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4100 Reserved for Future Use

4200 Professional Therapies

4210 General Description of Service Component

4220 Billable Activity

4230 Activity Not Billable

4240 Qualified Service Provider

4250 Unit of Service

4260 Written Documentation

4270 Insurance Co-payment and Deductible

4300 Day Habilitation

4310 General Description of Service Component

4320 Requirements of Setting

4330 Billable Activity

4340 Activity Not Billable

4350 Restrictions Regarding Submission of Claims for Day Habilitation

4360 Qualified Service Provider

4370 Unit of Service

4380 Written Documentation

4400 Registered Nursing

4410 General Description of Service Component

4420 Billable Activity

4430 Activity Not Billable

4440 Qualified Service Provider

4450 Unit of Service

4460 Accumulation of Service Times

4470 Written Documentation

4471 Licensed Vocational Nursing

4471.1 General Description of Service Component

4471.2 Billable Activity

4471.3 Activity Not Billable

4471.4 Qualified Service Provider

4471.5 Unit of Service

4471.6 Accumulation of Service Times

4471.7 Written Documentation

4472 Specialized Registered Nursing

4472.1 General Description of Service Component

4472.2 Billable Activity

4472.3 Activity Not Billable

4472.4 Qualified Service Provider

4472.5 Unit of Service

4472.6 Accumulation of Service Times

4472.7 Written Documentation

4473 Specialized Licensed Vocational Nursing

4473.1 General Description of Service Component

4473.2 Billable Activity

4473.3 Activity Not Billable

4473.4 Qualified Service Provider

4473.5 Unit of Service

4473.6 Accumulation of Service Times

4473.7 Written Documentation

4500 Residential Assistance

4510 General Description of Service Component

4520 Restrictions Regarding Submission of Claims for Residential Assistance

4530 Residential Location

4540 Supported Home Living Billing Requirements

4550 Host Home/Companion Care Subcomponent

4560 Residential Support Subcomponent

4570 Supervised Living Subcomponent

4580 Submitting a Service Claim for Residential Assistance During a Preselection Visit

4470 Respite

4610 General Description of Service Component

4620 Billable Activity

4630 Respite in Residence or During Overnight Stay in Non-residence

4631 Residential Location

4640 Activity Not Billable

4650 Submitting a Service Claim for Respite

4651 Restrictions Regarding Submission of Claims for Respite

4660 Qualified Service Provider

4670 Unit of Service

4680 Payment Limit

4690 Written Documentation

4700 Supported Employment

4710 General Description of Service Component

4720 Billable Activity 4730 Activity Not Billable

4740 Qualified Service Provider

4750 Restrictions Regarding Submission of Claims for Supported Employment

4760 Unit of Service

4770 Written Documentation

4780 Supported Employment Documentation Requirements

4800 Employment Assistance

4810 General Description of Service Component

4820 Employment Assistance Billable Time/Activities

4830 Employment Assistance Non-billable Time/Activities

4840 Employment Assistance Qualified Service Provider

4850 Unit of Service

4860 Employment Assistance Documentation Requirements

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