| Home Health | 251E00000X | Primary |
| Durable Medical Equipment & Medical Supplies - Customized Equipment — Customized Equipment | 332BC3200X | |
| Durable Medical Equipment & Medical Supplies - Oxygen Equipment & Supplies — Oxygen Equipment & Supplies | 332BX2000X | |
| Durable Medical Equipment & Medical Supplies - Dialysis Equipment & Supplies — Dialysis Equipment & Supplies | 332BD1200X | |
| Non-emergency Medical Transport (VAN) | 343900000X | |
| Durable Medical Equipment & Medical Supplies - Nursing Facility Supplies — Nursing Facility Supplies | 332BN1400X | |
| Durable Medical Equipment & Medical Supplies - Parenteral & Enteral Nutrition — Parenteral & Enteral Nutrition | 332BP3500X | |
| Private Vehicle | 347C00000X | |