Below are the Electronic Visit Verification (EVV) mandated services and service codes. If providers are billing these services, they will be required to use EVV to clock in and clock out.
HCBS DD WAIVER SERVICES (CDD AND DDAD)
|
| SERVICES | SERVICE CODES | PROVIDER TYPE |
| Independent Living | 2639
| Agency and Independent |
| Supported Family Living | 7494 | Agency and Independent |
| Medical In-Home Habilitation | 9220 | Agency |
Behavioral In-Home Habilitation
| 1796 | Agency |
| Respite | 2656
| Agency
|
Respite (In-Home)
| 8148
| Independent |
| Homemaker | 9393 | Independent
|
| Homemaker | 9769 | Agency
|
HCBS AD WAIVER SERVICES
|
| SERVICES | SERVICE CODES | PROVIDER TYPE |
Chore (Discontinued 10/31/21)
| 1691
| Agency and Independent
|
Personal Care (Effective 11/1/21)
| 5761
| Agency and Independent
|
Companion (Effective 11/1/21)
| 9510
| Agency and Independent |
| Respite Care -- (In-Home) | 1113
| Agency and Independent
|
Disability related Child-Care -- In Home
| 2500
| Agency and Independent
|
| MEDICAID PAS |
| SERVICES | SERVICE CODES | PROVIDER TYPE |
Personal Assistance
| 4475
| Agency and Independent
|
HCBS TBI WAIVER SERVICES
|
| SERVICES | SERVICE CODES | PROVIDER TYPE |
TBI Personal Care
| 6222
| Agency and Independent
|
TBI Companion
| 7934
| Agency and Independent
|
HCPCS SERVICES
|
| SERVICES | SERVICE CODES
|
Brief RN Service in Private-Duty Nursing Setting (1-8 Units)
| T1000 TD
|
Brief LPN Service in Private-Duty Nursing Setting (1-8 Units)
| T1000 TE
|
Hourly RN Service in Private-Duty Nursing Setting
| T1002
|
Hourly LPN Service in Private-Duty Nursing Setting
| T1003
|
Brief Aide Service in Home Health Setting (1-8 Units)
| G0156
|
Direct Skilled Nursing Services of an RN in a Home Health or Hospice Setting, each 15 minutes
| G0299
|
Direct Skilled Nursing Services of an LPN in a Home Health Setting, each 15 minutes (not payable for hospice)
| G0300
|
Hourly Aide service in home health setting
| S9122
|
Hourly RN service in home health setting
| S9123
|
Hourly LPN service in home health setting
| S9124 |
Hourly RN service in home health setting for high tech service
| S9123 TG |
Hourly LPN service in home health setting for high tech service
| S9124 TG |
Hourly RN service in home health setting for 2 clients at the same time
| S9123 UN |
Hourly LPN service in home health setting for 2 clients at the same time
| S9124 UN |
Physical Therapist in home health or hospice setting, each 15 minutes
| G0151
|
Occupational Therapist in home health or hospice setting, each 15 minutes
| G0152
|
Speech-Language Pathologist in the home health or hospice setting, each 15 minutes
| G0153
|
Contracted home health agency services all services provided under contract, per day
| T1022 TG
|