| Name | Value |
|---|---|
| CATEGORY | CHOICE RX CO-PAYMENT |
| ABBREVIATION | CG |
| REFER TO DMC? | YES |
| REFER TO TOP? | PRIOR TO 8/1/15 |
| REFER TO CS? | 8/1/15 AND AFTER |
| DISPLAY IN BILL PROFILE? | CC RX |
| DISP BILL PROF DESC INFO? | COMM CARE RX DISPLAY |
| ELIG FOR RPP | 1 |
| PRINT SPECIAL NOTICE? | 1 |
| CHARGE ADMINISTRATIVE? | YES |
| CHARGE PENALTY? | NO |
| ACCRUED? | ACCRUED |
| REFUND/REIMBURSEMENT | REIMBURSEMENT |
| PARAGRAPH CODES | 25,40,55,80,85,50,60,65,70 |
| SEGMENT | 294 |
| GL # | 1212 |
| TYPE | PATIENT |
| CATEGORY NUMBER | 64 |
| RECEIVABLE CODE | NON-FEDERAL |
| CHARGE INTEREST? | YES |