Use the links in the table below to access your addendum. Complete your addendum and upload it to ePREP > Applications tab >Additional Information > Practice Information. Be sure to upload any other documents requested in the addendum.
| Addendum by Provider/Program | PT Code |
| ADAA Certified Addictions Outpatient Program | 50 |
| Ambulance Company | T1 |
| Ambulatory Surgical Center | 39 |
| Autism Waiver | 40 |
| Behavioral Health Crisis Stabilization Center | CF |
| Brain Injury Waiver | 86 |
| Centering Pregnancy Individual Centering Pregnancy Group | N/A |
| Clinic, Drug | 32 |
| Clinic, Federally Qualified Health Center | 34 |
| Clinic, General | 38 |
| Clinic, Local Health Department | 35 |
| Community Options, Assisted Living (ALF) Community Options, Other | 76 |
| Community Violence Prevention | VP |
| DDA Services, Provider New Enrollees | 90 |
| Dental Provider Individual Dental Provider Group | 14 |
| Diabetes Prevention Program (DPP) Provider | DP |
| Diagnosis Services, Other | 60 |
| Dialysis Facility | 61 |
| DMS/DME Provider | 62 |
| Doula Individual Doula Group | DL |
| EPSDT Therapeutic Behavioral Services | 51 |
| Freestanding Oncology Services | 36 |
| Gender Affirming Treatment - Electrologist and Medical Tattoo Artist Individual Gender Affirming Treatment - Electrologist and Medical Tattoo Artist Group | |
| HCBS, 1915i | 89 |
| HCBS, 1915i Individual HCBS, 1915i Group | HG |
| Healthy Steps Individual Health Steps Group | NA |
| HIV Case Management | VC |
| HMO/PACE | 70 |
| Home Health Agency | 41 |
| Home Visiting Services | HV |
| Hospice Provider | 71 |
| Hospital, Acute | 01 |
| Hospital, Acute Rehabilitation | 03 |
| Hospital, Chronic | 05 |
| Hospital, Chronic Rehabilitation | 04 |
| Hospital, Specific Other Acute | 06 |
| Hospital, Specific Other Chronic | 07 |
| IMD Residential SUD Adult | 54 |
| Intermediate Care Facility, Addiction | 55 |
| Local Education Agencies/Local Lead Agency | 91 |
| Medical Day Care, Adults | 42 |
| Medicare Crossover Only | XV |
| Mental Health Case Management Provider | CM |
| Mental Health Clinic | MC |
| Mobile Crisis Team | MS |
| Mobile Treatment Program | MT |
| Nursing Facility | 57 |
| Ordering, Referring, Prescribing (ORP-only) Provider | 92 |
| Pain Management | N/A |
| Partial Hospitalization Program | MH |
| Pediatric Nursing/Home Health Aide Services Agency | 53 |
| Pharmacist Group | PH |
| Portable X-Ray | 59 |
| Psychiatric Rehab Services Facility | PR |
| Residential Treatment Center | 88 |
| School Based Health Center (SBHC) | N/A |
| Supported Employment | SE |
| Urgent Care Center | 08 |