The UnitedHealthcare Community Plan of Pennsylvania has made changes to the bill form and coding utilized to support home health care for the Medicaid and Child Health Plus benefit plans, effective Nov. 1, 2020.
These updates resulted from changes made by the Commonwealth of Pennsylvania made to support EVV, which went live Nov. 1, 2020.
Effective Nov. 1, 2020:
home health services must be billed on a CMS 1500 form with HCPCS codes. All home health aide services not pertaining to personal care must be billed with a UD modifier.
non-personal care home health aide services must be billed with HCPCS code S9122 and modifier UD
personal care home health aide services
must be billed with HCPCS code G0156
must be billed through our EVV vendor, HHAeXchange*
Additional coding changes were implemented to support private duty nursing, also known as shift care. Services rendered by
registered nurse (RN) are now required to be billed with HCPCS code T1002.
licensed practical nurse (LPN) are now required to be billed with HCPCS code T1000.
You’ll need to ensure that all prior authorization requests reflect the new codes as of Nov. 1, 2020.
The new HCPCS codes, G0156, T1000 and T1002, have a unit of per 15 minutes.
This is a change from the codes historically used, which had a unit of per hour. Submitt your claims to reflect the appropriate number of units based on the unit of measure for the HCPCS code being billed.
*The HHAeXchange vendor will perform validation of the required data elements prior to submitting the claims to our plan. You will continue to receive reimbursement directly us.