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Attention I/DD Providers: LTCS Service Code and Billing Structure Change

Issued: May 1, 2026

The North Carolina Department of Health and Human Services (NCDHHS) will discontinue modifiers U1-U6 for Long Term Community Supports (LTCS), effective July 1, 2026. Partners Health Management (Partners) is issuing this alert to ensure providers know about the change which pertains to both NC Medicaid Direct (MD) beneficiaries and Tailored Plan (TP) members.

MD beneficiaries will transition from the MD In Lieu of Service LTCS to 1915(b)(3) Long Term Residential and Day Supports (LTRDS). TP members will continue receiving LTCS. Providers will use a single service code (T2016 U5) for both levels of service.

What do providers need to know?

  • When requesting an authorization, providers must choose the appropriate Service Description to distinguish the level of service requested.
  • The applicable service level will no longer be indicated by a modifier.
  • Instead, it must be reported in the Demonstration Project Identifier field on the provider claim form, using the REF*P4 segment in Loop 2300 of the 837 professional claim.
  • Partners is working to align our TP In Lieu of Service Long-Term Community Supports with the 1915(b)(3) Long Term Residential and Day Supports definition to ensure continuity of care for our members.
  • The 1915(b)(3) LTRDS code and service definition will be effective July 1, 2026.

What is changing?

The following service codes will be discontinued effective June 30, 2026:

  • T2016 U5 U1 – Home Living LTCS Level 1
  • T2016 U5 U2- Independent Living LTCS Level 2
  • T2016 U5 U3- Companion Living LTCS Level 3
  • T2016 U5 U3 TL- Companion Living LTCS Level 3 Therapeutic Leave
  • T2016 U5 U4– Supervised Living LTCS Level 4
  • T2016 U5 U4 TL- Supervised Living LTCS Level 4 Therapeutic Leave
  • T2016 U5 U6 – Group Living LTCS Level 5
  • T2016 U5 U6 TL- Group Living LTCS Level 5

The following service codes, service descriptions and claim segments will be effective July 1, 2026:

Service Code Service Description Milestone Level
T2016 U5 T2016 U5 – Level 1 LTCS/LTRDS – Home Living – resides in private home (alone or with family) or in non-Medicaid residential setting with no home/residential support M1
T2016 U5 T2016 U5 – Level 2 LTCS/LTRDS – Independent/ Supported Living – resides in private home (alone or with unpaid roommate) with 24/7 staff access M2
T2016 U5 T2016 U5 – Level 3 LTCS/LTRDS – Companion Living – resides in AFL home or provider owned/operated home with paid roommate, overnight (non-awake) staffing M3
T2016 U5 T2016 U5 TL – Level 3 LTCS/LTRDS – Companion Living Therapeutic Leave M3
T2016 U5 T2016 U5 – Level 4 LTCS/LTRDS – Supervised Living – resides in 3 beds or less provider owned/operated setting with 24/7 overnight (non-awake) staff/virtual monitoring M4
T2016 U5 T2016 U5 TL – Level 4 LTCS/LTRDS – Supervised Living Therapeutic Leave M4
T2016 U5 T2016 U5 – Level 5 LTCS/LTRDS – Group Living – resides in Licensed Group Home (4 beds or less) with 24/7 awake-overnight staff/virtual monitoring M5
T2016 U5 T2016 U5 TL – Level 5 LTCS/LTRDS – Group Living Therapeutic Leave M5

 

What do providers need to do?

  • Effective July 1, 2026, providers should submit LTCS/LTRDS service authorization requests using T2016 U5 with the appropriate Service Description for requested service level.
  • Claims submitted via an 837 should be submitted under T2016 U5 or T2016 U5 TL with the corresponding REF*P4 segment for the service level provided (The format of the REF*P4 segment will contain 1915B3 followed by the designated milestone.)
    • Ref *P4*1915B3-M1
    • Ref *P4*1915B3-M2
    • Ref *P4*1915B3-M3
    • Ref *P4*1915B3-M4
    • Ref *P4*1915B3-M5

Be certain to include the milestone to prevent the claim from being processed as a Behavioral Health Urgent Care (BHUC) claim.

  • Claims submitted via the portal (CMS1500) The Milestone will be designated by field 19 of the CMS 1500 form. Field 19 will be mandatory for LTRDS services (T2016 U5 or T2016 U5 TL). This field should contain indications of the program, in addition to the milestone being reported. Examples: 1915B3-M1,1915B3-M2

Be certain to include N/A in field 19 if you submit a BHUC (Behavioral Health Urgent Care) claim.

  • Partners Utilization Management (UM) will end date current and/or under review LTCS authorizations with the discontinued modifiers for June 30, 2026. UM will create new authorizations effective July 1, 2026, under T2016 U5, using the Service Description that aligns with the authorized service level.
  • Providers must ensure that the new service code and service description are accurately reflected in the Person-Centered Plan (PCP) for any annual or plan update occurring on or after July 1, 2026.
  • Existing provider contracts will be updated to reflect the code changes.

Who do I contact if I have questions?

Updated: