001A = Inpatient Hospital — Reg. Payments
001B = Inpatient Hospital — DSH
001C = Inpatient Hospital — Sup. Payments
001D = Inpatient Hospital — GME Payments
002A = Mental Health Facility Services — Reg. Payments
002B = Mental Health Facility – DSH
002C = Certified Community Behavior Health Clinic Payments
003A = Nursing Facility Services — Reg. Payments
003B = Nursing Facility Services — Sup. Payments
004A = Intermediate Care Facility Services — Individuals with Intellectual Disabilities: Public Providers
004B = Intermediate Care Facility Services — Individuals with Intellectual Disabilities: Private Providers
005A = Physician and Surgical Services — Reg. Payments
005B = Physician and Surgical Services — Sup. Payments
005C = Physician and Surgical Services — Evaluation and Management
006A = Outpatient Hospital Services — Reg. Payments
006B = Outpatient Hospital Services — Sup. Payments
0007 = Prescribed Drugs
0008 = Dental Services
009A = Other Practitioners Services — Reg. Payments
009B = Other Practitioners Services — Sup. Payments
0010 = Clinic Services
0011 = Laboratory/Radiological
0012 = Home Health Services
0013 = Sterilizations
0014 = Other Pregnancy-related Procedures
0015 = EPSDT Screening
0016 = Rural Health
017A = Medicare — Part A
017B = Medicare — Part B
17C1 = 120% — 134% of Poverty
017D = Coinsurance
018A = Medicaid — MCO
18A5 = Medicaid MCO - Certified Community Behavior Health Clinic Payments
18B1 = Prepaid Ambulatory Health Plan
18B2 = Prepaid Inpatient Health Plan
018C = Medicaid — Group Health
018D = Medicaid — Coinsurance
018E = Medicaid — Other
019A = Home and Community-Based Services — Reg. Pay. (Waiv)
019B = Home and Community-Based Services — St. Plan 1915(i) Only Pay
019C = Home and Community-Based Services — St. Plan 1915(j) Only Pay
019D = Home and Community Based Services State Plan 1915(k) Community First Choice
0022 = All-Inclusive Care Elderly
023A = Personal Care Services — Reg. Payments
023B = Personal Care Services — SDS 1915(j)
024A = Targeted Case Management Services — Com. Case-Man.
024B = Case Management — Statewide
0025 = Primary Care Case Management
0026 = Hospice Benefits
0027 = Emergency Services for Undocumented Aliens
0028 = Federally Qualified Health Center
0029 = Non-Emergency Medical Transportation
0030 = Physical Therapy
0031 = Occupational Therapy
0032 = Services for Speech, Hearing and Language
0033 = Prosthetic Devices, Dentures, Eyeglasses
0034 = Diagnostic Screening and Preventive Services
034A = Preventive Services Grade A OR B, ACIP Vaccines and their Admin
0035 = Nurse Mid-Wife
0036 = Emergency Hospital Services
0037 = Critical Access Hospitals
0038 = Nurse Practitioner Services
0039 = School Based Services
0040 = Rehabilitative Services (non- school-based)
0041 = Private Duty Nursing
0042 = Freestanding Birth Center
0043 = Health Home for Enrollees w Chronic Conditions
0044 = Tobacco Cessation for Pregnant Women
0045 = Health Homes for Substance-Use-Disorder Enrollees per section 1006 of the SUPPORT for
Patients and Communities Act
0046 = Opioid Use Disorder (OUD) Medicaid Assisted Treatment – Drugs
046B = OUD Medicaid Assisted Treatment Services
0047 = American Rescue Plan Act of 2021 (ARP) Section 9811 COVID Vaccine/Vaccine Administration
0049 = Other Care Services
Null/missing = source value is missing or unknown