Electronic Visit Verification (EVV) Applicable Billing Codes

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.

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
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 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
PCAII PCA II – NURSING SUPERVISION 2742
PCAII NURSING ASSESSMENT 2787

Managed Care EVV Applicable Procedure Codes
Program Service Description Procedure Code Rate Code Type
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
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