101|99991231| 123|Disproportionate share hospital (DSH) payments| |00010101|99991231| 131|Drug Rebates| |00010101|99991231| 132|Supplemental payment - inpatient| |00010101|99991231| 133|Supplemental payment - nursing| |00010101|99991231| 134|Supplemental payment - outpatient| |00010101|99991231| 135|EHR payments to provider| |00010101|99991231| 138|Per member per month (PMPM) payments for health home services| |00010101|99991231| 139|Per member per month (PMPM) payments for Medicare Part A premiums| |00010101|99991231| 140|Per member per month (PMPM) payments for Medicare Part B premiums| |00010101|99991231| 141|Per member per month (PMPM) payments for Medicare Advantage Dual Special Needs Plans (D-SNP) – Medicare Part C.| |00010101|99991231| 142|Per member per month (PMPM) payments for Medicare Part D premiums| |00010101|99991231| 143|Per member per month (PMPM) payments for other payments| |00010101|99991231| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 119|Capitated payments to HMOs, HIOs, or PACE plans| |00010101|20250930| 120|Capitated payments for primary care case management (PCCM)| |00010101|20250930| 121|Premium payments for private health insurance| |00010101|20250930| 122|Capitated payments to prepaid health plans (PHPs)| |00010101|20250930| 123|Disproportionate share hospital (DSH) payments| |00010101|20250930| 131|Drug Rebates| |00010101|20250930| 132|Supplemental payment - inpatient| |00010101|20250930| 133|Supplemental payment - nursing| |00010101|20250930| 134|Supplemental payment - outpatient| |00010101|20250930| 135|EHR payments to provider| |00010101|20250930| 138|Per member per month (PMPM) payments for health home services| |00010101|20250930| 139|Per member per month (PMPM) payments for Medicare Part A premiums| |00010101|20250930| 140|Per member per month (PMPM) payments for Medicare Part B premiums| |00010101|20250930| 141|Per member per month (PMPM) payments for Medicare Advantage Dual Special Needs Plans (D-SNP) – Medicare Part C.| |00010101|20250930| 142|Per member per month (PMPM) payments for Medicare Part D premiums| |00010101|20250930| 143|Per member per month (PMPM) payments for other payments| |00010101|20250930| |
| 2023-09-28 | VALUE-BASED-PAYMENT-MODEL-TYPE | ADD | All Valid Value Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 2A |FFS/Q&V Foundational payments for infrastructure and operations|01/01/0001|12/31/9999 2B|FFS/Q&V Pay for reporting|01/01/0001|12/31/9999 2C|FFS/Q&V Pay for performance|01/01/0001|12/31/9999 3A|APM/FFS APMs with Shared savings|01/01/0001|12/31/9999 3B|APM/FFS APMs with shared savings and downside risk|01/01/0001|12/31/9999 3N|APM/FFS Risk based payments NOT linked to quality|01/01/0001|12/31/9999 4A |POP/PAY Condition-specific population-based payment|01/01/0001|12/31/9999 4B|POP/PAY Comprehensive population-based payment|01/01/0001|12/31/9999 4C |POP/PAY Integrated finance and delivery system|01/01/0001|12/31/9999 4N|POP/PAY Capitated payments NOT linked to quality|01/01/0001|12/31/9999 |
| 2024-04-15 | 1115A-DEMONSTRATION-IND | UPDATE | VVL_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1115A-DEMONSTRATION-IND|1115A Demonstration Indicator List|0|Not an 1115(A)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1115A-DEMONSTRATION-IND|1115A Demonstration Indicator List|0|Not a 1115A|01/01/0001|12/31/9999 |
| 2024-04-15 | 1115A-DEMONSTRATION-IND | UPDATE | VVL_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1115A-DEMONSTRATION-IND|1115A Demonstration Indicator List|1|1115(A)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 1115A-DEMONSTRATION-IND|1115A Demonstration Indicator List|1|1115A|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|10|Vision Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|11|Other Practitioners|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|12|Clinic Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|13|Therapy Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|14|Laboratory/Radiological|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|15|Medical Equipment|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|16|Family Planning|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|17|Abortions|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|18|Screening Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|19|Home Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|1A|Premiums: Up To 150% - Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|1B|Premiums: Up To 150% - Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|1C|Premiums: Over 150% - Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|1D|Premiums: Over 150% - Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|2|Inpatient Hospital|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|20|Health Services Initiatives|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|21|Home and Community|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|22|Hospice|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|23|Medical Transportation|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|24|Case Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|25|Translation and Interpretation|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|26|ARP Section 9821 COVID Vaccine/Vaccine Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|3|Inpatient Mental Health |01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|31|Other Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|32|Outreach|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|32A|Increased Outreach and Enrollment of Indians|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|32B|Increase Outreach and Enrollment of children through premium subsidies|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|33|Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|34|PERM Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|35|Citizenship Verification Technology-CHIPRA|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|35A|CVT Development|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|35B|CVT Operation|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|4|Nursing Care Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
21.P-FORM|21.P Form List|5|Physician/Surgical|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|6|Outpatient Hospital|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|7|Outpatient Mental Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|8|Prescribed Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|8A|Drug Rebate|01/01/0001|12/31/9999 |
| 2024-04-15 | 21.P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21.P-FORM|21.P Form List|9|Dental Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|10|Vision Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|11|Other Practitioners|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|12|Clinic Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|13|Therapy|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|14|Laboratory/Radiological|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|15|Medical Equipment|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|16|Family Planning|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|17|Abortions|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|18|Screening Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|19|Home Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|1A|Premiums - Up To 150%: Gross Premiums Paid |01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|1B|Premiums - Up To 150%: Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|1C|Premiums - Over 150%: Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|1D|Premiums - Over 150%: Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|2|Inpatient Hospital|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|20|Health Services Initiatives|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|21|Home And Community-Based Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|22|Hospice|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|23|Medical Transportation|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|24|Case Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|25|Translation and Interpretation|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|26|ARP Section 9821 COVID Vaccine/Vaccine Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|3|Inpatient Mental Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|31|Other Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|32|Outreach|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|32A|Increased Outreach and Enrollment of Indians|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|32B|Increase Outreach and Enrollment of children through premium subsidies|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|33|Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|34|PERM Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|35|Citizenship Verification Technology-CHIPRA|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|35A|CVT Development|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|35B|CVT Operation|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|4|Nursing Care|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|5|Physician/Surgical|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|6|Outpatient Hospital|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|7|Outpatient Mental Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|8|Prescribed Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|8A|Drug Rebate|01/01/0001|12/31/9999 |
| 2024-04-15 | 21BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 21BASE-FORM|21BASE Form List|9|Dental Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.10BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.10BASE-FORM|64.10BASE Form List|29|Non-Emergency Medical Transportation|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|10|Vision Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|11|Other Practitioners|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|12|Clinic Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|13|Therapy Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|14|Laboratory/Radiological|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|15|Medical Equipment|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|16|Family Planning|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|17|Abortions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|18|Screening Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|19|Home Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|1A|Premiums: Up To 150% - Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|1B|Premiums: Up To 150% - Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|1C|Premiums: Over 150% - Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|1D|Premiums: Over 150% - Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|2|Inpatient Hospital Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|20|Medicare Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|21|Home And Community|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|21A|Home and Community-Based Services - Regular Payment (WAIVER)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|22|Hospice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|23|Medical Transport|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|24|Case Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|26|ARP Section 9821 COVID Vaccine/Vaccine Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|2A|Inpatient Hospital Services - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|3|Inpatient Mental Health - Reg. Payment|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|31|Other Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|3A|Inpatient Mental Health - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|3B|Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|4|Nursing Care Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|5|Physician/Surgical|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|6|Outpatient Hospital Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|7|Outpatient Mental Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8|Prescribed Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A1|Drug Rebate - National|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A2|Drug Rebate - State|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A3|MCO - National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A4|MCO - State Sidebar Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A5|Increased ACA OFFSET - Fee for Service - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A6|Increased ACA OFFSET - MCO - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|8A7|Drug Rebate Offset - Value Based Purchasing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21U-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21U-FORM|64.21U Form List|9|Dental Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|10|Vision Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|11|Other Practitioners|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|12|Clinic services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|13|Therapy Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|14|Laboratory/Radiological|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|15|Medical Equipment|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|16|Family Planning|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|17|Abortions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|18|Screening|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|19|Home Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|1A|Premiums Up To 150% - Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|1B|Premiums Up To 150% - Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|1C|Premiums Over 150% - Gross Premiums Paid|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|1D|Premiums Over 150% - Cost Sharing Offset|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|2|Inpatient Hospital - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|20|Medicare Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|21|Home And Community|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|21A|Home and Community-Based Services - Regular Payment (WAIVER)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|22|Hospice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|23|Medical Transport|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|24|Case Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
64.21UP-FORM|64.21UP Form List|26|ARP Section 9821 COVID Vaccine/Vaccine Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|2A|Inpatient Hospital - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|3|Inpatient Mental Health - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|31|Other Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|3A|Inpatient Mental Health - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|3B|Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|4|Nursing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|5|Physician/Surgical|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|6|Outpatient Hospital|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|7|Outpatient Mental Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8|Prescribed Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A1|Drug Rebate - National|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A2|Drug Rebate - State|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A3|MCO - National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A4|MCO - State Sidebar Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A5|Increased ACA OFFSET - Fee for Service - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A6|Increased ACA OFFSET - MCO - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|8A7|Drug Rebate Offset - Value Based Purchasing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.21UP-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.21UP-FORM|64.21UP Form List|9|Dental Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1A|Medicare Collections|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1B1|Other Collection - Health Insurance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1B2|Other Collections - Casualty Insurance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1C|Total Collections - Cooperative Agreements & Assign of Rights|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1C1|Less: Excess Paid to Individuals|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1C2|Net Collections To Reimburse State Title XIX Medical Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1C3|Less 15% Incentive Actually Paid Under Section 1903(p)(1)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A1C4|Net Federal Share|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|A2|Total TPL Collections|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|B1|Medicare Title XVIII|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|B2|Health Insurance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9A-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9A-FORM|64.9A Form List|B3|Other Cost Avoidance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|10A|Clinic Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|10B|Clinic Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|11|Laboratory/Radiological|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|12|Home Health Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|13|Sterilizations|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|14|Abortions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|15|EPSDT Screening|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|16|Rural Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|17A|Medicare - Part A|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|17B|Medicare - Part B|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|17C1|120% - 134% Of Poverty|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|17D|Coinsurance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A|Medicaid - MCO|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A1|Medicaid MCO - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A2|Medicaid MCO - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A3|Medicaid MCO - Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A4|Medicaid MCO - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A5|Medicaid MCO - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18A6|Medicaid MCO - Services Subject to Electronic Visit Verification Requirements|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1|Prepaid Ambulatory Health Plan|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1a|MCO PAHP - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1b|MCO PAHP - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1c|MCO PAHP - Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1d|MCO PAHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1e|Medicaid PAHP - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B1f|MCO PAHP - Services Subject to Electronic Visit Verification Requirements|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2|Prepaid Inpatient Health Plan|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2a|MCO PIHP - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2b|MCO PIHP - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2c|MCO PIHP - Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2d|MCO PIHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2e|Medicaid PIHP - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18B2f|MCO PIHP - Services Subject to Electronic Visit Verification Requirements|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18C|Medicaid - Group Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18D|Medicaid - Coinsurance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|18E|Medicaid - Other|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|19A|Home & Community-Based Services - Regular Payment (1915(c) Waiver)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|19B|Home & Community-Based Services - St. Plan 1915(i) Only Pay.|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|19C|Home & Community-Based Services - St. Plan 1915(j) Only Pay.|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|19D|Home & Community Based Services State Plan 1915(k) Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|1A|Inpatient Hospital - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|1B|Inpatient Hospital - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|1C|Inpatient Hospital - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|1D|Inpatient Hospital - GME Sup Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|22|All-Inclusive Care Elderly|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|23A|Personal Care Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|23B|Personal Care Services - SDS 1915(j)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|24A|Targeted Case Management Services - Com. Case-Man.|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|24B|Case Management - State Wide|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|25|Primary Care Case Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|26|Hospice Benefits|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|27|Emergency Services for Undocumented Aliens|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|28|Federally-Qualified Health Center|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|29A|Non-Emergency Medical Transportation - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|29B|Non-Emergency Medical Transportation - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|2A|Mental Health Facility Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|2B|Mental Health Facility - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|2C|Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|30|Physical Therapy|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|31|Occupational Therapy|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|32|Services for Speech, Hearing & Language|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|33|Prosthetic Devices, Dentures, Eyeglasses|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|34|Diagnostic Screening & Preventive Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|34A|Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|35|Nurse Mid-Wife|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|36|Emergency Hospital Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|37A|Critical Access Hospitals - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|37B|Critical Access Hospitals Inpatient - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|37C|Critical Access Hospitals Outpatient - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|38|Nurse Practitioner Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|39|School Based Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|3A|Nursing Facility Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|3B|Nursing Facility Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|40|Rehabilitative Services (non-school-based)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|41|Private Duty Nursing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|42|Freestanding Birth Center|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|43|Health Home for Enrollees w Chronic Conditions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|44|Tobacco Cessation for Pregnant Women|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|45|Health Home for Enrollees w Substance-Use-Disorder|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46|OUD Medicaid Assisted Treatment – Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46A1|OUD MAT DRUG REBATE/National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46A2|OUD MAT DRUG REBATE/State Sidebar|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46A3|OUD MAT DRUG REBATE MCO /National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46A4|OUD MAT DRUG REBATE MCO /State Sidebar|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46A5|OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46A6|OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|46B|OUD Medicaid Assisted Treatment Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|47|ARP Section 9811 COVID Vaccine/Vaccine Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|48|ARP Section 9813 Qualified Community Based Mobile Crisis Intervention – 85%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|49|Health Homes for Children with Medically Complex Conditions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|4A|Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Public Providers|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|4B|Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Private Providers|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|4C|Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Supplemental Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|5A|Physician & Surgical Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|5B|Physician & Surgical Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|5C|Physician & Surgical Services - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|5D|Physician & Surgical Services - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|69|Other Care Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|6A|Outpatient Hospital Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|6B|Outpatient Hospital Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7|Prescribed Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A1|Drug Rebate Offset - National|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A2|Drug Rebate Offset - State Sidebar Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A3|MCO - National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A4|MCO - State Sidebar Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A5|Increased ACA OFFSET - Fee for Service - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A6|Increased ACA OFFSET - MCO - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|7A7|Drug Rebate Offset - Value Based Purchasing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|8|Dental Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|9A|Other Practitioners Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9BASE-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9BASE-FORM|64.9BASE Form List|9B|Other Practitioners Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|10A|Clinic Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|10B|Clinic Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|11|Laboratory/Radiological|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|12|Home Health|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|13|Sterilizations|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|14|Abortions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|15|EPSDT Screen|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|16|Rural Health Clinic|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|17A|MHIP - Part A|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|17B|MHIP - Part B|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|17C1|MHIP - Qual. Ind. 120-134|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|17D|MHIP - Coinsurance|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A|MHIP - MCO|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A1|Medicaid MCO - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A2|Medicaid MCO - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A3|Medicaid MCO - Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A4|Medicaid MCO - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A5|Medicaid MCO - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18A6|Medicaid MCO - Services Subject to Electronic Visit Verification Requirements|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1|Prepaid Ambulatory Health Plan|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1a|MCO PAHP - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1b|MCO PAHP - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1c|MCO PAHP - Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1d|MCO PAHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1e|Medicaid PAHP - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B1f|MCO PAHP - Services Subject to Electronic Visit Verification Requirements|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2|Prepaid Inpatient Health Plan|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2a|MCO PIHP - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2b|MCO PIHP - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2c|MCO PIHP - Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2d|MCO PIHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2e|Medicaid PIHP - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18B2f|MCO PIHP - Services Subject to Electronic Visit Verification Requirements|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18C|MHIP - Group Health Plan|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18D|MHIP - Coinsurance and Deductibles|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|18E|MHIP - Other|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|19A|Home & Community-Based Services - Regular Payment (1915(c) Waiver)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|19B|Home & Community-Based Services - St. Plan 1915(i) Only Pay.|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|19C|Home & Community-Based Services - St. Plan 1915(j) Only Pay.|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|19D|Home & Community Based Services State Plan 1915(k) Community First Choice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|1A|Inpat. Hos. Serv. - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|1B|Inpat. Hos. Serv. - DSH|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|1C|Inpatient Hospital - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|1D|Inpatient Hospital - GME Sup Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|22|Programs/All-Inclusive|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|23A|Personal Care Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|23B|Personal Care Services - SDS 1915(j)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|24A|Targeted Case Management Services - Com. Case-Man.|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|24B|Case Management - State Wide|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|25|Primary Care Case Manage|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|26|Hospice|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|27|Emergency Services for Undocumented Aliens|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|28|Federally-Qualified Health Center|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|29A|Non-Emergency Medical Transportation - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|29B|Non-Emergency Medical Transportation - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|2A|Men. Health Fac. Serv. - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|2B|Men. Health Fac. Serv. - DSH Adjustment Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|2C|Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|30|Physical Therapy|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|31|Occupational Therapy|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|32|Services for Speech, Hearing & Language|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|33|Prosthetic Devices, Dentures, Eyeglasses|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|34|Diagnostic Screening & Preventive Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|34A|Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|35|Nurse Mid-Wife|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|36|Emergency Hospital Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|37A|Critical Access Hospitals - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|37B|Critical Access Hospitals Inpatient - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|37C|Critical Access Hospitals Outpatient - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|38|Nurse Practitioner Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|39|School Based Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|3A|Nursing Facility Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|3B|Nursing Facility Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|40|Rehabilitative Services (non-school-based)|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|41|Private Duty Nursing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|42|Freestanding Birth Center|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|43|Health Home for Enrollees w Chronic Conditions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|44|Tobacco Cessation for Pregnant Women|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|45|Health Home for Enrollees w Substance-Use-Disorder|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46|OUD Medicaid Assisted Treatment – Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46A1|OUD MAT DRUG REBATE/National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46A2|OUD MAT DRUG REBATE/State Sidebar|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46A3|OUD MAT DRUG REBATE MCO /National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46A4|OUD MAT DRUG REBATE MCO /State Sidebar|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46A5|OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46A6|OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|46B|OUD Medicaid Assisted Treatment Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|47|ARP Section 9811 COVID Vaccine/Vaccine Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|48|ARP Section 9813 Qualified Community Based Mobile Crisis Intervention – 85%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|49|Health Homes for Children with Medically Complex Conditions|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|4A|Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Public Providers|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|4B|Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Private Providers|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|4C|Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Supplemental Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|5A|Physician & Surgical Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|5B|Physician & Surgical Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|5C|Physician & Surgical Services - Evaluation and Management|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|5D|Physician & Surgical Services - Vaccine codes|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|69|Other Care Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|6A|Outpatient Hospital Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|6B|Outpatient Hospital Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7|Prescribed Drugs|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A1|Drug Rebate - National|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A2|Drug Rebate - State|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A3|MCO - National Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A4|MCO - State Sidebar Agreement|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A5|Increased ACA OFFSET - Fee for Service - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A6|Increased ACA OFFSET - MCO - 100%|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|7A7|Drug Rebate Offset - Value Based Purchasing|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|8|Dental Services|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|9A|Other Practitioners Services - Reg. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | 64.9P-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date 64.9P-FORM|64.9P Form List|9B|Other Practitioners Services - Sup. Payments|01/01/0001|12/31/9999 |
| 2024-04-15 | ACCREDITATION-ORGANIZATION | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ACCREDITATION-ORGANIZATION|Accreditation Organization List|See next cell|For background and context, see https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/ and https://www.aaahc.org/accreditation/accreditation-general-information/terms-of-accreditation/|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ACCREDITATION-ORGANIZATION|Accreditation Organization List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/ and https://www.aaahc.org/accreditation/accreditation-general-information/terms-of-accreditation/|N/A|N/A |
| 2024-04-15 | ADJUSTMENT-REASON-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ADJUSTMENT-REASON-CODE|Adjustment Reason Code List|See next cell|For background and context, see https://x12.org/codes/claim-adjustment-reason-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ADJUSTMENT-REASON-CODE|Adjustment Reason Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://x12.org/codes/claim-adjustment-reason-codes|N/A|N/A |
| 2024-04-15 | ADMISSION-TYPE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ADMISSION-TYPE|Admission Type List|See next cell|For background and context, see https://www.nubc.org/license|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ADMISSION-TYPE|Admission Type List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.nubc.org/license|N/A|N/A |
| 2024-04-15 | ATYPICAL-PROV-IND | UPDATE | vvl_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ATYPICAL-PROV-IND|Atypical Provider Indicator List|0|No, the State does not this to be an atypical provider|01/01/0001|2958465 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ATYPICAL-PROV-IND|Atypical Provider Indicator List|0|No, the State does not consider this to be an atypical provider|01/01/0001|12/31/9999 |
| 2024-04-15 | CLAIM-PYMT-REM-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CLAIM-PYMT-REM-CODE|Claim Payment Remittance Code List|See next cell|For background and context, see https://x12.org/codes/remittance-advice-remark-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CLAIM-PYMT-REM-CODE|Claim Payment Remittance Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://x12.org/codes/remittance-advice-remark-codes|N/A|N/A |
| 2024-04-15 | CLAIM-STATUS | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CLAIM-STATUS|Claim Status Code List|See next cell|For background and context, see https://x12.org/codes/claim-status-codes and https://x12.org/codes/claim-status-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CLAIM-STATUS|Claim Status Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://x12.org/codes/claim-status-codes and https://x12.org/codes/claim-status-codes|N/A|N/A |
| 2024-04-15 | CLAIM-STATUS-CATEGORY | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CLAIM-STATUS-CATEGORY|Claim Status Category List|See next cell|For background and context, see http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-category-codes/|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date CLAIM-STATUS-CATEGORY|Claim Status Category List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-category-codes/|N/A|N/A |
| 2024-04-15 | COMPOUND-DOSAGE-FORM | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date COMPOUND-DOSAGE-FORM|Compound Dosage Form List|See next cell|For background and context, see https://www.ncpdp.org/|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date COMPOUND-DOSAGE-FORM|Compound Dosage Form List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ncpdp.org/|N/A|N/A |
| 2024-04-15 | COUNTY | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date COUNTY|US County Code List|See next cell|For background and context, see https://www.census.gov/library/reference/code-lists/ansi.html#cou|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date COUNTY|US County Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.census.gov/library/reference/code-lists/ansi.html#cou|N/A|N/A |
| 2024-04-15 | DIAGNOSIS-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date DIAGNOSIS-CODE|Diagnosis Code List|See next cell|For background and context, see https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date DIAGNOSIS-CODE|Diagnosis Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes|N/A|N/A |
| 2024-04-15 | DIAGNOSIS-POA-FLAG | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date DIAGNOSIS-POA-FLAG|Diagnosis POA Flag List|See next cell|For background and context, see https://www.nubc.org/license|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date DIAGNOSIS-POA-FLAG|Diagnosis POA Flag List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.nubc.org/license|N/A|N/A |
| 2024-04-15 | DRUG-UTILIZATION-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date DRUG-UTILIZATION-CODE|Drug Utilization Code List|See next cell|For background and context, see https://www.ncpdp.org/|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date DRUG-UTILIZATION-CODE|Drug Utilization Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ncpdp.org/|N/A|N/A |
| 2024-04-15 | FILE-NAME | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-IP|Inpatient Claim/Encounters File - Claims/encounters with TYPE-OF-SERVICE = 001, 058, 084, 086, 090, 091, 092, 093, 123, or 132. (Note : In CLAIMIP, TYPE-OF-SERVICE 086 and 084 refer only to services received on an inpatient basis.)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-IP|Inpatient Claim/Encounters File|01/01/0001|12/31/9999 |
| 2024-04-15 | FILE-NAME | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-LT|Long Term Care Claims/Encounters File - Claims/encounters with TYPE-OF-SERVICE = 009, 044, 045, 046, 047, 048, 059, or 133 (all mental hospital, and NF services). (Note: Individual services billed by a long-term care facility belong in this file regardless|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-LT|Long Term Care Claims/Encounters File|01/01/0001|12/31/9999 |
| 2024-04-15 | FILE-NAME | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-OT|Other Claims/Encounters File - Claims/encounters with TYPE-OF-SERVICE= 002, 003, 004, 005, 006, 007, 008, 010, 011, 012, 013, 015, 016, 017, 018, 019, 020, 021, 022, 025, 026, 027, 028, 029, 030, 031, 032, 035, 036, 037, 039, 040, 041, 043, 051, 052, 053,|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-OT|Other Claims/Encounters File|01/01/0001|12/31/9999 |
| 2024-04-15 | FILE-NAME | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-RX|Pharmacy Claims/Encounters File - Claims/encounters with TYPE-OF-SERVICE= 033, 034, or 131.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date FILE-NAME|T-MSIS File Type List|CLAIM-RX|Pharmacy Claims/Encounters File|01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|1|Female|01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|2|Male|01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|3|Transgender female|01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|4|Transgender male|01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|5|Not sure |01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|6|Prefer not to answer|01/01/0001|12/31/9999 |
| 2024-04-15 | GENDER-IDENTITY | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date GENDER-IDENTITY|Gender Identity List|7|Other|01/01/0001|12/31/9999 |
| 2024-04-15 | LINE-ADJUSTMENT-REASON-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date LINE-ADJUSTMENT-REASON-CODE|Line Adjustment Reason Code List|See next cell|For background and context, see https://x12.org/codes/claim-adjustment-reason-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date LINE-ADJUSTMENT-REASON-CODE|Line Adjustment Reason Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://x12.org/codes/claim-adjustment-reason-codes|N/A|N/A |
| 2024-04-15 | MANAGED-CARE-SERVICE-AREA-NAME | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MANAGED-CARE-SERVICE-AREA-NAME|Managed Care Service Area Name List|See next cell|For background and context, see https://www.census.gov/library/reference/code-lists/ansi.html|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MANAGED-CARE-SERVICE-AREA-NAME|Managed Care Service Area Name List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.census.gov/library/reference/code-lists/ansi.html|N/A|N/A |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|10|Clinic Services|01/01/0001|09/30/2021 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|10A|Clinic Services - Reg. Payments|10/01/2021|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|10B|Clinic Services - Sup. Payments|10/01/2021|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|11|Laboratory/Radiological|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|12|Home Health Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|13|Sterilizations|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|14|Other Pregnancy-related Procedures|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|15|EPSDT Screening|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|16|Rural Health|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|17A|Medicare - Part A|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|17B|Medicare - Part B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|17C1|120% - 134% Of Poverty|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|17D|Coinsurance|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18A|Medicaid - MCO|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18A1|Medicaid MCO - Evaluation and Management|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18A2|Medicaid MCO - Vaccine codes|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18A3|Medicaid MCO - Community First Choice|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18A4|Medicaid MCO - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18A5|Medicaid MCO - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B1|Prepaid Ambulatory Health Plan|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B1a|MCO PAHP - Evaluation and Management|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B1b|MCO PAHP - Vaccine codes|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B1c|MCO PAHP - Community First Choice|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B1d|MCO PAHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B1e|Medicaid PAHP - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B2|Prepaid Inpatient Health Plan|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B2a|MCO PIHP - Evaluation and Management|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B2b|MCO PIHP - Vaccine codes|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B2c|MCO PIHP - Community First Choice|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B2d|MCO PIHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18B2e|Medicaid PIHP - Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18C|Medicaid - Group Health|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18D|Medicaid - Coinsurance|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|18E|Medicaid - Other|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|19A|Home & Community-Based Services - Reg. Pay. (Waiver)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|19B|Home & Community-Based Services - St. Plan 1915(i) Only Pay.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|19C|Home & Community-Based Services - St. Plan 1915(j) Only Pay.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|19D|Home & Community Based Services State Plan 1915(k) Community First Choice|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|1A|Inpatient Hospital - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|1B|Inpatient Hospital - DSH|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|1C|Inpatient Hospital - Sup. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|1D|Inpatient Hospital - GME Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|22|All-Inclusive Care Elderly|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|23A|Personal Care Services - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|23B|Personal Care Services - SDS 1915(j)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|24A|Targeted Case Management Services - Com. Case-Man.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|24B|Case Management - State Wide|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|25|Primary Care Case Management|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|26|Hospice Benefits|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|27|Emergency Services for Undocumented Aliens|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|28|Federally-Qualified Health Center|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|29|Non-Emergency Medical Transportation|01/01/0001|12/31/2021 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|29A|Non-Emergency Medical Transportation - Reg. Payments|01/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|29B|Non-Emergency Medical Transportation - Sup. Payments|01/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|2A|Mental Health Facility Services - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|2B|Mental Health Facility - DSH|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|2C|Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|30|Physical Therapy|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|31|Occupational Therapy|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|32|Services for Speech, Hearing & Language|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|33|Prosthetic Devices, Dentures, Eyeglasses|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|34|Diagnostic Screening & Preventive Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|34A|Preventive Services Grade A OR B, ACIP Vaccines and their Admin|01/01/0001|12/31/9999 | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|35|Nurse Mid-Wife|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|36|Emergency Hospital Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|37|Critical Access Hospitals|01/01/0001|12/31/2021 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|37A|Critical Access Hospitals - Reg. Payments|01/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|37B|Critical Access Hospitals Inpatient - Sup. Payments|01/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|37C|Critical Access Hospitals Outpatient - Sup. Payments|01/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|38|Nurse Practitioner Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|39|School Based Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|3A|Nursing Facility Services - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|3B|Nursing Facility Services - Sup. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|40|Rehabilitative Services (non-school-based)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|41|Private Duty Nursing|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|42|Freestanding Birth Center|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|43|Health Home for Enrollees w Chronic Conditions|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|44|Tobacco Cessation for Pregnant Women|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|45|Health Homes for Substance-Use-Disorder Enrollees per section 1006 of the SUPPORT for Patients and Communities Act|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46|OUD Medicaid Assisted Treatment – Drugs|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46A1|OUD MAT DRUG REBATE/National Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46A2|OUD MAT DRUG REBATE/State Sidebar|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46A3|OUD MAT DRUG REBATE MCO /National Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46A4|OUD MAT DRUG REBATE MCO /State Sidebar|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46A5|OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46A6|OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|46B|OUD Medicaid Assisted Treatment Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|47|ARP Section 9811 COVID Vaccine/Vaccine Administration|03/11/2021|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|49|Health Homes For Children With Medically Complex Conditions|10/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|49|Other Care Services|01/01/0001|09/30/2022 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|4A|Intermediate Care Facility Services - Individuals with Intellectual Disabilities: Public Providers|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|4B|Intermediate Care Facility Services - Individuals with Intellectual Disabilities: Private Providers|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|4C|Intermediate Care Facility Services - Individuals with Intellectual Disabilities: Supplemental Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|5A|Physician & Surgical Services - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|5B|Physician & Surgical Services - Sup. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|5C|Physician & Surgical Services - Evaluation and Management|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|5D|Physician & Surgical Services - Vaccine codes|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|69|Other Care Services|01/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|6A|Outpatient Hospital Services - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|6B|Outpatient Hospital Services - Sup. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7|Prescribed Drugs|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A1|Drug Rebate Offset - National|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A2|Drug Rebate Offset - State Sidebar Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A3|MCO - National Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A4|MCO - State Sidebar Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A5|Increased ACA OFFSET - Fee for Service - 100%|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A6|Increased ACA OFFSET - MCO - 100%|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|7A7|Drug Rebate Offset - Value Based Purchasing|10/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|8|Dental Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|9A|Other Practitioners Services - Reg. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XIX) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XIX)|XIX MBESCBES Category of Service List|9B|Other Practitioners Services - Sup. Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|10|Vision Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|11|Other Practitioners|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|12|Clinic Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|13|Therapy Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|14|Laboratory/Radiological|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|15|Medical Equipment|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|16|Family Planning|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|17|Other Pregnancy-related Procedures|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|18|Screening Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|19|Home Health|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|1A|Premiums - Up To 150%: Gross Premiums Paid|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|1B|Premiums - Up To 150%: Cost Sharing Offset|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|1C|I Premiums - Over 150%: Gross Premiums Paid|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|1D|Premiums - Over 150%: Cost Sharing Offset|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|2|Inpatient Hospital|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|20|Health Services Initiatives|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|21|Home and Community|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|21A|Home and Community-Based Services - Regular Payment (WAIVER)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|22|Hospice|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|23|Medical Transportation|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|24|Case Management|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|25|Translation and Interpretation|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|26|ARP Section 9821 COVID Vaccine/Vaccine Administration|03/11/2021|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|2A|Inpatient Hospital Services - DSH|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|3|Inpatient Mental Health|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|31|Other Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|32|Outreach|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|32A|Increased Outreach and Enrollment of Indians|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|32B|Increase outreach and enrollment of children through premium subsidies|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|33|Administration|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|34|PERM Administration|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|35|Citizenship Verification Technology CHIPRA|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|35A|CVT Development|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|35B|CVT Operation|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|3A|Inpatient Mental Health - DSH|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|3B|Certified Community Behavior Health Clinic Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|4|Nursing Care Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|5|Physician/Surgical|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|6|Outpatient Hospital|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|7|Outpatient Mental Health|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8|Prescribed Drugs|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A|Drug Rebate|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A2|Drug Rebate - State|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A3|MCO - National Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A4|MCO - State Sidebar Agreement|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A5|Increased ACA OFFSET - Fee for Service - 100%|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A6|Increased ACA OFFSET - MCO - 100%|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|8A7|Drug Rebate Offset - Value Based Purchasing|10/01/2022|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-CATEGORY-OF-SERVICE (XXI) | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-CATEGORY-OF-SERVICE (XXI)|XXI MBESCBES Category of Service List|9|Dental Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|21.P|Quarterly Children's Health Insurance Program, Prior Period Adjustments|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21.11|Summary Total of Receipts from Form CMS 21.11A|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21.11A|Actual Receipts by Plan Name|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21|Child Health Expenditures by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21AD|21 REMAP Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21C|CHIP Fiscal Year Allotment|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21L|Calculation of 10% Limit|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21LSUB|Form CMS-21L Outreach Allowance|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21NARR|Narrative Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21O|Children's Health Expenditures For the Title XXI Program Overpayment Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21OMEQC|Children's Health Expenditures For the Title XXI Program Overpayment Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21PERM|Child Health Expenditures by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21PWAIVER|Child Health Waivers by Type of Service for Title XXI Program|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21Summary|Summary of CMS 21|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21T.TRACK|20% Medicaid Allowance|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21WAIVER|Child Health Waivers by Type Of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10200K|Quarterly Expenditures for State & Local Administration - 200K|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10I|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10P|Prior Period Adjustments for Lines 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10P200K|Prior Period Adjustments for Lines 7, 8, 10A, 10B - 200K|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10PI|Prior Period Adjustments for Lines 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10WAIV|64.10 Waivers|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10WAIVP|Waiver Prior Period Adjustments for Lines 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.11|Summary Total of Receipts from Form CMS 64.11a|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.1108CAP|Quarterly Medicaid Statement of Expenditures For the Medical Assistance Program Summary Sheet|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.11A|Actual Receipts by Plan Name|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21|Quarterly MAP Payments for CHIP Categories|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21P|Prior Period MAP Adjustments for CHIP Categories|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21U114|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21U115|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21U200K|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UP114|Child Health Expenditures by Service - Prior Period|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UP115|Child Health Expenditures by Service - Prior Period|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UP200K|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UPWAV|Child Health Expenditures by Service - Prior Period Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UPWAV114|Child Health Expenditures by Service - Prior Period Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UPWAV115|Child Health Expenditures by Service - Prior Period Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UWAIV|Child Health Expenditures by Service - Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UWAIV114|Child Health Expenditures by Service - Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UWAIV115|Child Health Expenditures by Service - Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21WAIV|Waiver Quarterly MAP Payments for CHIP Categories|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21WAIVP|Waiver Prior Period MAP Adjustments for CHIP Categories|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9200K|Medical Assistance Expenditures by Type of Service 200K|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9200KP|Medical Assistance Expenditures by Type of Service 200KP|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9ARPSection9817|ARP 9817 HCBS|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9C1|Fraud, Waste & Abuse Recoveries From State Medicaid Program Integrity Activities|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9C1F|Fraud, Waste & Abuse Recoveries From State Medicaid Program Integrity Activities|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9C2|Recoveries From OIG State Compliant Fraud Claims Act|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9D|DSH Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9E|Medical Assistance Expenditures Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9EP|Medical Assistance Expenditures Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9EPWAIV|Waiver for Medical Assistance Expenditures Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9EWAIV|Waiver for Medical Assistance Expenditures Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9I.DSHDIV.WAIV|DSH Diversion Waiver for Medical Assistance Payments by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9I.VIII|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9I|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9O|Medicaid Overpayment Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9OARRA|Medicaid Overpayment Adjustments - ARRA Portion|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9OFWA|Fraud, Waste & Abuse Amounts Overpayments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9OMEQC|Medicaid Eligibility Quality Control Collections and Overpayment|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9OPerm|Medicaid Overpayment Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9ORAC|Medicaid Overpayment Adjustments for RAC|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PE|Medical Assistance Expenditures PE Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PEP|Medical Assistance Expenditures PE Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PEPWAIV|Waiver for Medical Assistance Expenditures PE Eligibility Form for Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PEWAIV|Waiver for Medical Assistance Expenditures PE Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PI.DSHDIV.WAIV|DSH Diversion Waiver for MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PI.VIII|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9PI|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9QI|QI Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9R|Drug Rebate Schedule|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9SAP|Support Act Section 1003 Payment|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9T|Medical Assistance Expenditures by Type of Service Applied Against the CHIP Amount|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9TP|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B Applied Against the CHIP Amount|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9TPWAIV|Line 7, 8, 10A, 10B Waiver MAP Prior Period Adjustments Applied Against the CHIP Amount|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9TWAIV|Waivers for Medical Assistance Payments by Type of Service Applied Against the CHIP Amount|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9VIII.P|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B Newly Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9VIII.WAIV.P|Waiver for Prior Period Adjustments for Line 7, 8, 10A, 10B Newly Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9VIII.WAIV|Waivers for Medical Assistance Expenditures Newly Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9VIII|Medical Assistance Expenditures Newly Eligibility Form|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9VIIIARPSection9817|ARP Section 9817 - VIII Group|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9WAIV.DSH|Waivers for Medical Assistance Payments by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9WAIV.P.DSH|Line 7, 8, 10A, 10B DHS Diversion Waiver MAP Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9WAIV.P|Line 7, 8, 10A, 10B Waiver MAP Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9WAIV|Waivers for Medical Assistance Payments by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.ENROLL|Medicaid Enrollees|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.F|Medicaid Statement of Expenditures Summary Sheet|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.REH|Medical Assistance Expenditures by Type of Service for Rehabilitation Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.S9RAC|RAC Collection|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.SCH|Medical Assistance Expenditures by Type of Service for School-Based Services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.SPV.NARR|Supplemental Payment Validation Narrative|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.SPV.PAYMENTS|Supplemental Payment Validation Payments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.SPV.PROVIDERSUBMISSION|Supplemental Payment Validation Providers|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|HCBS.1915c|Medical Assistance Expenditures by Type of Service for 1915(c) HCBS Waiver|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|HCBS.1915i|Medical Assistance Expenditures by Type of Service for 1915(i) HCBS Supplemental Benefit Package|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|HCBS.1915j|Medical Assistance Expenditures by Type of Service for 1915(j) Self-Directed Personal Assistance Services State Plan Option|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | DELETE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21PAD|21 REMAP Waiver P|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-04-15 | MBESCBES-FORM | UPDATE | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21P|Child Health Expenditures by Type of Service for Title XXI Program|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|21.P|Quarterly Children's Health Insurance Program, Prior Period Adjustments|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21UP|Child Health Expenditures by Service - Prior Period|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.21UP|Child Health Expenditures by Type of Service for Title XXI Program|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.1|Summary Sheet|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.1|Summary Sheet|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|21BASE|Children's Health Expenditures By Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|21BASE|Children's Health Expenditures By Type of Service|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.1|Summary Sheet|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.1|Summary Sheet|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.10BASE|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.10BASE|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.21U|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.21U|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9BASE|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.9BASE|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORM | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9P|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.9P|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-1 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-1|MBESCBES Form Group 1 List|64.10BASE|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-1 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-1|MBESCBES Form Group 1 List|64.9A|Third Party Liability Collections and Cost Avoidance|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-1 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-1|MBESCBES Form Group 1 List|64.9BASE|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-1 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-1|MBESCBES Form Group 1 List|64.9P|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-2 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-2|MBESCBES Form Group 2 List|64.21U|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-2 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-2|MBESCBES Form Group 2 List|64.21UP|Quarterly Medical Assistance Expenditures by Children’s Health Insurance Program expenditure categories|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-3 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-3|MBESCBES Form Group 3 List|21BASE|Children's Health Expenditures By Type of Service|01/01/0001|12/31/9999 |
| 2024-04-15 | MBESCBES-FORMGP-3 | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORMGP-3|MBESCBES Form Group 3 List|21P|Quarterly Children's Health Insurance Program|01/01/0001|12/31/9999 |
| 2024-04-15 | NDC-UNIT-OF-MEASURE | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date NDC-UNIT-OF-MEASURE|NDC Unit of Measure List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.x12.org/|01/01/0001|12/31/9999 |
| 2024-04-15 | OCCURRENCE-CODE | UPDATE | VVL_Code_description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date OCCURRENCE-CODE|Occurrence Code List |See next cell|For background and context, see https://www.nubc.org/license or https://med.noridianmedicare.com/web/jea/topics/claim-submission/occurrence-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date OCCURRENCE-CODE|Occurrence Code List |See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.nubc.org/license or https://med.noridianmedicare.com/web/jea/topics/claim-submission/occurrence-codes|N/A|N/A |
| 2024-04-15 | PATIENT-STATUS | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PATIENT-STATUS|Patient Status List|See next cell|For background and context, see https://www.nubc.org/license|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PATIENT-STATUS|Patient Status List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.nubc.org/license|N/A|N/A |
| 2024-04-15 | PLACE-OF-SERVICE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PLACE-OF-SERVICE|Place of Service Code List|See next cell|For background and context, see https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PLACE-OF-SERVICE|Place of Service Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set|N/A|N/A |
| 2024-04-15 | PREFERRED-LANGUAGE-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PREFERRED-LANGUAGE-CODE|Preferred Language Code List|See next cell|For background and context, see https://en.wikipedia.org/wiki/List_of_ISO_639-2_codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PREFERRED-LANGUAGE-CODE|Preferred Language Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://en.wikipedia.org/wiki/List_of_ISO_639-2_codes|N/A|N/A |
| 2024-04-15 | PRESCRIPTION-ORIGIN-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PRESCRIPTION-ORIGIN-CODE|Prescription Origin Code List|See next cell|For background and context, see https://www.ncpdp.org/ or https://www.ncpdp.org/NCPDP/media/pdf/VersionD-Questions.pdf|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PRESCRIPTION-ORIGIN-CODE|Prescription Origin Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ncpdp.org/ or https://www.ncpdp.org/NCPDP/media/pdf/VersionD-Questions.pdf|N/A|N/A |
| 2024-04-15 | PROV-FACILITY-TYPE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-FACILITY-TYPE|Provider Facility Type|See next cell|For background and context, see https://x12.org/codes/provider-taxonomy-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-FACILITY-TYPE|Provider Facility Type|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://x12.org/codes/provider-taxonomy-codes|N/A|N/A |
| 2024-04-15 | PROV-SPECIALTY | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-SPECIALTY|Provider Specialty List|57|Individual Certified Orthotist-Prosthetist|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-SPECIALTY|Provider Specialty List|57|Individual Certified Orthotist-Prosthetist|01/01/0001|12/31/9999 |
| 2024-04-15 | PROV-TAXONOMY | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-TAXONOMY|Provider Taxonomy List|See next cell|For background and context, see https://x12.org/codes/provider-taxonomy-codes|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-TAXONOMY|Provider Taxonomy List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://x12.org/codes/provider-taxonomy-codes|N/A|N/A |
| 2024-04-15 | RECORD-ID | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date RECORD-ID|Record ID List|ELG00023|SOGI|01/01/0001|12/31/9999 |
| 2024-04-15 | REVENUE-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date REVENUE-CODE|Revenue Code List|See next cell|For background and context, see https://www.nubc.org/|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date REVENUE-CODE|Revenue Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.nubc.org/|N/A|N/A |
| 2024-04-15 | SEX-ASSIGNED-AT-BIRTH | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEX-ASSIGNED-AT-BIRTH|Sex Assigned at Birth List|1|Female|01/01/0001|12/31/9999 |
| 2024-04-15 | SEX-ASSIGNED-AT-BIRTH | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEX-ASSIGNED-AT-BIRTH|Sex Assigned at Birth List|2|Male|01/01/0001|12/31/9999 |
| 2024-04-15 | SEX-ASSIGNED-AT-BIRTH | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEX-ASSIGNED-AT-BIRTH|Sex Assigned at Birth List|3|Not sure |01/01/0001|12/31/9999 |
| 2024-04-15 | SEX-ASSIGNED-AT-BIRTH | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEX-ASSIGNED-AT-BIRTH|Sex Assigned at Birth List|4|Prefer not to answer|01/01/0001|12/31/9999 |
| 2024-04-15 | SEX-ASSIGNED-AT-BIRTH | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEX-ASSIGNED-AT-BIRTH|Sex Assigned at Birth List|5|Other|01/01/0001|12/31/9999 |
| 2024-04-15 | SEXUAL-ORIENTATION | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEXUAL-ORIENTATION|Sexual Orientation List|1|Lesbian or gay|01/01/0001|12/31/9999 |
| 2024-04-15 | SEXUAL-ORIENTATION | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEXUAL-ORIENTATION|Sexual Orientation List|2|Straight|01/01/0001|12/31/9999 |
| 2024-04-15 | SEXUAL-ORIENTATION | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEXUAL-ORIENTATION|Sexual Orientation List|3|Bisexual|01/01/0001|12/31/9999 |
| 2024-04-15 | SEXUAL-ORIENTATION | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEXUAL-ORIENTATION|Sexual Orientation List|4|Not sure |01/01/0001|12/31/9999 |
| 2024-04-15 | SEXUAL-ORIENTATION | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEXUAL-ORIENTATION|Sexual Orientation List|5|Prefer not to answer|01/01/0001|12/31/9999 |
| 2024-04-15 | SEXUAL-ORIENTATION | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date SEXUAL-ORIENTATION|Sexual Orientation List|6|Other|01/01/0001|12/31/9999 |
| 2024-04-15 | STATE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date STATE|State Code List|See next cell|For background and context, see https://www.census.gov/library/reference/code-lists/ansi.html#par_textimage_3|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date STATE|State Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.census.gov/library/reference/code-lists/ansi.html#par_textimage_3|N/A|N/A |
| 2024-04-15 | TOOTH-NUM | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TOOTH-NUM|Tooth Number List|See next cell|For background and context, see https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/ada_utds_value_set_v1_2022_aug.pdf|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TOOTH-NUM|Tooth Number List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/ada_utds_value_set_v1_2022_aug.pdf|N/A|N/A |
| 2024-04-15 | TOOTH-QUAD-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TOOTH-QUAD-CODE|Tooth Quad Code List|See next cell|For background and context, see https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/areaoftheoralcavityandtoothanatomybycdtcode_2022jan.pdf|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TOOTH-QUAD-CODE|Tooth Quad Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/areaoftheoralcavityandtoothanatomybycdtcode_2022jan.pdf|N/A|N/A |
| 2024-04-15 | TOOTH-SURFACE-CODE | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TOOTH-SURFACE-CODE|Tooth Surface Code List|See next cell|For background and context, see https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/ada_utds_value_set_v1_2022_aug.pdf|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TOOTH-SURFACE-CODE|Tooth Surface Code List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/ada_utds_value_set_v1_2022_aug.pdf|N/A|N/A |
| 2024-04-15 | TYPE-OF-BILL | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-BILL|Type of Bill List|See next cell|For background and context, see https://www.nubc.org/license|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-BILL|Type of Bill List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.nubc.org/license|N/A|N/A |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|EA|Each|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|EA|Each|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|F2|International Unit|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|F2|International Unit|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|GM|Grams|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|GM|Grams|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|GR|Gram|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|GR|Gram|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|ME|Milligram|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|ME|Milligram|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|ML|Milliliter|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|ML|Milliliter|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|UN|Unit|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|UN|Unit|01/01/0001|12/31/9999 |
| 2024-04-15 | UNIT-OF-MEASURE | UPDATE | VVL_Name, VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|NDC Unit of Measure List|See next cell|For background and context, see https://www.ncpdp.org/|N/A|N/A |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date UNIT-OF-MEASURE|Unit of Measure List|See "VVL_Code_Description" field|This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, see https://www.ncpdp.org/|N/A|N/A |
| 2024-04-15 | ZIP-CODE | ADD | All valid value attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ZIP-CODE|Zip Code List|See "VVL_Code_Description" field|"This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version. For background and context, https://tools.usps.com/zip-code-lookup.htm?bycitystate|N/A|N/A |
| 2024-06-03 | MANAGED-CARE-PLAN-OTHER-ID-TYPE | UPDATE | VVL_Field, VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MANAGED-CARE-PLAN-ID-TYPE|Managed Care Plan ID Type List|01|Federal Tax ID|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MANAGED-CARE-PLAN-OTHER-ID-TYPE|Managed Care Plan Other ID Type List|01|Federal Tax ID|01/01/0001|12/31/9999 |
| 2024-06-03 | MANAGED-CARE-PLAN-OTHER-ID-TYPE | UPDATE | VVL_Field, VVL_Name | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MANAGED-CARE-PLAN-ID-TYPE|Managed Care Plan ID Type List|02|State Tax ID|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MANAGED-CARE-PLAN-OTHER-ID-TYPE|Managed Care Plan Other ID Type List|02|State Tax ID|01/01/0001|12/31/9999 |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.1|Summary Sheet|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|21.P|Quarterly Children's Health Insurance Program, Prior Period Adjustments|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|21BASE|Children's Health Expenditures By Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|21Summary|Summary of CMS 21|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.10BASE|Quarterly Expenditures for State & Local Administration|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.21U|Child Health Expenditures by Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.21UP|Child Health Expenditures by Type of Service for Title XXI Program|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.9A|Third Party Liability Collections and Cost Avoidance|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.9BASE|Medical Assistance Expenditures by Type of Service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | MBESCBES-FORM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBESCBES Form List|64.9P|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | PROV-CLASSIFICATION-CODE-TYPE-4 | UPDATE | VVL_Code_Description | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-CLASSIFICATION-CODE-TYPE-4|Provider Authorized Category of Service Code List|046|Intermediate care facility (ICF/IIDICF/IID) services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date PROV-CLASSIFICATION-CODE-TYPE-4|Provider Authorized Category of Service Code List|046|Intermediate care facility (ICF/IID) services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|2|Medicaid or Medicaid-expansion Capitated Payment|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|4|Medicaid or Medicaid-expansion Service Tracking Claim|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|5|Medicaid or Medicaid-expansion Supplemental Payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement)|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|6|Medicaid or Medicaid-expansion CHIP financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|B|Separate CHIP (Title XXI) claim: Capitated Payment|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|D|Separate CHIP (Title XXI) Service Tracking Claim|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|E|Separate CHIP (Title XXI) claim for a supplemental payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement)|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|F|Separate CHIP (Title XXI) financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|V|Other Capitated Payment|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|X|Non-Medicaid/CHIP service tracking claims|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-CLAIM | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-CLAIM|Type of Claim List|Y|Other Supplemental Payment|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|001|Inpatient hospital services, other than services in an institution for mental diseases|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|002|Outpatient hospital services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|003|Rural health clinic services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|004|Other ambulatory services furnished by a rural health clinic|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|005|Professional laboratory services, Technical laboratory services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|006|Technical laboratory services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|007|Professional radiological services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|008|Technical radiological services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|009|Nursing facility services for individuals age 21 or older (other than services in an institution for mental disease)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|010|Early and periodic screening and diagnosis and treatment (EPSDT) services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|011|Family planning services and supplies for individuals of child-bearing age|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|012|Physicians' services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|013|Medical and surgical services of a dentist|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|014|Outpatient substance abuse treatment services.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|015|Medical or other remedial care or services, other than physicians' services, provided by licensed practitioners within the scope of practice as defined under State law|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|016|Home health services - Nursing services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|017|Home health services - Home health aide services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|018|Home health services - Medical supplies, equipment, and appliances suitable for use in the home|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|019|Home health services - Physical therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|020|Home health services - Occupational therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|021|Home health services - Speech pathology and audiology services provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|022|Private duty nursing services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|023|Advanced practice nurse services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|024|Pediatric nurse|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|025|Nurse-midwife service|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|026|Nurse practitioner services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|027|Respiratory care for ventilator-dependent individuals|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|028|Clinic services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|029|Dental services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|030|Physical therapy services (when not provided under home health services)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|031|Occupational therapy services (when not provided under home health services)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|032|Speech, hearing, and language disorders services (when not provided under home health services)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|033|Prescribed drugs|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|034|Over-the-counter medications.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|035|Dentures|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|036|Medical equipment/prosthetic devices|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|037|Eyeglasses|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|038|Hearing Aids|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|039|Diagnostic services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|040|Screening services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|041|Preventive services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|042|Well-baby and well-child care services as defined by the State.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|043|Rehabilitative services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|044|Inpatient hospital services for individuals age 65 or older in institutions for mental diseases|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|045|Nursing facility services for individuals age 65 or older in institutions for mental diseases|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|046|Intermediate care facility (ICF/IIDICF/IID) services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|047|Nursing facility services, other than in institutions for mental diseases|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|048|Inpatient psychiatric services for individuals under age 21|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|049|Outpatient mental health services, other than Outpatient substance abuse treatment services. This TOS includes services furnished in a State-operated mental hospital and including community-based services.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|050|Inpatient substance abuse treatment services and residential substance abuse treatment services.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|051|Personal care services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|052|Primary care case management services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|053|Targeted case management services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|054|Case Management services other than those that meet the definition of primary care case management services or targeted case management services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|055|Care coordination services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|056|Transportation services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|057|Enabling services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|058|Services furnished in a religious nonmedical health care institution|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|059|Skilled nursing facility services for individuals under age 21|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|060|Emergency hospital services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|061|Critical access hospital services - OT|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|062|HCBS - Case management services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|063|HCBS - Homemaker services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|064|HCBS - Home health aide services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|065|HCBS - Personal care services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|066|HCBS - Adult day health services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|067|HCBS - Habilitation services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|068|HCBS - Respite care services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|069|HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|070|HCBS - Day Care|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|071|HCBS - Training for family members|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|072|HCBS - Minor modification to the home|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|073|HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|074|HCBS - Expanded habilitation services - Prevocational services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|075|HCBS - Expanded habilitation services - Educational services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|076|HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|077|HCBS-65-plus - Case management services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|078|HCBS-65-plus - Homemaker services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|079|HCBS-65-plus - Home health aide services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|080|HCBS-65-plus - Personal care services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|081|HCBS-65-plus - Adult day health services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|082|HCBS-65-plus - Respite care services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|083|HCBS-65-plus - Other medical and social services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|084|Sterilizations|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|085|Prenatal care and pre-pregnancy family planning services and supplies.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|086|Other Pregnancy-related Procedures|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|087|Hospice services|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|088|Any other health care services or items specified by the Secretary and not excluded under regulations.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|089|Disposable medical supplies.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|090|Critical access hospital services - IP|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|091|Skilled care - hospital residing|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|092|Exceptional care - hospital residing|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|093|Non-acute care - hospital residing|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|115|Residential care|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|119|Capitated payments to HMOs, HIOs, or PACE plans|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|120|Capitated payments for primary care case management (PCCM)|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|121|Premium payments for private health insurance|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|122|Capitated payments to prepaid health plans (PHPs)|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|123|Disproportionate share hospital (DSH) payments|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|127|Indian Health Service (IHS) - Family Plan|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|131|Drug Rebates|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|132|Supplemental payment - inpatient|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|133|Supplemental payment - nursing|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|134|Supplemental payment - outpatient|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|135|EHR payments to provider|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|136|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products|03/18/2020|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|137|COVID–19 testing-related services|03/18/2020|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|138|Per member per month (PMPM) payments for health home services|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|139|Per member per month (PMPM) payments for Medicare Part A premiums|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|140|Per member per month (PMPM) payments for Medicare Part B premiums|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|141|Per member per month (PMPM) payments for Medicare Advantage Dual Special Needs Plans (D-SNP) – Medicare Part C.|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|142|Per member per month (PMPM) payments for Medicare Part D premiums|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|143|Per member per month (PMPM) payments for other payments|01/01/0001|09/30/2025 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|144|Payments to individuals for personal assistance services under 1915(j)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | TYPE-OF-SERVICE|Type of Service List|145|Medication Assisted Treatment (MAT) services and drugs for evidenced-based treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the Social Security Act|10/01/2020|12/31/9999 | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|146|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE | DELETE | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE|Type of Service List|147|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|001|Inpatient hospital services, other than services in an institution for mental diseases|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|058|Services furnished in a religious nonmedical health care institution|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|060|Emergency hospital services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|084|Sterilizations|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|086|Other Pregnancy-related Procedures|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|090|Critical access hospital services - IP|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|091|Skilled care - hospital residing|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|092|Exceptional care - hospital residing|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|093|Non-acute care - hospital residing|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|136|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-IP | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-IP|Type of Service IP List|137|COVID–19 testing-related services|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|009|Nursing facility services for individuals age 21 or older (other than services in an institution for mental disease)|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|044|Inpatient hospital services for individuals age 65 or older in institutions for mental diseases|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|045|Nursing facility services for individuals age 65 or older in institutions for mental diseases|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|046|ICF/IID (Intermediate Care Facilities for individuals with Intellectual Disabilities)|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|047|Nursing facility services, other than in institutions for mental diseases|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|048|Inpatient psychiatric services for individuals under age 21|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|050|Inpatient substance abuse treatment services and residential substance abuse treatment services.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|059|Skilled nursing facility services for individuals under age 21|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|136|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|137|COVID–19 testing-related services|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|146|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-LT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-LT|Type of Service LT List|147|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|002|Outpatient hospital services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|003|Rural health clinic services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|004|Other ambulatory services furnished by a rural health clinic|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|005|Professional laboratory services, Technical laboratory services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|006|Technical laboratory services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|007|Professional radiological services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|008|Technical radiological services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|010|Early and periodic screening and diagnosis and treatment (EPSDT) services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|011|Family planning services and supplies for individuals of child-bearing age|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|012|Physicians' services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|013|Medical and surgical services of a dentist|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|014|Outpatient substance abuse treatment services.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|015|Medical or other remedial care or services, other than physicians' services, provided by licensed practitioners within the scope of practice as defined under State law|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|016|Home health services - Nursing services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|017|Home health services - Home health aide services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|018|Home health services - Medical supplies, equipment, and appliances suitable for use in the home|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|019|Home health services - Physical therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|020|Home health services - Occupational therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|021|Home health services - Speech pathology and audiology services provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|022|Private duty nursing services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|023|Advanced practice nurse services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|024|Pediatric nurse|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|025|Nurse-midwife service|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|026|Nurse practitioner services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|027|Respiratory care for ventilator-dependent individuals|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|028|Clinic services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|029|Dental services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|030|Physical therapy services (when not provided under home health services)|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|031|Occupational therapy services (when not provided under home health services)|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|032|Speech, hearing, and language disorders services (when not provided under home health services)|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|035|Dentures|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|036|Medical equipment/prosthetic devices|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|037|Eyeglasses|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|038|Hearing Aids|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|039|Diagnostic services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|040|Screening services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|041|Preventive services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|042|Well-baby and well-child care services as defined by the State.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|043|Rehabilitative services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|049|Outpatient mental health services, other than Outpatient substance abuse treatment services. This TOS includes services furnished in a State-operated mental hospital and including community-based services.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|050|Inpatient substance abuse treatment services and residential substance abuse treatment services.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|051|Personal care services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|052|Primary care case management services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|053|Targeted case management services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|054|Case Management services other than those that meet the definition of primary care case management services or targeted case management services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|055|Care coordination services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|056|Transportation services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|057|Enabling services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|058|Services furnished in a religious nonmedical health care institution|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|060|Emergency hospital services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|061|Critical access hospital services - OT|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|062|HCBS - Case management services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|063|HCBS - Homemaker services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|064|HCBS - Home health aide services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|065|HCBS - Personal care services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|066|HCBS - Adult day health services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|067|HCBS - Habilitation services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|068|HCBS - Respite care services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|069|HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|070|HCBS - Day Care|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|071|HCBS - Training for family members|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|072|HCBS - Minor modification to the home|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|073|HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|074|HCBS - Expanded habilitation services - Prevocational services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|075|HCBS - Expanded habilitation services - Educational services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|076|HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|077|HCBS-65-plus - Case management services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|078|HCBS-65-plus - Homemaker services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|079|HCBS-65-plus - Home health aide services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|080|HCBS-65-plus - Personal care services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|081|HCBS-65-plus - Adult day health services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|082|HCBS-65-plus - Respite care services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|083|HCBS-65-plus - Other medical and social services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|084|Sterilizations|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|085|Prenatal care and pre-pregnancy family planning services and supplies.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|086|Other Pregnancy-related Procedures|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|087|Hospice services|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|088|Any other health care services or items specified by the Secretary and not excluded under regulations.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|089|Disposable medical supplies.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|115|Residential care|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|127|Indian Health Service (IHS) - Family Plan|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|136|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-OT | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-OT|Type of Service OT List|137|COVID–19 testing-related services|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|011|Family planning services and supplies for individuals of child-bearing age|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|018|Home health services - Medical supplies, equipment, and appliances suitable for use in the home|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|033|Prescribed drugs|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|034|Over-the-counter medications.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|036|Medical equipment/prosthetic devices|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|085|Prenatal care and pre-pregnancy family planning services and supplies.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|089|Disposable medical supplies.|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|127|Indian Health Service (IHS) - Family Plan|01/01/0001|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|131|Drug Rebates|01/01/0001|09/30/2025 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date ||||| |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|136|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9200K|Medical Assistance Expenditures by Type of Service 200K|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|137|COVID–19 testing-related services|03/18/2020|12/31/9999 |
| 2024-06-03 | TYPE-OF-SERVICE-RX | ADD | All_VVL_Attributes | VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date MBESCBES-FORM|MBES or CBES Form List|64.9200K|Medical Assistance Expenditures by Type of Service 200K|01/01/0001|12/31/9999 |
VVL_Field|VVL_Name|VVL_Code|VVL_Code_Description|Effective Start Date|Effective End Date TYPE-OF-SERVICE-RX|Type of Service RX List|145|Medication Assisted Treatment (MAT) services and drugs for evidenced-based treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the Social Security Act|10/01/2020|12/31/9999 |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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