HCS and TxHmL 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

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)