101 C.M.R. 351.03
Service Code- Rate Unit Service Description Modifier S5140 $54.37 Per Diem AFC Level I S5140-TG $91.31 Per Diem AFC Level II S5140-TF $54.37 Per Diem AFC Level I Alternative Caregiver Day S5140-U5 $91.31 Per Diem AFC Level II Alternative Caregiver Day S5140-U6 $54.37 Per Diem AFC Level I MLOA Day S5140-TG-U6 $91.31 Per Diem AFC Level II MLOA Day S5140-U7 $54.37 Per Diem AFC Level I NMLOA Day S5140-TG-U7 $91.31 Per Diem AFC Level II NMLOA Day T1028 $266.62 Per Admission AFC Intake and Assessment Services H0043 $50.00 Per Diem GAFC