Minnesota Department of Human Services Electronic Visit Verification (EVV) Data Aggregator API Specifications
This specification provides guidance and instructions in preparing data for import to HHAeXchange. Herein are the various Application Programming Interface (API) endpoint definitions indicating required fields and proper format for a successful import.
The topic is intended for project management and technical teams at designated providers and/or Electronic Visit Verification (EVV) vendors who are implementing this interface.
Submit a General inquiries ticket for EVV aggregation to 3rd Party Integration Support Desk. Include 'State Abbreviation' EVV General Inquiry in the subject line. Cases are escalated to the Integration Support queue. An available team member will contact you to assist.
Caregiver Data Structure
| Index | Element | Description | Max Length | Type | Required |
|---|---|---|---|---|---|
| 1 | providerTaxID | Provider Tax ID - Unique Identifier for the Provider. Format: 999999999 | 9 | String | Required |
| 2 | qualifier | Identifier being sent as the unique identifier for the Caregiver. Possible Values: ExternalID | 50 | String | Required |
| 3 | externalID | Unique Caregiver identifier in the external system. | 20 | String | Required |
| 4 | ssn | Provider and EVV vendors should only send a default value of ‘999999999’ for the social security number field Format: 999999999 | 9 | String | Required |
| 5 | dateOfBirth | Caregiver's Date of Birth. Format: YYYY-MM-DD Cannot be greater than the current date. | 10 | Date | Required |
| 6 | lastName | Caregiver’s Last Name. | 30 | String | Required |
| 7 | firstName | Caregiver’s First Name. | 30 | String | Required |
| 8 | gender | Caregiver’s Gender. This is an HHAeXchange application requirement. If you do not wish to send this, please default to ‘Other’. Possible Values: Male, Female, Other | 20 | String | Required |
| 9 | Caregiver’s Email Address. If the value is empty, then the existing value of caregiver’s email address in HHAeXchange is removed | 100 | String | Optional | |
| 10 | phoneNumber | Caregiver’s Phone Number. Format: 9999999999 If the value is empty, then the existing value of caregiver’s phone number in HHAeXchange is removed | 10 | String | Optional |
| 11 | type | Caregiver’s Type. Possible Values: Skilled, Non-Skilled or Both Select ‘Both’ to reduce conflict rejections in the Visits endpoint when the Procedure Code attribute or skill type is unknown. | 15 | String | Required |
| 12 | stateRegistrationID | Unique ID provided to Caregiver once credentialed by state. If the value is empty, then the existing value of caregiver’s state registration ID in HHAeXchange is removed | 20 | String | Optional |
| 13 | professionalLicenseNumber | Possible Values: UMPI Required when: Unique ID is provided by State of MN Caregiver Registration System. If providing self-directed services and license number is not available, please default to ‘999999999999’. | 50 | String | Required |
| 14 | hireDate | Date on which caregiver hired by Provider. This is an HHAeXchange application requirement. Providers and EVV vendors should default to sending 1900-01-02 Format: YYYY-MM-DD | 10 | Date | Required |
| 15 | Address | ||||
| addressLine1 | Individual’s street address. | 100 | String | ||
| addressLine2 | Individual’s additional street address information if applicable. | 50 | String | Optional | |
| city | City | 50 | String | Optional | |
| state | State abbreviation (2 letter state code) e.g. MN | 2 | String | Optional | |
| zipcode | Zip Code (5 or 9-digit format i.e., 12345). Format: 99999 OR 999999999 | 9 | String | Required | |
| Required | |||||
Duties
| Code | Task Name | HHAeXchangeCategory | Payer |
|---|---|---|---|
| 300 | Dressing | Personal Care | MICS & MINN |
| 301 | Grooming | Personal Care | MICS & MINN |
| 302 | Bathing | Personal Care | MICS & MINN |
| 303 | Toileting | Personal Care | MICS & MINN |
| 304 | Eating | Personal Care | MICS & MINN |
| 305 | Mobility | Personal Care | MICS & MINN |
| 306 | Transferring | Personal Care | MICS & MINN |
| 307 | Positioning | Personal Care | MICS & MINN |
| 308 | Meal preparation | Personal Care | MICS & MINN |
| 309 | Meal planning | Personal Care | MICS & MINN |
| 310 | Housecleaning | Personal Care | MICS & MINN |
| 311 | Laundry | Personal Care | MICS & MINN |
| 312 | Personal paperwork | Personal Care | MICS & MINN |
| 313 | Finances | Personal Care | MICS & MINN |
| 314 | Community Participation | Personal Care | MICS & MINN |
| 315 | Shopping | Personal Care | MICS & MINN |
| 316 | Communicating | Personal Care | MICS & MINN |
| 317 | Transportation | Personal Care | MICS & MINN |
| 318 | Behavioral support | Personal Care | MICS & MINN |
| 319 | Health-related tasks | Personal Care | MICS & MINN |
| 320 | Crisis respite | Waiver | MIWS |
| 321 | Homemaker w/ personal cares | Waiver | MIWS |
| 322 | Individual community living support (ICLS) | Waiver | MIWS |
| 323 | Night Supervision | Waiver | MIWS |
| 324 | Individualized home supports w/ training | Waiver | MIWS |
| 325 | Individualized home supports w/o training | Waiver | MIWS |
| 326 | Home health aide | Home Health | MIHH |
| 327 | Skilled nursing | Home Health | MIHH |
| 328 | Occupational therapy | Home Health | MIHH |
| 329 | Physical therapy | Home Health | MIHH |
| 330 | Respiratory therapy | Home Health | MIHH |
| 331 | Speech therapy | Home Health | MIHH |
Electronic Visit Verification (EVV) Information
When the third-party EVV system sends EVV records, the EVV API returns a transaction ID. This transaction ID can be queried by the caller (Vendor/Provider) to get status of the EVV records. Upon successful submission of an EVV record, an EVVMSID (unique visit identifier) is returned along with status. The EVVMSID can be used to update or delete that EVV record in the future. All data sent to HHAeXchange is loaded as-is; there is no data manipulation when processing.
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Third-Party EVV systems can submit multiple EVV records (new or update) per request. Currently a maximum of 100 EVV records are allowed per request
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Third-Party EVV systems can submit EVV records from multiple providers.calltype
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If the EVV data does not pass validations, the records are rejected with the appropriate error code and message. The EVV Provider can react by resubmitting corrected EVV records
An option exists for the 3rd party EVV submitter to provide the EVVMSID. The external EVVMSID must be unique across agencies if the 3rd party is sending on behalf of multiple agencies using same Client ID.
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This value must be prefixed with a tilde ("~") sign to differentiate it from the HHAeXchange derived EVVMSID
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The EVV submitter will be responsible to pass a Unique Visit Identifier as the EVVMSID for each new visit created in the system
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When selecting this option use the same EVVMSID with the prefixed tilde when calling the PUT and DELETE endpoints
-
Using this option, the HHAeXchange EVVMSID will still be returned in the transactions endpoint and can be used interchangeably.
API consumers must adhere to the following rules:
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Adhere to REST design principles while interacting with the API
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Protocol: secure HTTP (HTTPS)
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Communication Method: Use the appropriate Uniform Resource Identifier (URI) patterns along with HTTP verb (POST, PUT, DELETE, and GET)
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Message Format (Request/Response): application/json
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Produce JSON payloads that meet the API specification
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The API leverages the HTTP response status codes to inform the consumer
EVV Request Data Structure
POST and PUT Operation
Optional fields are not required. Situational fields are dependent on other fields and may be required as indicated. For example, if a Missed Visit is marked as True, then the Situational fields Missed Visit Reason Code and Missed Visit Action Code are required.
| Index | Element | Description | Max Length | Type | Required? |
|---|---|---|---|---|---|
| 1 | providerTaxID | Provider Tax ID - Unique Identifier for the Provider. Format: 999999999 | 9 | String | Required |
| 2 | Office | ||||
| qualifier | Value being sent to uniquely identify the member. Possible Values: FederalTaxID, NPI or UMPI If agency operates in a single office location, same tax ID can be submitted as ‘providerTaxID’ above. If agency has multiple locations, submit office-level NPI, or UMPI. If service code is configured for auto-placement, submit office-level NPI, or UMPI. | 50 | String | Required | |
| identifier | Office identifier identified by Office Qualifier. | 64 | String | Required | |
| 3 | Member | ||||
| qualifier | Value being sent to uniquely identify the member. Possible Values: MedicaidID | 50 | String | Required | |
| identifier | Member identifier identified by Member Qualifier. *Length of this field will be based on the qualifier (For MedicaidID, it will be 50 characters) | *64 | String | Required | |
| admissionId | Secondary Member identifier. If patient has multiple profiles in HHAeXchange, send both Member qualifier and Admission ID. | 80 | String | Optional | |
| 4 | Caregiver | ||||
| qualifier | Value being sent to unique identify the Caregiver. Possible Values: ExternalID | 50 | String | Required | |
| identifier | Caregiver identifier identified by Caregiver Qualifier. *Length of this field will be based on the qualifier (For ExternalID, it will be 20 characters) | *64 | String | Required | |
| 5 | residingCaregiver | Possible Values: Yes or No Required When: If Caregiver is Live-in | 50 | String | Optional |
| 6 | payerID | HHAeXchange assigned ID for the payer. Payer ID is determined during the implementation process. | 50 | String | Required |
| 7 | externalVisitID | Unique Visit identifier in the external system. | 30 | String | Required |
| 8 | evvmsId | Unique Visit identifier in the HHAeXchange aggregator system. HHAeXchange EVVMSID: Required for updates to the EVV record. External EVVMSID: Required for creation and updates to the EVV record. If externally sourced, must start with a “~” and contain alphanumeric, the “_” or “-” characters. | 64 | String | Situational |
| 9 | procedureCode | This is the billable procedure code which would be mapped to the associated service. | 50 | String | Required |
| 10 | procedureModifierCode | Two characters Modifier for the HCPCS code for the 837. Up to 4 of these are allowed. Please consult specific program requirements for exact usage. | 2 | Array of String | Optional |
| 11 | timezone | Time zone visit data is captured in. Required timezone: US/Central All time sent to HHAeXchange from third-party provider will be in UTC. Time zone values are based on the Internet Assigned Numbers Authority (IANA) Time Zone Database, which contains data that represents the history of local time for locations around the globe. It is updated periodically to reflect changes made by political bodies to time zone boundaries, UTC offsets, and daylight-saving rules. | 20 | String | Required |
| 12 | scheduleStartTime | Schedule Start Time in UTC Time. Format: YYYY-MM-DDThh:mm If the schedule already exists in HHAeXchange, the Schedule Start Time is overwritten. MN DHS does not require an agency to have a pre-determined schedule. HHAeXchange system behavior requires data in the schedule fields, so to fulfill this requirement, visit data can be copied into schedule data. This configuration will not have an impact on EVV compliance as it supports MN DHS requirements. | DateTime | Required | |
| 13 | scheduleEndTime |
Schedule End Time in UTC Time. Format: YYYY-MM-DDThh:mm If the schedule already exists in HHAeXchange, the Schedule Start Time is overwritten. MN DHS does not require an agency to have a pre-determined schedule. HHAeXchange system behavior requires data in the schedule fields, so to fulfill this requirement, visit data can be copied into schedule data. This configuration will not have an impact on EVV compliance as it supports MN DHS requirements. |
DateTime | Required | |
| 14 | visitStartDateTime |
When Required: When “Visit End Date Time” OR “EVV Clock In Time” is provided. Visit Start Time in UTC Time. Format: YYYY-MM-DDThh:mm If a value is provided in this field, then the schedule is confirmed with the start time provided. Cannot be greater than current date. If the value is empty, then the existing value of Visit Start Time in HHAeXchange is removed. If visitStartDateTime/visitEndDateTime and EVV Clock In/Out Time do not match, visit is marked as manually confirmed or adjusted and visit edits should be transmitted. |
DateTime | Situational | |
| 15 | visitEndDateTime |
When Required: When “EVV Clock Out Time” is provided. Visit End Time in UTC Time. Format: YYYY-MM-DDThh:mm If a value is provided in this field, then the Schedule is confirmed with the End Time provided. Must be greater than Visit Start Date Time. Cannot be greater than current date. If the value is empty, then the existing value of Visit End Time in HHAeXchange is removed. If visitStartDateTime/visitEndDateTime and EVV Clock In/Out Time do not match, visit is marked as manually confirmed or adjusted and visit edits should be transmitted. |
DateTime | Situational | |
| 16 | timesheetRequired | Timesheet Required. Possible Values: True or False An empty value is considered as “False”. If the value is empty, then the existing value of Timesheet Required in HHAeXchange is removed. | Boolean | Optional | |
| 17 | timesheetApproved | Timesheet Approved. Possible Values: True or False An empty value is considered as “False”. If the value is empty, then the existing value of Timesheet Approved in HHAeXchange is removed. If timesheetRequired is set as “False", then this field’s value is ignored. | Boolean | Optional | |
| Evv | |||||
| clockIn: When Required: if EVV Clock In Time is confirmed via EVV | |||||
| 1 | callDateTime | When Required: if EVV Clock In Time is confirmed via EVV EVV Clock In Time in UTC Time. Format: YYYY-MM-DDThh:mm If a value is provided in this field, then the Visit Start Time is marked as confirmed via EVV; otherwise, it is considered manually confirmed if visitStartDateTime is provided. | DateTime | Situational | |
| 2 | callType | When Required: if EVV Clock In Time is confirmed via EVV The type of device used to create the event. Values: Telephony, Mobile and FOB. Any call with GPS data collected should be identified as Mobile. If callDateTime is not provided, then API will ignore value in this field. | 20 | String | Situational |
| 3 | callLatitude | When Required: - If EVV Clock In Time is confirmed by GPS (i.e. CallType = Mobile) GPS Latitude recorded during event. Latitude has a range of -90 to 90 with a 6-digit precision. If callDateTime is not provided, then API will ignore value in this field. | Decimal (8,6) | Situational | |
| 4 | callLongitude | When Required: - If EVV Clock In Time is confirmed by GPS (i.e. CallType = Mobile) GPS Longitude recorded during event. Longitude has a range of -180 to 180 with a 6-digit precision. If callDateTime is not provided, then API will ignore value in this field. | Decimal (9,6) | Situational | |
| 5 | originatingPhoneNumber | When Required: - If EVV Clock In Time is confirmed by Telephony (i.e. CallType = Telephony) Originating Phone Number (Caller ID) for telephony. Format: 9999999999 If a value is provided in this field, then it is considered as a Telephony confirmation and this phone number is imported into HHAeXchange. If callDateTime is not provided, then API will ignore value in this field. | 10 | String | Situational |
| 6 |
locationType |
Possible values: Home or Community Send when: if visit is confirmed or billed. | 9 | String | Situational |
| 7 | serviceAddress | ||||
| addressLine1 |
The physical address where the EVV check-in took place. If callDateTime is not provided, then API will ignore value in this field. |
100 | String | Situational | |
| addressLine2 |
The physical address where the EVV check-in took place. If callDateTime is not provided, then API will ignore value in this field. |
50 | String | Optional | |
| city | City If callDateTime is not provided, then API will ignore value in this field. | 50 | String | Situational | |
| state | State abbreviation (2 letter state code). If callDateTime is not provided, then API will ignore value in this field. | 2 | String | Situational | |
| zipcode | Zip Code (5 or 9-digit format i.e., 12345). Format: 99999 OR 999999999 If callDateTime is not provided, then API will ignore value in this field. | 9 | String | Situational | |
| clockOut: When Required: if EVV Clock Out Time is confirmed via EVV | |||||
| 1 | callDateTime | When Required: if EVV Clock Out Time is confirmed via EVV EVV Clock Out Time in UTC Time. Format: YYYY-MM-DDThh:mm If a value is provided in this field, then the Visit End Time is marked as confirmed via EVV; otherwise, it is considered manually confirmed if visitEndDateTime is provided. | DateTime | Situational | |
| 2 | callType | When Required: if EVV Clock Out Time is confirmed via EVV The type of device used to create the event. Values: Telephony, Mobile and FOB. Any call with GPS data collected should be identified as Mobile. If callDateTime is not provided, then API will ignore value in this field. | 20 | String | Situational |
| 3 | callLatitude | When Required: - If EVV Clock In Time is confirmed by GPS (i.e. CallType = Mobile) GPS Latitude recorded during event. Latitude has a range of -90 to 90 with a 6-digit precision. If callDateTime is not provided, then API will ignore value in this field. | Decimal (8,6) | Situational | |
| 4 | callLongitude | When Required: - If EVV Clock Out Time is confirmed by GPS (i.e. CallType = Mobile) GPS Longitude recorded during event. Longitude has a range of -180 to 180 with a 6-digit precision. If callDateTime is not provided, then API will ignore value in this field. | Decimal (9,6) | Situational | |
| 5 | originatingPhoneNumber | When Required: - If EVV Clock Out Time is confirmed by Telephony (i.e. CallType = Telephony) Originating Phone Number (Caller ID) for telephony. Format: 9999999999 If callDateTime is not provided, then API will ignore value in this field. | 10 | String | Situational |
| 6 | locationType | Possible values: Home or Community Send when: if visit is confirmed or billed. | 9 | String | Situational |
| 7 | performedTasks | List of performed task codes. | Array of String | Optional | |
| 8 | refusedTasks | List of refused task codes. If callDateTime is not provided, then API will ignore value in this field. | Array of String | Optional | |
| 8 | serviceAddress | ||||
| addressLine1 |
The physical address where the EVV check-out took place. If callDateTime is not provided, then API will ignore value in this field. |
100 | String | Situational | |
| addressLine2 |
The physical address where the EVV check-out took place. If callDateTime is not provided, then API will ignore value in this field. |
50 | String | Optional | |
| city | City If callDateTime is not provided, then API will ignore value in this field. | 50 | String | Situational | |
| state | State abbreviation (2 letter state code). If callDateTime is not provided, then API will ignore value in this field. | 2 | String | Situational | |
| zipcode | Zip Code (5 or 9-digit format i.e., 12345). Format: 99999 OR 999999999 If callDateTime is not provided, then API will ignore value in this field. | 9 | String | Situational | |
| missedVisit: When Required: When Visit is marked as Missed | |||||
| 1 | missed | When Required: When Visit is marked as Missed Possible Values: True or False An empty value is considered as False. If the value is True, then the Visit is marked as a ‘Missed’ Visit. If False, then the Missed Visit is removed from HHAeXchange if Visit was previously marked as missed and schedule reappears (if the Visit is not yet billed in HHAeXchange). If the Visit is already billed in HHAeXchange, then this flag is ignored. | Boolean | Situational | |
| 2 | reasonCode |
When Required: When Missed Visit = True Missed Visit Reason Code If the value is empty, then the existing value of Reason in HHAeXchange is not removed. If missed flag is not true, then API will ignore value in this field |
4 | String | Situational |
| 3 | actionCode |
When Required: When Missed Visit = True Missed Visit Action Code. If the value is empty, then the existing value of Action Taken in HHAeXchange is not removed. If missed flag is not true, then API will ignore value in this field |
4 | String | Situational |
| 4 | notes | Free Text Notes - Data in this field is imported as Visit Notes. Reason/Description of the change being made if entered. If the value is empty, then the existing value of Notes in HHAeXchange is not removed. If missed flag is not true, then API will ignore value in this field | 256 | String | Optional |
| editVisit | |||||
| 1 | edited | When Required: When Visit is updated after confirmation Possible Values: True or False If the value is True, then the Visit is considered as manually updated. An empty value is considered as False. | Boolean | Situational | |
| 2 | reasonCode | When Required: When Edit Visit = True Edit Visit Reason Code. If the value is empty, then the existing value of Reason in HHAeXchange is not removed. If edited flag is not true, then API will ignore value in this field. | 4 | String | Situational |
| 3 | actionCode |
When Required: When Edit Visit = True Edit Visit Action Code. If the value is empty, then the existing value of Action Taken in HHAeXchange is not removed. If edited flag is not true, then API will ignore value in this field. |
4 | String | Situational |
| 4 | Notes | Free Text Notes - Data in this field is imported as Visit Notes. Reason/Description of the change being made if entered. If the value is empty, then the existing value of Notes in HHAeXchange is not removed. If edited flag is not true, then API will ignore value in this field. | 256 | String | Optional |
| Billing | |||||
| 1 | externalInvoiceNumber |
Field is required to trigger the submission of claims to the payer. To avoid duplicate billing, this field should not be sent if the provider is billing the payer directly.
|
18 | String | Situational |
| 2 | totalBilledAmount | When Required: When Visit is billed; this field should be sent along with externalInvoiceNumber. Total billed amount in third-party system. | Decimal (8,2) | Situational | |
| 3 | totalUnitsBilled | When Required: When visit is billed; this field should be sent along with externalInvoiceNumber. Total units billed in third-party system | 5 | Integer | Situational |
| 4 | contractRate | When Required: When visit is billed; this field should be sent along with externalInvoiceNumber. Hourly contract rate. | Decimal (8,2) | Situational | |
| 5 | diagnosisCodes | When Required: When visit is billed; this field should be sent along with externalInvoiceNumber. Diagnosis Code Up to 26 of these are allowed. | 50 | Array of String | Situational |
| billSecondaryPayer : When Required: When Visit has secondary bill info | |||||
| 1 | enableSecondaryBilling | When Required: When Visit has secondary billing info. Possible Values: True or False If the value is True, then the Visit is considered to have secondary billing info. An empty value is considered as False. | Boolean | Situational | |
| 2 | otherSubscriberId | When Required: When enableSecondaryBilling = true Other Subscriber ID If enableSecondaryBilling flag is not true, then API will ignore value in this field. | 80 | String | Situational |
| 3 | primaryPayerId | When Required: When enableSecondaryBilling = true Primary Payer ID If enableSecondaryBilling flag is not true, then API will ignore value in this field. | 80 | String | Situational |
| 4 | primaryPayerName | When Required: When enableSecondaryBilling = true Primary Payer Name If enableSecondaryBilling flag is not true, then API will ignore value in this field. | 60 | String | Situational |
| 5 | relationshipToInsured |
Relationship to Insured If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. |
2 | String | Optional |
| 6 | primaryPayerPolicyOrGroupNumber | When Required: When enableSecondaryBilling = true Primary payer policy or Group number If enableSecondaryBilling flag is not true, then API will ignore value in this field. | 3 | String | Situational |
| 7 | primaryPayerProgramName | Primary Payer Program Name If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | 2 | String | Optional |
| 8 | planType |
Plan Type If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. |
2 | String | Optional |
| 9 | totalPaidAmount | When Required: When enableSecondaryBilling = true Total Paid Amount If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 10 | paidDate | When Required: When enableSecondaryBilling = true Paid Date If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Situational | |
| 11 | Deductible | Deductible If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 12 | Coinsurance | Coinsurance. If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 13 | Copay | Copay If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 14 | contractedAdjustments | Contracted Adjustments If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 15 | notMedicallyNecessary | Not Medically Necessary If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 16 | nonCoveredCharges | Non-Covered Charges If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
| 17 | maxBenefitExhausted | Max Benefit Exhausted If the value is empty, then the existing value of Reason in HHAeXchange is removed. If enableSecondaryBilling flag is not true, then API will ignore value in this field. | Decimal (7,2) | Optional | |
MCO/Payer
MCO Portal initials are in the PayerID field on a Visit.
| MCO/Payer | Initials |
|---|---|
| Blue Cross MN | BCMP |
| Community First Services and Support (PCA) FFS | MICS |
| Financial Management Services FFS | MINN |
| HealthPartners MN | HPMP |
| Hennepin Health MN | HHMP |
| HomeHealth FFS | MIHH |
| IMCare Itasca MN | ICMP |
| Medica MN | MDMP |
| PrimeWest MN | PWMP |
| South Country Health Alliance MN | SCMP |
| UCare MN | UCMP |
| United Healthcare MN | UHMP |
| Waiver Services FFS | MIWS |
Missed Visit Edit Action Taken
| Code | Description |
|---|---|
| 501 | Confirmed with the Member or the Member's family member/representative and documented (this service cannot be billed) |
| 502 | New attendant assigned to member (this service cannot be billed) |
| 503 | Other (this service cannot be billed) |
| 504 | Service(s) cancelled or suspended until further notice (this service cannot be billed) |
| 505 | Unverified visit; this service cannot be billed |
| 506 | Visit rescheduled (this service cannot be billed) |
Missed Visit Edit Reason Codes
| Code | Description |
|---|---|
| 600 | Agency unable to provide replacement coverage (no show, no replacement) |
| 601 | Attendant failed to report to Member's home |
| 602 | Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member's services being suspended |
| 603 | Member Refused Service |
| 604 | Member Refused Service - original aide on vacation |
| 605 | COVID-19: All other cases where the agency could not staff due to COVID-19 |
| 606 | COVID-19: Member refused, receiving service through informal supports |
| 607 | COVID-19: Member refused, self-isolating, not receiving service |
| 608 | Hospitalization unplanned |
| 609 | Other |
Plan Type
| Code | Plan Type |
|---|---|
| BL | Blue Cross/Blue Shield |
| CH | Champus |
| CI | Commercial Insurance Co. |
| MB | Medicare Part B |
| MC | Medicaid |
Procedure Codes
Blue Cross MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| S5130:TG | Homemaker, Assistance with Personal Cares, 15 Minutes | Hourly |
| S5150 | Respite Care Services, In Home, 15 Minutes | Hourly |
| S5151 | Respite Care Services, In Home, Daily | Daily |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HG:TG:UC | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:HG:UC | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U5 | Notice of Reduction, 1:3, complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:U5 | Notice of Reduction, 1:3 | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U5 | Notice of Reduction, 1:2, complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U5 | Notice of Reduction, complex | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:U5 | Notice of Reduction, 1:2 | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
| T2028 | CDCS Personal Assistance, Decremental | Decremental budget |
Community First Services and Support PCA FFS Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U5 | Notice of Reduction, 1:3, complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:U5 | Notice of Reduction, 1:3 | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:HQ:U5 | Notice of Reduction PCA Complex 1:3 | Hourly |
| T1019:TG:HQ:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U5 | Notice of Reduction, 1:2, complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:TG:U5 | Notice of Reduction, complex | Hourly |
| T1019:TG:U5:U9 | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:TG:U8 | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:TG:U9 | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:U9 | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:UN:U9 | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:TG:UC:UP:U9 | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:TG:UN:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:TG:UN:U5:U9 | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:TG:UN:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:TG:UN:U9 | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:TG:UP:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:TG:UP:U5:U9 | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:TG:UP:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:TG:UP:U9 | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:TG | 1:2 PCA Complex | Hourly |
| T1019:TT:U5 | Notice of Reduction, 1:2 | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:HQ | Notice of Reduction, 1:3 | Hourly |
| T1019:U5:HQ:TG | Notice of Reduction, 1:3, complex | Hourly |
| T1019:U5:TG | Notice of Reduction, complex | Hourly |
| T1019:U5:TT:TG | Notice of Reduction, 1:2, complex | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:U6:U9 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U8 | CFSS, Agency, 45 Day Temporary Start | Hourly |
| T1019:U8:TG | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:U9 | CFSS, Agency, 1:1 | Hourly |
| T1019:U9:TG | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:U9:U4 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U9:U4:TG | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:U9:U5 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U9:U5:TG | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:U9:U5:UN | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:U9:U5:UN:TG | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:U9:U5:UP | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:U9:U5:UP:TG | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:U9:U6 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U9:U6:TG | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:U9:U6:UN:TG | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:U9:U6:UP:TG | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:U9:UC | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:U9:UC:TG | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:U9:UC:UN | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:U9:UC:UN:TG | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:U9:UC:UP | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:U9:UC:UP:TG | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:U9:UN | CFSS, Agency, 1:2 | Hourly |
| T1019:U9:UN:TG | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:U9:UN:U4 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:U9:UN:U4:TG | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:U9:UN:U6 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:U9:UP | CFSS, Agency, 1:3 | Hourly |
| T1019:U9:UP:TG | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:U9:UP:U4 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:U9:UP:U4:TG | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:U9:UP:U6 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1019:UC:HG | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:UC:HG:TG | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:UC:TG | Extended PCA Services (waiver services), complex | Hourly |
| T1019:UC:TT | Extended PCA Services (waiver services) 1:2 | Hourly |
| T1019:UC:TT:TG | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:UC:U9 | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:UC:UN:U9 | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:UC:UP:U9 | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:UN:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:UN:U5:U9 | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:UN:U6:U9 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:UN:U9 | CFSS, Agency, 1:2 | Hourly |
| T1019:UP:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:UP:U5:U9 | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:UP:U6:U9 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UP:U9 | CFSS, Agency, 1:3 | Hourly |
Financial Management Services FFS Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:TG | CFSS, Budget, Complex, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U4:TG | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U5:TG | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:UB:U5:UN | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:U5:UN:TG | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:UB:U5:UP | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:U5:UP:TG | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:U6:TG | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:U6:UN:TG | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:U6:UP:TG | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:TG | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UN:TG | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UC:UP:TG | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:TG | CFSS, Budget, Complex, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U4:TG | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:TG | CFSS, Budget, Complex, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U4:TG | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T2025 | Consumer Support Grant, Decremental | Decremental budget |
| T2028 | CDCS Personal Assistance, Decremental | Decremental budget |
| T2028:U1 | CDCS Personal Assistance, Decremental | Decremental budget |
HealthPartners MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HG:TG:UC | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:HG:UC | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
Hennepin Health MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
HomeHealth FFS Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
IMCare Itasca MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
Medica MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| S5130:TG | Homemaker, Assistance with Personal Cares, 15 Minutes | Hourly |
| S5135:U4 | Personal Support, 15 Minutes | Hourly |
| S5150 | Respite Care Services, In Home, 15 Minutes | Hourly |
| S5151 | Respite Care Services, In Home, Daily | Daily |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HG:TG:UC | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:HG:UC | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U5 | Notice of Reduction, 1:3, complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:U5 | Notice of Reduction, 1:3 | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U5 | Notice of Reduction, 1:2, complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:TG:U5 | Notice of Reduction, complex | Hourly |
| T1019:TG:U5:U9 | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:TG:U8 | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:TG:U9 | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:U9 | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:UN:U9 | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:TG:UC:UP:U9 | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:TG:UN:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:TG:UN:U5:U9 | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:TG:UN:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:TG:UN:U9 | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:TG:UP:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:TG:UP:U5:U9 | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:TG:UP:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:TG:UP:U9 | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:U5 | Notice of Reduction, 1:2 | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:U6:U9 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U8 | CFSS, Agency, 45 Day Temporary Start | Hourly |
| T1019:U9 | CFSS, Agency, 1:1 | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1019:UC:U9 | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:UC:UN:U9 | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:UC:UP:U9 | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:UN:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:UN:U5:U9 | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:UN:U6:U9 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:UN:U9 | CFSS, Agency, 1:2 | Hourly |
| T1019:UP:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:UP:U5:U9 | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:UP:U6:U9 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UP:U9 | CFSS, Agency, 1:3 | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
| T2028 | CDCS Personal Assistance, Decremental | Decremental budget |
PrimeWest MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| S5130:TG | Homemaker, Assistance with Personal Cares, 15 Minutes | Hourly |
| S5150 | Respite Care Services, In Home, 15 Minutes | Hourly |
| S5151 | Respite Care Services, In Home, Daily | Daily |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HG:TG:UC | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:HG:UC | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U5 | Notice of Reduction, 1:3, complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:U5 | Notice of Reduction, 1:3 | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U5 | Notice of Reduction, 1:2, complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:TG:U5 | Notice of Reduction, complex | Hourly |
| T1019:TG:U5:U9 | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:TG:U8 | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:TG:U9 | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:U9 | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:UN:U9 | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:TG:UC:UP:U9 | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:TG:UN:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:TG:UN:U5:U9 | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:TG:UN:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:TG:UN:U9 | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:TG:UP:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:TG:UP:U5:U9 | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:TG:UP:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:TG:UP:U9 | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:U5 | Notice of Reduction, 1:2 | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:U6:U9 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U8 | CFSS, Agency, 45 Day Temporary Start | Hourly |
| T1019:U9 | CFSS, Agency, 1:1 | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:TG | CFSS, Budget, Complex, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U4:TG | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U5:TG | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:UB:U5:UN | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:U5:UN:TG | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:UB:U5:UP | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:U5:UP:TG | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:U6:TG | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:U6:UN:TG | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:U6:UP:TG | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:TG | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UN:TG | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UC:UP:TG | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:TG | CFSS, Budget, Complex, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1019:UC:U9 | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:UC:UN:U9 | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:UC:UP:U9 | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:UN:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:UN:U5:U9 | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:UN:U6:U9 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:UN:U9 | CFSS, Agency, 1:2 | Hourly |
| T1019:UP:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:UP:U5:U9 | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:UP:U6:U9 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UP:U9 | CFSS, Agency, 1:3 | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
| T2028 | CDCS Personal Assistance, Decremental | Decremental budget |
| T2028:U1 | CDCS Personal Assistance, Decremental | Decremental budget |
South Country Health Alliance MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| S5130:TG | Homemaker, Assistance with Personal Cares, 15 Minutes | Hourly |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:TG:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:TG:U5:U9 | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:TG:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:TG:U8 | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:TG:U9 | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:TG:UC:U9 | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:UN:U9 | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:TG:UC:UP:U9 | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:TG:UN:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:TG:UN:U5:U9 | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:TG:UN:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:TG:UN:U9 | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:TG:UP:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:TG:UP:U5:U9 | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:TG:UP:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:TG:UP:U9 | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6:U9 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U8 | CFSS, Agency, 45 Day Temporary Start | Hourly |
| T1019:U9 | CFSS, Agency, 1:1 | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1019:UC:U9 | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:UC:UN:U9 | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:UC:UP:U9 | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:UN:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:UN:U5:U9 | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:UN:U6:U9 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:UN:U9 | CFSS, Agency, 1:2 | Hourly |
| T1019:UP:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:UP:U5:U9 | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:UP:U6:U9 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UP:U9 | CFSS, Agency, 1:3 | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
| T2025 | Consumer Support Grant, Decremental | Decremental budget |
| T2028 | CDCS Personal Assistance, Decremental | Decremental budget |
| T2028:U1 | CDCS Personal Assistance, Decremental | Decremental budget |
UCare MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| S5150 | Respite Care Services, In Home, 15 Minutes | Hourly |
| S5151 | Respite Care Services, In Home, Daily | Daily |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HG:TG:UC | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:HG:UC | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U5 | Notice of Reduction, 1:3, complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:U5 | Notice of Reduction, 1:3 | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U5 | Notice of Reduction, 1:2, complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:TG:U5 | Notice of Reduction, complex | Hourly |
| T1019:TG:U5:U9 | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:TG:U8 | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:TG:U9 | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:U9 | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:UN:U9 | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:TG:UC:UP:U9 | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:TG:UN:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:TG:UN:U5:U9 | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:TG:UN:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:TG:UN:U9 | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:TG:UP:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:TG:UP:U5:U9 | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:TG:UP:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:TG:UP:U9 | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:U5 | Notice of Reduction, 1:2 | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:U6:U9 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U8 | CFSS, Agency, 45 Day Temporary Start | Hourly |
| T1019:U9 | CFSS, Agency, 1:1 | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1019:UC:U9 | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:UC:UN:U9 | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:UC:UP:U9 | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:UN:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:UN:U5:U9 | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:UN:U6:U9 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:UN:U9 | CFSS, Agency, 1:2 | Hourly |
| T1019:UP:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:UP:U5:U9 | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:UP:U6:U9 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UP:U9 | CFSS, Agency, 1:3 | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
United Healthcare MN Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| G0299 | Direct Skilled Nursing, RN, Home or Hospice, 15 Minutes | Hourly |
| G0300 | Direct Skilled Nursing, LPN, Home or Hospice, 15 Minutes | Hourly |
| H0043:UC:U3 | Individualized Home Supports with training | Hourly |
| H2014:UC:UN:U3 | Individualized Home Supports with Training (1:2) | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| S5125:UC | Individualized Home Supports with family training | Hourly |
| S5125:UC:UN | Individualized Home Supports with family training (1:2) | Hourly |
| S5130:TG | Homemaker, Assistance with Personal Cares, 15 Minutes | Hourly |
| S5135:U4 | Personal Support, 15 Minutes | Hourly |
| S5135:UC | Individualized Home Supports without training | Hourly |
| S5135:UC:UN | Individualized Home Supports without training (1:2) | Hourly |
| S5150 | Respite Care Services, In Home, 15 Minutes | Hourly |
| S5151 | Respite Care Services, In Home, Daily | Daily |
| S5181 | Respiratory Therapy, Per Visit | Visit |
| S5181:UC | Respiratory Therapy, Extended, Per Visit | Visit |
| S9125 | Crisis Respite, Daily | Daily |
| S9128 | Speech Therapy, Per Visit | Visit |
| S9128:UC | Speech Therapy, Extended, Per Visit | Visit |
| S9129 | Occupational Therapy, Per Visit | Visit |
| S9129:TF | Occupational Therapy Assistant, Per Visit | Visit |
| S9129:TF:UC | Occupational Therapy Assistant, Extended, Per Visit | Visit |
| S9129:UC | Occupational Therapy, Extended, Per Visit | Visit |
| S9131 | Physical Therapy, Per Visit | Visit |
| S9131:TF | Physical Therapy Assistant, Per Visit | Visit |
| S9131:TF:UC | Physical Therapy Assistant, Extended, Per Visit | Visit |
| S9131:UC | Physical Therapy, Extended, Per Visit | Visit |
| T1004 | Home Health Aide, Extended, 15 Minutes | Hourly |
| T1005 | Crisis Respite, 15 Minutes | Hourly |
| T1005:TG | Crisis Respite, Specialized, 15 Minutes | Hourly |
| T1019 | 1:1 PCA Services | Hourly |
| T1019:HG:TG:UC | Extended PCA Services (waiver services) 1:3 complex | Hourly |
| T1019:HG:UC | Extended PCA Services (waiver services) 1:3 | Hourly |
| T1019:HQ | 1:3 PCA Services | Hourly |
| T1019:HQ:TG | 1:3 PCA Complex | Hourly |
| T1019:HQ:TG:U5 | Notice of Reduction, 1:3, complex | Hourly |
| T1019:HQ:TG:U6 | Temporary Increase in Units PCA Complex 1:3 | Hourly |
| T1019:HQ:TG:UC | 1:3 Extended PCA Services (waiver services), Complex | Hourly |
| T1019:HQ:U5 | Notice of Reduction, 1:3 | Hourly |
| T1019:HQ:UC | 1:3 Extended PCA Services (waiver services) | Hourly |
| T1019:TG | 1:1 PCA Complex | Hourly |
| T1019:TG:TT | 1:2 PCA Complex | Hourly |
| T1019:TG:TT:U5 | Notice of Reduction, 1:2, complex | Hourly |
| T1019:TG:TT:U6 | Temporary Increase in Units PCA Complex 1:2 | Hourly |
| T1019:TG:TT:UC | Extended PCA Services (waiver services) 1:2 complex | Hourly |
| T1019:TG:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:1 | Hourly |
| T1019:TG:U5 | Notice of Reduction, complex | Hourly |
| T1019:TG:U5:U9 | CFSS, Agency, Complex, Reduction, 1:1 | Hourly |
| T1019:TG:U6 | Temporary Increase in Units PCA Complex 1:1 | Hourly |
| T1019:TG:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:1 | Hourly |
| T1019:TG:U8 | CFSS, Agency, Complex, 45 Day Temporary Start | Hourly |
| T1019:TG:U9 | CFSS, Agency, Complex, 1:1 | Hourly |
| T1019:TG:UB | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:TG:UB:U5 | CFSS, Budget, Complex, Reduction, 1:1 | Decremental budget |
| T1019:TG:UB:U6 | CFSS, Budget, Complex, Temporary Increase, 1:1 | Decremental budget |
| T1019:TG:UB:UC | CFSS, Budget, Complex, Extended, 1:1 | Decremental budget |
| T1019:TG:UB:UC:UN | CFSS, Budget, Complex, Extended, 1:2 | Decremental budget |
| T1019:TG:UB:UC:UP | CFSS, Budget, Complex, Extended, 1:3 | Decremental budget |
| T1019:TG:UB:UN | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U5 | CFSS, Budget, Complex, Reduction, 1:2 | Decremental budget |
| T1019:TG:UB:UN:U6 | CFSS, Budget, Complex, Temporary Increase, 1:2 | Decremental budget |
| T1019:TG:UB:UP | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U4 | CFSS, Budget, Complex, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U5 | CFSS, Budget, Complex, Reduction, 1:3 | Decremental budget |
| T1019:TG:UB:UP:U6 | CFSS, Budget, Complex, Temporary Increase, 1:3 | Decremental budget |
| T1019:TG:UC | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:U9 | CFSS, Agency, Complex, Extended, 1:1 | Hourly |
| T1019:TG:UC:UN:U9 | CFSS, Agency, Complex, Extended, 1:2 | Hourly |
| T1019:TG:UC:UP:U9 | CFSS, Agency, Complex, Extended, 1:3 | Hourly |
| T1019:TG:UN:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:2 | Hourly |
| T1019:TG:UN:U5:U9 | CFSS, Agency, Complex, Reduction, 1:2 | Hourly |
| T1019:TG:UN:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:2 | Hourly |
| T1019:TG:UN:U9 | CFSS, Agency, Complex, 1:2 | Hourly |
| T1019:TG:UP:U4:U9 | CFSS, Agency, Complex, Continuation of Benefits, 1:3 | Hourly |
| T1019:TG:UP:U5:U9 | CFSS, Agency, Complex, Reduction, 1:3 | Hourly |
| T1019:TG:UP:U6:U9 | CFSS, Agency, Complex, Temporary Increase, 1:3 | Hourly |
| T1019:TG:UP:U9 | CFSS, Agency, Complex, 1:3 | Hourly |
| T1019:TT | 1:2 PCA Services | Hourly |
| T1019:TT:U5 | Notice of Reduction, 1:2 | Hourly |
| T1019:TT:U6 | Personal Care Assistance (PCA), 1:2, Temporary 45 Day Increase | Hourly |
| T1019:TT:UC | 1:2 Extended PCA Services (waiver services) | Hourly |
| T1019:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:1 | Hourly |
| T1019:U5 | Notice of Reduction | Hourly |
| T1019:U5:U9 | CFSS, Agency, Reduction, 1:1 | Hourly |
| T1019:U6 | Temporary Increase in Units | Hourly |
| T1019:U6:U9 | CFSS, Agency, Temporary Increase, 1:1 | Hourly |
| T1019:U8 | CFSS, Agency, 45 Day Temporary Start | Hourly |
| T1019:U9 | CFSS, Agency, 1:1 | Hourly |
| T1019:UA | Supervision of PCA Services | Hourly |
| T1019:UB | CFSS, Budget, 1:1 | Decremental budget |
| T1019:UB:U4 | CFSS, Budget, Continuation of Benefits, 1:1 | Decremental budget |
| T1019:UB:U5 | CFSS, Budget, Reduction, 1:1 | Decremental budget |
| T1019:UB:U6 | CFSS, Budget, Temporary Increase, 1:1 | Decremental budget |
| T1019:UB:UC | CFSS, Budget, Extended, 1:1 | Decremental budget |
| T1019:UB:UC:UN | CFSS, Budget, Extended, 1:2 | Decremental budget |
| T1019:UB:UC:UP | CFSS, Budget, Extended, 1:3 | Decremental budget |
| T1019:UB:UN | CFSS, Budget, 1:2 | Decremental budget |
| T1019:UB:UN:U4 | CFSS, Budget, Continuation of Benefits, 1:2 | Decremental budget |
| T1019:UB:UN:U5 | CFSS, Budget, Reduction, 1:2 | Decremental budget |
| T1019:UB:UN:U6 | CFSS, Budget, Temporary Increase, 1:2 | Decremental budget |
| T1019:UB:UP | CFSS, Budget, 1:3 | Decremental budget |
| T1019:UB:UP:U4 | CFSS, Budget, Continuation of Benefits, 1:3 | Decremental budget |
| T1019:UB:UP:U5 | CFSS, Budget, Reduction, 1:3 | Decremental budget |
| T1019:UB:UP:U6 | CFSS, Budget, Temporary Increase, 1:3 | Decremental budget |
| T1019:UC | Extended PCA Services (waiver services) | Hourly |
| T1019:UC:U9 | CFSS, Agency, Extended, 1:1 | Hourly |
| T1019:UC:UN:U9 | CFSS, Agency, Extended, 1:2 | Hourly |
| T1019:UC:UP:U9 | CFSS, Agency, Extended, 1:3 | Hourly |
| T1019:UN:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:2 | Hourly |
| T1019:UN:U5:U9 | CFSS, Agency, Reduction, 1:2 | Hourly |
| T1019:UN:U6:U9 | CFSS, Agency, Temporary Increase, 1:2 | Hourly |
| T1019:UN:U9 | CFSS, Agency, 1:2 | Hourly |
| T1019:UP:U4:U9 | CFSS, Agency, Continuation of Benefits, 1:3 | Hourly |
| T1019:UP:U5:U9 | CFSS, Agency, Reduction, 1:3 | Hourly |
| T1019:UP:U6:U9 | CFSS, Agency, Temporary Increase, 1:3 | Hourly |
| T1019:UP:U9 | CFSS, Agency, 1:3 | Hourly |
| T1021 | Home Health Aide, Per Visit | Visit |
| T1030 | Skilled Nurse Visit, RN, Per Visit | Visit |
| T1031 | Skilled Nurse Visit, LPN, Per Visit | Visit |
| T2025 | Consumer Support Grant, Decremental | Decremental budget |
| T2028 | CDCS Personal Assistance, Decremental | Decremental budget |
| T2028:U1 | CDCS Personal Assistance, Decremental | Decremental budget |
Waiver Services FFS Procedure Codes
| Procedure Code | Description | Unit of Service |
|---|---|---|
| H0043:U3 | Individualized Home Supports, Daily | Daily |
| H0043:UC:U3 | Individualized Home Supports with training | Hourly |
| H2014:U3 | Individualized Home Supports, 15 Minutes | Hourly |
| H2014:UC:U3 | Individualized Home Supports with training | Hourly |
| H2014:UC:UN:U3 | Individualized Home Supports with Training (1:2) | Hourly |
| H2015:U3 | Individual Community Living Support, In Person, 15 Minutes | Hourly |
| H2032:TF | Independent Living Skills (ILS) Training, 15 Minutes (1:1) | Hourly |
| H2032:TF:TT | Independent Living Skills (ILS) Training, 15 Minutes (1:2) | Hourly |
| S5125 | In-Home Family Support, 15 Minutes | Hourly |
| S5125:UC | Individualized Home Supports with family training | Hourly |
| S5125:UC:UN | Individualized Home Supports with family training (1:2) | Hourly |
| S5130:TG | Homemaker, Assistance with Personal Cares, 15 Minutes | Hourly |
| S5135 | Personal Support/Adult Companion, 15 Minutes | Hourly |
| S5135:UA | Night Supervision, 15 Minutes | Hourly |
| S5135:UC | Individualized Home Supports without training | Hourly |
| S5135:UC:UN | Individualized Home Supports without training (1:2) | Hourly |
| S5150 | Respite Care Services, In Home, 15 Minutes | Hourly |
| S5151 | Respite Care Services, In Home, Daily | Daily |
| S9125 | Crisis Respite, Daily | Daily |
| T1005 | Crisis Respite, 15 Minutes | Hourly |
| T1005:TG | Crisis Respite, Specialized, 15 Minutes | Hourly |
Relationship to Insured
| Code | Relationship |
|---|---|
| 01 | Spouse |
| 18 | Self |
| 19 | Child |
| G8 | Other |
Status
| Status | Meaning | Description |
|---|---|---|
| Pending | Request Pending | Request is received at HHAeXchange. Request is yet to be processed |
| Success | Request Success | Request processed successfully and data is also saved into HHAeXchange system |
| Failed | Request Failed | Request processed successfully and data is not saved into HHAeXchange system due to either validation errors or issue at request data. |
Visit Edit Action Taken
| Code | Description |
|---|---|
| 101 | Confirmed visit with outside entity and documented |
| 103 | New attendant assigned to Member |
| 104 | Visit rescheduled |
| 105 | Service(s) cancelled or suspended until further notice |
| 106 | Updated Member's address and documented |
| 107 | Updated Member's phone number and documented |
| 108 | Changed verification collection method and documented |
| 109 | Timesheet received and signed by supervisor |
| 110 | Mutual Case/ or Cluster Case/ or Live-in Case |
| 111 | Change in schedule |
| 122 | Unverified visit; this service cannot be billed |
| 123 | Supervisor approved change |
| 124 | Confirmed with the Member or the Member's family member/representative and documented (this service cannot be billed) |
| 125 | Timesheet Verified |
| 126 | Other |
Visit Edit Reason Codes
| Code | Description |
|---|---|
| 200 | Phone number did not link to the Member |
| 201 | Member won't let attendant use phone |
| 202 | Member doesn't have a phone in home |
| 203 | Phone in use by member or individual in member's home |
| 204 | Member received services outside of the home |
| 205 | Member's phone line not working (technical issue or natural disaster) |
| 206 | Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member's services being suspended |
| 207 | Address did not link to the Member (GPS) |
| 208 | Attendant failed to call in |
| 209 | Attendant failed to call out |
| 210 | Attendant failed to call in and out |
| 211 | Attendant called in to or out of the EVV system early or late |
| 212 | Attendant's identification number (s) does not match the scheduled shift or task discrepancy/task does not match plan of care |
| 213 | Attendant entered invalid fixed location device code(s) |
| 214 | Attendant failed to report to Member's home |
| 215 | Fixed location device on order or pending placement in the home |
| 216 | Fixed location device malfunctioned |
| 217 | Attendant unable to use mobile device |
| 218 | Attendant unable to connect to internet or EVV system down |
| 219 | Data Entry Error |
| 220 | Agency unable to provide replacement coverage (no show, no replacement) |
| 221 | Timesheet Received |
| 222 | Other |