Payor Code Rules

Payor Service Code

Payor Code Description

Modifier 1

Modifier 2

Price / % UCR

Value

Expected

Not Covered Not Billable Require Payor Panel

Minimum Minutes

Maximum Minutes

Payor Rank - Minimum

Payor Rank - Maximum

Use Age Range

Minimum

Maximum

Service Status

Billing Form

Contract Services

Service Item	Rate Class	Company / Program / Program Unit	UCR	Effective Date	Expiration Date
Initial Assessment				22/12/2016	22/12/2016
Initial Assessment				22/12/2016	22/12/2016

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