New Jersey Medicaid 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.

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 email   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 by State of NJ Caregiver Registration System. If the value is empty, then the existing value of caregiver’s state registration ID in HHAeXchange is removed  20 String   Optional 
13 professionalLicenseNumber Unique ID provided to Caregiver once credentialed by state. If license number is not available, send default value ‘999999999999’. If the value is empty, then the existing value of Professional License Number in HHAeXchange is removed 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   Optional 
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. NJ 2  String   Required   
zipcode Zip Code (5 or 9-digit format i.e., 12345). Format: 99999 OR 999999999 9 String   Required   
Code Description
11 Other Non-Federal Programs
12 Preferred Provider Organization (PPO)
13 Point of Service (POS)
14 Exclusive Provider Organization (EPO)
15 Indemnity Insurance
16 Health Maintenance Organiztion (HMO) Medicare Risk
17 Dental Maintenance Organization
AM Automobile Medical
BL Blue Cross/Blue Shield
CH Champus
CI Commercial Insurance Co.
DS Disability
FI Federal Employees Program
HM Health Maintenance Organization
LM Liability Medical
MA Medicare Part A
MB Medicare Part B
MC Medicaid
OF Other Federal Programs
TV Title V
VA Veterans Affairs Plan
WC Workers' Compensation Health Claim
ZZ Mutually Defined
Code Task Name HHAeXchange Category
115 Meal Preparation Personal Care
116 Housework/Chore Personal Care
117 Managing Finances Personal Care
118 Managing Medications Personal Care
119 Shopping Personal Care
120 Transportation Personal Care
122 Hygiene Personal Care
123 Dressing Upper Personal Care
124 Dressing Lower Personal Care
125 Locomotion Personal Care
126 Transfer Personal Care
127 Toilet Use Personal Care
128 Bed Mobility Personal Care
129 Eating Personal Care
130 Bladder Incontinence Personal Care
131 Bowel Incontinence Personal Care
132 Personal Care T1019 Personal Care
134 Bathing Personal Care
201 In Person Patient Support Activities
202 Via Telephone Patient Support Activities
203 Other Patient Support Activities

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.

  • 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

  • Third-Party EVV systems can submit EVV records from multiple providers.calltype

  • 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.

  • This value must be prefixed with a tilde ("~") sign to differentiate it from the HHAeXchange derived EVVMSID

  • The EVV submitter will be responsible to pass a Unique Visit Identifier as the EVVMSID for each new visit created in the system

  • 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.

Visit Endpoint Workflow

API consumers must adhere to the following rules:

  • Adhere to REST design principles while interacting with the API

  • Protocol: secure HTTP (HTTPS)

  • Communication Method: Use the appropriate Uniform Resource Identifier (URI) patterns along with HTTP verb (POST, PUT, DELETE, and GET)

  • Message Format (Request/Response): application/json

  • Produce JSON payloads that meet the API specification

  • The API leverages the HTTP response status codes to inform the consumer

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 payerID HHAeXchange assigned ID for the payer. Payer ID is determined during the implementation process.   50 String  Required 
6 externalVisitID Unique Visit identifier in the external system. 30 String  Required 
7 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
8 procedureCode This is the billable procedure code which would be mapped to the associated service.  50 String  Required 
9 procedureModifierCode Two characters Modifier for the HCPCS code for the 837. Up to 4 of these are allowed. Consult specific program requirements for exact usage. 2 Array of String Optional
10 timezone Time zone visit data is captured in.  Required timezone: US/Eastern 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
11 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.   DateTime Required
12 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   DateTime Required
13 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
14 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
15 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
16 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 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.

S 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 performedTasks List of performed task codes.   Array of String Optional
7 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  

IThe 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.

  • If a value is provided in this field, the visit is considered billed in the provider’s third-party EVV system. The invoice number is imported, and the visit is processed for billing overnight, maintaining the same batching structure as invoiced in the file submission.

  • Visits must be invoiced in accordance with Payer specific billing requirements noted in the Payer Companion Guide.

  • If this field is left empty, visit is not processed for billing.

HHAeXchange generates an 837 for visits sent from third-party EVV system to HHAeXchange for Aetna, Fee for Service, United & WellCare to associated payer; HHAeXchange only performs EVV data aggregation for visits sent for Amerigroup & Horizon.

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. Up to 2 records are supported for secondary payer:  Secondary Payer 1 and Secondary Payer 2.
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 Optional
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

When Required: When enableSecondaryBilling = true Primary Payer Program Name

If enableSecondaryBilling flag is not true, then API will ignore value in this field.

2 String   Situational
8 planType

Plan Type

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) Situational
10 paidDate

When Required: When enableSecondaryBilling = true Format: YYYY-MM-DD

If enableSecondaryBilling flag is not true, then API will ignore value in this field.

  Date Situational
11 Deductible Deductible If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
12 Coinsurance Coinsurance.  If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
13 Copay Copay If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
14 contractedAdjustments Contracted Adjustments If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
15 notMedicallyNecessary Not Medically Necessary If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
16 nonCoveredCharges Non-Covered Charges If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
17 maxBenefitExhausted Max Benefit Exhausted If enableSecondaryBilling flag is not true, then API will ignore value in this field.   Decimal (7,2) Optional
18 payerResponsibilitySequence

When Required: When enableSecondaryBilling = true Payer Responsibility Sequence 

If enableSecondaryBilling flag is not true, then API will ignore value in this field. Possible Values: 1 or 2 1 = Primary 2 = Secondary

  String Situational
19 claimFilingCode

When Required: When enableSecondaryBilling = true Claim Filing Code

If enableSecondaryBilling flag is not true, then API will ignore value in this field.

  String  Situational
20 otherPayerPaidAmount Other Payer Paid Amount  If enableSecondaryBilling flag is not true, then API will ignore value in this field. Note: It’s applicable only if payerResponsibilitySequence = 2   Decimal (7,2) Optional
MCO/Payer Initials
Aetna ANNJ
Amerigroup AGNJ
Fee for Service FFNJ
Horizon HRNJ
United UNNJ
Wellcare WCNJ
CSOC NJCS
Code Description Payer
51 Confirmed with the Member or the Member’s family member/representative and documented (this service cannot be billed) All MCOs
52 New attendant assigned to Member (this service cannot be billed) All MCOs
53 Other (this service cannot be billed) All MCOs
54 Service(s) cancelled or suspended until further notice (this service cannot be billed) All MCOs
55 Unverified visit: this service cannot be billed All MCOs
56 Visit rescheduled (this service cannot be billed) All MCOs
Code Description Payer
600 Agency unable to provide replacement coverage (no show, no replacement) All MCOs
601 Attendant failed to report to Member’s home All MCOs
602 Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member’s services being suspended All MCOs
603 Member Refused Service All MCOs
604 Member Refused Service - original aide on vacation All MCOs
605 COVID-19: All other cases where the agency could not staff due to COVID-19 All MCOs
606 COVID-19: Member refused, receiving service through informal supports All MCOs
607 COVID-19: Member refused, self-isolating, not receiving service All MCOs
608 Hospitalization unplanned All MCOs
609 Other All MCOs
Code Plan Type
BL Blue Cross/Blue Shield
CH Champus
CI Commercial Insurance Co.
MB Medicare Part B
MC Medicaid
Procedure Code Description Unit of Service Payer
96158:HA Functional behavioral Assessment (BCBA-D) 1 Hour CSOC
96159:HA Behavior Consultative Supports (BCS) - Doctor Level IIH habilitation (BCBA -D) 1 Hour CSOC
 CSC30 Bundle Code 1 Hour CSOC
 CSC31 Bundle Code 1 Hour CSOC
 CSC32 Bundle Code 1 Hour CSOC
 CSC34 Bundle Code 1 Hour CSOC
 H0031:HA Functional Behavior Assessment (BCaBA) 1 Hour CSOC
 H0031:HA:22 Functional Behavior Assessment (BCBA) 1 Hour CSOC
 H2015:HA:HN Behavioral Technician, HS Diploma/GED with 3 years of relevant experience 1 Hour CSOC
 H2015:HA:HO Individual Supports-Behavioral Technician, HS Diploma/GED with 3 years of relevant experience (Habilitative-In Home) 1 Hour CSOC
 H2015:HM Individual Supports - Individual Support Technician 1 BA/BS with 1-year relevant experience 1 Hour CSOC
 H2016:HA:HN Behavioral Technician: Behavioral, BA/BS with 1-year relevant experience) 1 Hour CSOC
 H2016:HA:HO Individual Supports-Behavioral Technician: Behavioral, BA/BS with 1 year relevant experience)-(Habilitative-In Home) 1 Hour CSOC
 S9125:HA:52 Agency Hired Respite 15 Minutes CSOC
 T2021:HA:HN II-Habilitation Bachelors Level/Master's Level-BCaBA 1 Hour CSOC
 T2021:HA:HO II-Habilitation Masters Level BCBA 1 Hour CSOC
92507:HI:EXEMPT SPEECH THERAPY,IN HOME 15 min FFS
0362T Behavior identification assessment requiring administration by QHP, assistance of two or more techs, to address destructive behavior, in a customized environment 15 min units   All MCOs & FFS
0373T Adaptive treatment with modifications by QHP, assistance of two or more techs, to address destructive behavior, in a customized environment to address behavior 15 min units   All MCOs & FFS
92507 Speech, Language and Hearing Therapy Individual Per Diem All MCOs & FFS
92507​:U1 Speech, Language and Hearing Therapy Individual ​ Per diem  FFS NJ
92507:59 Mod 59 - Distinct procedural service performed by the physician on the day with other procedures and services Per Diem Aetna
92507:96 Mod 96 - Indicates the services when the physician or other skilled or qualified professional offers habilitative and rehabilitative procedures or services for habilitative services in nature. Per Diem Aetna
92507:96:59 Speech, Language and Hearing Therapy Individual Per Diem Aetna & UHC
92507:GN Speech, Language and Hearing Therapy Individual Per Diem UHC
92507:GO Speech, Language and Hearing Therapy Individual Per Diem UHC
92507:GP Speech, Language and Hearing Therapy Individual Per Diem UHC
92507:HI Speech, Language and Hearing Therapy Individual, In Home 15 min FFS
92507:HI:UN Speech, Language and Hearing Therapy Individual, In Home 15 min FFS
92507:HI:UN:EXEMPT SPEECH THERAPY,IN HOME 15 min FFS
92507:SZ:59 Mod 59 - Distinct procedural service performed by the physician on the day with other procedures and services Per Diem Aetna
96156:EP DIR Health behavior assessment or re-assessment Per diem, updated per SME All MCOs & FFS
96158:EP DIR Health behavior intervention Initial 30 mins All MCOs & FFS
96159:EP DIR Health behavior intervention Each additional 15 mins All MCOs & FFS
96164:EP DIR Health behavior intervention Initial 30 mins All MCOs & FFS
96165:EP DIR Health behavior intervention Each additional 15 mins All MCOs & FFS
96167:EP DIR Health behavior intervention, family Initial 30 mins All MCOs & FFS
96168:EP DIR Health behavior intervention, family Each additional 15 mins All MCOs & FFS
96170:EP DIR Health behavior intervention Initial 30 mins All MCOs & FFS
96171:EP DIR Health behavior intervention Each additional 15 mins All MCOs & FFS
97110 Physical Therapy, Therapeutic procedure, 1 or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility 15 mins All MCOs & FFS
97110 :U1 Physical Therapy, Therapeutic procedure, 1 or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility​ 15 minutes FFS NJ
97110:59 Mod 59 - Distinct procedural service performed by the physician on the day with other procedures and services Per hour Aetna
97110:96:59 Speech, Language and Hearing Therapy Individual Per hour Aetna & UHC
97110:GN Therapeutic procedure, 1 or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility - speech language pathology 15 mins UHC
97110:GO Therapeutic procedure, 1 or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility - occupational therapy 15 mins UHC
97110:GP Therapeutic procedure, 1 or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility - physical therapy 15 mins UHC
97110:SZ:59 Mod SZ - Habilitative services 15 Mins Aetna
97129 Cognitive Therapy, Individual   15 mins All MCOs & FFS
97129:95:59 Mod 95 - Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System 15 Mins Aetna
97129:96:59 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact     15 Mins UHC
97130 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact (List separately in addition to code for primary procedure) Each additional 15 mins All MCOs & FFS
97130:95:59 Mod 95 - Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System 15 Mins Aetna & UHC
97151 Behavior assessment by physician, QHP 15 min units   All MCOs & FFS
97152 Supporting assessment by Tech 15 min units   All MCOs & FFS
97153 Adaptive treatment by tech 15 min units   All MCOs & FFS
97154 Group adaptive treatment by tech 15 min units   All MCOs & FFS
97155 Adaptive treatment with modification by QHP 15 min units   All MCOs & FFS
97156 Family adaptive treatment by QHP with or without patient present 15 min units   All MCOs & FFS
97157 Multiple family group adaptive guidance by QHP 15 min units   All MCOs & FFS
97158 Group adaptive treatment by QHP 15 min units   All MCOs & FFS
97535 Occupational Therapy, Individual - Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact 15 mins All MCOs & FFS
97535:96:59 OT Individual, 15 minutes unit of service 15 Mins UHC
97535:GN Occupational Therapy, Individual - Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact 15 Mins UHC
97535:GO Occupational Therapy, Individual - Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact 15 Mins UHC
97535:GP Occupational Therapy, Individual - Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact 15 Mins UHC
97535:HI Occupational Therapy, Individual - Self-care/home management training 15 mins FFS
97535:HI:EXEMPT Self-Care/HME HGT Training 15 min FFS
97535:HI:UN Occupational Therapy, Individual - Self-care/home management training 15 mins FFS
97535:HI:UN:EXEMPT Self-Care/HME HGT Training 15 min FFS
97597 Debridement, open wound, wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, total wound(s) surface area; first 20 sq cm or less Per visit All MCOs & FFS
97597​:U1 Debridement , open wound, wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, total wound(s) surface area; first 20 sq cm or less​ Per visit FFS NJ
99601 Infusion- Skilled nursing Up to 2 hours All MCOs & FFS
99601​:U1 Infusion- Skilled nursing​ Up to 2 hours FFS NJ
99602 Infusion- Skilled nursing-additional hour(s) Each additional hour All MCOs & FFS
99602​:U1 Infusion- Skilled nursing-additional hour(s)​ Each additional hour FFS NJ
G0151  Services performed by a qualified physical therapist in the home health or hospice setting 15 mins All MCOs & FFS
G0151:PT Mod PT - Colorectal cancer screening test; converted to diagnostic test or other procedure 15 Mins Aetna
G0152  Services performed by a qualified physical therapist in the home health or hospice setting 15 mins All MCOs & FFS
G0153 Services performed by a qualified speech language pathologist in the home or hospice setting. 15 mins All MCOs & FFS
G0155 Services performed by a social worker in the home or hospice setting. 15 mins All MCOs & FFS
G0299 Direct skilled nursing services of a registered nurse (run) in the home or hospice setting 15 mins All MCOs & FFS
G0300 Direct skilled nursing services of a licensed practical nurse (LPN) in the home or hospice setting.  15 mins ALL MCOs & FFS
H0004:HI Behavioral Health Council  15 Minutes FFS
H0004:HI:EXEMPT Behavioral Health Council  15 Minutes FFS
H0004:HI:22 Behavioral Health Council & Therapy  15 Minutes FFS
H0004:H1:22:EXEMPT Behavioral Health Council & Therapy  15 Minutes FFS
H2016:HI DDD Individual Supports 15 Minutes FFS
H2016:HI:EXEMPT DDD Individual Supports 15 Minutes FFS
H2016:HI:22 DDD Individual Supports 15 Minutes FFS
H2016:HI:22:EXEMPT DDD Individual Supports 15 Minutes FFS
H2016:HI:U8 DDD Individual Supports 15 Minutes FFS
H2016:HI:U8:EXEMPT DDD Individual Supports 15 Minutes FFS
H2021:HI DDD Community Based Supports 15 Minutes FFS
H2021:HI:EXEMPT DDD Community Based Supports 15 Minutes FFS
H2021:HI:22 DDD Community Based Supports 15 Minutes FFS
H2021:HI:22:EXEMPT DDD Community Based Supports 15 Minutes FFS
H2021:HI:52 DDD Community Based Supports 15 Minutes FFS
H2021:HI:52:EXEMPT DDD Community Based Supports 15 Minutes FFS
S5120 15 minutes, Chore Services 15 Minutes MCO (Wellcare only)
S5121 Per Diem, Chore Services; Per Diem Per Diem MCO (Wellcare only)
S5125:SE:HQ Personal Care Assistance Group (Self Directed) Group 15 Minutes All MCOs & FFS
S5125:SE:U3 Personal Care Assistance (Self Directed) Group – Agency 15 Minutes All MCOs & FFS
S5130 MLTSS Home Based Supportive Care 15 Minutes MCOs (excluding Aetna) & FFS
S5130:HQ MLTSS Home Based Supportive Care - Self Directed 15 Minutes MCOs (excluding Aetna) & FFS
S5181 Respiratory Therapy Per Visit MCO (Wellcare only)
S8990:HI Maintenance Physical Therapy  15 Minutes FFS
S8990:HI:EXEMPT Maintenance Physical Therapy  15 Minutes FFS
S8990:HI:UN Maintenance Physical Therapy  15 Minutes FFS
S8990:HI:UN:EXEMPT Maintenance Physical Therapy  15 Minutes FFS
S9122 Home Health Aide/Certified Nurse Assistant  Per hour All MCOs & FFS
S9122​:U1 Home Health Aide/Certified Nurse Assistant​ Per hour FFS NJ
S9122:SE:52 Mod 52 - Applicable when the service reduces or is partially performed by the physician or other skilled professional due to unavoidable circumstances. Each additional 15 mins Aetna 
S9123 RN/HR/PDN/EPSDT 1 Hour MCO (Wellcare only)
S9123  Nursing care, in the home; by registered nurse,   Per hour All MCOs & FFS
S9123:EP_U1 Nursing care, in the home; by registered nurse,  ​ Per hour FFS NJ
S9123:U1 Nursing care, in the home; by registered nurse,  ​ Per hour FFS NJ
S9124 Nursing care, in the home; by licensed practical nurse Per hour All MCOs & FFS
S9124:U1 Nursing care, in the home; by licensed practical nurse​ Per hour FFS NJ
S9127  Social work visit, in the home Per diem All MCOs & FFS
S9127​:U1 Social work visit, in the home​ Per diem  FFS NJ
S9128 Speech therapy, in the home Per diem All MCOs & FFS
S9128​:U1 Speech therapy, in the home​  ​ Per diem  FFS NJ
S9129 Occupational therapy, in the home Per diem All MCOs & FFS
S9129​:U1 Occupational therapy, in the home​ Per diem FFS NJ
S9131 Physical therapy; in the home Per diem All MCOs & FFS
S9131:U1 Physical therapy; in the home​ Per diem  FFS NJ
S9470 Nutritional Counseling Per Visit MCO (Wellcare only)
S91244:EP_U1 Nursing care, in the home; by licensed practical nurse​ Per hour FFS NJ
T1000 Private duty / independent nursing service(s)   15 mins All MCOs & FFS
T1000​:U1 Private duty / independent nursing service(s)  ​ 15 minutes FFS NJ
T1000:UA 15 minutes, RN/LPN Private duty/independent nursing service (S)- licensed; up to 15 min, Medicaid level of care 10, as defined by each state 15 Minutes Wellcare, Horizon
T1002  Private duty / independent nursing service(s) / RN 15 mins All MCOs & FFS
T1002:EP RN SERVICES - EPSDT (Members aged 0 -21) 15 Mins UHC
T1002:EP:TT RN SERVICES - EPSDT – Ages 0-20 mutual service for additional member 15 Mins UHC
T1002:TG RN SERVICES - Specialty Services 15 Mins UHC
T1002:TN:EP RN SERVICES - EPSDT (Members aged 0 -21) - Difficult to serve 15 Mins UHC
T1002:TN:UA RN SERVICES -  (Members age 22 and older) - Difficult to serve 15 Mins UHC
T1002:U1 Private duty / independent nursing service(s) / RN​ 15 minutes FFS NJ
T1002:UA RN Only Private Duty/Independent Nursing, Medicaid level of care 10, as defined by each state 15 Minutes MCO (Wellcare only)
T1002:UA:TT RN – ages 21 and over mutual service for additional member 15 Mins UHC
T1003  LPN/LVN SERVICES  15 mins All MCOs & FFS
T1003:EP LPN/LVN SERVICES - EPSDT (Member aged 0-21) 15 Mins UHC
T1003:EP:TT LPN SERVICES - EPSDT – Ages 0-20 mutual service for Per Diem UHC
T1003:TG LPN/LVN SERVICES - Specialty Services Per Diem UHC
T1003:TN:EP LPN/LVN SERVICES - EPSDT (Members aged 0 -21) - Difficult to serve Per Diem UHC
T1003:TN:UA LPN/LVN SERVICES (Members age 22 and older) - Difficult to serve Per Diem UHC
T1003:U1 LPN/LVN SERVICES ​ 15 minutes FFS NJ
T1003:UA LPN Only Private Duty/Independent Nursing Services, Medicaid Level of care 10, as defined by each state 15 Minutes Wellcare & UHC
T1003:UA:TT LPN – Ages 21 and over mutual service for additional member Each additional 15 mins UHC
T1005 MLTSS In Home Respite 15 Minutes All MCOs & FFS
T1005:HI DDD In Home Respite 15 Minutes FFS
T1005:HI:EXEMPT DDD In Home Respite 15 Minutes FFS
T1005:HI:U8 DDD In Home Respite 15 Minutes FFS
T1005:HI:U8:EXEMPT DDD In Home Respite 15 Minutes FFS
T1019 Personal Care Assistance_15M 15 Minutes All MCOs & FFS
T1019​:U1 Personal  Care Service​ 15 minutes FFS NJ
T1019:HQ Personal Care Assistance Group 15 Minutes All MCOs & FFS
T1019:SE Personal Care Assistance (Self Directed) Individual 15 Minutes Aetna, Amerigroup, FFS, Horizon, Wellcare
T1019:SE:UI Personal Care Assistance (Self Directed) Individual - Agency 15 Minutes All MCOs & FFS
T1019:TN 15 minutes, PERSONAL CARE SVC PER 15 MIN, RURAL/OUTSIDE PROVIDERS' CUSTOMARY SERVICE AREA HCPCS 15 Minutes All MCOs & FFS
T1020 Personal Care Assistance PD Per Diem All MCOs & FFS
T1030 Nursing care, in the home, by registered nurse Per diem All MCOs & FFS
T1030​:U1 Nursing care, in the home, by registered nurse​ Per diem FFS NJ
T1031 Nursing care, in the home, by licensed practical nurse Per diem All MCOs & FFS
T1031​:U1 Nursing care, in the home, by licensed practical nurse​ Per diem FFS NJ
T10200:U1 Personal Care Service​ Per diem FFS NJ
Code Relationship
01 Spouse
18 Self
19 Child
G8 Other
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.
Code Description  
11 Confirmed visit with outside entity and documented All MCOs
12 Confirmed with the Member or the Member’s family member/representative and documented (this service cannot be billed) All MCOs
13 New attendant assigned to Member All MCOs
14 Visit rescheduled All MCOs
15 Service(s) cancelled or suspended until further notice All MCOs
16 Updated Member’s address and documented All MCOs
17 Updated Member’s phone number and documented All MCOs
18 Changed verification collection method and documented All MCOs
19 Timesheet received and signed by supervisor All MCOs
20 Mutual Case/ or Cluster Case/ or Live-in Case All MCOs
21 Change in schedule All MCOs
22 Unverified visit; this service cannot be billed All MCOs
23 Supervisor approved change All MCOs
24 Timesheet Verified All MCOs
25 Other All MCOs
Code Description Payer
200 Phone number did not link to the Member All MCOs
201 Member won't let attendant use phone All MCOs
202 Member doesn't have a phone in home All MCOs
203 Phone in use by Member or individual in Member's home All MCOs
204 Member received services outside of the home All MCOs
205 Member's phone line not working (technical issue or natural disaster) All MCOs
206 Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member’s services being suspended All MCOs
207 Address did not link to the Member (GPS) All MCOs
208 Attendant failed to call in All MCOs
209 Attendant failed to call out All MCOs
210 Attendant failed to call in and out All MCOs
211 Attendant called in to or out of the EVV system early or late All MCOs
212 Attendant's identification number (s) does not match the scheduled shift or task discrepancy/task does not match plan of care All MCOs
213 Attendant entered invalid fixed location device code(s) All MCOs
214 Attendant failed to report to Member’s home All MCOs
215 Fixed location device on order or pending placement in the home All MCOs
216 Fixed location device malfunctioned All MCOs
217 Attendant unable to use mobile device All MCOs
218 Attendant unable to connect to internet or EVV system down All MCOs
219 Data Entry Error All MCOs
220 Agency unable to provide replacement coverage (no show, no replacement) All MCOs
221 Timesheet Received All MCOs
222 Other All MCOs
223 EPSDT PDN During the School Day Aetna, Amerigroup, FFS, Horizon, United, and Wellcare