pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_vbid_group_id	pbp_b13a_bendesc_yn	pbp_b13a_bendesc_ehc	pbp_b13a_bendesc_amo	pbp_b13a_bendesc_lim	pbp_b13a_bendesc_numv	pbp_b13a_bendesc_per	pbp_b13a_bendesc_per_d	pbp_b13a_maxplan_yn	pbp_b13a_maxplan_amt	pbp_b13a_maxplan_per	pbp_b13a_maxplan_per_d	pbp_b13a_maxenr_yn	pbp_b13a_maxenr_amt	pbp_b13a_maxenr_per	pbp_b13a_maxenr_per_d	pbp_b13a_coins_yn	pbp_b13a_coins_pct_min	pbp_b13a_coins_pct_max	pbp_b13a_ded_yn	pbp_b13a_ded_amt	pbp_b13a_copay_yn	pbp_b13a_copay_amt_min	pbp_b13a_copay_amt_max	pbp_b13a_auth_yn	pbp_b13a_refer_yn	pbp_b13b_bendesc_otc	pbp_b13b_bendesc_amo	pbp_b13b_maxplan_yn	pbp_b13b_maxplan_amt	pbp_b13b_otc_maxplan_per	pbp_b13b_maxplan_prd_yn	pbp_b13b_maxenr_yn	pbp_b13b_maxenr_amt	pbp_b13b_maxenr_per	pbp_b13b_maxenr_per_d	pbp_b13b_nrt_yn	pbp_b13b_nrt_attestation	pbp_b13b_coins_yn	pbp_b13b_coins_pct_min	pbp_b13b_coins_pct_max	pbp_b13b_ded_yn	pbp_b13b_ded_amt	pbp_b13b_copay_yn	pbp_b13b_copay_amt_min	pbp_b13b_copay_amt_max	pbp_b13b_cms_otc_list_yn	pbp_b13c_bendesc_service	pbp_b13c_bendesc_amo	pbp_b13c_meal_type_chk	pbp_b13c_maxplan_yn	pbp_b13c_maxplan_amt	pbp_b13c_maxplan_per	pbp_b13c_maxplan_per_d	pbp_b13c_maxenr_yn	pbp_b13c_maxenr_amt	pbp_b13c_maxenr_per	pbp_b13c_maxenr_per_d	pbp_b13c_coins_yn	pbp_b13c_coins_pct_min	pbp_b13c_coins_pct_max	pbp_b13c_ded_yn	pbp_b13c_ded_amt	pbp_b13c_copay_yn	pbp_b13c_copay_amt_min	pbp_b13c_copay_amt_max	pbp_b13c_auth_yn	pbp_b13c_refer_yn	pbp_b13d_bendesc_service	pbp_b13d_bendesc_amo	pbp_b13d_maxplan_yn	pbp_b13d_maxplan_amt	pbp_b13d_maxplan_per	pbp_b13d_maxplan_per_d	pbp_b13d_maxenr_yn	pbp_b13d_maxenr_amt	pbp_b13d_maxenr_per	pbp_b13d_maxenr_per_d	pbp_b13d_coins_yn	pbp_b13d_coins_pct_min	pbp_b13d_coins_pct_max	pbp_b13d_ded_yn	pbp_b13d_ded_amt	pbp_b13d_copay_yn	pbp_b13d_copay_amt_min	pbp_b13d_copay_amt_max	pbp_b13d_auth_yn	pbp_b13d_refer_yn	pbp_b13e_bendesc_service	pbp_b13e_bendesc_amo	pbp_b13e_maxplan_yn	pbp_b13e_maxplan_amt	pbp_b13e_maxplan_per	pbp_b13e_maxplan_per_d	pbp_b13e_maxenr_yn	pbp_b13e_maxenr_amt	pbp_b13e_maxenr_per	pbp_b13e_maxenr_per_d	pbp_b13e_coins_yn	pbp_b13e_coins_pct_min	pbp_b13e_coins_pct_max	pbp_b13e_ded_yn	pbp_b13e_ded_amt	pbp_b13e_copay_yn	pbp_b13e_copay_amt_min	pbp_b13e_copay_amt_max	pbp_b13e_auth_yn	pbp_b13e_refer_yn	pbp_b13f_bendesc_service	pbp_b13f_bendesc_amo	pbp_b13f_maxplan_yn	pbp_b13f_maxplan_amt	pbp_b13f_maxplan_per	pbp_b13f_maxplan_per_d	pbp_b13f_maxenr_yn	pbp_b13f_maxenr_amt	pbp_b13f_maxenr_per	pbp_b13f_maxenr_per_d	pbp_b13f_coins_yn	pbp_b13f_coins_pct_min	pbp_b13f_coins_pct_max	pbp_b13f_ded_yn	pbp_b13f_ded_amt	pbp_b13f_copay_yn	pbp_b13f_copay_amt_min	pbp_b13f_copay_amt_max	pbp_b13f_auth_yn	pbp_b13f_refer_yn
H0028	007	0	1	01	01	H0028_007_0	6	1																										1	2	1	215.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	215.00	7		2				2			2		2			2	2	Living Expense Support	2	1	215.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	215.00	7		2				2			2		2			2	2
H0028	007	0	1	01	01	H0028_007_0	6	2	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			2																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	014	0	1	01	01	H0028_014_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000.00	3	2	2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	015	0	1	02	01	H0028_015_0	7	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H0028	015	0	1	02	01	H0028_015_0	7	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	016	0	1	02	01	H0028_016_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2																									Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	017	0	1	01	01	H0028_017_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			2																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	021	0	1	01	01	H0028_021_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	023	0	1	01	01	H0028_023_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	025	1	1	01	01	H0028_025_1	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	025	2	1	01	01	H0028_025_2	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	027	0	1	01	01	H0028_027_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	028	0	1	01	01	H0028_028_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	031	0	1	01	01	H0028_031_0	6	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Living Expense Support	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2
H0028	031	0	1	01	01	H0028_031_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	032	0	1	01	01	H0028_032_0	6	1																										1	2	1	85.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	85.00	7		2				2			2		2			2	2	Living Expense Support	2	1	85.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	85.00	7		2				2			2		2			2	2
H0028	032	0	1	01	01	H0028_032_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	033	0	1	01	01	H0028_033_0	6	1																										1	2	1	75	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75	7		2				2			2		2			2	2	Living Expense Support	2	1	75	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	7		2				2			2		2			2	2
H0028	033	0	1	01	01	H0028_033_0	6	2																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Living Expense Support	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2
H0028	033	0	1	01	01	H0028_033_0	6	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	034	0	1	01	01	H0028_034_0	7	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H0028	036	0	1	01	01	H0028_036_0	6	1																										1	2	1	100	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100	6	$100 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	100	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H0028	039	0	1	01	01	H0028_039_0	7	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H0028	041	0	1	01	01	H0028_041_0	7	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	041	0	1	01	01	H0028_041_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	042	0	1	01	01	H0028_042_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	043	1	1	01	01	H0028_043_1	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	043	2	1	01	01	H0028_043_2	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	044	0	1	01	01	H0028_044_0	6	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Living Expense Support	2	1	75	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	7		2				2			2		2			2	2
H0028	045	0	1	01	01	H0028_045_0	6	1																										1	2	1	100	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100	6	$100 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	100	6	$100 loaded on a prepaid card every month to spend on general supports for living.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	100	6	$100 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2
H0028	047	0	1	01	01	H0028_047_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	050	0	1	01	01	H0028_050_0	10	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1600	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	051	0	1	01	01	H0028_051_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1600	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	052	0	1	01	01	H0028_052_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	053	1	1	01	01	H0028_053_1	7	1	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			2		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	053	3	1	01	01	H0028_053_3	7	1	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			2		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	054	1	1	02	01	H0028_054_1	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	054	2	1	02	01	H0028_054_2	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2				1	2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	055	0	1	02	01	H0028_055_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1600	3		2				1	1	2			2		2			1	1	2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	056	0	1	02	01	H0028_056_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1600	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	057	0	1	01	01	H0028_057_0	6	1	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1420.00	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	058	0	1	01	01	H0028_058_0	7	1																										1	2	1	125	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125	7		2				2			2		2			2	2	Living Expense Support	2	1	125	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H0028	058	0	1	01	01	H0028_058_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H0028	059	0	1	01	01	H0028_059_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H0028	060	0	1	01	01	H0028_060_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H0028	064	0	1	01	01	H0028_064_0	7	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Living Expense Support	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2
H0028	064	0	1	01	01	H0028_064_0	7	2	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H0104	012	0	1	04	01	H0104_012_0	5	1																																																2	010	2				2				2			2		2			2	2																																																												
H0104	014	0	1	04	01	H0104_014_0	4	1																																																2	010	2				2				2			2		2			2	2																																																												
H0104	015	0	1	04	01	H0104_015_0	3	1																																																2	010	2				2				2			2		2			2	2																																																												
H0169	001	0	1	02	01	H0169_001_0	6	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	216.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0169	002	0	1	02	01	H0169_002_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	220.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0169	003	0	1	02	01	H0169_003_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	211.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0169	003	0	1	02	01	H0169_003_0	4	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H0169	004	0	1	02	01	H0169_004_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	244.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0169	004	0	1	02	01	H0169_004_0	5	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H0169	006	0	1	02	01	H0169_006_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	62.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0169	008	0	1	02	01	H0169_008_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	64.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0251	002	0	1	02	01	H0251_002_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	248.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0251	004	0	1	02	01	H0251_004_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	309.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	005	0	1	04	01	H0271_005_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	146.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	006	0	1	04	01	H0271_006_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	80.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	013	0	1	04	01	H0271_013_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	135.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	014	0	1	04	01	H0271_014_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	130.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	016	0	1	04	01	H0271_016_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	236.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	020	0	1	04	01	H0271_020_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	86.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	023	0	1	04	01	H0271_023_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	188.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	024	0	1	04	01	H0271_024_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	58.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	028	0	1	04	01	H0271_028_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	168.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	029	0	1	04	01	H0271_029_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	190.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	030	0	1	04	01	H0271_030_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	137.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	037	0	1	04	01	H0271_037_0	6	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	112.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	038	0	1	04	01	H0271_038_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	138.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	039	0	1	04	01	H0271_039_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	87.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	042	0	1	04	01	H0271_042_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	112.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	044	0	1	04	01	H0271_044_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	159.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	045	0	1	04	01	H0271_045_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	70.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	046	0	1	04	01	H0271_046_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	165.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	050	0	1	04	01	H0271_050_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	187.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	050	0	1	04	01	H0271_050_0	4	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				1	0	75	2		2			2	2																				
H0271	053	0	1	04	01	H0271_053_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	191.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	054	0	1	04	01	H0271_054_0	6	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	120.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	055	0	1	04	01	H0271_055_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	161.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	056	0	1	04	01	H0271_056_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	96.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	058	0	1	04	01	H0271_058_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	65.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	059	0	1	04	01	H0271_059_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	48.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	060	1	1	04	01	H0271_060_1	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	163.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	060	2	1	04	01	H0271_060_2	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	163.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	063	0	1	04	01	H0271_063_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	252.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0271	065	0	1	04	01	H0271_065_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	161.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0292	001	0	1	01	01	H0292_001_0	8	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2																				
H0292	003	0	1	01	01	H0292_003_0	5	1																										1	2	1	45.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	45.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	45.00	7		2				2			2		2			2	2																				
H0294	027	0	1	04	01	H0294_027_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	164.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0321	002	0	1	02	01	H0321_002_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	157.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0321	002	0	1	02	01	H0321_002_0	5	2																																																																																																												VBID Pest Control	2	1	225.00	5		2				2			2		1	0.00	0.00	2	2
H0321	004	0	1	02	01	H0321_004_0	9	3																																																																																																												VBID Pest Control	2	1	260.00	5		2				2			2		1	0.00	0.00	2	2
H0321	004	0	1	02	01	H0321_004_0	9	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	272.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0321	004	0	1	02	01	H0321_004_0	9	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H0363	001	0	1	01	01	H0363_001_0	9	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H0422	001	0	1	02	01	H0422_001_0	7	1																																																2	011	2				2				2			2		2			2	2																																																												
H0422	003	0	1	02	01	H0422_003_0	9	1																																																2	011	2				2				2			2		2			2	2																																																												
H0432	009	0	1	02	01	H0432_009_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	133.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0432	013	0	1	02	01	H0432_013_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	68.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0473	006	0	1	04	01	H0473_006_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Living Expense Support	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2
H0523	801	0	1	01	01	H0523_801_0	10	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H0523	801	0	1	01	01	H0523_801_0	10	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H0523	805	0	1	01	01	H0523_805_0	10	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H0523	805	0	1	01	01	H0523_805_0	10	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H0524	008	0	1	01	01	H0524_008_0	11	1																																																																																																												Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1
H0524	033	0	1	01	01	H0524_033_0	11	1																																																																																																												Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1
H0524	061	0	1	01	01	H0524_061_0	11	1																																																																																																												Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1
H0524	063	0	1	01	01	H0524_063_0	11	1																																																																																																												Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1
H0571	001	0	1	01	01	H0571_001_0	7	1																										1	2	1	10.00	7	2	2				2		2			2		2			1																																																																																	
H0571	005	0	1	01	01	H0571_005_0	6	2																										1	2	1	10.00	7	2	2				2		2			2		2			1																																																																																	
H0571	007	0	1	01	01	H0571_007_0	7	1																										1	2	1	20.00	7	2	2				2		2			2		2			2																																																																																	
H0609	052	0	1	02	01	H0609_052_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	131.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0609	053	0	1	02	01	H0609_053_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	125.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0609	057	0	1	02	01	H0609_057_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	126.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0609	064	0	1	02	01	H0609_064_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	75.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0609	065	0	1	02	01	H0609_065_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	78.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0624	001	0	1	02	01	H0624_001_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	185.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0628	001	0	1	02	01	H0628_001_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0628	005	0	1	02	01	H0628_005_0	8	2																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0628	017	0	1	02	01	H0628_017_0	7	2																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0628	801	0	1	01	01	H0628_801_0	9	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H0628	801	0	1	01	01	H0628_801_0	9	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H0628	802	0	1	01	01	H0628_802_0	7	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H0628	802	0	1	01	01	H0628_802_0	7	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H0764	001	0	1	04	01	H0764_001_0	6	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	146.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0764	001	0	1	04	01	H0764_001_0	6	3																																																																																																												VBID Pest Control	2	1	150.00	5		2				1	0	75	2		2			2	2
H0764	001	0	1	04	01	H0764_001_0	6	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				1	0	75	2		2			2	2																				
H0838	024	0	1	01	01	H0838_024_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0838	039	1	1	01	01	H0838_039_1	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0838	039	2	1	01	01	H0838_039_2	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0838	040	1	1	01	01	H0838_040_1	9	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0838	040	2	1	01	01	H0838_040_2	10	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0838	047	0	1	01	01	H0838_047_0	10	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H0845	001	0	1	01	01	H0845_001_0	7	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H0845	001	0	1	01	01	H0845_001_0	7	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	180.00	7		2				2			2		1	0.00	0.00	2	2																																								
H0845	001	0	1	01	01	H0845_001_0	7	3																																																																																																												VBID Pest Control	2	1	150.00	5		2				2			2		1	0.00	0.00	2	2
H0982	002	0	1	01	01	H0982_002_0	13	1																																																																				Healthy Living Card	2	1	160.00	7		2				2			2		2			1	1																																								
H0982	010	0	1	01	01	H0982_010_0	13	1																																																																				Healthy Living Card	2	1	140.00	7		2				2			2		2			1	1																																								
H0982	012	0	1	01	01	H0982_012_0	13	1																																																																				Healthy Living Card	2	1	160.00	7		2				2			2		2			1	1																																								
H0982	013	0	1	01	01	H0982_013_0	13	1																																																																				Healthy Living Card	2	1	160.00	7		2				2			2		2			1	1																																								
H1016	023	0	1	01	01	H1016_023_0	8	1																										1	2	1	75.00	5	2	2				2		2			2		2			1		2	010	2				2				2			2		2			2	2																																																												
H1016	024	0	1	01	01	H1016_024_0	8	1																										1	2	1	75.00	5	2	2				2		2			2		2				1	2	010	2				2				2			2		2			2	2																																																												
H1016	031	0	1	01	01	H1016_031_0	8	1																										1	2	1	75.00	5	2	2				2		2			2		2			1		2	010	2				2				2			2		2			1	2																																																												
H1016	032	0	1	01	01	H1016_032_0	8	1																										1	2	1	75.00	5	2	2				2		2			2		2			1		2	010	2				2				2			2		2			1	2																																																												
H1019	001	0	1	01	01	H1019_001_0	6	2																										1	2	1	50.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2																				
H1019	001	0	1	01	01	H1019_001_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	006	0	1	01	01	H1019_006_0	6	2																										1	2	1	50.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2																				
H1019	006	0	1	01	01	H1019_006_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	023	0	1	01	01	H1019_023_0	6	2																										1	2	1	175.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175.00	7		2				2			2		2			2	2	Living Expense Support	2	1	175.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175.00	7		2				2			2		2			2	2
H1019	023	0	1	01	01	H1019_023_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1019	026	0	1	01	01	H1019_026_0	6	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1019	026	0	1	01	01	H1019_026_0	6	1																										1	2	1	150.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H1019	057	0	1	02	01	H1019_057_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	069	0	1	01	01	H1019_069_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	073	0	1	01	01	H1019_073_0	6	1																										1	2	1	125.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H1019	073	0	1	01	01	H1019_073_0	6	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1019	098	0	1	01	01	H1019_098_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	102	0	1	01	01	H1019_102_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	103	1	1	01	01	H1019_103_1	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	103	2	1	01	01	H1019_103_2	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	108	0	1	01	01	H1019_108_0	13	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	109	0	1	01	01	H1019_109_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	117	0	1	01	01	H1019_117_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	118	0	1	01	01	H1019_118_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	121	0	1	01	01	H1019_121_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	122	0	1	01	01	H1019_122_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	123	0	1	01	01	H1019_123_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	124	0	1	01	01	H1019_124_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	125	0	1	01	01	H1019_125_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	130	0	1	01	01	H1019_130_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	141	0	1	02	01	H1019_141_0	11	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	142	0	1	02	01	H1019_142_0	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1019	145	0	1	01	01	H1019_145_0	5	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1019	145	0	1	01	01	H1019_145_0	5	2																										1	2	1	275.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	275.00	7		2				2			2		2			2	2	Living Expense Support	2	1	275.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	275.00	7		2				2			2		2			2	2
H1019	146	0	1	01	01	H1019_146_0	5	1																										1	2	1	250.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	250.00	7		2				2			2		2			2	2	Living Expense Support	2	1	250.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	250.00	7		2				2			2		2			2	2
H1019	146	0	1	01	01	H1019_146_0	5	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1035	022	0	1	01	01	H1035_022_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	023	0	1	01	01	H1035_023_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	024	0	1	01	01	H1035_024_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	025	0	1	01	01	H1035_025_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	026	0	1	01	01	H1035_026_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	033	0	1	01	01	H1035_033_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	034	0	1	01	01	H1035_034_0	10	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	045	0	1	01	01	H1035_045_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1035	048	0	1	01	01	H1035_048_0	9	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1		2	001	2				2				2			2		2			1	2																																																												
H1036	025	0	1	01	01	H1036_025_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	054	0	1	01	01	H1036_054_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	054	0	1	01	01	H1036_054_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	062	0	1	01	01	H1036_062_0	7	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	062	0	1	01	01	H1036_062_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2																									Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	065	0	1	01	01	H1036_065_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	065	0	1	01	01	H1036_065_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	077	0	1	01	01	H1036_077_0	6	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H1036	077	0	1	01	01	H1036_077_0	6	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	077	0	1	01	01	H1036_077_0	6	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	102	0	1	01	01	H1036_102_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	102	0	1	01	01	H1036_102_0	6	2																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H1036	102	0	1	01	01	H1036_102_0	6	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	119	0	1	01	01	H1036_119_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	121	0	1	01	01	H1036_121_0	6	1																										1	2	1	35	7	2	2				1	1	2			2		2			2																																																																																	
H1036	121	0	1	01	01	H1036_121_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	146	0	1	01	01	H1036_146_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	160	0	1	01	01	H1036_160_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	167	0	1	01	01	H1036_167_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	167	0	1	01	01	H1036_167_0	7	1																										1	2	1	325.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	325.00	7		2				2			2		2			2	2	Living Expense Support	2	1	325.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	325.00	7		2				2			2		2			2	2
H1036	209	0	1	01	01	H1036_209_0	7	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	209	0	1	01	01	H1036_209_0	7	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H1036	210	0	1	01	01	H1036_210_0	7	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2																									Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	210	0	1	01	01	H1036_210_0	7	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H1036	213	0	1	01	01	H1036_213_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	213	0	1	01	01	H1036_213_0	7	2																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H1036	213	0	1	01	01	H1036_213_0	7	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	214	0	1	01	01	H1036_214_0	7	1																										1	2	1	125	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H1036	214	0	1	01	01	H1036_214_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	222	0	1	01	01	H1036_222_0	6	1																										1	2	1	2100.00	3	2	2				1	1	2			2		1	0.00	0.00	2																						Healthy Living Products	2	1	2100.00	3		2				2			2		1	0.00	0.00	2	2	Living Expense Support	2	1	2100.00	3		2				2			2		1	0.00	0.00	2	2	Aging Support and Safety Products	2	1	2100.00	3		2				2			2		1	0.00	0.00	2	2
H1036	226	0	1	01	01	H1036_226_0	6	1																										1	2	1	125.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H1036	230	0	1	01	01	H1036_230_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	233	0	1	02	01	H1036_233_0	6	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H1036	234	0	1	01	01	H1036_234_0	7	2																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Living Expense Support	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2
H1036	234	0	1	01	01	H1036_234_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1900	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H1036	235	0	1	01	01	H1036_235_0	6	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	235	0	1	01	01	H1036_235_0	6	1																										1	2	1	200.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200.00	7		2				2			2		2			2	2	Living Expense Support	2	1	200.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200.00	7		2				2			2		2			2	2
H1036	236	0	1	01	01	H1036_236_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	265	1	1	01	01	H1036_265_1	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	269	0	1	01	01	H1036_269_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	279	0	1	01	01	H1036_279_0	10	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	280	0	1	01	01	H1036_280_0	5	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H1036	285	0	1	01	01	H1036_285_0	6	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H1036	285	0	1	01	01	H1036_285_0	6	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	290	0	1	01	01	H1036_290_0	3	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	292	0	1	01	01	H1036_292_0	7	1																										1	2	1	50.00	7	2	2				1	1	2			2		2			2																																																																																	
H1036	295	0	1	01	01	H1036_295_0	6	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H1036	295	0	1	01	01	H1036_295_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	297	0	1	01	01	H1036_297_0	6	1																										1	2	1	35	7	2	2				1	1	2			2		2			2																																																																																	
H1036	297	0	1	01	01	H1036_297_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	298	0	1	01	01	H1036_298_0	5	1																										1	2	1	35	7	2	2				1	1	2			2		2			2																																																																																	
H1036	299	0	1	01	01	H1036_299_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	299	0	1	01	01	H1036_299_0	6	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																																																																																	
H1036	300	0	1	01	01	H1036_300_0	6	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																																																																																	
H1036	300	0	1	01	01	H1036_300_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	301	0	1	01	01	H1036_301_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	1100	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	302	0	1	01	01	H1036_302_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	1100	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	304	0	1	01	01	H1036_304_0	5	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	304	0	1	01	01	H1036_304_0	5	1																										1	2	1	275	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	275	7		2				2			2		2			2	2	Living Expense Support	2	1	275	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	275	7		2				2			2		2			2	2
H1036	304	0	1	01	01	H1036_304_0	5	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	305	0	1	01	01	H1036_305_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	306	0	1	01	01	H1036_306_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1600	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H1036	307	0	1	01	01	H1036_307_0	5	1																										1	2	1	175.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175.00	7		2				2			2		2			2	2	Living Expense Support	2	1	175.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175.00	7		2				2			2		2			2	2
H1036	307	0	1	01	01	H1036_307_0	5	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	308	0	1	01	01	H1036_308_0	5	1																										1	2	1	175.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175.00	7		2				2			2		2			2	2																				
H1036	308	0	1	01	01	H1036_308_0	5	2																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																																																																																	
H1036	309	0	1	01	01	H1036_309_0	5	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	309	0	1	01	01	H1036_309_0	5	1																										1	2	1	175	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175	7		2				2			2		2			2	2	Living Expense Support	2	1	175	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175	7		2				2			2		2			2	2
H1036	312	0	1	01	01	H1036_312_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	312	0	1	01	01	H1036_312_0	5	2																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H1036	313	0	1	01	01	H1036_313_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H1036	313	0	1	01	01	H1036_313_0	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																																																																																	
H1036	314	0	1	01	01	H1036_314_0	6	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	314	0	1	01	01	H1036_314_0	6	1																										1	2	1	250.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	250.00	7		2				2			2		2			2	2	Living Expense Support	2	1	250.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	250.00	7		2				2			2		2			2	2
H1036	315	0	1	01	01	H1036_315_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	1100	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1036	316	0	1	01	01	H1036_316_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	1100	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H1045	012	0	1	01	01	H1045_012_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	305.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1045	038	0	1	01	01	H1045_038_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	295.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1045	039	0	1	02	01	H1045_039_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	270.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1109	801	0	1	01	01	H1109_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1109	801	0	1	01	01	H1109_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1109	802	0	1	01	01	H1109_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1109	802	0	1	01	01	H1109_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1170	002	0	1	01	01	H1170_002_0	8	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	008	0	1	01	01	H1170_008_0	8	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	009	0	1	01	01	H1170_009_0	8	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	010	0	1	01	01	H1170_010_0	8	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	011	0	1	01	01	H1170_011_0	8	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	012	0	1	01	01	H1170_012_0	8	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	013	0	1	02	01	H1170_013_0	9	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1170	014	0	1	01	01	H1170_014_0	5	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H1206	801	0	1	01	01	H1206_801_0	3	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1206	801	0	1	01	01	H1206_801_0	3	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1206	802	0	1	01	01	H1206_802_0	3	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1206	802	0	1	01	01	H1206_802_0	3	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1280	001	0	1	01	01	H1280_001_0	5	1																										1	2	2				2				2		2			2		2			1																																																																																	
H1280	002	0	1	01	01	H1280_002_0	5	1																										1	2	2				2				2		2			2		2			1																																																																																	
H1347	001	0	1	04	01	H1347_001_0	3	1																																																2	010	2				2				2			2		2			2	2																																																												
H1347	002	0	1	04	01	H1347_002_0	3	1																																																2	010	2				2				2			2		2			2	2																																																												
H1347	003	0	1	04	01	H1347_003_0	3	1																																																2	010	2				2				2			2		2			2	2																																																												
H1352	004	0	1	01	01	H1352_004_0	6	3																																																																				Supplemental PT	2	2				2				2			2		2			2	2																																								
H1360	001	0	1	02	01	H1360_001_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	138.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1360	001	0	1	02	01	H1360_001_0	4	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H1365	001	0	1	04	01	H1365_001_0	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H1365	004	2	1	04	01	H1365_004_2	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H1365	004	3	1	04	01	H1365_004_3	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H1468	017	0	1	01	01	H1468_017_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1600	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H1587	001	0	1	02	01	H1587_001_0	9	1																										1	2	2				2				2		2			2		2			2																																																																																	
H1608	027	0	1	04	01	H1608_027_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H1608	073	0	1	04	01	H1608_073_0	5	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H1608	075	0	1	04	01	H1608_075_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H1608	078	0	1	04	01	H1608_078_0	5	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H1608	801	0	1	04	01	H1608_801_0	8	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H1608	801	0	1	04	01	H1608_801_0	8	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H1608	802	0	1	04	01	H1608_802_0	8	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H1608	802	0	1	04	01	H1608_802_0	8	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H1609	801	0	1	01	01	H1609_801_0	7	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1609	801	0	1	01	01	H1609_801_0	7	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1609	807	0	1	01	01	H1609_807_0	7	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1609	807	0	1	01	01	H1609_807_0	7	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1644	001	0	1	01	01	H1644_001_0	4	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H1692	801	0	1	01	01	H1692_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1692	801	0	1	01	01	H1692_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1692	802	0	1	01	01	H1692_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H1692	802	0	1	01	01	H1692_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H1748	005	0	1	01	01	H1748_005_0	12	2																																																																				Gasoline Card	2	1	25.00	7		2				2			2		2			2	2																																								
H1799	001	0	1	01	01	H1799_001_0	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H1799	002	0	1	01	01	H1799_002_0	7	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H1889	002	1	1	04	01	H1889_002_1	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	220.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	002	2	1	04	01	H1889_002_2	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	220.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	005	0	1	04	01	H1889_005_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	301.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	006	0	1	04	01	H1889_006_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	244.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	007	0	1	04	01	H1889_007_0	13	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	157.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	007	0	1	04	01	H1889_007_0	13	2																																																																																																												VBID Pest Control	2	1	150.00	5		2				1	0	75	2		2			2	2
H1889	008	0	1	04	01	H1889_008_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	149.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	009	0	1	04	01	H1889_009_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	146.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	010	0	1	04	01	H1889_010_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	215.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	011	0	1	04	01	H1889_011_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	189.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	012	0	1	04	01	H1889_012_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	109.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1889	012	0	1	04	01	H1889_012_0	4	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				1	0	75	2		2			2	2																				
H1951	032	0	1	01	01	H1951_032_0	6	1																										1	2	1	100	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100	7		2				2			2		2			2	2	Living Expense Support	2	1	100	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100	7		2				2			2		2			2	2
H1951	038	0	1	01	01	H1951_038_0	7	1																																																2	011	2				2				2			2		2			1	2																																																												
H1951	039	0	1	01	01	H1951_039_0	6	1																																																2	010	2				2				2			2		2			1	2																																																												
H1951	041	0	1	01	01	H1951_041_0	7	1																										1	2	1	75	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75	6	$75 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	75	6	$75 loaded on a prepaid card every month to spend on general supports for living.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	6	$75 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2
H1951	044	0	1	01	01	H1951_044_0	6	1																										1	2	1	75	7	1	2				1	1	2			2		2			2																																																																																	
H1951	056	0	1	01	01	H1951_056_0	6	1																										1	2	1	100	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100	6	$100 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	100	6	$100 loaded on card monthly to spend on supports for living including mortgage assistance, pest control, non-medical transport, disaster kits, utilities, internet service payments, and social needs.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	100	6	$100 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2
H1951	057	0	1	01	01	H1951_057_0	6	1																										1	2	1	245.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	245.00	7		2				2			2		2			2	2	Living Expense Support	2	1	245.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	245.00	7		2				2			2		2			2	2
H1961	003	0	1	02	01	H1961_003_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	112.00	7		2				2			2		1	0.00	0.00	2	2																																								
H1961	019	0	1	02	01	H1961_019_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	248.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2056	801	0	1	01	01	H2056_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H2056	801	0	1	01	01	H2056_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H2056	802	0	1	01	01	H2056_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H2056	802	0	1	01	01	H2056_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H2226	001	0	1	01	01	H2226_001_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	125.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2226	003	0	1	01	01	H2226_003_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	125.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2235	001	0	1	01	01	H2235_001_0	15	1																										1	2	1	25.00	5	2	2				1		2			2		2			1																																																																																	
H2235	003	0	1	01	01	H2235_003_0	15	1																										1	2	1	50.00	5	2	2				1		2			2		2			1																																																																																	
H2237	001	0	1	01	01	H2237_001_0	7	2																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H2237	001	0	1	01	01	H2237_001_0	7	1	1	1	2	1				1	500.00	3		2				2			2		2			1	2	1	2	1	500.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500.00	3		2				2			2		2			1	2																																								
H2237	007	0	1	01	01	H2237_007_0	7	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H2247	001	0	1	02	01	H2247_001_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	198.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2247	003	0	1	02	01	H2247_003_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	68.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2256	001	1	1	01	01	H2256_001_1	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	001	2	1	01	01	H2256_001_2	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	001	6	1	01	01	H2256_001_6	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	015	1	1	01	01	H2256_015_1	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	015	2	1	01	01	H2256_015_2	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	015	6	1	01	01	H2256_015_6	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	016	1	1	01	01	H2256_016_1	5	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	016	2	1	01	01	H2256_016_2	5	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	018	1	1	01	01	H2256_018_1	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	018	7	1	01	01	H2256_018_7	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	018	8	1	01	01	H2256_018_8	6	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	019	1	1	01	01	H2256_019_1	5	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	019	7	1	01	01	H2256_019_7	5	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	026	1	1	01	01	H2256_026_1	7	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	026	2	1	01	01	H2256_026_2	7	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	026	3	1	01	01	H2256_026_3	7	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	028	0	1	01	01	H2256_028_0	5	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	033	0	1	01	01	H2256_033_0	7	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	034	0	1	01	01	H2256_034_0	8	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	036	0	1	01	01	H2256_036_0	8	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	039	0	1	01	01	H2256_039_0	5	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	040	0	1	01	01	H2256_040_0	5	1																										1	2	2				2				2		1	10	10	2		2			2																																																																																	
H2256	041	0	1	01	01	H2256_041_0	5	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	042	0	1	01	01	H2256_042_0	5	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2256	046	0	1	01	01	H2256_046_0	8	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H2272	001	0	1	02	01	H2272_001_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	62.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2272	001	0	1	02	01	H2272_001_0	4	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H2293	001	0	1	04	01	H2293_001_0	5	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	002	0	1	04	01	H2293_002_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	003	0	1	04	01	H2293_003_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	004	0	1	04	01	H2293_004_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	005	0	1	04	01	H2293_005_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	006	0	1	04	01	H2293_006_0	5	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	007	0	1	04	01	H2293_007_0	5	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	007	0	1	04	01	H2293_007_0	5	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	008	0	1	04	01	H2293_008_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	009	0	1	04	01	H2293_009_0	2	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	011	0	1	04	01	H2293_011_0	5	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	023	0	1	04	01	H2293_023_0	4	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2293	023	0	1	04	01	H2293_023_0	4	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2406	050	0	1	04	01	H2406_050_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	125.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2406	051	0	1	04	01	H2406_051_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	129.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2406	052	0	1	04	01	H2406_052_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	66.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2406	053	0	1	04	01	H2406_053_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	119.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2406	099	0	1	04	01	H2406_099_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	84.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2425	001	0	1	01	01	H2425_001_0	8	1																										1	2	2				2				2		2			2		2			2																																																																																	
H2456	002	0	1	01	01	H2456_002_0	8	3	1	1	2	2	12	3		2				2				2			2		2			2	2																																																																																																						
H2459	021	1	1	02	01	H2459_021_1	8	1																																																2	011	2				2				2			2		2			2	2																																																												
H2459	021	2	1	02	01	H2459_021_2	8	1																																																2	011	2				2				2			2		2			2	2																																																												
H2459	021	3	1	02	01	H2459_021_3	8	1																																																2	011	2				2				2			2		2			2	2																																																												
H2459	031	0	1	01	01	H2459_031_0	7	1																										1	2	2				2				2		2			2		1	0.00	20.00	2																																																																																	
H2459	032	0	1	01	01	H2459_032_0	9	1																										1	2	2				2				2		1	0	20	2		2			2																																																																																	
H2463	001	0	1	01	01	H2463_001_0	8	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H2478	001	0	1	01	01	H2478_001_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2478	002	0	1	01	01	H2478_002_0	7	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2486	006	0	1	01	01	H2486_006_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H2486	007	0	1	01	01	H2486_007_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H2506	001	0	1	48	05	H2506_001_0	3	1																																																																				Flex card	2	1	60.00	7		2				2			2		2			1	2																																								
H2509	001	0	1	02	01	H2509_001_0	3	2																																																																																																												VBID Pest Control	2	1	600.00	5		2				2			2		1	0.00	0.00	2	2
H2509	001	0	1	02	01	H2509_001_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	330.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2509	002	0	1	02	01	H2509_002_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	270.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2582	002	0	1	02	01	H2582_002_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	86.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2610	005	0	1	01	01	H2610_005_0	4	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1																																																																																	
H2610	006	0	1	01	01	H2610_006_0	4	1																										1	2	1	50.00	5	2	2				1	1	2			2		2			1																																																																																	
H2663	067	0	1	01	01	H2663_067_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2663	067	0	1	01	01	H2663_067_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H2663	805	0	1	01	01	H2663_805_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H2663	805	0	1	01	01	H2663_805_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H2663	810	0	1	01	01	H2663_810_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H2663	810	0	1	01	01	H2663_810_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H2694	001	0	1	04	01	H2694_001_0	5	1																										1	2	2				2				2		2			2		2			1																																																																																	
H2715	001	0	1	01	01	H2715_001_0	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2802	044	0	1	02	01	H2802_044_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	108.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2802	053	0	1	02	01	H2802_053_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	212.00	7		2				2			2		1	0.00	0.00	2	2																																								
H2802	053	0	1	02	01	H2802_053_0	3	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H2879	001	0	1	01	01	H2879_001_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2879	002	0	1	01	01	H2879_002_0	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2879	003	0	1	01	01	H2879_003_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2879	005	0	1	01	01	H2879_005_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H2962	021	0	1	01	01	H2962_021_0	6	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	022	0	1	01	01	H2962_022_0	6	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	023	0	1	01	01	H2962_023_0	6	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	025	0	1	01	01	H2962_025_0	6	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	026	0	1	01	01	H2962_026_0	7	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	029	0	1	01	01	H2962_029_0	6	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	033	0	1	01	01	H2962_033_0	6	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	050	0	1	01	01	H2962_050_0	5	1																										1	2	1	125.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	051	0	1	01	01	H2962_051_0	5	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H2962	052	0	1	01	01	H2962_052_0	5	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			1																																																																																	
H3015	001	0	1	01	01	H3015_001_0	5	1																										1	2	1	260.00	7	2	2				1	1	2			2		2			1																																																																																	
H3015	001	0	1	01	01	H3015_001_0	5	2																										1	2	1	260.00	7	2	2				1	1	2			2		2			1																																																																																	
H3038	001	0	1	01	01	H3038_001_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H3038	002	0	1	01	01	H3038_002_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H3038	003	0	1	01	01	H3038_003_0	3	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H3113	005	0	1	01	01	H3113_005_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	290.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3113	005	0	1	01	01	H3113_005_0	3	2																																																																																																												VBID Pest Control	2	1	150.00	5		2				2			2		1	0.00	0.00	2	2
H3113	009	0	1	02	01	H3113_009_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	202.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3113	010	0	1	02	01	H3113_010_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	166.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3113	010	0	1	02	01	H3113_010_0	3	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H3113	011	0	1	02	01	H3113_011_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	189.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3113	013	0	1	02	01	H3113_013_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	64.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3113	014	0	1	02	01	H3113_014_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	50.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3146	001	0	1	02	01	H3146_001_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	004	0	1	02	01	H3146_004_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	006	0	1	01	01	H3146_006_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	007	0	1	02	01	H3146_007_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	011	0	1	01	01	H3146_011_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	012	0	1	01	01	H3146_012_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	013	0	1	01	01	H3146_013_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	014	0	1	02	01	H3146_014_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3146	801	0	1	01	01	H3146_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3146	801	0	1	01	01	H3146_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3146	802	0	1	01	01	H3146_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3146	802	0	1	01	01	H3146_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3152	801	0	1	01	01	H3152_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3152	801	0	1	01	01	H3152_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3152	804	0	1	01	01	H3152_804_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3152	804	0	1	01	01	H3152_804_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3186	001	0	1	04	01	H3186_001_0	8	1																																																2	111	2				2				2			2		2			2	1																																																												
H3186	002	0	1	04	01	H3186_002_0	8	1																																																2	111	2				2				2			2		2			2	1																																																												
H3192	007	0	1	01	01	H3192_007_0	8	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3192	801	0	1	01	01	H3192_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3192	801	0	1	01	01	H3192_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3192	802	0	1	01	01	H3192_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3192	802	0	1	01	01	H3192_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3219	801	0	1	04	01	H3219_801_0	9	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H3219	801	0	1	04	01	H3219_801_0	9	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H3219	802	0	1	04	01	H3219_802_0	9	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H3219	802	0	1	04	01	H3219_802_0	9	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H3239	013	0	1	01	01	H3239_013_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	015	0	1	01	01	H3239_015_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	016	0	1	01	01	H3239_016_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	017	0	1	01	01	H3239_017_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	017	0	1	01	01	H3239_017_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	018	0	1	01	01	H3239_018_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	019	0	1	01	01	H3239_019_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	020	0	1	01	01	H3239_020_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3239	020	0	1	01	01	H3239_020_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3256	001	0	1	04	01	H3256_001_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	169.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3256	002	0	1	04	01	H3256_002_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	71.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3259	001	0	1	01	01	H3259_001_0	5	1																										1	2	2				2				1	1	2			2		2			2																																																																																	
H3259	002	0	1	01	01	H3259_002_0	4	1																										1	2	2				2				1	1	2			2		2			2																																																																																	
H3259	003	0	1	01	01	H3259_003_0	6	1																										1	2	2				2				1	1	2			2		2			2																																																																																	
H3276	001	0	1	02	01	H3276_001_0	12	1																										1	2	1	60.00	7	2	2				1	1	2			2		2			1																																																																																	
H3276	003	0	1	02	01	H3276_003_0	11	1																										1	2	1	150.00	7	2	2				1	1	2			2		2			1																																																																																	
H3288	034	0	1	04	01	H3288_034_0	3	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3288	047	0	1	04	01	H3288_047_0	9	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3288	801	0	1	04	01	H3288_801_0	8	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H3288	801	0	1	04	01	H3288_801_0	8	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H3288	802	0	1	04	01	H3288_802_0	8	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H3288	802	0	1	04	01	H3288_802_0	8	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H3305	007	0	1	02	01	H3305_007_0	8	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3305	015	0	1	02	01	H3305_015_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3305	020	0	1	02	01	H3305_020_0	9	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3305	021	0	1	02	01	H3305_021_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3305	022	0	1	02	01	H3305_022_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3305	030	0	1	02	01	H3305_030_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3305	032	0	1	02	01	H3305_032_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H3312	801	0	1	01	01	H3312_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3312	801	0	1	01	01	H3312_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3312	804	0	1	01	01	H3312_804_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3312	804	0	1	01	01	H3312_804_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3359	019	0	1	01	01	H3359_019_0	12	1																																																																				Healthy Foods	2	2				2				2			2		2			2	2	Utilities	2	2				2				2			2		2			2	2																				
H3359	021	0	1	01	01	H3359_021_0	17	1																																																																				Healthy Foods	2	2				2				2			2		2			2	2	Utilities	2	2				2				2			2		2			2	2																				
H3359	038	0	1	01	01	H3359_038_0	12	1																																																																				Healthy Foods	2	2				2				2			2		2			2	2	Utilities	2	2				2				2			2		2			2	2																				
H3387	013	0	1	01	01	H3387_013_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	184.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3387	014	1	1	02	01	H3387_014_1	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	213.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3387	014	2	1	02	01	H3387_014_2	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	193.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3387	015	1	1	02	01	H3387_015_1	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	57.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3387	015	2	1	02	01	H3387_015_2	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	57.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3407	001	0	1	01	01	H3407_001_0	8	2																																																																				Utility Assistance	2	2				2				2			2		2			2	2																																								
H3443	001	0	1	01	01	H3443_001_0	16	2																										1	2	1	230.00	5	2	2				1	1	2			2		2			2																																																																																	
H3443	002	0	1	01	01	H3443_002_0	16	2																										1	2	1	230.00	5	2	2				1	1	2			2		2			2																																																																																	
H3533	002	0	1	01	01	H3533_002_0	7	1																										1	2	1	140.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	140.00	7		2				2			2		2			2	2	Living Expense Support	2	1	140.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	140.00	7		2				2			2		2			2	2
H3533	006	0	1	01	01	H3533_006_0	6	1																																																2	011	2				2				2			2		2			1	2																																																												
H3533	013	0	1	01	01	H3533_013_0	6	1																																																2	011	2				2				2			2		2			1	2																																																												
H3533	033	0	1	01	01	H3533_033_0	6	1																																																2	011	2				2				2			2		2			1	2																																																												
H3533	034	1	1	01	01	H3533_034_1	6	1																										1	2	1	155.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	155.00	7		2				2			2		2			2	2	Living Expense Support	2	1	155.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	155.00	7		2				2			2		2			2	2
H3533	034	2	1	01	01	H3533_034_2	6	1																										1	2	1	155.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	155.00	7		2				2			2		2			2	2	Living Expense Support	2	1	155.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	155.00	7		2				2			2		2			2	2
H3551	001	0	1	01	01	H3551_001_0	8	1																										1	2	2				2				2		2			2		2			1																																																																																	
H3551	002	0	1	01	01	H3551_002_0	8	1																										1	2	2				2				2		2			2		2			1																																																																																	
H3551	003	0	1	02	01	H3551_003_0	6	1																										1	2	2				2				2		2			2		2			1																																																																																	
H3597	801	0	1	01	01	H3597_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3597	801	0	1	01	01	H3597_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3597	802	0	1	01	01	H3597_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3597	802	0	1	01	01	H3597_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3660	028	0	1	02	01	H3660_028_0	7	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	029	0	1	02	01	H3660_029_0	7	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	044	0	1	01	01	H3660_044_0	7	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	050	0	1	01	01	H3660_050_0	9	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	052	1	1	01	01	H3660_052_1	7	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	052	2	1	01	01	H3660_052_2	7	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	053	1	1	01	01	H3660_053_1	9	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	053	2	1	01	01	H3660_053_2	9	2																																																2	001	2				2				2			2		2			2	2																																																												
H3660	056	1	1	01	01	H3660_056_1	9	1																																																2	001	2				2				2			2		2			2	2																																																												
H3660	056	2	1	01	01	H3660_056_2	10	1																																																2	001	2				2				2			2		2			2	2																																																												
H3660	801	0	1	01	01	H3660_801_0	3	2																																																2	011	2				2				2			2		2			2	2																																																												
H3660	805	0	1	02	01	H3660_805_0	3	2																																																2	011	2				2				2			2		2			2	2																																																												
H3672	019	0	1	01	01	H3672_019_0	13	1																										1	2	1	165.00	7	2	2				2		2			2		2			2																																																																																	
H3706	024	0	1	01	01	H3706_024_0	4	1																										1	2	1	150.00	5	2	2				1	1	2			2		2			1																																																																																	
H3706	025	0	1	01	01	H3706_025_0	6	1																										1	2	1	150.00	5	2	2				1	1	2			2		2			1																																																																																	
H3706	028	0	1	01	01	H3706_028_0	6	1																										1	2	1	250.00	7	2	2				1	1	2			2		2			1																																																																																	
H3706	028	0	1	01	01	H3706_028_0	6	2																																																2	101	2				2				2			2		2			2	2																																																												
H3706	029	0	1	01	01	H3706_029_0	5	2																																																2	101	2				2				2			2		2			2	2																																																												
H3706	029	0	1	01	01	H3706_029_0	5	1																										1	2	1	215.00	7	2	2				1	1	2			2		2			1																																																																																	
H3748	801	0	1	01	01	H3748_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3748	801	0	1	01	01	H3748_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3748	802	0	1	01	01	H3748_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3748	802	0	1	01	01	H3748_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3794	002	0	1	02	01	H3794_002_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	189.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3794	004	0	1	02	01	H3794_004_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	74.00	7		2				2			2		1	0.00	0.00	2	2																																								
H3815	007	0	1	01	01	H3815_007_0	19	2	1	1	2	2	12	3		2				2				2			2		2			2	2	1	2	1	240.00	5	2	2				1	1	2			2		2			2		2	011	2				2				2			2		2			1	1																																																												
H3907	002	0	1	01	01	H3907_002_0	7	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	006	0	1	01	01	H3907_006_0	11	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	029	0	1	01	01	H3907_029_0	11	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	037	0	1	01	01	H3907_037_0	8	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	046	0	1	01	01	H3907_046_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	050	0	1	01	01	H3907_050_0	9	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	052	0	1	01	01	H3907_052_0	11	1																																																2	011	2				2				2			2		2			1	2																																																												
H3907	057	1	1	01	01	H3907_057_1	12	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	057	2	1	01	01	H3907_057_2	12	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	057	3	1	01	01	H3907_057_3	12	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	057	4	1	01	01	H3907_057_4	12	1																																																2	011	2				2				2			2		2			2	2																																																												
H3907	057	5	1	01	01	H3907_057_5	13	1																																																2	011	2				2				2			2		2			2	2																																																												
H3916	005	0	1	04	01	H3916_005_0	7	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3916	012	0	1	04	01	H3916_012_0	5	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3916	015	0	1	04	01	H3916_015_0	7	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3928	001	0	1	01	01	H3928_001_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3928	801	0	1	01	01	H3928_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3928	801	0	1	01	01	H3928_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3928	803	0	1	01	01	H3928_803_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3928	803	0	1	01	01	H3928_803_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3931	004	0	1	02	01	H3931_004_0	6	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H3931	801	0	1	01	01	H3931_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3931	801	0	1	01	01	H3931_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3931	804	0	1	01	01	H3931_804_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3931	804	0	1	01	01	H3931_804_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3952	053	0	1	02	01	H3952_053_0	9	3																										1	2	1	10.00	5	2	2				2		2			2		2			2																																																																																	
H3952	054	0	1	02	01	H3952_054_0	9	3																										1	2	1	10.00	5	2	2				2		2			2		2			2																																																																																	
H3954	097	0	1	01	01	H3954_097_0	5	1																										1	2	2				2				1	1	2			2		2			1																																																																																	
H3957	042	1	1	01	01	H3957_042_1	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	042	2	1	01	01	H3957_042_2	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	042	4	1	01	01	H3957_042_4	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	042	5	1	01	01	H3957_042_5	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	043	1	1	02	01	H3957_043_1	6	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	043	2	1	02	01	H3957_043_2	6	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	044	1	1	02	01	H3957_044_1	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	045	1	1	02	01	H3957_045_1	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	045	2	1	02	01	H3957_045_2	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	046	1	1	02	01	H3957_046_1	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3957	046	2	1	02	01	H3957_046_2	8	1																																																																				Healthcare Kit	2	2				2				2			2		2			2	2																																								
H3959	001	0	1	02	01	H3959_001_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H3959	002	0	1	02	01	H3959_002_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H3959	010	0	1	02	01	H3959_010_0	6	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	032	0	1	02	01	H3959_032_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	035	0	1	01	01	H3959_035_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3959	036	0	1	01	01	H3959_036_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H3959	039	0	1	02	01	H3959_039_0	6	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H3959	046	0	1	02	01	H3959_046_0	8	2																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	046	0	1	02	01	H3959_046_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	047	0	1	02	01	H3959_047_0	8	2																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	047	0	1	02	01	H3959_047_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	049	0	1	02	01	H3959_049_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	049	0	1	02	01	H3959_049_0	7	2																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	051	0	1	02	01	H3959_051_0	6	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H3959	803	0	1	01	01	H3959_803_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H3959	803	0	1	01	01	H3959_803_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3959	804	0	1	01	01	H3959_804_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H3959	804	0	1	01	01	H3959_804_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4003	017	0	1	01	01	H4003_017_0	7	1																										1	2	1	80.00	7	2	2				1	1	2			2		2			2																																																																																	
H4003	019	0	1	02	01	H4003_019_0	5	1																										1	2	1	35.00	7	2	2				1	1	2			2		2			2																																																																																	
H4003	049	0	1	01	01	H4003_049_0	6	1																										1	2	1	50.00	7	2	2				1	1	2			2		2			2																																																																																	
H4003	058	0	1	01	01	H4003_058_0	6	1																										1	2	1	145.00	7	2	2				1	1	2			2		2			2																																																																																	
H4004	048	0	1	01	01	H4004_048_0	6	1																										1	2	1	85.00	7	2	2				1	1	2			2		2			2																																																																																	
H4004	056	0	1	02	01	H4004_056_0	5	1																										1	2	1	50.00	7	2	2				1	1	2			2		2			2																																																																																	
H4004	062	0	1	01	01	H4004_062_0	6	1																										1	2	1	120.00	7	2	2				1	1	2			2		2			2																																																																																	
H4004	063	0	1	02	01	H4004_063_0	5	1																										1	2	1	80.00	7	2	2				1	1	2			2		2			2																																																																																	
H4004	065	0	1	02	01	H4004_065_0	5	1																										1	2	1	60.00	7	2	2				1	1	2			2		2			2																																																																																	
H4004	067	0	1	01	01	H4004_067_0	6	1																										1	2	1	15.00	7	2	2				1	1	2			2		2			2																																																																																	
H4005	001	0	1	04	01	H4005_001_0	4	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																																																																																	
H4007	012	0	1	01	01	H4007_012_0	5	2																										1	2	1	200.00	7	2	2				2		2			2		2																																																																																				
H4007	012	0	1	01	01	H4007_012_0	5	1																										1	2	1	50	7	1	2				1	1	2			2		2																									Healthy Living Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on home supplies and personal wellness care.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on robotic pets and speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2																				
H4007	016	0	1	01	01	H4007_016_0	10	1																										1	2	1	40.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	40.00	7		2				2			2		2			2	2	Living Expense Support	2	1	40.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	40.00	7		2				2			2		2			2	2
H4007	016	0	1	01	01	H4007_016_0	10	2																										1	2	1	200.00	7	2	2				2		2			2		2			2																																																																																	
H4007	018	0	1	01	01	H4007_018_0	5	1																										1	2	1	60.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	60.00	7		2				2			2		2			2	2	Living Expense Support	2	1	60.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	60.00	7		2				2			2		2			2	2
H4007	019	0	1	01	01	H4007_019_0	5	1																										1	2	1	60.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	60.00	7		2				2			2		2			2	2	Living Expense Support	2	1	60.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	60.00	7		2				2			2		2			2	2
H4007	020	0	1	01	01	H4007_020_0	6	1																										1	2	1	20.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	20.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	20.00	7		2				2			2		2			2	2																				
H4007	021	0	1	01	01	H4007_021_0	6	1																										1	2	1	75	7	1	2				1	1	2			2		2																									Healthy Living Products	2	1	75	6	$75 loaded on a prepaid card every month to spend on home supplies and personal wellness care.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	6	$75 loaded on a prepaid card every month to spend on robotic pets and speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2																				
H4007	024	0	1	01	01	H4007_024_0	5	1																										1	2	1	140.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	140.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	140.00	7		2				2			2		2			2	2																				
H4007	026	0	1	01	01	H4007_026_0	5	1																										1	2	1	65.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	65.00	7		2				2			2		2			2	2	Living Expense Support	2	1	65.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	65.00	7		2				2			2		2			2	2
H4007	027	0	1	01	01	H4007_027_0	5	1																										1	2	1	265	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	265	7		2				2			2		2			2	2	Living Expense Support	2	1	265	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	265	7		2				2			2		2			2	2
H4007	029	0	1	01	01	H4007_029_0	5	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2																				
H4007	030	0	1	01	01	H4007_030_0	5	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H4094	001	0	1	02	01	H4094_001_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	65.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4140	009	0	1	01	01	H4140_009_0	11	1																										1	2	2				2				2		2			2		2			1																																																																																	
H4140	010	0	1	01	01	H4140_010_0	11	1																										1	2	2				2				2		2			2		2			1																																																																																	
H4140	012	0	1	01	01	H4140_012_0	11	1																										1	2	2				2				2		2			2		2			1																																																																																	
H4140	013	0	1	01	01	H4140_013_0	11	1																										1	2	2				2				2		2			2		2			1																																																																																	
H4141	003	0	1	01	01	H4141_003_0	8	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H4141	003	0	1	01	01	H4141_003_0	8	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H4141	003	0	1	01	01	H4141_003_0	8	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H4141	015	0	1	01	01	H4141_015_0	10	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H4141	017	3	1	01	01	H4141_017_3	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H4141	021	0	1	01	01	H4141_021_0	6	3	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2																									Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H4141	021	0	1	01	01	H4141_021_0	6	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H4141	021	0	1	01	01	H4141_021_0	6	2																										1	2	1	25	7	1	2				1	1	2			2		2																									Healthy Living Products	2	1	25	6	Members seeing a high-value provider receives additional $25 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	25	6	Members seeing a high-value provider receives additional $25 loaded on a prepaid card every month to spend on general supports for living including rent and mortgage assistance, pest control, non-medical transportation, disaster relief kits, utilities, internet service payments, and social needs, including social organization membership fees and activity expenses.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	25	6	Members seeing a high-value provider receives additional $25 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2
H4141	021	0	1	01	01	H4141_021_0	6	4																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H4152	020	0	1	02	01	H4152_020_0	8	2																										1	2	1	75.00	7	2	2				1	1	2			2		2			2																																																																																	
H4152	021	0	1	01	01	H4152_021_0	9	1																										1	2	1	160.00	7	2	2				1	1	2			2		2			2																																																																																	
H4279	001	0	1	01	01	H4279_001_0	8	1																										1	2	2				2				1	1	2			2		2			1																																																																																	
H4279	004	0	1	01	01	H4279_004_0	8	1																										1	2	2				2				1	1	2			2		2			1																																																																																	
H4461	004	0	1	01	01	H4461_004_0	4	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2																				
H4461	022	0	1	01	01	H4461_022_0	9	1																										1	2	1	215.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	215.00	7		2				2			2		2			2	2	Living Expense Support	2	1	215.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	215.00	7		2				2			2		2			2	2
H4461	022	0	1	01	01	H4461_022_0	9	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H4461	038	0	1	01	01	H4461_038_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H4461	038	0	1	01	01	H4461_038_0	7	1																										1	2	1	195.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	195.00	7		2				2			2		2			2	2	Living Expense Support	2	1	195.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	195.00	7		2				2			2		2			2	2
H4461	042	0	1	01	01	H4461_042_0	7	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																																																																																	
H4514	013	1	1	02	01	H4514_013_1	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	135.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4514	013	2	1	02	01	H4514_013_2	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	135.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4514	013	3	1	02	01	H4514_013_3	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	135.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4514	016	0	1	02	01	H4514_016_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	152.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4514	018	0	1	02	01	H4514_018_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	60.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4514	019	0	1	02	01	H4514_019_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	50.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4514	021	0	1	02	01	H4514_021_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	110.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4523	801	0	1	01	01	H4523_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4523	801	0	1	01	01	H4523_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4523	802	0	1	01	01	H4523_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4523	802	0	1	01	01	H4523_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4527	003	0	1	02	01	H4527_003_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	69.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4527	004	0	1	02	01	H4527_004_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	51.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4527	006	0	1	02	01	H4527_006_0	3	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	80.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4527	015	0	1	02	01	H4527_015_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	125.00	7		2				2			2		1	0.00	0.00	2	2																																								
H4623	001	0	1	02	01	H4623_001_0	12	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H4623	002	0	1	02	01	H4623_002_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H4711	801	0	1	01	01	H4711_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4711	801	0	1	01	01	H4711_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4711	802	0	1	01	01	H4711_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4711	802	0	1	01	01	H4711_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4835	801	0	1	01	01	H4835_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4835	801	0	1	01	01	H4835_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4835	802	0	1	01	01	H4835_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4835	802	0	1	01	01	H4835_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4931	007	0	1	01	01	H4931_007_0	10	2																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H4931	015	0	1	01	01	H4931_015_0	9	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H4982	801	0	1	01	01	H4982_801_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4982	801	0	1	01	01	H4982_801_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H4982	802	0	1	01	01	H4982_802_0	8	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H4982	802	0	1	01	01	H4982_802_0	8	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5008	002	0	1	02	01	H5008_002_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	159.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5008	010	0	1	02	01	H5008_010_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	250.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5008	011	0	1	02	01	H5008_011_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	199.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5008	015	0	1	02	01	H5008_015_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	64.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5008	016	0	1	02	01	H5008_016_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	91.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5050	004	0	1	01	01	H5050_004_0	12	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	009	0	1	01	01	H5050_009_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	013	0	1	01	01	H5050_013_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	017	0	1	01	01	H5050_017_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	019	0	1	01	01	H5050_019_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	021	0	1	01	01	H5050_021_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	022	0	1	01	01	H5050_022_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5050	023	0	1	01	01	H5050_023_0	10	1																																																																				Advanced Care At Home	2	2				2				2			2		1	0.00	0.00	1	1																																								
H5178	002	0	1	01	01	H5178_002_0	5	2																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2																				
H5178	002	0	1	01	01	H5178_002_0	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5211	001	0	1	02	01	H5211_001_0	3	1																																															1	2	010	2				2				2			2		2			2	2																																																												
H5211	001	0	1	02	01	H5211_001_0	3	2																																																																																									2	2				2				1	0	20	2		1	0.00	150.00	1	2																				
H5211	002	0	1	02	01	H5211_002_0	5	2																																																																																									2	2				2				1	0	20	2		1	0.00	200.00	1	2																				
H5211	002	0	1	02	01	H5211_002_0	5	1																																															1	2	010	2				2				2			2		2			2	2																																																												
H5211	003	0	1	02	01	H5211_003_0	3	2																																																																																									2	2				2				1	0	20	2		1	0.00	200.00	1	2																				
H5211	003	0	1	02	01	H5211_003_0	3	1																																															1	2	010	2				2				2			2		2			2	2																																																												
H5211	004	0	1	02	01	H5211_004_0	4	2																																																																																									2	2				2				1	0	20	2		1	0.00	150.00	1	2																				
H5211	004	0	1	02	01	H5211_004_0	4	1																																															1	2	010	2				2				2			2		2			2	2																																																												
H5211	010	0	1	01	01	H5211_010_0	5	1																																																2	010	2				2				2			2		2			2	2																																																												
H5211	012	0	1	02	01	H5211_012_0	4	2																																																																																									2	2				2				1	0	20	2		1	0.00	250.00	1	2																				
H5211	012	0	1	02	01	H5211_012_0	4	1																																																2	010	2				2				2			2		2			2	2																																																												
H5211	013	0	1	02	01	H5211_013_0	4	1																																															1	2	010	2				2				2			2		2			2	2																																																												
H5211	013	0	1	02	01	H5211_013_0	4	2																																																																																									2	2				2				1	0	20	2		1	0.00	200.00	1	2																				
H5215	001	0	1	04	01	H5215_001_0	7	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	002	0	1	04	01	H5215_002_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	005	0	1	04	01	H5215_005_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	006	0	1	04	01	H5215_006_0	7	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	007	0	1	04	01	H5215_007_0	6	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	008	0	1	04	01	H5215_008_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	009	0	1	04	01	H5215_009_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	010	0	1	04	01	H5215_010_0	6	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	011	0	1	04	01	H5215_011_0	6	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	012	0	1	04	01	H5215_012_0	8	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	013	0	1	04	01	H5215_013_0	4	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5215	014	0	1	04	01	H5215_014_0	5	1	1	1	2	2	12	3		2				2				2			2		2			1	2																																																																																																						
H5216	014	0	1	04	01	H5216_014_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2				1	2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	023	0	1	04	01	H5216_023_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	032	0	1	04	01	H5216_032_0	9	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	034	0	1	04	01	H5216_034_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	037	0	1	04	01	H5216_037_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	042	0	1	04	01	H5216_042_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	043	1	1	04	01	H5216_043_1	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	043	5	1	04	01	H5216_043_5	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	043	6	1	04	01	H5216_043_6	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	047	0	1	04	01	H5216_047_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	048	0	1	04	01	H5216_048_0	9	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	068	0	1	04	01	H5216_068_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	073	0	1	04	01	H5216_073_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	077	0	1	04	01	H5216_077_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	078	1	1	04	01	H5216_078_1	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	083	0	1	04	01	H5216_083_0	9	1	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5216	128	0	1	04	01	H5216_128_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	137	0	1	04	01	H5216_137_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	140	0	1	04	01	H5216_140_0	11	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	140	0	1	04	01	H5216_140_0	11	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	141	0	1	04	01	H5216_141_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	144	0	1	04	01	H5216_144_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	152	0	1	04	01	H5216_152_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H5216	152	0	1	04	01	H5216_152_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	154	0	1	04	01	H5216_154_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	157	0	1	04	01	H5216_157_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	160	0	1	04	01	H5216_160_0	6	1																										1	2	1	600.00	3	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	600.00	3		2				2			2		2			2	2	Aging Support and Safety Products	2	1	600.00	3		2				2			2		2			2	2																				
H5216	161	0	1	04	01	H5216_161_0	6	1																										1	2	1	50	7	2	2				1	1	2			2		2			1																						Healthy Living Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on home supplies and personal wellness care.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2																				
H5216	164	0	1	04	01	H5216_164_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	164	0	1	04	01	H5216_164_0	8	2																										1	2	1	125.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H5216	180	0	1	04	01	H5216_180_0	6	1																										1	2	1	65.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	65.00	3		2				2			2		2			2	2	Aging Support and Safety Products	2	1	65.00	3		2				2			2		2			2	2																				
H5216	195	0	1	04	01	H5216_195_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	197	0	1	04	01	H5216_197_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	200	0	1	04	01	H5216_200_0	6	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on home supplies and personal wellness care.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2																				
H5216	201	0	1	04	01	H5216_201_0	5	1																										1	2	1	50	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on home supplies and personal wellness care.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2																				
H5216	203	1	1	04	01	H5216_203_1	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	205	0	1	04	01	H5216_205_0	11	1																										1	2	1	150	7	1	2				1	1	2			2		2																									Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H5216	205	0	1	04	01	H5216_205_0	11	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5216	205	0	1	04	01	H5216_205_0	11	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	206	0	1	04	01	H5216_206_0	8	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	206	0	1	04	01	H5216_206_0	8	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5216	206	0	1	04	01	H5216_206_0	8	1																										1	2	1	75	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75	6	$75 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	75	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	7		2				2			2		2			2	2
H5216	213	0	1	04	01	H5216_213_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	216	0	1	04	01	H5216_216_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	217	0	1	04	01	H5216_217_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	218	0	1	04	01	H5216_218_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	219	0	1	04	01	H5216_219_0	7	1																										1	2	1	125	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125	7		2				2			2		2			2	2	Living Expense Support	2	1	125	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H5216	220	0	1	04	01	H5216_220_0	7	2	1	1	2	1				1	750.00	3		2				2			2		2			1	2	1	2	1	750.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	750.00	3		2				2			2		2			1	2																																								
H5216	220	0	1	04	01	H5216_220_0	7	1																										1	2	1	70.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	70.00	7		2				2			2		2			2	2	Living Expense Support	2	1	70.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	70.00	7		2				2			2		2			2	2
H5216	223	0	1	04	01	H5216_223_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	224	0	1	04	01	H5216_224_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	227	0	1	04	01	H5216_227_0	7	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	227	0	1	04	01	H5216_227_0	7	1																										1	2	1	170.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	170.00	7		2				2			2		2			2	2	Living Expense Support	2	1	170.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	170.00	7		2				2			2		2			2	2
H5216	228	0	1	04	01	H5216_228_0	5	1																										1	2	1	100	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100	7		2				2			2		2			2	2	Living Expense Support	2	1	100	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100	7		2				2			2		2			2	2
H5216	242	0	1	04	01	H5216_242_0	7	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	242	0	1	04	01	H5216_242_0	7	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H5216	243	0	1	04	01	H5216_243_0	7	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H5216	244	0	1	04	01	H5216_244_0	6	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H5216	246	0	1	04	01	H5216_246_0	6	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			1																																																																																	
H5216	246	0	1	04	01	H5216_246_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	247	0	1	04	01	H5216_247_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	254	0	1	04	01	H5216_254_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	257	0	1	04	01	H5216_257_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5216	261	0	1	04	01	H5216_261_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	265	0	1	04	01	H5216_265_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	266	0	1	04	01	H5216_266_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	267	0	1	04	01	H5216_267_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	267	0	1	04	01	H5216_267_0	5	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H5216	268	0	1	04	01	H5216_268_0	7	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1		2	010	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	268	0	1	04	01	H5216_268_0	7	1																										1	2	1	170.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	170.00	7		2				2			2		2			2	2	Living Expense Support	2	1	170.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	170.00	7		2				2			2		2			2	2
H5216	277	0	1	04	01	H5216_277_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5216	277	0	1	04	01	H5216_277_0	7	1																										1	2	1	200	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200	7		2				2			2		2			2	2	Living Expense Support	2	1	200	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200	7		2				2			2		2			2	2
H5216	279	0	1	04	01	H5216_279_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	280	1	1	04	01	H5216_280_1	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on home supplies and personal wellness care.	2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	6	$50 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2																				
H5216	280	1	1	04	01	H5216_280_1	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	280	2	1	04	01	H5216_280_2	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H5216	281	0	1	04	01	H5216_281_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	284	0	1	04	01	H5216_284_0	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H5216	285	0	1	04	01	H5216_285_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	286	0	1	04	01	H5216_286_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	286	0	1	04	01	H5216_286_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5216	290	0	1	04	01	H5216_290_0	5	1																										1	2	1	90.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	90.00	7		2				2			2		2			2	2	Living Expense Support	2	1	90.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	90.00	7		2				2			2		2			2	2
H5216	291	0	1	04	01	H5216_291_0	5	1																										1	2	1	110.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	110.00	7		2				2			2		2			2	2	Living Expense Support	2	1	110.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	110.00	7		2				2			2		2			2	2
H5216	292	0	1	04	01	H5216_292_0	5	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H5216	293	0	1	04	01	H5216_293_0	9	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5216	296	0	1	04	01	H5216_296_0	5	1																										1	2	1	120.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	120.00	7		2				2			2		2			2	2	Living Expense Support	2	1	120.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	120.00	7		2				2			2		2			2	2
H5216	298	0	1	04	01	H5216_298_0	5	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H5216	301	4	1	04	01	H5216_301_4	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	302	0	1	04	01	H5216_302_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	302	0	1	04	01	H5216_302_0	6	1																										1	2	1	75	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75	7		2				2			2		2			2	2	Living Expense Support	2	1	75	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	7		2				2			2		2			2	2
H5216	307	0	1	04	01	H5216_307_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	308	0	1	04	01	H5216_308_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	309	0	1	04	01	H5216_309_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	310	0	1	04	01	H5216_310_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	312	0	1	04	01	H5216_312_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	315	0	1	04	01	H5216_315_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	317	0	1	04	01	H5216_317_0	5	1																										1	2	1	40.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	40.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	40.00	7		2				2			2		2			2	2																				
H5216	318	1	1	04	01	H5216_318_1	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	318	2	1	04	01	H5216_318_2	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	318	3	1	04	01	H5216_318_3	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	329	0	1	04	01	H5216_329_0	10	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	330	0	1	04	01	H5216_330_0	5	1																										1	2	1	150	7	2	2				1	1	2			2		2			1																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H5216	331	0	1	04	01	H5216_331_0	7	1																										1	2	1	170.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	170.00	7		2				2			2		2			2	2	Living Expense Support	2	1	170.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	170.00	7		2				2			2		2			2	2
H5216	332	0	1	04	01	H5216_332_0	7	1																										1	2	1	175	7	2	2				1	1	2			2		2			1																						Healthy Living Products	2	1	175	7		2				2			2		2			2	2	Living Expense Support	2	1	175	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175	7		2				2			2		2			2	2
H5216	333	0	1	04	01	H5216_333_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	334	0	1	04	01	H5216_334_0	6	1																										1	2	1	900.00	3	2	2				1	1	2			2		2			2																																																																																	
H5216	335	0	1	04	01	H5216_335_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	338	0	1	04	01	H5216_338_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	345	0	1	04	01	H5216_345_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	348	0	1	04	01	H5216_348_0	4	1																																																																					2	2				2				2			2		2			1	2																																								
H5216	351	0	1	04	01	H5216_351_0	8	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	352	0	1	04	01	H5216_352_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	358	0	1	04	01	H5216_358_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	361	0	1	04	01	H5216_361_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Living Expense Support	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2
H5216	362	0	1	04	01	H5216_362_0	8	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H5216	363	0	1	04	01	H5216_363_0	5	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2																				
H5216	363	0	1	04	01	H5216_363_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5216	366	0	1	04	01	H5216_366_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H5216	367	0	1	04	01	H5216_367_0	6	1																										1	2	1	2700.00	3	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	2700.00	3		2				2			2		2			2	2	Living Expense Support	2	1	2700.00	3		2				2			2		2			2	2	Aging Support and Safety Products	2	1	2700.00	3		2				2			2		2			2	2
H5216	369	0	1	04	01	H5216_369_0	10	1	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5216	370	0	1	04	01	H5216_370_0	6	1																										1	2	1	200.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200.00	7		2				2			2		2			2	2	Living Expense Support	2	1	200.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200.00	7		2				2			2		2			2	2
H5216	372	0	1	04	01	H5216_372_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H5216	373	0	1	04	01	H5216_373_0	8	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	373	0	1	04	01	H5216_373_0	8	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H5216	375	0	1	04	01	H5216_375_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H5216	376	0	1	04	01	H5216_376_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H5216	377	0	1	04	01	H5216_377_0	6	2	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5216	377	0	1	04	01	H5216_377_0	6	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Living Expense Support	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2
H5216	379	0	1	04	01	H5216_379_0	4	2																																																2	011	2				2				2			2		2			1	2																																																												
H5216	379	0	1	04	01	H5216_379_0	4	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H5216	381	0	1	04	01	H5216_381_0	4	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2																				
H5216	381	0	1	04	01	H5216_381_0	4	2																																																2	010	2				2				2			2		2			1	2																																																												
H5216	385	0	1	04	01	H5216_385_0	6	1																										1	2	1	120.00	7	2	2				1	1	2			2		2			1																						Healthy Living Products	2	1	120.00	7		2				2			2		2			2	2	Living Expense Support	2	1	120.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	120.00	7		2				2			2		2			2	2
H5216	386	1	1	04	01	H5216_386_1	4	1																																																2	011	2				2				2			2		2			1	2																																																												
H5216	386	2	1	04	01	H5216_386_2	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H5216	387	1	1	04	01	H5216_387_1	6	1																																																2	011	2				2				2			2		2			1	2																																																												
H5216	387	2	1	04	01	H5216_387_2	7	1																																																2	011	2				2				2			2		2			1	2																																																												
H5216	388	0	1	04	01	H5216_388_0	6	1																										1	2	1	190.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	190.00	7		2				2			2		2			2	2	Living Expense Support	2	1	190.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	190.00	7		2				2			2		2			2	2
H5216	390	0	1	04	01	H5216_390_0	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H5216	394	0	1	04	01	H5216_394_0	6	1																										1	2	1	200.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200.00	7		2				2			2		2			2	2	Living Expense Support	2	1	200.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200.00	7		2				2			2		2			2	2
H5216	400	0	1	04	01	H5216_400_0	6	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional care	2	1	3000.00	3		2				2			2		2			1	2																																								
H5216	401	0	1	04	01	H5216_401_0	7	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H5253	024	0	1	02	01	H5253_024_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	174.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5253	041	0	1	02	01	H5253_041_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	326.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5253	059	0	1	02	01	H5253_059_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	222.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5253	116	0	1	02	01	H5253_116_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	72.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5253	122	0	1	02	01	H5253_122_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	91.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5262	001	0	1	01	01	H5262_001_0	5	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H5262	001	0	1	01	01	H5262_001_0	5	2																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	003	0	1	01	01	H5262_003_0	4	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H5262	003	0	1	01	01	H5262_003_0	4	2																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	004	0	1	01	01	H5262_004_0	3	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H5262	004	0	1	01	01	H5262_004_0	3	2																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	005	0	1	01	01	H5262_005_0	3	2																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	005	0	1	01	01	H5262_005_0	3	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H5262	007	0	1	01	01	H5262_007_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	008	0	1	01	01	H5262_008_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	009	0	1	01	01	H5262_009_0	3	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	010	0	1	01	01	H5262_010_0	3	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	011	0	1	01	01	H5262_011_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	012	0	1	01	01	H5262_012_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	013	0	1	01	01	H5262_013_0	3	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	018	0	1	01	01	H5262_018_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	019	0	1	01	01	H5262_019_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	020	0	1	01	01	H5262_020_0	3	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	021	0	1	01	01	H5262_021_0	4	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H5262	021	0	1	01	01	H5262_021_0	4	2																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	023	0	1	01	01	H5262_023_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	024	0	1	01	01	H5262_024_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	025	0	1	01	01	H5262_025_0	3	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	026	0	1	01	01	H5262_026_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	027	0	1	01	01	H5262_027_0	3	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	029	0	1	01	01	H5262_029_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	030	0	1	01	01	H5262_030_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5262	031	0	1	01	01	H5262_031_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5302	012	0	1	01	01	H5302_012_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5302	809	0	1	01	01	H5302_809_0	7	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5302	809	0	1	01	01	H5302_809_0	7	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H5302	810	0	1	01	01	H5302_810_0	7	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5302	810	0	1	01	01	H5302_810_0	7	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H5322	025	0	1	02	01	H5322_025_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	134.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	026	0	1	02	01	H5322_026_0	6	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	73.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	028	0	1	02	01	H5322_028_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	187.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	029	0	1	02	01	H5322_029_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	244.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	029	0	1	02	01	H5322_029_0	4	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H5322	030	0	1	02	01	H5322_030_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	185.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	031	0	1	02	01	H5322_031_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	224.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	031	0	1	02	01	H5322_031_0	5	2																																																																																																												VBID Pest Control	2	1	150.00	5		2				2			2		1	0.00	0.00	2	2
H5322	033	0	1	02	01	H5322_033_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	67.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	034	0	1	02	01	H5322_034_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	77.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5322	038	0	1	02	01	H5322_038_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	68.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5325	010	0	1	01	01	H5325_010_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5325	011	0	1	01	01	H5325_011_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5374	001	0	1	01	01	H5374_001_0	8	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H5420	006	0	1	01	01	H5420_006_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	281.00	7		2				2			2		1	0.00	0.00	2	2																																								
H5431	001	0	1	01	01	H5431_001_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	006	0	1	01	01	H5431_006_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	012	0	1	01	01	H5431_012_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	013	0	1	01	01	H5431_013_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	016	0	1	01	01	H5431_016_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	017	0	1	01	01	H5431_017_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	018	0	1	01	01	H5431_018_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	019	0	1	01	01	H5431_019_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	020	0	1	01	01	H5431_020_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	021	0	1	01	01	H5431_021_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5431	022	0	1	01	01	H5431_022_0	6	1																																																2	001	2				2				2			2		1	0.00	0.00	1	2																																																												
H5521	116	0	1	04	01	H5521_116_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	171	0	1	04	01	H5521_171_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	178	0	1	04	01	H5521_178_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	216	0	1	04	01	H5521_216_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	218	0	1	04	01	H5521_218_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	220	0	1	04	01	H5521_220_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	222	0	1	04	01	H5521_222_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	224	0	1	04	01	H5521_224_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	227	0	1	04	01	H5521_227_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	229	0	1	04	01	H5521_229_0	4	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	230	0	1	04	01	H5521_230_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	232	0	1	04	01	H5521_232_0	6	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	233	0	1	04	01	H5521_233_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	234	0	1	04	01	H5521_234_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	326	0	1	04	01	H5521_326_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	360	0	1	04	01	H5521_360_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	360	0	1	04	01	H5521_360_0	7	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	364	0	1	04	01	H5521_364_0	7	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	364	0	1	04	01	H5521_364_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	365	0	1	04	01	H5521_365_0	7	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	365	0	1	04	01	H5521_365_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	366	0	1	04	01	H5521_366_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	366	0	1	04	01	H5521_366_0	7	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	467	0	1	04	01	H5521_467_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	470	0	1	04	01	H5521_470_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	471	0	1	04	01	H5521_471_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	472	0	1	04	01	H5521_472_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	473	0	1	04	01	H5521_473_0	6	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	474	0	1	04	01	H5521_474_0	7	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	474	0	1	04	01	H5521_474_0	7	1																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H5521	801	0	1	04	01	H5521_801_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	801	0	1	04	01	H5521_801_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	802	0	1	04	01	H5521_802_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	802	0	1	04	01	H5521_802_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	805	0	2	04	01	H5521_805_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	805	0	2	04	01	H5521_805_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	806	0	2	04	01	H5521_806_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	806	0	2	04	01	H5521_806_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	809	0	1	04	01	H5521_809_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	809	0	1	04	01	H5521_809_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	810	0	1	04	01	H5521_810_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	810	0	1	04	01	H5521_810_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	812	0	1	04	01	H5521_812_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	812	0	1	04	01	H5521_812_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	814	0	2	04	01	H5521_814_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	814	0	2	04	01	H5521_814_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	815	0	2	04	01	H5521_815_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	815	0	2	04	01	H5521_815_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	816	0	2	04	01	H5521_816_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	816	0	2	04	01	H5521_816_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	817	0	1	04	01	H5521_817_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	817	0	1	04	01	H5521_817_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	818	0	2	04	01	H5521_818_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	818	0	2	04	01	H5521_818_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	819	0	1	04	01	H5521_819_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	819	0	1	04	01	H5521_819_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	820	0	1	04	01	H5521_820_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	820	0	1	04	01	H5521_820_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	821	0	1	04	01	H5521_821_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	821	0	1	04	01	H5521_821_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	822	0	1	04	01	H5521_822_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	822	0	1	04	01	H5521_822_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	823	0	2	04	01	H5521_823_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	823	0	2	04	01	H5521_823_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	824	0	2	04	01	H5521_824_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	824	0	2	04	01	H5521_824_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	825	0	1	04	01	H5521_825_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	825	0	1	04	01	H5521_825_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	826	0	2	04	01	H5521_826_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	826	0	2	04	01	H5521_826_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	827	0	2	04	01	H5521_827_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	827	0	2	04	01	H5521_827_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	828	0	2	04	01	H5521_828_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	828	0	2	04	01	H5521_828_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	829	0	1	04	01	H5521_829_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	829	0	1	04	01	H5521_829_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	830	0	2	04	01	H5521_830_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	830	0	2	04	01	H5521_830_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	831	0	1	04	01	H5521_831_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	831	0	1	04	01	H5521_831_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	832	0	1	04	01	H5521_832_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	832	0	1	04	01	H5521_832_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	833	0	1	04	01	H5521_833_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	833	0	1	04	01	H5521_833_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	834	0	1	04	01	H5521_834_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	834	0	1	04	01	H5521_834_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	835	0	2	04	01	H5521_835_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	835	0	2	04	01	H5521_835_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	836	0	1	04	01	H5521_836_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5521	836	0	1	04	01	H5521_836_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	837	0	1	04	01	H5521_837_0	7	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5521	837	0	1	04	01	H5521_837_0	7	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	001	0	1	04	01	H5522_001_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H5522	002	0	1	04	01	H5522_002_0	7	2																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5522	002	0	1	04	01	H5522_002_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H5522	005	0	1	04	01	H5522_005_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2		2	001	2				2				2			2		1	0.00	0.00	2	2	Reminder Device	2	2				2				2			2		1	0.00	0.00	2	2																																								
H5522	802	0	1	04	01	H5522_802_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	802	0	1	04	01	H5522_802_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	803	0	1	04	01	H5522_803_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	803	0	1	04	01	H5522_803_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	808	0	2	04	01	H5522_808_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	808	0	2	04	01	H5522_808_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	809	0	2	04	01	H5522_809_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	809	0	2	04	01	H5522_809_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	810	0	1	04	01	H5522_810_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	810	0	1	04	01	H5522_810_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	811	0	1	04	01	H5522_811_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	811	0	1	04	01	H5522_811_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	813	0	2	04	01	H5522_813_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	813	0	2	04	01	H5522_813_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	814	0	2	04	01	H5522_814_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	814	0	2	04	01	H5522_814_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	815	0	1	04	01	H5522_815_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	815	0	1	04	01	H5522_815_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	816	0	1	04	01	H5522_816_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	816	0	1	04	01	H5522_816_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	817	0	2	04	01	H5522_817_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	817	0	2	04	01	H5522_817_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	818	0	2	04	01	H5522_818_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	818	0	2	04	01	H5522_818_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	819	0	1	04	01	H5522_819_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	819	0	1	04	01	H5522_819_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	820	0	1	04	01	H5522_820_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	820	0	1	04	01	H5522_820_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	821	0	1	04	01	H5522_821_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	821	0	1	04	01	H5522_821_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	822	0	2	04	01	H5522_822_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	822	0	2	04	01	H5522_822_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	823	0	1	04	01	H5522_823_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	823	0	1	04	01	H5522_823_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	824	0	2	04	01	H5522_824_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	824	0	2	04	01	H5522_824_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	825	0	2	04	01	H5522_825_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	825	0	2	04	01	H5522_825_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	826	0	2	04	01	H5522_826_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	826	0	2	04	01	H5522_826_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	827	0	2	04	01	H5522_827_0	6	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	827	0	2	04	01	H5522_827_0	6	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	828	0	1	04	01	H5522_828_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	828	0	1	04	01	H5522_828_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	829	0	2	04	01	H5522_829_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	829	0	2	04	01	H5522_829_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	830	0	1	04	01	H5522_830_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	830	0	1	04	01	H5522_830_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	831	0	1	04	01	H5522_831_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	831	0	1	04	01	H5522_831_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	832	0	1	04	01	H5522_832_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	832	0	1	04	01	H5522_832_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	833	0	1	04	01	H5522_833_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	833	0	1	04	01	H5522_833_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	834	0	2	04	01	H5522_834_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	834	0	2	04	01	H5522_834_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	835	0	1	04	01	H5522_835_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	835	0	1	04	01	H5522_835_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5522	836	0	1	04	01	H5522_836_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H5522	836	0	1	04	01	H5522_836_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H5525	017	0	1	04	01	H5525_017_0	5	1																										1	2	1	40.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	40.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	40.00	7		2				2			2		2			2	2																				
H5525	030	0	1	04	01	H5525_030_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5525	034	0	1	04	01	H5525_034_0	5	1																																															1	2	011	2				2				2			2		2			1	2																																																												
H5525	036	0	1	04	01	H5525_036_0	6	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5525	036	0	1	04	01	H5525_036_0	6	1																										1	2	1	250.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	250.00	7		2				2			2		2			2	2	Living Expense Support	2	1	250.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	250.00	7		2				2			2		2			2	2
H5525	041	0	1	04	01	H5525_041_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5525	042	0	1	04	01	H5525_042_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5525	045	0	1	04	01	H5525_045_0	6	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5525	045	0	1	04	01	H5525_045_0	6	2																										1	2	1	100	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100	7		2				2			2		2			2	2	Living Expense Support	2	1	100	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100	7		2				2			2		2			2	2
H5525	046	0	1	04	01	H5525_046_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5525	046	0	1	04	01	H5525_046_0	5	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H5525	053	0	1	04	01	H5525_053_0	7	1																										1	2	1	110.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	110.00	7		2				2			2		2			2	2	Living Expense Support	2	1	110.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	110.00	7		2				2			2		2			2	2
H5525	053	0	1	04	01	H5525_053_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5525	070	0	1	04	01	H5525_070_0	5	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2																				
H5525	072	0	1	04	01	H5525_072_0	7	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H5525	072	0	1	04	01	H5525_072_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5525	073	0	1	04	01	H5525_073_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5525	073	0	1	04	01	H5525_073_0	7	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H5533	003	0	1	04	01	H5533_003_0	9	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	005	0	1	04	01	H5533_005_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	008	0	1	04	01	H5533_008_0	9	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	009	0	1	04	01	H5533_009_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	011	0	1	04	01	H5533_011_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	012	0	1	04	01	H5533_012_0	9	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	013	0	1	04	01	H5533_013_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	015	1	1	04	01	H5533_015_1	11	1																																																2	011	2				2				2			2		2			2	2																																																												
H5533	015	2	1	04	01	H5533_015_2	11	1																																																2	011	2				2				2			2		2			2	2																																																												
H5591	003	0	1	01	01	H5591_003_0	4	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	005	0	1	02	01	H5591_005_0	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	006	1	1	02	01	H5591_006_1	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	006	2	1	02	01	H5591_006_2	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	006	4	1	02	01	H5591_006_4	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	006	5	1	02	01	H5591_006_5	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	009	0	1	02	01	H5591_009_0	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	013	0	1	02	01	H5591_013_0	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	015	1	1	02	01	H5591_015_1	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5591	015	2	1	02	01	H5591_015_2	6	1	1	1	2	1				2				2				2			2		2			2	1																																																																																																						
H5593	801	0	1	01	01	H5593_801_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5593	801	0	1	01	01	H5593_801_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H5593	802	0	1	01	01	H5593_802_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5593	802	0	1	01	01	H5593_802_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H5608	001	0	1	01	01	H5608_001_0	9	1																										1	2	1	135.00	1		2				2		2			2		2			2																																																																																	
H5608	002	0	1	01	01	H5608_002_0	9	1																										1	2	1	135.00	1		2				2		2			2		2			2																																																																																	
H5619	001	0	1	01	01	H5619_001_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H5619	003	0	1	01	01	H5619_003_0	6	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H5619	038	0	1	01	01	H5619_038_0	6	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Living Expense Support	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2
H5619	046	0	1	01	01	H5619_046_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	049	0	1	02	01	H5619_049_0	5	1																										1	2	1	45.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	45.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	45.00	7		2				2			2		2			2	2																				
H5619	054	0	1	02	01	H5619_054_0	5	1																										1	2	1	250.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	250.00	7		2				2			2		2			2	2	Living Expense Support	2	1	250.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	250.00	7		2				2			2		2			2	2
H5619	054	0	1	02	01	H5619_054_0	5	2	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	055	0	1	01	01	H5619_055_0	5	1																										1	2	1	35	7	1	2				1	1	2			2		2			2																																																																																	
H5619	057	0	1	01	01	H5619_057_0	8	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	057	0	1	01	01	H5619_057_0	8	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	059	0	1	01	01	H5619_059_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	061	0	1	01	01	H5619_061_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	061	0	1	01	01	H5619_061_0	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	063	0	1	01	01	H5619_063_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	065	0	1	01	01	H5619_065_0	8	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5619	066	0	1	01	01	H5619_066_0	5	1																																																2	001	2				2				2			2		2			1	2																																																												
H5619	071	0	1	01	01	H5619_071_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	075	0	1	01	01	H5619_075_0	5	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Living Expense Support	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2
H5619	075	0	1	01	01	H5619_075_0	5	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5619	082	0	1	01	01	H5619_082_0	7	1																										1	2	1	175	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175	7		2				2			2		2			2	2	Living Expense Support	2	1	175	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175	7		2				2			2		2			2	2
H5619	082	0	1	01	01	H5619_082_0	7	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	093	0	1	01	01	H5619_093_0	5	1																										1	2	1	125	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125	7		2				2			2		2			2	2	Living Expense Support	2	1	125	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H5619	100	0	1	01	01	H5619_100_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	100	0	1	01	01	H5619_100_0	7	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	113	0	1	02	01	H5619_113_0	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	123	0	1	02	01	H5619_123_0	5	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H5619	126	0	1	02	01	H5619_126_0	7	2	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	126	0	1	02	01	H5619_126_0	7	1																										1	2	1	70.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	70.00	7		2				2			2		2			2	2	Living Expense Support	2	1	70.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	70.00	7		2				2			2		2			2	2
H5619	134	0	1	01	01	H5619_134_0	7	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	134	0	1	01	01	H5619_134_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5619	136	1	1	01	01	H5619_136_1	5	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H5619	136	2	1	01	01	H5619_136_2	5	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H5619	136	2	1	01	01	H5619_136_2	5	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	136	3	1	01	01	H5619_136_3	5	1																										1	2	1	125	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125	7		2				2			2		2			2	2	Living Expense Support	2	1	125	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H5619	136	4	1	01	01	H5619_136_4	7	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	136	4	1	01	01	H5619_136_4	7	2	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	136	4	1	01	01	H5619_136_4	7	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125.00	7		2				2			2		2			2	2	Living Expense Support	2	1	125.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125.00	7		2				2			2		2			2	2
H5619	137	0	1	01	01	H5619_137_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H5619	145	0	1	01	01	H5619_145_0	8	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	3800.00	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	145	0	1	01	01	H5619_145_0	8	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	152	0	1	01	01	H5619_152_0	6	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	153	0	1	01	01	H5619_153_0	7	3	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H5619	153	0	1	01	01	H5619_153_0	7	2																										1	2	1	25	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	25	7		2				2			2		2			2	2	Living Expense Support	2	1	25	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	25	7		2				2			2		2			2	2
H5619	153	0	1	01	01	H5619_153_0	7	1																										1	2	1	200	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200	7		2				2			2		2			2	2	Living Expense Support	2	1	200	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200	7		2				2			2		2			2	2
H5619	154	0	1	01	01	H5619_154_0	5	1	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1600.00	3		2				1	1	2			2		2			1		2	011	2				2				2			2		2			1	2	Transitional care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	155	0	1	01	01	H5619_155_0	5	3																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	155	0	1	01	01	H5619_155_0	5	1																										1	2	1	185.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	185.00	7		2				2			2		2			2	2	Living Expense Support	2	1	185.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	185.00	7		2				2			2		2			2	2
H5619	156	0	1	02	01	H5619_156_0	5	1																										1	2	1	100.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H5619	157	0	1	01	01	H5619_157_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H5619	158	0	1	02	01	H5619_158_0	5	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H5619	160	0	1	01	01	H5619_160_0	7	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H5619	161	0	1	01	01	H5619_161_0	6	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																																																																																	
H5619	162	0	1	02	01	H5619_162_0	5	2	1	1	2	1				1	1000.00	3		2				2			2		2			1	2	1	2	1	1000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	162	0	1	02	01	H5619_162_0	5	1																										1	2	1	145.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	145.00	7		2				2			2		2			2	2	Living Expense Support	2	1	145.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	145.00	7		2				2			2		2			2	2
H5619	163	0	1	01	01	H5619_163_0	5	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5619	163	0	1	01	01	H5619_163_0	5	1																										1	2	1	180.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	180.00	7		2				2			2		2			2	2	Living Expense Support	2	1	180.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	180.00	7		2				2			2		2			2	2
H5619	164	0	1	01	01	H5619_164_0	5	1																										1	2	1	65.00	7	1	2				1	1	2			2		2			2																																																																																	
H5628	001	0	1	01	01	H5628_001_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5628	007	0	1	01	01	H5628_007_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5628	008	0	1	01	01	H5628_008_0	4	2																																																2	001	2				2				2			2		2			1	2																																																												
H5628	008	0	1	01	01	H5628_008_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5628	010	0	1	01	01	H5628_010_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5628	011	0	1	01	01	H5628_011_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5628	012	0	1	01	01	H5628_012_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5649	001	0	1	01	01	H5649_001_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	002	0	1	01	01	H5649_002_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	006	0	1	01	01	H5649_006_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	008	0	1	01	01	H5649_008_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	009	0	1	01	01	H5649_009_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	018	0	1	01	01	H5649_018_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	019	0	1	01	01	H5649_019_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	020	1	1	01	01	H5649_020_1	9	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	020	2	1	01	01	H5649_020_2	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	021	1	1	01	01	H5649_021_1	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5649	021	2	1	01	01	H5649_021_2	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H5774	003	0	1	01	01	H5774_003_0	4	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																																																																																	
H5774	005	0	1	01	01	H5774_005_0	5	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H5774	026	0	1	01	01	H5774_026_0	4	3																										1	2	1	165.00	7	1	2				1	1	2			2		2			2																																																																																	
H5774	035	0	1	01	01	H5774_035_0	5	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																																																																																	
H5774	036	0	1	01	01	H5774_036_0	5	1																										1	2	1	75.00	7	1	2				1		2			2		2			2																																																																																	
H5774	040	0	1	01	01	H5774_040_0	4	1																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																																																																																	
H5793	801	0	1	01	01	H5793_801_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H5793	801	0	1	01	01	H5793_801_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5793	802	0	1	01	01	H5793_802_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H5793	802	0	1	01	01	H5793_802_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H5810	014	0	1	01	01	H5810_014_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5823	006	0	1	01	01	H5823_006_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5823	010	0	1	01	01	H5823_010_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5823	012	1	1	01	01	H5823_012_1	7	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5823	012	2	1	01	01	H5823_012_2	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5826	006	0	1	01	01	H5826_006_0	3	3																										1	2	2				2				2		2			2		2			2																																																																																	
H5826	008	0	1	01	01	H5826_008_0	4	3																										1	2	2				2				2		2			2		2			2																																																																																	
H5826	009	0	1	01	01	H5826_009_0	4	3																										1	2	2				2				2		2			2		2			2																																																																																	
H5826	010	0	1	01	01	H5826_010_0	4	1																										1	2	2				2				2		2			2		2			2																																																																																	
H5826	014	0	1	01	01	H5826_014_0	5	4																										1	2	1	100.00	7	2	2				2		2			2		2			2																																																																																	
H5826	014	0	1	01	01	H5826_014_0	5	3																										1	2	2				2				2		2			2		2			2																																																																																	
H5826	016	0	1	01	01	H5826_016_0	4	3																										1	2	2				2				2		2			2		2			2																																																																																	
H5826	017	0	1	01	01	H5826_017_0	5	3																										1	2	2				2				2		2			2		2			2																																																																																	
H5843	001	0	1	01	01	H5843_001_0	8	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H5843	002	0	1	01	01	H5843_002_0	10	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H5843	005	0	1	01	01	H5843_005_0	7	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H5859	001	0	1	02	01	H5859_001_0	9	2																										1	2	2				2				2		2			2		2			2																																																																																	
H5926	001	0	1	01	01	H5926_001_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5926	005	0	1	01	01	H5926_005_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5926	006	0	1	01	01	H5926_006_0	6	1																																																																					2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5937	001	0	1	01	01	H5937_001_0	9	2	1	1	2	2	12	3		2				2				2			2		2			2	2																																																																																																						
H5969	002	0	1	01	01	H5969_002_0	3	1																										1	2	1	70.00	7	2	2				2		2			2		2			1																						Groceries and utilities	2	1	70.00	6	The maximum plan benefit coverage amount of $70 is per month and is shared with the OTC benefit.	2				2			2		2			2	2																																								
H5969	003	0	1	01	01	H5969_003_0	3	1																										1	2	1	70.00	7	2	2				2		2			2		2			1																						Groceries and utilities	2	1	70.00	6	The maximum plan benefit coverage amount of $70 is per month and is shared with the OTC benefit.	2				2			2		2			2	2																																								
H5970	020	0	1	04	01	H5970_020_0	7	2																										1	2	1	200	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200	7		2				2			2		2			2	2	Living Expense Support	2	1	200	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200	7		2				2			2		2			2	2
H5970	020	0	1	04	01	H5970_020_0	7	1	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H5970	026	0	1	04	01	H5970_026_0	8	1																										1	2	1	200.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	200.00	7		2				2			2		2			2	2	Living Expense Support	2	1	200.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	200.00	7		2				2			2		2			2	2
H5991	010	0	1	01	01	H5991_010_0	11	1																										1	2	1	20.00	7	2	2				1	1	2			2		2			1																																																																																	
H5991	012	2	1	01	01	H5991_012_2	11	1																										1	2	1	60.00	7	2	2				1	1	2			2		2			1																																																																																	
H5992	007	0	1	01	01	H5992_007_0	8	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5992	009	1	1	01	01	H5992_009_1	8	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H5992	009	2	1	01	01	H5992_009_2	9	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H6067	001	1	1	01	01	H6067_001_1	7	1																										1	2	2				2				2		2			2		2			2																						Additional Diabetic Supplies	2	2				2				2			2		2			2	2																																								
H6067	001	2	1	01	01	H6067_001_2	7	1																										1	2	2				2				2		2			2		2			2																						Additional Diabetic Supplies	2	2				2				2			2		2			2	2																																								
H6067	002	1	1	01	01	H6067_002_1	7	1																										1	2	2				2				2		2			2		2																									Additional Diabetic Supplies	2	2				2				2			2		2			2	2																																								
H6067	002	2	1	01	01	H6067_002_2	7	1																										1	2	2				2				2		2			2		2																									Additional Diabetic Supplies	2	2				2				2			2		2			2	2																																								
H6170	001	0	1	01	01	H6170_001_0	7	1																																																																																									2	2				2				2			2		2			1	2																				
H6170	002	0	1	01	01	H6170_002_0	7	1																																																																																									2	2				2				2			2		2			1	2																				
H6170	003	0	1	01	01	H6170_003_0	7	1																																																																																									2	2				2				2			2		2			1	2																				
H6396	005	0	1	01	01	H6396_005_0	7	1																										1	2	2			2	2				1	1	2			2		2			1																																																																																	
H6396	014	0	1	01	01	H6396_014_0	7	1																										1	2	2			2	2				1	1	2			2		2			1																																																																																	
H6396	015	0	1	01	01	H6396_015_0	7	1																										1	2	2			2	2				1	1	2			2		2			1																																																																																	
H6474	001	0	1	01	01	H6474_001_0	7	1																																																																																									2	2				2				2			2		2			1	2																				
H6474	002	0	1	01	01	H6474_002_0	7	1																																																																																									2	2				2				2			2		2			1	2																				
H6474	003	0	1	01	01	H6474_003_0	7	1																																																																																									2	2				2				2			2		2			1	2																				
H6502	002	0	1	04	01	H6502_002_0	7	3																																																																				Supplemental PT	2	2				2				2			2		2			2	2																																								
H6502	004	0	1	04	01	H6502_004_0	7	3																																																																				Supplemental PT	2	2				2				2			2		2			2	2																																								
H6502	005	0	1	04	01	H6502_005_0	7	3																																																																				Supplemental PT	2	2				2				2			2		2			2	2																																								
H6595	003	0	1	02	01	H6595_003_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	68.00	7		2				2			2		1	0.00	0.00	2	2																																								
H6595	004	0	1	02	01	H6595_004_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	174.00	7		2				2			2		1	0.00	0.00	2	2																																								
H6622	004	0	1	01	01	H6622_004_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	008	0	1	01	01	H6622_008_0	8	1																										1	2	1	75	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75	7		2				2			2		2			2	2	Living Expense Support	2	1	75	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75	7		2				2			2		2			2	2
H6622	008	0	1	01	01	H6622_008_0	8	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H6622	010	0	1	02	01	H6622_010_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H6622	013	0	1	02	01	H6622_013_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	013	0	1	02	01	H6622_013_0	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H6622	014	0	1	02	01	H6622_014_0	5	1																										1	2	1	45.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	45.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	45.00	7		2				2			2		2			2	2																				
H6622	015	0	1	01	01	H6622_015_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	015	0	1	01	01	H6622_015_0	5	1																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H6622	017	0	1	01	01	H6622_017_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	017	0	1	01	01	H6622_017_0	5	1																										1	2	1	35	7	2	2				1	1	2			2		2			2																																																																																	
H6622	018	0	1	01	01	H6622_018_0	5	1																										1	2	1	175.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175.00	7		2				2			2		2			2	2	Living Expense Support	2	1	175.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175.00	7		2				2			2		2			2	2
H6622	019	0	1	01	01	H6622_019_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	021	1	1	02	01	H6622_021_1	5	1																										1	2	1	25.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	25.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	25.00	7		2				2			2		2			2	2																				
H6622	021	2	1	02	01	H6622_021_2	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	021	2	1	02	01	H6622_021_2	5	1																										1	2	1	40.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	40.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	40.00	7		2				2			2		2			2	2																				
H6622	022	0	1	02	01	H6622_022_0	5	1																										1	2	1	125.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	45.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	45.00	7		2				2			2		2			2	2																				
H6622	027	0	1	02	01	H6622_027_0	8	1																										1	2	1	175.00	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175.00	6	$175 loaded on a prepaid card every month to spend on food and produce, home supplies, personal wellness care, indoor air quality equipment and services, and pet care/supplies.	2				2			2		2			2	2	Living Expense Support	2	1	175.00	6	$175 on a prepaid card every mnth to on general supprts for living includg rent and mortgage assist, pest control, non-medical transport, disaster relief kits, utilities, internet service  and act exp	2				2			2		2			2	2	Aging Support and Safety Products	2	1	175.00	6	$175 loaded on a prepaid card every month to spend on robotic pets, speech/language assistive devices, and weighted mugs and utensils.	2				2			2		2			2	2
H6622	027	0	1	02	01	H6622_027_0	8	2	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H6622	028	0	1	01	01	H6622_028_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	029	0	1	01	01	H6622_029_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	030	0	1	01	01	H6622_030_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	035	0	1	01	01	H6622_035_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H6622	036	0	1	01	01	H6622_036_0	5	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H6622	037	0	1	01	01	H6622_037_0	7	1	1	1	2	1				1	500	3		2				2			2		2			1	2	1	2	1	500	3		2				1	1	2			2		2			1																						Transitional Care	2	1	500	3		2				2			2		2			1	2																																								
H6622	048	0	1	01	01	H6622_048_0	5	1																										1	2	1	175	7	2	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175	7		2				2			2		2			2	2	Living Expense Support	2	1	175	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175	7		2				2			2		2			2	2
H6622	051	0	1	01	01	H6622_051_0	5	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H6622	051	0	1	01	01	H6622_051_0	5	2																																																2	011	2				2				2			2		2			1	2																																																												
H6622	055	0	1	01	01	H6622_055_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	056	0	1	01	01	H6622_056_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	060	0	1	02	01	H6622_060_0	5	1																										1	2	1	50	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50	7		2				2			2		2			2	2																				
H6622	063	0	1	01	01	H6622_063_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H6622	071	0	1	01	01	H6622_071_0	7	2																																																																				Facility Referred	2	2				2				2			2		2			1	2																																								
H6622	071	0	1	01	01	H6622_071_0	7	1																										1	2	1	35.00	7	1	2				1	1	2			2		2			2																																																																																	
H6622	078	1	1	01	01	H6622_078_1	8	1																										1	2	1	170.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	170.00	7		2				2			2		2			2	2	Living Expense Support	2	1	170.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	170.00	7		2				2			2		2			2	2
H6622	078	1	1	01	01	H6622_078_1	8	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H6622	078	2	1	01	01	H6622_078_2	8	2	1	1	2	1				1	1000	3		2				2			2		2			1	2	1	2	1	1000	3		2				1	1	2			2		2			1																						Transitional Care	2	1	1000	3		2				2			2		2			1	2																																								
H6622	078	2	1	01	01	H6622_078_2	8	1																										1	2	1	150	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150	7		2				2			2		2			2	2	Living Expense Support	2	1	150	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150	7		2				2			2		2			2	2
H6622	079	0	1	01	01	H6622_079_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	079	0	1	01	01	H6622_079_0	5	1																										1	2	1	125	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	125	7		2				2			2		2			2	2	Living Expense Support	2	1	125	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	125	7		2				2			2		2			2	2
H6622	081	0	1	01	01	H6622_081_0	5	1																																																2	011	2				2				2			2		2			1	2																																																												
H6622	082	0	1	01	01	H6622_082_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	083	0	1	01	01	H6622_083_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	084	0	1	01	01	H6622_084_0	5	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																																																																																	
H6622	085	0	1	01	01	H6622_085_0	5	2																										1	2	1	50.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	50.00	7		2				2			2		2			2	2																				
H6622	085	0	1	01	01	H6622_085_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	086	0	1	01	01	H6622_086_0	5	2																																																2	010	2				2				2			2		2			1	2																																																												
H6622	086	0	1	01	01	H6622_086_0	5	1																										1	2	1	75.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2	Living Expense Support	2	1	75.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	75.00	7		2				2			2		2			2	2
H6622	087	0	1	01	01	H6622_087_0	6	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H6622	087	0	1	01	01	H6622_087_0	6	1																										1	2	1	250.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	250.00	7		2				2			2		2			2	2	Living Expense Support	2	1	250.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	250.00	7		2				2			2		2			2	2
H6622	088	0	1	02	01	H6622_088_0	7	1	1	1	2	1				1	3000.00	3		2				2			2		2			1	2	1	2	1	3000.00	3		2				1	1	2			2		2			1																						Transitional Care	2	1	3000.00	3		2				2			2		2			1	2																																								
H6874	001	0	1	04	01	H6874_001_0	13	1																																																2	011	2				2				2			2		2			2	2																																																												
H6874	003	0	1	04	01	H6874_003_0	6	1																																																2	011	2				2				2			2		2			2	2																																																												
H6988	001	0	1	01	01	H6988_001_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H6988	002	0	1	01	01	H6988_002_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H6988	004	0	1	01	01	H6988_004_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H7123	001	0	1	01	01	H7123_001_0	9	1																										1	2	2				2				1	1	2			2		2			1																																																																																	
H7149	801	0	1	01	01	H7149_801_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H7149	801	0	1	01	01	H7149_801_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H7149	802	0	1	01	01	H7149_802_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H7149	802	0	1	01	01	H7149_802_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H7172	001	0	1	48	05	H7172_001_0	3	1																																																																				Flex Card	2	1	50.00	7		2				2			2		2			1	2																																								
H7220	002	0	1	01	01	H7220_002_0	2	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	004	0	1	02	01	H7220_004_0	4	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	009	1	1	01	01	H7220_009_1	3	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	009	2	1	01	01	H7220_009_2	3	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	009	3	1	01	01	H7220_009_3	3	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	010	0	1	01	01	H7220_010_0	3	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	011	0	1	02	01	H7220_011_0	3	1																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	012	0	1	01	01	H7220_012_0	3	2																																																																				Hospital at Home	2	2				2				2			2		2			1	2																																								
H7220	012	0	1	01	01	H7220_012_0	3	1																																																2	001	2				2				2			2		2			1	2																																																												
H7273	001	0	1	04	01	H7273_001_0	10	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H7273	002	0	1	04	01	H7273_002_0	9	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H7273	005	0	1	04	01	H7273_005_0	9	1																																																																				Exercise Physiologist for Dial into Diabetes (DID)	2	2				2				2			2		2			2	2																																								
H7284	003	0	1	04	01	H7284_003_0	5	1																										1	2	1	100.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2	Living Expense Support	2	1	100.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	100.00	7		2				2			2		2			2	2
H7284	008	0	1	04	01	H7284_008_0	5	2																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
H7284	010	0	1	04	01	H7284_010_0	6	2																										1	2	1	150.00	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	150.00	7		2				2			2		2			2	2	Living Expense Support	2	1	150.00	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	150.00	7		2				2			2		2			2	2
H7301	002	0	1	04	01	H7301_002_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H7301	006	0	1	04	01	H7301_006_0	7	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H7301	801	0	1	04	01	H7301_801_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H7301	801	0	1	04	01	H7301_801_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H7301	803	0	1	04	01	H7301_803_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H7301	803	0	1	04	01	H7301_803_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H7464	001	0	1	02	01	H7464_001_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	264.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	005	0	1	02	01	H7464_005_0	4	2																																																																																																												VBID Pest Control	2	1	450.00	5		2				2			2		1	0.00	0.00	2	2
H7464	005	0	1	02	01	H7464_005_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	359.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	006	0	1	02	01	H7464_006_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	120.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	007	0	1	02	01	H7464_007_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	309.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	008	1	1	02	01	H7464_008_1	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	110.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	008	2	1	02	01	H7464_008_2	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	130.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	010	0	1	01	01	H7464_010_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	209.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	011	0	1	02	01	H7464_011_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	60.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	012	0	1	02	01	H7464_012_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	79.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7464	013	0	1	02	01	H7464_013_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	59.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7557	001	0	1	01	01	H7557_001_0	7	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H7559	001	0	1	01	01	H7559_001_0	9	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H7559	002	0	1	01	01	H7559_002_0	9	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H7559	003	0	1	01	01	H7559_003_0	11	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H7607	002	1	1	01	01	H7607_002_1	15	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	002	2	1	01	01	H7607_002_2	15	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	002	3	1	01	01	H7607_002_3	15	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	002	4	1	01	01	H7607_002_4	15	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	002	5	1	01	01	H7607_002_5	15	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	007	1	1	01	01	H7607_007_1	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	007	2	1	01	01	H7607_007_2	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	007	3	1	01	01	H7607_007_3	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	007	4	1	01	01	H7607_007_4	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	007	5	1	01	01	H7607_007_5	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	008	1	1	01	01	H7607_008_1	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	008	2	1	01	01	H7607_008_2	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	008	3	1	01	01	H7607_008_3	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	008	4	1	01	01	H7607_008_4	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	008	5	1	01	01	H7607_008_5	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	011	1	1	01	01	H7607_011_1	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	011	2	1	01	01	H7607_011_2	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	011	4	1	01	01	H7607_011_4	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7607	011	5	1	01	01	H7607_011_5	16	1																																																2	001	2				2				2			2		2			1	1																																																												
H7678	001	0	1	01	01	H7678_001_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H7678	004	0	1	01	01	H7678_004_0	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H7778	001	0	1	01	01	H7778_001_0	5	2																																																																																								VBID Transportation to Non-Benefit Related Locations	2	2				2				2			2		1	0.00	0.00	2	2																				
H7778	001	0	1	01	01	H7778_001_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	225.00	7		2				2			2		1	0.00	0.00	2	2																																								
H7778	001	0	1	01	01	H7778_001_0	5	3																																																																																																												VBID Pest Control	2	1	150.00	5		2				2			2		1	0.00	0.00	2	2
H8026	001	0	1	48	05	H8026_001_0	3	1																																																																				Flex card	2	1	50.00	7		2				2			2		2			1	2																																								
H8145	004	0	1	09	04	H8145_004_0	4	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8145	032	0	1	09	04	H8145_032_0	4	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8145	042	0	1	09	04	H8145_042_0	8	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8145	069	0	1	09	04	H8145_069_0	5	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8145	084	0	1	09	04	H8145_084_0	11	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8145	122	0	1	09	04	H8145_122_0	4	1																																																2	011	2				2				2			2		2																																																																
H8145	123	0	1	09	04	H8145_123_0	4	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8145	126	0	1	09	04	H8145_126_0	4	1																																																																				Provider Referred	2	2				2				2			2		2																																												
H8176	001	0	1	01	01	H8176_001_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H8176	003	0	1	01	01	H8176_003_0	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H8298	001	0	1	01	01	H8298_001_0	9	1																										1	2	2				2				2		2			2		2			2																																																																																	
H8330	001	0	1	01	01	H8330_001_0	8	1																										1	2	2			2	2				1	1	2			2		2			1																																																																																	
H8330	002	0	1	01	01	H8330_002_0	8	1																										1	2	2			2	2				1	1	2			2		2			1																																																																																	
H8332	001	0	1	01	01	H8332_001_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H8332	002	0	1	01	01	H8332_002_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H8332	003	0	1	01	01	H8332_003_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H8332	004	0	1	01	01	H8332_004_0	8	1																										1	2	2				2				2		2			2		1	0.00	0.00	2																																																																																	
H8332	801	0	1	01	01	H8332_801_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H8332	801	0	1	01	01	H8332_801_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H8332	802	0	1	01	01	H8332_802_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H8332	802	0	1	01	01	H8332_802_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H8379	001	0	1	01	01	H8379_001_0	8	1																										1	2	1	0.00	5	2	2				1	1	2			2		2			1																																																																																	
H8379	002	0	1	01	01	H8379_002_0	9	1																										1	2	1	0.00	7	2	2				1	1	2			2		2			1																																																																																	
H8385	001	0	1	04	01	H8385_001_0	7	1																																															1	2	111	2				2				2			2		2			2	1																																																												
H8385	002	0	1	04	01	H8385_002_0	8	1																																																2	111	2				2				2			2		2			2	1																																																												
H8385	003	0	1	04	01	H8385_003_0	7	1																																															1	2	111	2				2				2			2		2			2	1																																																												
H8385	004	0	1	04	01	H8385_004_0	8	1																																															1	2	111	2				2				2			2		2			2	1																																																												
H8578	001	0	1	01	01	H8578_001_0	9	1																																																																					2	2				2				2			2		2			2	2																																								
H8578	003	0	1	01	01	H8578_003_0	7	1																																																																					2	2				2				2			2		2			2	2																																								
H8578	004	0	1	01	01	H8578_004_0	9	1																																																																					2	2				2				2			2		2			2	2																																								
H8578	009	0	1	01	01	H8578_009_0	7	1																																																																					2	2				2				2			2		2			2	2																																								
H8578	012	0	1	01	01	H8578_012_0	9	1																																																																					2	2				2				2			2		2			2	2																																								
H8578	018	0	1	01	01	H8578_018_0	10	1																																																																					2	2				2				2			2		2			2	2																																								
H8597	002	0	1	01	01	H8597_002_0	8	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H8597	003	0	1	01	01	H8597_003_0	8	2																										1	2	2				2				1	1	2			2		1	0.00	0.00	1																																																																																	
H8649	801	0	1	01	01	H8649_801_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H8649	801	0	1	01	01	H8649_801_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H8649	803	0	1	01	01	H8649_803_0	5	1	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1																																																												
H8649	803	0	1	01	01	H8649_803_0	5	2	1	1	2	1				2				2				2			2		2			2	1	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1	Non-Medicare (Other)	2	2				2				2			2		2			2	1																				
H8783	001	0	1	04	01	H8783_001_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H8783	002	0	1	04	01	H8783_002_0	9	1																																																2	011	2				2				2			2		2			2	2																																																												
H8783	003	0	1	04	01	H8783_003_0	10	1																																																2	011	2				2				2			2		2			2	2																																																												
H8845	001	0	1	01	01	H8845_001_0	4	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H8845	002	0	1	01	01	H8845_002_0	7	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H8854	002	0	1	01	01	H8854_002_0	6	1																																																2	001	2				2				2			2		2			1	2																																																												
H8889	001	0	1	04	01	H8889_001_0	6	1																																																2	111	2				2				2			2		2			2	2	Osteoporosis Services	2	2				2				2			2		2			2	2																																								
H8889	002	0	1	04	01	H8889_002_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	003	0	1	04	01	H8889_003_0	6	1																																																2	111	2				2				2			2		2			2	2	Osteoporosis Services	2	2				2				2			2		2			2	2																																								
H8889	004	0	1	04	01	H8889_004_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	005	0	1	04	01	H8889_005_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	008	0	1	04	01	H8889_008_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	009	0	1	04	01	H8889_009_0	4	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	010	0	1	04	01	H8889_010_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	011	0	1	04	01	H8889_011_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	012	0	1	04	01	H8889_012_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	013	0	1	04	01	H8889_013_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	014	0	1	04	01	H8889_014_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8889	015	0	1	04	01	H8889_015_0	5	1																																																2	111	2				2				2			2		2			2	2																																																												
H8908	005	0	1	01	01	H8908_005_0	5	1																										1	2	1	175	7	1	2				1	1	2			2		2			2																						Healthy Living Products	2	1	175	7		2				2			2		2			2	2	Living Expense Support	2	1	175	7		2				2			2		2			2	2	Aging Support and Safety Products	2	1	175	7		2				2			2		2			2	2
H9003	001	0	1	02	01	H9003_001_0	10	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9003	006	0	1	02	01	H9003_006_0	10	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9003	009	0	1	02	01	H9003_009_0	10	1																																																																																																												Acute Care at Home	2	2				2				2			2		1	0.00	0.00	1	1
H9047	043	0	1	01	01	H9047_043_0	8	1																										1	2	1	400.00	5	2	2				2		2			2		2			1																																																																																	
H9431	801	0	1	04	01	H9431_801_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H9431	801	0	1	04	01	H9431_801_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H9431	802	0	1	04	01	H9431_802_0	5	1	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2																																																												
H9431	802	0	1	04	01	H9431_802_0	5	2	1	1	2	1				2				2				2			2		2			2	2	1	2	2				2				1	1	2			2		2			2		2	111	2				2				2			2		2			2	2	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																				
H9590	001	0	1	01	01	H9590_001_0	5	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H9615	007	0	1	04	01	H9615_007_0	11	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	008	0	1	04	01	H9615_008_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	010	0	1	04	01	H9615_010_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	012	0	1	04	01	H9615_012_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	014	0	1	04	01	H9615_014_0	10	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	015	0	1	04	01	H9615_015_0	14	3																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	015	0	1	04	01	H9615_015_0	14	4																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	015	0	1	04	01	H9615_015_0	14	6	1	1	2	2	10	3		2				2				1	50	50	2		2			1	2																																																																																																						
H9615	015	0	1	04	01	H9615_015_0	14	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	016	0	1	04	01	H9615_016_0	13	4																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	016	0	1	04	01	H9615_016_0	13	3																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	016	0	1	04	01	H9615_016_0	13	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	016	0	1	04	01	H9615_016_0	13	6	1	1	2	2	15	3		2				2				1	50	50	2		2			1	2																																																																																																						
H9615	017	0	1	04	01	H9615_017_0	12	4																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	017	0	1	04	01	H9615_017_0	12	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	017	0	1	04	01	H9615_017_0	12	6	1	1	2	2	20	3		2				2				1	50	50	2		2			1	2																																																																																																						
H9615	017	0	1	04	01	H9615_017_0	12	3																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	018	0	1	04	01	H9615_018_0	11	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9615	019	0	1	04	01	H9615_019_0	11	1																										1	2	2				2				2		2			2		2			2																																																																																	
H9834	001	0	1	01	01	H9834_001_0	4	2																										1	2	2				2				2		2			2		2			2																																																																																	
H9834	001	0	1	01	01	H9834_001_0	4	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H9834	003	0	1	01	01	H9834_003_0	4	2																										1	2	2				2				2		2			2		2			2																																																																																	
H9834	003	0	1	01	01	H9834_003_0	4	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H9834	004	0	1	01	01	H9834_004_0	3	2																										1	2	2				2				2		2			2		2			2																																																																																	
H9834	004	0	1	01	01	H9834_004_0	3	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H9834	005	0	1	01	01	H9834_005_0	3	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H9834	005	0	1	01	01	H9834_005_0	3	2																										1	2	2				2				2		2			2		2			2																																																																																	
H9834	006	0	1	01	01	H9834_006_0	4	1																																																																				Hospital at Home	2	2				2				2			2		2			2	2																																								
H9834	006	0	1	01	01	H9834_006_0	4	2																										1	2	2				2				2		2			2		2			2																																																																																	
H9907	001	0	1	04	01	H9907_001_0	7	1																										1	2	2				2				2		1	20	20	2		2			2																																																																																	
H9917	003	0	1	01	01	H9917_003_0	8	1																																																2	001	2				2				2			2		2			2	2																																																												
H9940	001	0	1	01	01	H9940_001_0	11	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H9942	001	0	1	04	01	H9942_001_0	5	1																																																																				Non-Medicare Covered Restorative Nursing	2	2				2				2			2		2			2	2																																								
H9946	001	0	1	04	01	H9946_001_0	7	1																										1	2	1	240.00	7	2	2				1	1	2			2		2			1																																																																																	
H9946	001	0	1	04	01	H9946_001_0	7	2																										1	2	1	240.00	7	2	2				1	1	2			2		2			1																																																																																	
H9955	001	0	1	01	01	H9955_001_0	5	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H9955	002	0	1	01	01	H9955_002_0	7	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H9955	003	0	1	01	01	H9955_003_0	6	1																																																																				Mental Health & Wellness Applications	2	1	150.00	5		2				2			2		2			1	2	Non-Medicare-covered Genetic Test Kit	2	1	150.00	5		2				2			2		2			1	2																				
H9986	002	0	1	01	01	H9986_002_0	6	1																																																2	001	2				2				2			2		2			1	2																																																												
H9986	003	0	1	01	01	H9986_003_0	6	1																																																2	001	2				2				2			2		2			1	2																																																												
R0759	003	0	1	31	11	R0759_003_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	43.00	7		2				2			2		1	0.00	0.00	2	2																																								
R1390	001	0	1	31	11	R1390_001_0	5	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R1390	002	0	1	31	11	R1390_002_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R1390	003	0	1	31	11	R1390_003_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R3175	003	0	1	31	11	R3175_003_0	4	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	44.00	7		2				2			2		1	0.00	0.00	2	2																																								
R3392	001	0	1	31	11	R3392_001_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R3392	002	0	1	31	11	R3392_002_0	9	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R3392	004	0	1	31	11	R3392_004_0	9	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R4182	001	0	1	31	11	R4182_001_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R4182	003	0	1	31	11	R4182_003_0	8	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R4182	004	0	1	31	11	R4182_004_0	8	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R5495	001	0	1	31	11	R5495_001_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R5495	002	0	1	31	11	R5495_002_0	7	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R6801	011	0	1	31	11	R6801_011_0	5	1																																																																				OTC VBID Food Allowance and Utilities Combined Benefit	2	1	60.00	7		2				2			2		1	0.00	0.00	2	2																																								
R7220	001	0	1	31	11	R7220_001_0	6	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
R7220	002	0	1	31	11	R7220_002_0	4	1																																																																				Provider Referred	2	2				2				2			2		2			1	2																																								
