New waiver service billing code (HCPCS) changes for waiver provider standards implementation

Transcription

1 New waiver service billing code (HCPCS) changes for waiver provider standards implementation Updates to service agreements to reflect new procedure codes and modifiers may begin on Jan. 1, Counties and tribes had until March 31, 2014 to update all service agreements. Table 1: Homemaker Homemaker/Cleaning S5130 per 15 S5131 per diem Homemaker/Home Management S5130, TF per 15 S5131, TF per diem When authorizing all categories of Homemaker, use the S5130 and S5131 codes When updating service authorizations, S5130 and S5131 should only be used when authorizing cleaning services including assistance with laundry. The per diem billing code S5131 can only be used for When updating service authorizations, use the S5130 and S5131 with a TF modifier when cleaning in addition to incidental home management activities are being authorized. Home management activities may include assistance with meal preparation, shopping for food, clothing and supplies, simple household repairs and arranging for transportation. The per diem billing code S5131 TF can only be used for New Waiver Service billing code (HCPCS) changes for Waiver Provider Standards implementation PAGE 1

2 Homemaker/Assistance with personal care S5130, TG per 15 S5131, TG per diem When updating service authorizations, use S5130 and S5131 with a TG modifier when cleaning, in addition to incidental assistance with activities of daily living are being authorized. If a person needs incidental home-management assistance as well as assistance with activities of daily living and cleaning, the TG modifier should be used. Assistance with activities of daily living includes dressing, bathing, toileting, grooming, eating and ambulating. The per diem billing code S5131 TG can only be used for Table 2: Environmental accessibility adaptations vehicle Environmental accessibility adaptations/vehicle install T2039 When updating service authorizations, T2039 should be used when authorizing vehicle installations. Vehicle installations may include but are not limited to: adapted seat devices, door handle replacements, lifting devices, roof extensions and wheelchair securing devices. Assessment of EAA/Vehicle T2039 UD When updating service authorizations, use T2039 with a UD modifier when authorizing assessments to determine the most appropriate vehicle modifications. New Waiver Service billing code (HCPCS) changes for Waiver Provider Standards implementation PAGE 2

3 Table 3: Environmental accessibility adaptations home Environmental accessibility adaptations/home install S5165 Currently, use S5165 for all environmental accessibility adaptations. When updating service authorizations, use S5165 when authorizing home modification installations only. Home installations may include, but are not limited to: modification or adaptation of bathrooms and kitchens, modification and adaptation to meet egress requirements and floor coverings. Assessment of environmental accessibility adaptations/home T1028 When updating service authorizations, use T1028 when authorizing assessments to determine the most appropriate adaptation or equipment. Table 4: Assistive technology Service/sub-service Assistive technology/equipment T2029 When updating service authorizations, the only time the T2029 code should be used is when authorizing assistive technology equipment (this code may also be used to authorize specialized equipment and supplies) X Assistive technology/equipment includes the rental or purchase of an assistive device or software, maintenance and repair of the assistive device and training and evaluation about the product. New Waiver Service billing code (HCPCS) changes for Waiver Provider Standards implementation PAGE 3

4 Service/sub-service Assistive technology/assessment T2029 UD When updating service authorizations, use T2029 with a UD modifier when assessment of the need for assistive devices or software are being authorized. X Table 5: Family training and counseling Service Family training S5110 Currently, both family training and family counseling use S5100. When updating service authorizations, use S5110 when authorizing family training only. Training services may be offered inside or outside of the home by qualified professionals or by individuals, agencies or educational facilities offering classes, courses or conferences. Training and education topics include instruction about treatment regimens, updates as appropriate to safely maintain the person at home and use of equipment specified in the plan of care Family counseling H0004 When updating service authorizations, use H0004 when authorizing family counseling only. Counseling services may include help for a person and/or family members with boundary issues, communication techniques, conflict management, problem solving and relationships. New Waiver Service billing code (HCPCS) changes for Waiver Provider Standards implementation PAGE 4

5 Table 6: 24-Hour emergency assistance Service Personal emergency response systems S5160 Emergency response system installation and testing S5161 Emergency response system monthly service fee Counties must be sure when authorizing personal emergency response systems (PERS) under 24-hour emergency assistance equipment; they are using the PERS procedure codes. personal emergency response systems (PERS) should be authorized under specialized equipment and supplies for people on the Elderly Waiver and AC Program X X S5162 Emergency response system purchase H2011 per 15 minute 24-hour emergency assistance T2034 per diem When updating service authorizations, use T2034 or H2011 when authorizing emergency assistance services that include on-call counseling, problem solving or in-person assistance at a person s home. H2011 will replace S5135 UB (15 minute unit) and T2034 will replace S5136 UB (per diem) New Waiver Service billing code (HCPCS) changes for Waiver Provider Standards implementation PAGE 5