CODES:  
11 = NON-WAIVER PERSONAL CARE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 30  
12 = NON-WAIVER PRIVATE DUTY NURSING PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 38  
13 = NON-WAIVER ADULT DAY PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 54  
14 = NON-WAIVER HOME HEALTH PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 13  
15 = NON-WAIVER RESIDENTIAL CARE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 52  
16 = NON-WAIVER REHABILITATION FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 33 AND BOE = (1 OR 2)  
17 = NON-WAIVER TARGETED CASE MANAGEMENT FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 31 AND BOE = (1 OR 2)  
18 = NON-WAIVER TRANSPORTATION FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 26 AND BOE = (1 OR 2)  
19 = NON-WAIVER HOSPICE CARE FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 35 AND BOE = (1 OR 2)  
20 = NON-WAIVER DURABLE MEDICAL EQUIPMENT FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 51 AND BOE = (1 OR 2)  
30 = WAIVER SERVICE IN ANY OTHER TYPE OF SERVICE NOT LISTED BELOW PROGRAM TYPE EQ (6 OR 7) AND MAX TOS NE (30, 38, 54, 13, 52, 33, 31, 26, 35, 51)  
31 = WAIVER PERSONAL CARE PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 30  
32 = WAIVER PRIVATE DUTY NURSING PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 38  
33 = WAIVER ADULT DAY PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 54  
34 = WAIVER HOME HEALTH PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 13  
35 = WAIVER RESIDENTIAL CARE PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 52  
36 = WAIVER REHABILITATION PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 33  
37 = WAIVER TARGETED CASE MANAGEMENT PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 31  
38 = WAIVER TRANSPORTATION PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 26  
39 = WAIVER HOSPICE CARE PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 35  
40 = WAIVER DURABLE MEDICAL EQUIPMENT PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 51