September 17th, 2022
EVV Mismatches For DH
Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission
Concern and Issue
HCS and TxHmL providers are receiving unnecessary electronic visit verification (EVV) mismatches for Day Habilitation services due to providers not using proper bill code and modifier combinations based on where services are delivered.
Which day habilitation bill codes do I use?
In-Home Day Habilitation services delivered in an own home or family home setting require EVV visits before billing and must be billed using the following bill codes:
- M0115 – DAY HABILITATION – LN 1 – IN-HOME
- M0116 – DAY HABILITATION – LN 5 – IN-HOME
- M0117 – DAY HABILITATION – LN 6 – IN-HOME
- M0118 – DAY HABILITATION – LN 8 – IN-HOME
- M0119 – DAY HABILITATION – LN 9 – IN-HOME
- M0201 – DAY HABILITATION – LC 1 – IN-HOME
- M0202 – CDS DAY HABILITATION – LC 1 – IN-HOME – Modifier 1 Position UC
In-Home Day Habilitation delivered in a host home or companion care setting, three-person or four-person residence, and Day Habilitation provided outside of the home do not require EVV visits and must be billed using the following bill code and modifier combinations:
- M0421 – DAY HABILITATION – LN 1 – OUT-OF-HOME – Modifier 1 Position – KX
- M0422 – DAY HABILITATION – LN 5 – OUT-OF-HOME – Modifier 1 Position – KX
- M0423 – DAY HABILITATION – LN 6 – OUT-OF-HOME – Modifier 1 Position – KX
- M0424 – DAY HABILITATION – LN 8 – OUT-OF-HOME – Modifier 1 Position – KX
- M0425 – DAY HABILITATION – LN 9 – OUT-OF-HOME – Modifier 1 Position – KX
- M0460 – DAY HABILITATION – LC 1 – OUT-OF-HOME – Modifier 1 Position – KX
- M0461 – CDS DAY HABILITATION – LC 1 – OUT-OF-HOME – Modifier 1 Position – TG
September 17th, 2022
For HCS and TxHmL providers participating in the COVID add-on program, follow the instructions below.
Note: Only program providers delivering in-home Day Habilitation services in a three-person or four-person residence qualify for the COVID add-on program.
In-Home Day Habilitation services delivered in a three-person, or four-person residence do not require EVV visits and must be billed using the following bill code and modifier combinations:
- M0944 – DAY HABILITATION – LN 1 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0945 – DAY HABILITATION – LN 5 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0946 – DAY HABILITATION – LN 6 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0947 – DAY HABILITATION – LN 8 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0948 – DAY HABILITATION – LN 9 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
Resources
EVV PCS Service Bill Codes Table
HCS and TxHmL Bill Code Crosswalk (for claims with dates of service beginning 05-01-2022)
February 27th, 2022
HCS and TxHmL Billing Changes In The Crosswalk for DH
HCS and TxHmL providers must use the HCS and TxHmL Bill Code Crosswalk starting March 1, 2022 to submit claims for all services. The bill code was updated Dec. 28, 2021.
The HCS and TxHmL Bill Code Crosswalk includes new bill codes for the services that require electronic visit verification.
For HCS program providers:
- Providing out of home day habilitation or in-home day habilitation in a host home or companion care setting, program providers must use the out-of-home day habilitation bill codes.
- Not participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, program providers must use the out-of-home day habilitation bill codes.
- Participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, the program provider must use the out-of-home bill codes below with the modifiers “KX” and “CR.”
- For LON 1: M0944
- For LON 5: M0945
- For LON 8: M0947
- For LON 6: M0946
- For LON 9: M0948
Contact the HCS Policy Box with questions.
