Electronic Visit Verification (EVV) Applicable Billing Codes
- Billing Codes is also available in Portable Document Format (PDF)
The purpose of this document is to inform Medicaid providers of the Personal Care Services (PCS) and associated billing codes that are subject to Federal and State Electronic Visit Verification (EVV) requirements.
Below are the PCS billing codes for Fee for Service (FFS) and Managed Care (MC) Medicaid. The Department is requiring that providers implement and put into use an EVV system to capture the required data points (type of service performed, individual receiving service, date of service, location of service delivery, individual providing service, and time the service begins and ends) for services billed under the codes below and send them to the State’s data aggregator.
NOTE: For HCBS Children´s Waiver Respite EVV Claims, providers must apply Modifier 96 where applicable.
If you have questions, please contact the Department by email at EVVHelp@health.ny.gov.
| Fee-For-Service (FFS) EVV Applicable Rate Codes | |||
|---|---|---|---|
| Program | Service Description | Rate Code | |
| CDPA | CDPAP 1 CLIENT, QUARTER HOUR | 2422 | |
| CDPA | CDPAP 2 CLIENTS, PER CLIENT, QUARTER HOUR | 2423 | |
| CDPA | CDPAP 1 CLIENT, ENHANCED RATE, QUARTER HOUR | 2424 | |
| CDPA | CDPAP 2 CLIENTS, PER CLIENT, ENHANCED RATE, QTR HR | 2425 | |
| CDPA | CDPAP 1 CLIENT HOURLY | 2401 | |
| CDPA | CDPAP 2 OR MORE CLIENTS, HOURLY PER CLIENT | 2402 | |
| CDPA | CDPAP 1 CLIENT HOURLY, ENHANCED | 2403 | |
| CDPA | CDPAP 2 OR MORE CLIENTS, HOURLY PER CLIENT ENHANCED | 2404 | |
| CDPA | CONSUMER DIRECT PERSONAL ASSIST 1 CLNT LIVE-IN | 2405 | |
| CDPA | CONS DIR PERS ASSIST 2 OR > CLNTS PER CLNT LIVE-IN | 2406 | |
| HCBS CHILDRENS | COMMUNITY HCBS HABILITATION INDIVIDUAL | 8012 | |
| HCBS CHILDRENS | COMMUNITY HCBS HABILITATION GROUP OF 2 | 8013 | |
| HCBS CHILDRENS | COMMUNITY HCBS HABILITATION GROUP 3+ | 8014 | |
| HCBS CHILDRENS | PLANNED RESPITE INDIVIDUAL UP TO 6 HOURS | 8023 | |
| HCBS CHILDRENS | PLANNED RESPITE INDIVIDUAL PER DIEM OVER 6 HOURS | 8024 | |
| HCBS CHILDRENS | PLANNED RESPITE GROUP UP TO 6 HOURS | 8027 | |
| HCBS CHILDRENS | CRISIS RESPITE UP TO 6 HOURS | 8028 | |
| HCBS CHILDRENS | CRISIS RESPITE MORE THAN 6 HOURS, LESS THAN 12 HOURS | 8029 | |
| HCBS CHILDRENS | CRISIS RESPITE INDIVIDUAL 12+HOURS, LESS THAN 24 HOURS | 8030 | |
| NOTE: For HCBS CHILDRENS Respite EVV Claims, providers must apply Modifier 96 where applicable | |||
| HCBS NHTD | RESPITE, IN HOME (1-DAY MAX) | 9768 | |
| HCBS NHTD | HCSS LEVEL I | 9795 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; AGY SUP; VOL; IND | 4757 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; AGY SUP; VOL; GRP | 4758 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; VIA FI; VOL; IND | 4767 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; VIA FI; VOL; GRP | 4768 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; VOL; IND | 4796 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; VOL; GRP | 4797 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; STATE; IND | 4798 | |
| HCBS OPWDD | COM HAB; CERT FAC RESID; STATE; GRP | 4799 | |
| HCBS OPWDD | RESPITE; INTENSIVE; VOL | 7425 | |
| HCBS OPWDD | RESPITE; AGY SUP INTENSIVE; VOL | 7427 | |
| HCBS OPWDD | COM HAB; VOL; INDIV;1/4 HR | 4722 | |
| HCBS OPWDD | COM HAB; VOL; GROUP-2 INDIVIDUALS | 4723 | |
| HCBS OPWDD | COM HAB; VOL; GROUP-3 INDIVIDUALS | 4724 | |
| HCBS OPWDD | COM HAB; VOL; GROUP-4+ INDIVIDUALS | 4725 | |
| HCBS OPWDD | COM HAB; STATE; GROUP-1 INDIVIDUAL | 4741 | |
| HCBS OPWDD | COM HAB; STATE; GROUP-2 INDIVIDUALS | 4742 | |
| HCBS OPWDD | COM HAB; STATE; GROUP-3 INDIVIDUALS | 4743 | |
| HCBS OPWDD | COM HAB; AGY SUP; VOL; IND | 4755 | |
| HCBS OPWDD | COM HAB; AGY SUP; VOL; GRP | 4756 | |
| HCBS OPWDD | COM HAB; VIA FI; VOL; IND | 4765 | |
| HCBS OPWDD | COM HAB; VIA FI; VOL; GRP | 4766 | |
| HCBS OPWDD | RESPITE; VIA FI FEE; VOL | 4764 | |
| HCBS OPWDD | RESPITE; IN HOME; VOL | 7421 | |
| HCBS OPWDD | RESPITE; AGY SUP; IN HOME; VOL | 7426 | |
| HCBS OPWDD | RESPITE; IN HOME; VOL; PER DIEM | 7428 | |
| HCBS OPWDD | RESPITE; IN HOME; STATE | 7430 | |
| HCBS TBI | HOME AND COMMUNITY SUPPORT, HOURLY | 9879 | |
| HCBS TBI | HOME AND COMMUNITY SUPPORT, HOURLY | 9880 | |
| HCBS TBI | HOME AND COMMUNITY SUPPORT, HOURLY | 9881 | |
| HCBS TBI | HOME AND COMMUNITY SUPPORT, HOURLY | 9882 | |
| HCBS TBI | RESPITE, IN HOME (24 HOURS) | 9875 | |
| PCAI | PCAI, SHARED AIDE, BASIC, HOURLY | 2501 | |
| PCAI | PCAI, SHARED AIDE, BASIC, QUARTER HOUR | 2507 | |
| PCAI | PCA LEVEL I, 1 CLIENT, QUARTER HOUR | 2593 | |
| PCAI | PCA LEVEL I, 2 CLIENTS, PER CLIENT 1/4 HOUR | 2594 | |
| PCAI | PCA LEVEL I, ONE CLIENT HOURLY | 2601 | |
| PCAI | PCA LEVEL I, 2 CLIENTS, HOURLY (PER CLIENT) | 2602 | |
| PCAII | PCAII, SHARED AIDE, BASIC, HOURLY | 2502 | |
| PCAII | PCAII, SHARED AIDE, BASIC, QUARTER HOUR | 2508 | |
| PCAII | PCA LEVEL II, 1 CLIENT, 1/4 HOUR | 2595 | |
| PCAII | PCA LEVEL II, 2 CLIENTS PER CLIENT 1/4 HOUR | 2596 | |
| PCAII | PCA LEVEL II, 1 CLIENT HARD TO SERVE 1/4 HOUR | 2597 | |
| PCAII | PCA LVL 2, 2 CLNTS/CLNT HARD TO SERVE 1/4 HOUR | 2598 | |
| PCAII | PCA LEVEL 2, ONE CLIENT, HOURLY | 2622 | |
| PCAII | PCA LEVEL 2, TWO CLIENTS, HOURLY (PER CLIENT) | 2623 | |
| PCAII | PCA LEVEL 2, ONE CLIENT, HOURLY-SECONDARY CODE | 2626 | |
| PCAII | PCA LEVEL 2, CLIENTS HOURLY, PER CLNT-SECONDARY CD | 2627 | |
| CDPA | PCA LEVEL 2, ONE CLIENT, DAILY | 2632 | |
| CDPA | PCA LEVEL 2, 2 CLIENTS DAILY (PER CLIENT) | 2633 | |
| PCAII | PCA II – NURSING SUPERVISION | 2742 | |
| PCAII | NURSING ASSESSMENT | 2787 | |
| Managed Care EVV Applicable Procedure Codes | |||
|---|---|---|---|
| Program | Service Description | Procedure Code | Modifier Code |
| PCAI | PCS LEVEL I MULTIPLE CLIENT | S5130 | U3 |
| PCAI | PCS LEVEL I – 15 MINUTES | S5130 | U1 |
| PCAI | PCS LEVEL I TWO CLIENT | S5130 | U2 |
| PCAI | PCS LEVEL I WEEKEND/HOLIDAY | S5130 | TV |
| PCAII | PCS LEVEL II WEEKEND/HOLIDAY | T1019 | TV |
| PCAII | PCS LEVEL II MULTIPLE CLIENT | T1019 | U3 |
| PCAII | PCS LEVEL II BASIC – 15 MINUTES | T1019 | U1 |
| PCAII | PCS LEVEL II BASIC TWO CLIENT | T1019 | U2 |
| PCAII | PCS LEVEL II HARD TO SERVE | T1019 | U4 |
| PCAII | PCS LEVEL II TWO CLIENT HARD TO SERVE | T1019 | U5 |
| PCAII | PCS LEVEL II LIVE-IN | T1020 | NONE |
| PCAII | PCS LEVEL II LIVE-IN TWO CLIENT | T1020 | U2 |
| PCAII | PCS LEVEL II LIVE-IN WEEKEND/HOLIDAY | T1020 | TV |
| PCAII | PCS LEVEL II LIVE IN TWO CLIENT HARD TO SERVE | T1020 | U5 |
| CDPA | CDPA BASIC – 15 MINUTES | T1019 | U6 |
| CDPA | CDPA ENHANCED | T1019 | U8 |
| CDPA | CDPA TWO CONSUMER | T1019 | U7 |
| CDPA | CDPA TWO CONSUMER ENHANCED | T1019 | U9 |
| CDPA | CDPA LIVE IN | T1020 | U6 |
| CDPA | CDPA LIVE IN ENHANCED | T1020 | U8 |
| CDPA | CDPA LIVE IN TWO CONSUMER | T1020 | U7 |
| CDPA | CDPA LIVE IN TWO CONSUMER ENHANCED | T1020 | U9 |
| HCBS CHILDRENS | COMMUNITY HCBS HABILITATION INDIVIDUAL | H2014 | HA |
| HCBS CHILDRENS | COMMUNITY HCBS HABILITATION GROUP OF 2 | H2014 | HA, UN |
| HCBS CHILDRENS | COMMUNITY HCBS HABILITATION GROUP 3+ | H2014 | HA, UP |
| HCBS CHILDRENS | PLANNED RESPITE INDIVIDUAL UP TO 6 HOURS | S5150 | HA |
| HCBS CHILDRENS | PLANNED RESPITE INDIVIDUAL PER DIEM OVER 6 HOURS | S5151 | HA |
| HCBS CHILDRENS | PLANNED RESPITE GROUP UP TO 6 HOURS | S5150 | HA, HQ |
| HCBS CHILDRENS | CRISIS RESPITE UP TO 6 HOURS | S5150 | HA, ET |
| HCBS CHILDRENS | CRISIS RESPITE MORE THAN 6 HOURS, LESS THAN 12 HOURS | S5151 | HA, ET |
| HCBS CHILDRENS | CRISIS RESPITE INDIVIDUAL 12+HOURS, LESS THAN 24 HOURS | S5151 | HA, ET, HK |
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