Explanation of QSP Billing Codes

Adult Day Care

Procedure Code: S5101

Unit: 1/2 day

Special Instructions: This code is used to claim payment for a 1/2 day or full day of adult day care provided to an eligible individual. Payment may be claimed for one (1) unit when the eligible individual is there for at least three (3) hours. Payment can be claimed for 2 units ( full-day) when the recipient is there for five (5) or more hours. A maximum of two (2) units are allowed per calendar day. (1 unit = 1/2 day, 2 units = full-day)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Adult Residential Service 

Procedure Code: T2031

Unit: Day

Special Instructions: This code is used to claim payment for adult residential care provided to an eligible individual who receives overnight care in a ND licensed specialized basic care facility. This code is used to bill for care and supervision as well as routine transportation (if applicable), laundry and housekeeping as needed by the client. Payment for room and board is the responsibility of the eligible individual. Payment can be clamed for the day of "admission" into adult residential care, but cannot be claimed for the day of "discharge". This also applies to absences from the facility for example admission to the hospital or travel with family. Payment is not allowed for the day the eligible individual entered the hospital etc. but the provider can bill for the day the eligible individual returns to the facility. Payment may be claimed when services are provided at the facility on the day of death. (One (1) unit = one (1) day)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Case Management - Other  

Procedure Code: T2023

Unit: Month

Special Instructions: This code is used when claiming payment for the CM activities of implementing, monitoring and reviewing the Department approved person centered plan with individuals eligible for Medicaid State Plan - personal care, when the individual is NOT also receiving services under the HCBS Medicaid Waiver. All case management (CM) activities must be performed by a licensed social worker.  Payment under this code may be claimed for the following activities: referral and related activities, and monitoring and other activities. QSPs can only bill for this service once per month regardless of the number of contacts they have had with the eligible individual that month. To bill for services rendered, QSPs must have a signed Department approved person-centered plan of care and enter all required information into Therap. (One (1) unit = One (1) month of contacts)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Case Management - Assessment 

Procedure Code: T2023-TG

Unit: Month

Special Instructions: This code is used to claim payment when a HCBS comprehensive assessment has been completed with an eligible Medicaid recipient. All case management (CM) activities must be performed by a licensed social worker. Payment under this code may be claimed for the following activities: assessment of an individual to determine the need for any medical, education, social or other service, and; development of a person-centered plan of care. A one-time payment for CM can be claimed for individuals who are Medicaid eligible and who have been assessed for HCBS but chose not to participate. To bill for services rendered, a QSP must have a signed Department approved person-centered plan of care completed and enter all required information into Therap. (One (1) unit = One (1) assessment)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore - Labor  

Procedure Code: S5120

Unit: 15 minutes

Special Instructions: This code is used to claim payment when chore - labor for example, heavy or seasonal cleaning is provided for an eligible individual. Only bill for the time it takes to do these approved tasks in or around the individual's home. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore - Pest extermination/cleaning and restoration   

Procedure Code: S5121

Unit: Per job

Special Instructions: This code is used to claim payment when professional pest extermination or cleaning & restoration is provided to an eligible individual. The rate charged includes compensation for the provider's time and the equipment and cleaning or other supplies used during the process. One (1) unit = one completed job)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore - Snow removal   

Procedure Code: S5120

Unit: 15 minutes

Special Instructions: This code is used to claim payment when snow removal is provided to an eligible individual. Only bill for the time it takes to complete the authorized task. The rate charged covers both the provider's time and the equipment used for the snow removal. Tasks are limited to shoveling  the driveway and sidewalks adjacent to the individual's home. If a provider is going to use an individual's equipment to complete this task, the individual must sign a statement granting permission. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore - Lawn care   

Procedure Code: S5120

Unit: 15 minutes

Special Instructions: This code is used to claim payment when lawn care is provided to an eligible individual. Only bill for the time it takes to complete the authorized task. The rate charged covers both the provider's time and the equipment used for lawn care. It is limited to seasonal cutting and trimming grass, bagging/dumping. The service does not include landscaping, fertilizing, or weed control. You can only bill for lawn care provided to an eligible individual once per week.  If a provider is going to use an individual's equipment to complete this task, the individual must sign a statement granting permission. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

CHR Assessment    

Procedure Code: T1023

Unit: Each

Special Instructions: This code is used to claim payment for a Department approved assessment completed by an Indian Health Services (IHS) Community Health Representative (CHR) to determine the need for home and community-based services for an eligible tribal member. This service is eligible for the IHS encounter rate. (One (1) unit = 1 assessment)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Community Support Services   

Procedure Code: S5126

Unit: Per day

Special Instructions: This code is used to claim payment to provide up to 24-hour community support services to an eligible individual in their home. Payment can be claimed for the day that care starts but cannot be claimed for the day that care ends.  Payment is not allowed for the day the eligible individual entered the hospital or is traveling with family etc. but the provider can bill for the day the eligible individual returns to their care. This service must be provided by awake staff who have a completed background check and required training. Payment may be claimed when services are provided on the day of death. Do not use this code to bill for retainer payments. These payments must be approved by the HCBS Case Manager and require a modifier. (One (1) unit = one (1) day)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Community Support Services - Retainer payments  

Procedure Code: S5126-U5

Unit: Per day

Special Instructions: This code is used to claim up to 30 retainer payments per recipient, per calendar year. Personal assistance retainer payments are allowed for reimbursement when the eligible individual is absent and care is not provided. For example they are in the hospital or traveling with family.  This code can be used to claim a retainer payment on the day of "admission" to the hospital etc. but not the day of "discharge".  Retainer payments ensure stability and continuity of care while the eligible individual is absent for a short period. This service requires approval by an HCBS Case Manager. (One (1) unit = one (1) day)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Community Support / Residential Habilitation 
(Provided in a licensed agency adult foster care setting)  

Procedure Code: Refer to community support or residential habilitation service codes

Unit: 

Special Instructions: The service code for these services can also be used to claim payment to provide up to 24-hour community support services/ residential habilitation to an eligible individual in a licensed agency adult foster care. Payment for this service cannot include any room and board costs or the cost of facility maintenance and upkeep. Provides cannot bill for days the eligible individual is absent from the facility for example admission to the hospital, travel with family etc. Payment is not allowed for the day the eligible individual entered the hospital etc. but the provider can bill for the day the eligible individual returns to their care. Payment may be claimed when services are provided on the day of death. This service must be provided by awake staff who have a completed background check and required training. Retainer payments must be pre approved by the HCBS Case Manager and require a modifier. (One (1) unit = one (1) day)

Requires Electronic Visit Verification (EVV): 

Claim Type: 

Eligible for Billing in Therap: Yes

Companion Services  

Procedure Code: S5135-TF

Unit: 15 minutes

Special Instructions: This code is used to claim payment for companionship services provided to an eligible individual. This code cannot be used to bill for hand's on nursing or personal care but may include verbal instruction or cueing. Do not bill for any homemaking tasks unless the task is directly related to a companionship activity for example, cleaning up the kitchen after baking. Do not bill for any activity fees i.e. movie tickets etc. Friendly visiting is consider an allowable activity but cannot exceed 2 hours per week. (One (1) units = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Emergency Response System (ERS)

Procedure Code: S5161

Unit: Month

Special Instructions: This code is used to claim payment for ERS monthly service fees. Billing is limited to one (1) unit. (One (1) unit equals one (1) months service fee) 

Requires Electronic Visit Verification (EVV): No

Claim Type: Waiver

Eligible for Billing in Therap: No

Environmental Modification

Procedure Code: S5165

Unit: Per job

Special Instructions: This code is used to claim payment when an environmental modification of an eligible individual's home or vehicle is complete. Payment for services cannot be made until the job is done and the HCBS case manager has made a home visit to confirm completion. Payment cannot be made in advance for materials or for a deposit. (One (1) unit is based on the approved cost proposal)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Extended Personal Care

Procedure Code: S5115

Unit: At cost/max

Special Instructions: This code is used to claim payment for the time it takes the QSP to carry out the extended personal care task as instructed by the registered nurse (RN) and document the task as instructed. This code should not be used to bill for the nurse education part of extended personal care or when the task is provided by a nurse (RN/LPN). (One (1) units = 15 minutes) 

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Extended Personal Care - Nurse

Procedure Code: S5115-TD

Unit: At cost/max

Special Instructions: This code is used to claim payment for the time it takes the nurse (RN /LPN) to carry out the extended personal care task as instructed by the RN and document the task as required. This code should not be used to bill when a non  nurse completes the  extended personal care task. (One (1) units = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Higher Level Case Management - Assessment 

Procedure Code: T2024

Unit: Month

Special Instructions: This code is used when claiming payment for a CM activity conducted with individuals eligible for the HCBS Medicaid Waiver only. Payment under this code can be claimed for the following activities: assessment of an individual to determine the need for any medical, education, social or other services using the HCBS comprehensive assessment and development of a Department approved person-centered plan of care.  To bill for services rendered, QSPs must have a signed Department approved  person-centered plan of care completed and enter all required information into Therap. (One (1) unit = One (1) assessment) 

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Higher Level Case Management - Other

Procedure Code: T2022

Unit: Month

Special Instructions: This code is used when claiming payment for the CM activities of implementing, monitoring and reviewing the Department approved person centered plan with individuals eligible for the HCBS Medicaid waiver only.  All case management (CM) activities must be performed by a licensed social worker.  Payment under this code may be claimed for the following activities: referral and related activities, and monitoring and other activities. QSPs can only bill for this service once per month regardless of the number of contacts they have had with the eligible individual that month. To bill for services rendered, QSPs must have a signed person-centered plan of care and enter all required information into Therap. (One (1) unit = One (1) month of contacts) 

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Home Delivered Meals

Procedure Code: S5170

Unit: Per meal

Special Instructions: This code is used to claim payment for one hot or frozen home delivered meal that is transported or delivered to the eligible individuals' home. This service is limited to 2 units (meals) per calendar day. (One (1) units = (1) hot or frozen meal)

Requires Electronic Visit Verification (EVV): No

Claim Type: Waiver

Eligible for Billing in Therap: No

Homemaker

Procedure Code: S5130

Unit: 15 minutes

Special Instructions: This code is used to claim payment when homemaker services are provided to an eligible individual. Only bill for the time it takes to complete the authorized task. All homemaking tasks must be completed in the eligible individual's home while they are present except for laundry and shopping. Laundry may be completed in the home or at a laundry mat. Shopping is done in the community. Eligible individuals cannot go with the QSP when completing these tasks in the community. Time spent traveling to and from the individual's home for laundry or shopping counts as part of the billable time for homemaker services. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Installation Emergency Response System (ERS)

Procedure Code: S5160

Unit: One time

Special Instructions: This code is used to claim payment for installation fees that cover the cost of setting up an ERS for an eligible individual. Installation costs will only be paid one time unless approved by the HCBS Case Manager. (One (1) installation = 1 unit)

Requires Electronic Visit Verification (EVV): No

Claim Type: Waiver

Eligible for Billing in Therap: No

Non-Medical Transportation (carrier-bus-taxi)

Procedure Code: T2004

Unit: At cost/max

Special Instructions: This code is used to claim payment when non-medical transportation to essential community services like the grocery store, pharmacy and bank is provided to an eligible individual using a professional carrier, bus, or taxi provider. This code can only be billed for the time it takes to drive the eligible individual to the approved destination. (One (1) unit = one (1) ride)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Non-Medical Transportation (escort)

Procedure Code: T2001-UC

Unit: 15 minutes

Special Instructions: This code is used to claim payment when the eligible individual needs human assistance to participate in non-medical transportation or to accompany the individual for the assistance of boarding and existing the vehicle/public transit and to complete the activity for which the non-medical transportation was authorized. For example, grocery shopping. Do not bill for the time it takes to get to and from the eligible individual's home or the final destination or for transportation costs. Providers cannot bill for escort and non-medical transportation at the same time. Escort can only be billed if the eligible individual is present for the activity. (One (1) unit = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Non-Medical Transportation (local and out-of-town)

Procedure Code: T2001

Unit: 15 minutes

Special Instructions: This code is used to claim payment when transporting an eligible individual to essential community services like the grocery store, pharmacy and bank using a private or agency owned vehicle. This code can only be billed for the time it takes to drive the eligible individual to the approved destination. (One (1) unit = 15 minutes)   

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Nurse Education Care

Procedure Code: S5108

Unit: At cost/max

Special Instructions: This code is used to claim payment for the time it takes the registered nurse (RN) to assess and create the nursing plan of care and the time it takes to educate the QSP that will carry out the task. This code should not be used to bill for the time it takes to carry out the extended personal care task even if the task was completed by a nurse (RN/LPN). (One (1) units = 15 minutes)    

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

One-Time Transition Costs

Procedure Code: T5999

Unit: $3,000 max

Special Instructions: This code is used to claim payment for non-reoccurring set up expenses of an eligible individual's move to their own private residence. Payment can not be made for items that would be considered room and board; monthly rent or mortgage expenses; specials; insurance; food; regular utility charges and or household appliances or items that are intended for purely diversional/recreational purposes. (One (1) unit = the total cost of allowable items not to exceed $3,000 per eligible individual) 

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Personal Care - Assisted Living

Procedure Code: T2031

Unit: Per day

Special Instructions: This code is used to claim payment when personal care is provided to an eligible SPED recipient in a North Dakota licensed assisted living facility. This service cannot be provided outside of the assisted living facility. Payment for room and board is the responsibility of the eligible individual. Payment can be clamed for the day of "admission" into assisted living, but cannot be claimed for the day of "discharge". This also applies to absences from the facility for example admission to the hospital. Payment is not allowed for the day the eligible individual entered the hospital but the provider can bill for the day the eligible individual returns to the facility. Payment may be claimed when services are provided at the facility on the day of death. (1 unit of service = 1 day)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Personal Care - Unit Rate

Procedure Code: T1019

Unit: 15 minutes

Special Instructions: This code is used to claim payment when personal care is provided for portions of a calendar day. Only bill for the time it takes to complete the authorized task. Personal care service may be performed inside or outside the client's home when the eligible individual is present. Billing for services outside the local trade area is allowed however, you must discuss any limitations with the HCBS Case Manager. The number of services provided on each calendar day must be shown on the billing document. Span billing is not allowed. (15 minutes of services = 1 billing unit) 

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Residential Habilitation 

Procedure Code: T2016

Unit: Per day

Special Instructions: This code is used to claim payment to provide up to 24-hour residential habilitation to an eligible individual in their home. Payment can be claimed for the day that care starts but cannot be claimed for the day that care ends.  Payment is not allowed for the day the eligible individual entered the hospital or is traveling with family etc. but the provider can bill for the day the eligible individual returns to their care.  This service must be provided by awake staff who have a completed background check and required training. Payment may be claimed when services are provided on the day of death. Do not use this code to bill for retainer payments. These payments must be pre approved by the HCBS Case Manager and require a modifier. (One (1) unit = one (1) day)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Residential Habilitation - Retainer Payments

Procedure Code: T2016-U5

Unit: Per day

Special Instructions: This code is used to claim up to 30 retainer payments per recipient, per calendar year. Personal assistance retainer payments are allowed for reimbursement when the eligible individual is absent and care is not provided. For example, they are in the hospital or traveling with family. This code can be used to claim a retainer payment on the day of "admission" to the hospital etc. but not the day of "discharge". Retainer payments ensure stability and continuity of care while the eligible individual is absent for a short period. This service requires approval by an HCBS Case Manager.  (One (1) unit = one (1) day)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Respite Care 

Procedure Code: S5150

Unit: 15 minutes

Special Instructions: This code is used to claim payment when respite (short break) is provided to the primary caregiver. Only bill for the time it takes to complete the authorized task. Care must be provided in the eligible individual's home or in a provider's respite home that has been approved by an HCBS Case Manager. (One (1) unit = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Respite Care - Adult Foster Care

Procedure Code: S5150

Unit: 15 minutes

Special Instructions: This code is used to claim payment when respite (short break) is provided to assist a licensed adult foster care provider. Only bill for the time it takes to complete the authorized task. Care must be provided in a licensed adult foster care home that has been approved by an HCBS Case Manager. This service requires the provider to undergo a criminal background check. (One (1) unit = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Respite Care - Institutional 

Procedure Code: S5151

Unit: Per day

Special Instructions: This code is used when respite care (short break) is provided in a hospital, hospital swing-bed or nursing facility. Payment can be clamed for the day of "admission" into institutional respite, but cannot be claimed for the day of "discharge". This also applies to absences from the facility for example admission to the hospital. Payment is not allowed for the day the eligible individual entered the hospital but the provider can bill for the day the eligible individual returns to the facility. (One (1) unit =  1 calendar day)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Specialized Equipment  

Procedure Code: T2028

Unit: Per item

Special Instructions: This code is use to claim payment when a piece of specialized equipment or supplies have been provided to the eligible individual. (One (1) unit is based on the costs proposal)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Supervision   

Procedure Code: S5135

Unit: 15 minutes

Special Instructions: This code is used to claim payment for up to (24) hours of supervision provide to an eligible individual in their home. Supervision services must be provided by awake staff. Payment for this service cannot be claimed for time providing personal care, or homemaker, or any other service. Those tasks should be billed using the correct  procedure code for that service. (One (1) units = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Supported Employment    

Procedure Code: T2019

Unit: 15 minutes

Special Instructions: This code is used to claim payment for intensive, on-going support to individuals to perform in a work setting with necessary adaptations, supervision, and training appropriate to the individual's needs. This does not include supervision or training activities provided in a typical business setting. One (1) unit = 15 minutes)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Transition Coordination     

Procedure Code: T2038

Unit: 15 minutes

Special Instructions: This code is used to claim payment for providing community transition services to eligible individuals to plan a move from a institution or other provider operated living arrangement to a private residence where they can receive necessary care. (One (1) units = 15 minutes)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Transition Living 

Procedure Code: T2021

Unit: 15 minutes

Special Instructions: This code is used to claim payment when performing and/or training the eligible individual, who lives in a private residence, in tasks and activities as described in the individual plan of care. (One (1) unit = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional 

Eligible for Billing in Therap: Yes

Adult Day Care

Procedure Code: S5150

Unit: 1/2 day

Special Instructions: This code is used to claim payment for a 1/2 day or full day of adult day care provided to an eligible individual. Payment may be claimed for one (1) unit when the eligible individual is there for at least three (3) hours. Payment can be claimed for 2 units ( full-day) when the recipient is there for five (5) or more hours. A maximum of two (2) units are allowed per calendar day. (1 unit = 1/2 day, 2 units = full-day)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Adult Foster Care

Procedure Code: S5140

Unit: Per day

Special Instructions: This code is used when claiming payment for Adult Foster Care services provided in a licensed home. Payment can be claimed on the day of "admission" into the adult foster care but no the day of "discharge". Payment is not allowed for the day the eligible individual entered the hospital but the provider can bill for the day the eligible individual returns to the licensed home. Payment may be claimed when services are provided in the Adult Foster Care on the day of death. (One (1) unit = One (1) day) 

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Case Management - Other

Procedure Code: T2023

Unit: Month

Special Instructions: This code is used when claiming payment for the CM activities of implementing, monitoring and reviewing the Department approved person centered plan with individuals eligible for Medicaid State Plan - personal care, when the individual is NOT also receiving services under the HCBS Medicaid Waiver. All case management (CM) activities must be performed by a Licensed Master Social Worker or a Licensed Clinical Social Worker. Payment under this code may be claimed for the following activities: referral and related activities, and monitoring and other activities. QSPs can only bill for this service once per month regardless of the number of contacts they have had with the eligible individual that month. To bill for services rendered, QSPs must have a signed Department approved person-centered plan of care and enter all required information into Therap. (One (1) unit = One (1) month)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Case Management - Assessment

Procedure Code: T2023-TG

Unit: Month

Special Instructions: This code is used to claim payment when a HCBS comprehensive assessment has been completed with an eligible Medicaid recipient.  All case management (CM) activities must be performed by a Licensed Master Social Worker or a Licensed Clinical Social Worker.  Payment under this code may be claimed for the following activities: assessment of an individual to determine the need for any medical, education, social or other service, and; development of a person-centered plan of care.  A one-time payment for CM can be claimed for individuals who are Medicaid eligible and who have been assessed for HCBS but chose not to participate.  To bill for services rendered, a QSP must have a signed Department approved person-centered plan of care completed and enter all required information into Therap. (One (1) unit = One (1) assessment)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore Labor

Procedure Code: S5120

Unit: 15 minutes

Special Instructions: This code is used to claim payment when chore - labor for example, heavy or seasonal cleaning is provided for an eligible individual. Only bill for the time it takes to do these approved tasks in or around the individual's home. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore - Lawn Care

Procedure Code: S5120

Unit: 15 minutes

Special Instructions: This code is used to claim payment when lawn care is provided to an eligible individual. Only bill for the time it takes to complete the authorized task. The rate charged covers both the provider's time and the equipment used for lawn care. It is limited to seasonal cutting and trimming grass, bagging/dumping. The service does not include landscaping, fertilizing, or weed control. You can only bill for lawn care provided to an eligible individual once per week.  If a provider is going to use an individual's equipment to complete this task, the individual must sign a statement granting permission. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Chore - Snow Removal

Procedure Code: S5120

Unit: 15 minutes

Special Instructions: This code is used to claim payment when snow removal is provided to an eligible individual. Only bill for the time it takes to complete the authorized task. The rate charged covers both the provider's time and the equipment used for the snow removal. Tasks are limited to shoveling  the driveway and sidewalks adjacent to the individual's home. If a provider is going to use an individual's equipment to complete this task, the individual must sign a statement granting permission. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Companionship Services

Procedure Code: S5135-TF

Unit: 15 minutes

Special Instructions: This code is used to claim payment for companionship services provided to an eligible individual. This code cannot be used to bill for hand's on nursing or personal care but may include verbal instruction or cueing. Do not bill for any homemaking tasks unless the task is directly related to a companionship activity for example, cleaning up the kitchen after baking. Do not bill for any activity fees i.e. movie tickets etc. Friendly visiting is consider an allowable activity but cannot exceed 2 hours per week. (One (1) units = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Extended Personal Care

Procedure Code: S5115

Unit: 15 minutes

Special Instructions: This code is used to claim payment the time it takes the QSP to carry out the extended personal care task as instructed by the registered nurse (RN) and document the task as  required. This code should not be used to bill when a nurse (RN/LPN) completes the  extended personal care task. (One (1) units = 15 minutes) 

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Extended Personal Care - Nurse

Procedure Code: S5115-TD

Unit: 15 minutes

Special Instructions: This code is used to claim payment for the time it takes the nurse (RN/LPN) to carry out the extended personal care task as instructed by the registered nurse (RN) and document the task as instructed. This code should not be used to bill for the nurse education part of extended personal care or when the task is provided by a non nurse (RN/LPN). (One (1) units = 15 minutes) 

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Family Home Care

Procedure Code: 0001

Unit: Per day

Special Instructions: This code is used when claiming payment for Family Home Care to an eligible relative. You may claim payment for the day your authorization starts. Payment cannot be claimed for the days the individual in need of care was away from the home. For example, if they were hospitalized. Payment is not allowed for the day the eligible individual entered the hospital, but the provider can bill for the day the eligible individual returns home to their care. Payment can be claimed if in home cares are provided on the day of death. Payment cannot be claimed for care provided out of state unless approved by the program administrator. You cannot hire another person to provide care for your client during your absence from the home. (One (1) unit = One (1) day)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Waiver

Eligible for Billing in Therap: No

Family Personal Care

Procedure Code: S5136

Unit: Per day

Special Instructions: This code is used when claiming payment for Family Personal Care to an eligible relative.  Payment cannot be claimed for the days the individual in need of care was away from the home. For example, if they were hospitalized.  Payment is not allowed for the day the eligible individual entered the hospital but the provider can bill for the day the eligible individual returns home to their care. Payment can be claimed if in home cares are provided on the day of death.  Payment cannot be claimed for care provided out of state unless approved by the Program Administrator. (One (1) unit = One (1) day)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Waiver

Eligible for Billing in Therap: No

Higher Level Case Management - Assessment

Procedure Code: T2024

Unit: Month

Special Instructions: This code is used when claiming payment for a CM activity conducted with individuals eligible for the HCBS Medicaid Waiver only. All case management (CM) activities must be performed by a Licensed Master Social Worker or a Licensed Clinical Social Worker.  Payment under this code can be claimed for the following activities: assessment of an individual to determine the need for any medical, education, social or other services using the HCBS comprehensive assessment and development of a Department approved person-centered plan of care.  To bill for services rendered, QSPs must have a signed Department approved  person-centered plan of care completed and enter all required information into Therap. (One (1) unit = One (1) month)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Higher Level Case Management - Other

Procedure Code: T2022

Unit: Month

Special Instructions: This code is used when claiming payment for the CM activities of implementing, monitoring and reviewing the Department approved person centered plan with individuals eligible for the HCBS Medicaid waiver only.  All case management (CM) activities must be performed by a Licensed Master Social Worker or a Licensed Clinical Social Worker.  Payment under this code may be claimed for the following activities: referral and related activities, and monitoring and other activities. QSPs can only bill for this service once per month regardless of the number of contacts they have had with the eligible individual that month. To bill for services rendered, QSPs must have a signed person-centered plan of care and enter all required information into Therap. (One (1) unit = One (1) month)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Home Delivered Meals

Procedure Code: S5170

Unit: Per meal

Special Instructions: This code is used to claim payment for one hot or frozen home delivered meal that is transported or delivered to the eligible individuals' home.  This service is limited to 2 units per calendar day. (One (1) units = (1) hot or frozen meal)

Requires Electronic Visit Verification (EVV): No

Claim Type: Waiver

Eligible for Billing in Therap: No

Homemaker

Procedure Code: S5130

Unit: 15 minutes

Special Instructions: This code is used to claim payment when homemaker services are provided to an eligible individual. Only bill for the time it takes to complete the authorized task.  All homemaking tasks must be completed in the eligible individual's home while they are present except for laundry and shopping. Laundry may be completed in the home or at a laundry mat. Shopping is done in the community. Eligible individuals cannot go with the QSP when completing these tasks in the community.  Time spent traveling to and from the individual's home for laundry or shopping counts as part of the billable time for homemaker services. (One (1) unit = 15 minutes)

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Non-Medical Transportation (Escort)

Procedure Code: T2001-UC

Unit: 15 minutes

Special Instructions: This code is used to claim payment when the eligible individual needs human assistance to participate in non-medical transportation or to accompany the individual for the assistance of boarding and existing the vehicle/public transit and to complete the activity for which the non-medical transportation was authorized. For example, grocery shopping. Do not bill for the time it takes to get to and from the eligible individual's home or the final destination or for transportation costs. Providers cannot bill for escort and non-medical transportation at the same time. Escort can only be billed if the eligible individual is present for the activity. (One (1) unit = 15 minutes) 

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Non-Medical Transportation (local and out of town)

Procedure Code: T2001

Unit: 15 minutes

Special Instructions: This code is used to claim payment  when transporting an eligible individual to essential community services like the grocery store, pharmacy and bank using a private or agency owned vehicle. This code can only be billed for the time it takes to drive the eligible individual to the approved destination. (One (1) unit = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Nurse Education Care

Procedure Code: S5108

Unit: 15 minutes

Special Instructions: This code is used to claim payment for the time it takes the registered nurse (RN) to assess and create the nursing plan of care and the time it takes to educate the QSP that will carry out the task. This code should not be used to bill for the time it takes to carry out the extended personal care task even if the task was completed by a nurse (RN/LPN). (One (1) units = 15 minutes)   

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

One-Time Transition Costs

Procedure Code: T5999

Unit: $3,000 max

Special Instructions: This code is used to claim payment for non-reoccurring set up expenses of an eligible individual's move to their own private residence. Payment can not be made for items that would be considered room and board; monthly rent or mortgage expenses; specials; insurance; food; regular utility charges and or household appliances or items that are intended for purely diversional/recreational purposes. (One (1) unit = the total cost of allowable items not to exceed $3,000 per eligible individual)   

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Personal Care - Daily- Medicaid State Plan 

Procedure Code: T1020

Unit: Per day

Special Instructions: This code is used to claim payment when daily personal care is provided by a live-in caregiver to a Medicaid State Plan Personal Care recipient. This service cannot be provided by a spouse, legal guardian, or a parent of a minor child. Personal care service may be performed inside or outside the client's home when the eligible individual is present. Billing for services outside the local trade area is allowed however, you must discuss any limitations with the HCBS Case Manager. Payment cannot be claimed for the days the individual in need of care was away from the home. For example, if they were hospitalized.  Payment is not allowed for the day the eligible individual entered the hospital but the provider can bill for the day the eligible individual returns home to their care. Payment can be claimed if in home cares are provided on the day of death. The number of services provided on each calendar day must be shown on the billing document. Span billing is not allowed.(One (1) unit = One (1) day)

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Personal Care - Daily -SPED

Procedure Code: T1020

Unit: Per day

Special Instructions: This code is used to claim payment when daily personal care is provided by a live-in provider who is not related to the individual in need of care.  Personal care service may be performed inside or outside the client's home when the eligible individual is present. Billing for services outside the local trade area is allowed however, you must discuss any limitations with the HCBS Case Manager. Payment cannot be claimed for the days the individual in need of care was away from the home. For example, if they were hospitalized.  Payment is not allowed for the day the eligible individual entered the hospital but the provider can bill for the day the eligible individual returns home to their care. Payment can be claimed if in home cares are provided on the day of death. The number of services provided on each calendar day must be shown on the billing document. Span billing is not allowed. (One (1) unit = One (1) day)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes

Personal Care - Unit Rate

Procedure Code: T1019

Unit: 15 minutes

Special Instructions: This code is used to claim payment when personal care is provided for portions of a calendar day. Only bill for the time it takes to complete the authorized task. Personal care service may be performed inside or outside the client's home when the eligible individual is present. Billing for services outside the local trade area is allowed however, you must discuss any limitations with the HCBS Case Manager. The number of services provided on each calendar day must be shown on the billing document. Span billing is not allowed. (15 minutes of services = 1 billing unit)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Respite Care

Procedure Code: S5150

Unit: 15 minutes

Special Instructions: This code is used to claim payment when respite (short break) is provided to the primary caregiver. Only bill for the time it takes to complete the authorized task. Care must be provided in the eligible individual's home or in a provider's respite home that has been approved by an HCBS Case Manager. (One (1) unit = 15 minutes) 

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Supervision

Procedure Code: S5135

Unit: 15 minutes

Special Instructions: This code is used to claim payment for up to (24) hours of supervision provided to an eligible individual in their home. Supervision services must be provided by awake staff. Payment for this service cannot be claimed for time providing personal care, or homemaker, or any other service. Those tasks should be billed using the correct  procedure code for that service. (One (1) units = 15 minutes)  

Requires Electronic Visit Verification (EVV): Yes

Claim Type: Professional

Eligible for Billing in Therap: Yes

Transition Coordination

Procedure Code: T2038

Unit: 15 minutes

Special Instructions: This code is used to claim payment for providing community transition services to eligible individuals to plan a move from a institution or other provider operated living arrangement to a private residence where they can receive necessary care. (One (1) units = 15 minutes)  

Requires Electronic Visit Verification (EVV): No

Claim Type: Professional

Eligible for Billing in Therap: Yes