• Category 1: Services of Doctors
of Medicine (MDs), Doctors of Osteopathy (DOs), optometrists, podiatrists, psychologists,
oral surgeons, audiologists, and Certified Nurse Midwives (CNMs)
provided in a facility including, but not limited to, hospitals
(both inpatient and outpatient and billed with the appropriate revenue
code for the outpatient department where the services were rendered),
Residential Treatment Centers (RTCs), ambulances, hospices, Markets/MTFs,
psychiatric facilities, Community Mental Health Centers (CMHCs),
Skilled Nursing Facilities (SNFs), and Ambulatory Surgical Centers
(ASCs).
• Category 2: Services of MDs,
DOs, optometrists, podiatrists, psychologists, oral surgeons, audiologists,
and CNMs provided in a non-facility including provider offices,
home settings, and all other non-facility settings. The non-facility
CMAC rate applies to Occupational Therapy (OT), Physical Therapy
(PT), or Speech Therapy (ST) regardless of the setting.
• Category 3: Services, of all
other providers not found in Category 1, provided in a facility
including, but not limited to, hospitals (both inpatient and outpatient
and billed with the appropriate revenue code for the outpatient
department where the services were rendered), RTCs, ambulances,
hospices, Markets/MTFs, psychiatric facilities, CMHCs, SNFs, ASCs.
• Category 4: Services, of all
other providers not found in Category 2, provided in a non-facility
including provider offices, home settings, and all other non-facility
settings.