Appendix XVII, Service or Score Code Guide

Revision 17-1; Effective March 15, 2017

ServiceForm 2060, Needs Assessment Questionnaire and Task/Hour Guide, ScoreForm 2101, Authorization for Community Care Services, Item 16 Service Code
Adult Foster Care1818
Consumer Managed Personal Assistant ServicesNot required27
Community Attendant Services (CAS)2417D (CAS) 
Individual Directed Services (CDS) – Financial Management ServicesNot applicable63V 
63VY (ICM)
CDS – Support ConsultationNot applicable57V (for PHC and CAS) 
57CV (for FC) 
57V4 (For PHC in ICM)
Day Activity and Health ServicesNot required29 
29Y (ICM)
Residential Care (RC)1819I (RC Bed Hold, Non-Apt., Title XX) 
19J (RC, Apt., Title XX) 
19L (RC, Non Apt., Title XX) 
19M (RC Emergency Care) 
19N (grandfathered RC, R&B, Non-Apt.) 
19O (grandfathered RC, R&B, Apt.)
Emergency Response Service2020
Family Care (FC)2417C (FC) 
17CS (FC/SRO) 
Home-Delivered Meals2025

Primary Home Care (PHC)



2417 (PHC) 
17S (PHC/SRO) 
17V (PHC/CDS) 
17Y (PHC/ICM) 
Special Services to Persons with Disabilities928