|
STATE HEALTH PLAN |
PROGRAM | CODES | MODIFIER | DESCRIPTION |
| EVV is required for the following PCS and CAP service codes effective Jan. 1, 2021 | ||||
| State Plan PCS | PCS | 99509 | HA | Any beneficiary under 21 years regardless of setting |
| State Plan PCS | PCS | 99509 | HB | In-home care agencies, beneficiary 21 years or older |
| CAP | ||||
| Community Alternatives
Programs |
CAPDA | S5125 | UN | Attend Care Cong 15m |
| Community Alternatives
Programs |
CAPDA | S5150 | In-Home Respite 15m | |
| Community Alternatives
Programs |
CAPC | S5125 | CAPC In-Home Aide | |
| Community Alternatives
Programs |
CAPC | S5150 | In-Home Respite 15m | |
| Community Alternatives Programs | CAPC | T1019 | PNA Asst 15m | |
| Community Alternatives
Programs |
CAPC | T1004 | PNA In-Home Respite 15m | |
| Community Alternatives
Programs |
CAPC | S9122 | TF | In-Home Respite Cong 15m |
| Community Alternatives Programs | CAPC | S9122 | TG | PNA Respite Cong 15m |
| Community Alternatives
Programs |
CAPC | T2027 | Personal Care Assist 15m | |
| Community Alternatives Programs | CAPC | T2027 | TF | Personal Care Asst Cong |
| Community Alternatives
Programs |
CAPCD | S5135 | Personal Care Assist | |
| Community Alternatives
Programs |
CAPCD | S5135 | UN | Personal Care Assist Cong 15m |
| Community Alternatives
Programs |
CAPCD | S5125 | UN | Attend Care Cong 15m |
| Community Alternatives
Programs |
CAPCD | S5125 | Attendant Care Service 15m | |
| Community Alternatives Programs | CAPCD | S5150 | In-Home Respite 15m | |
| Community Alternatives
Programs |
CAPCD | S5150 | In-Home Respite 15m | |
|
BEHAVIORAL HEALTH |
EVV is required for Behavioral Health service codes in Medicaid Direct, and for Home Health service codes in Medicaid Direct and Standard Plans effective April. 1, 2023. The Tailored Plan launch and the required EVV services provided in the Tailored Plans will begin at a later date.
Please refer to NC Medicaid bulletin for specifics. https://www.ncdhhs.gov/news/press-releases/2023/07/11/launch-behavioral-health-and-intellectualdevelopmental-disabilities-tailored-plans-delayed |
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| Innovations Services | PROGRAM | CODES | MODIFER | DESCRIPTION |
|
Behavioral Health Services |
Innovations Waiver Services Subject to EVV | Group – T2013 |
TF HQ |
Community Living and Support (In- Home Services Only) |
| Behavioral Health Services | Innovations Waiver Services Subject to EVV | T2013 | TF | Community Living and Supports Individual (In- Home Services Only) |
| Behavioral Health Services | Innovations Waiver Services Subject to EVV |
T2033 |
U1 |
Supported Living – Periodic (In-Home Services Only) |
| TBI Services | ||||
| Behavioral Health Services | TBI Waiver Services
Subject to EVV |
S5125 | Personal Care (In-Home Services Only) | |
| Behavioral Health Services | TBI Waiver Services Subject to EVV | T1015 | In-Home Intensive (In-Home Services
Only) |
|
| Behavioral Health Services | TBI Waiver Services Subject to EVV | Group – T2013 |
TF HQ |
Community Living and Support (In- Home Services Only) |
| Behavioral Health Services | TBI Waiver Services Subject to EVV | T2013 | TF | Community Living and Supports Individual (In- Home Services Only)
|
| Behavioral Health Services | TBI Waiver Services Subject to EVV |
T2033 |
U1 |
Supported Living – Periodic (In-Home Services Only) |
| (b)(3) Waiver Services | ||||
| Behavioral Health Services | (b)(3) Services
Subject to EVV |
T1019 | HE * | Personal Care/ Individual Support (In-
Home Services Only) |
| Behavioral Health Services | (b)(3) Services
Subject to EVV |
T2013 | In-Home Skill Building (In-Home Services
Only) |
|
| Behavioral Health Services | (b)(3) Services
Subject to EVV |
H2022 | U4 | Transitional Living Skills (In-Home
Services Only) |
| Case Rate Clarification – (b)(3) Transitional Living Skills Services NOT Subject to EVV | H2022 | HA * | Transitional Living Skills – Bill the case rate for Transitional Youth services which are not provided in the home.
This is not subject to EVV. |
|
| * new procedure modifier combination, may not yet be available | ||||
| (i) Wavier Services | ||||
| Behavioral Health Services | (i) Waiver Services Subject to EVV | T2013 | TF, HQ, U4 | (i) Community Living and Supports- Group |
| Behavioral Health Services | (i) Waiver Services Subject to EVV | T2013 | TF, U4 | (i) Community Living and Supports |
| Behavioral Health Services | (i) Waiver Services Subject to EVV | T1019 | U4 | (i) Individual and Transitional Support |
| HOME HEALTH SERVICES | ||||
| Home Health Services | Therapy | RC420 | Physical Therapy | |
| Home Health Services | Therapy | RC424 | Physical Therapy – Evaluation | |
| Home Health Services | Therapy | RC430 | Occupational Therapy | |
| Home Health Services | Therapy | RC434 | Occupational Therapy – Evaluation | |
| Home Health Services | Therapy | RC440 | Speech Therapy | |
| Home Health Services | Therapy | RC444 | Speech Therapy – Evaluation | |
| Home Health Services | Skilled Nursing | RC550 | Skilled Nursing Visit -Initial Assessment/re-assessment | |
|
Home Health Services |
Skilled Nursing |
RC551 |
Skilled Nursing Visit -Treatment, Teaching/Training,
Observation/Evaluation |
|
|
Home Health Services |
Skilled Nursing |
RC559 |
Skilled Nursing Visit -for a dually eligible
beneficiary when visit doesn’t meet Medicare criteria (i.e., not homebound) |
|
| Home Health Services | Skilled Nursing | RC580 | Skilled Nursing Visit -Venipuncture | |
| Home Health Services | Skilled Nursing | RC581 | Skilled Nursing Visit- Pre-filling insulin syringes/Medi-Planners | |
| Home Health Services | HH Aide | RC570 | Home Health Aide | |
Updated: