Florida EDI Codes
The EDI Codes topic defines specific codes used in the import interface process.
Refer to Homecare EDI Import for import details and interface instructions.
If additional assistance is needed, submit a ticket to 3rd Party Integration Support Desk. Cases are escalated to the EDI Production Support queue.
Duties Code
The table below provides the assigned codes for services/tasks completed during a Patient’s Visit according to their Plan of Care (Duties).
| 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 – General | Personal Care |
| 134 | Bathing | Personal Care |
| 135 | Other | Personal Care |
MCO/Payer ID
The Payer ID is the unique identifier for each MCO, sent as a required field in the EDI Import file. The following table provides the MCO/Payer ID Code for each Payer.
| Code | MCO/Payer |
|---|---|
| 19729 | Staywell |
| 20062 | Sunshine Health Plan |
| 20135 | Humana |
| 22921 | Molina Healthcare |
| 24141 | Little Havana (LHANC) |
| 24281 | Molina Healthcare - MMA |
| 25106 | Staywell Coastal |
| 41185 | Children's Medical Services |
| 62527 | Florida Community Care |
| 90466 | AHCA FFS |
Missed Visit Action Taken
The following tables provide the codes and descriptions for the Missed Visit Action Taken fields for the Additional Visits Info EDI Import Interface file.
If a Missed Visit is canceled (unchecked), the codes revert to the Visit Edit Code Tables (Reason and Action Taken).
| Code | Description |
|---|---|
| 1 | Contingency Plan Put in Place |
| 2 | Rescheduled Service for Same Day |
| 3 | Rescheduled Service for Different Day |
| 4 | Service Authorization Renewed and Services Resumed |
| 5 | Services Resumed at Next Scheduled Visit |
| 6 | Other (must include description in Comments section) |
Missed Visit Reason Codes
The following tables provide the codes and descriptions for the Missed Visit Reason Code fields for the Additional Visits Info EDI Import Interface file.
If a Missed Visit is canceled (unchecked), the codes revert to the Visit Edit Code Tables (Reason and Action Taken).
| Code | Description | Payer |
|---|---|---|
| 1 | Provider Cancellation | All |
| 2 | Provider No-Show | All |
| 3 | Enrollee Cancellation | All |
| 4 | Enrollee No-Show | All |
| 5 | Scheduling Error due to Enrollee | All |
| 6 | Scheduling Error due to Provider | All |
| 7 | Service Authorization Issue | All |
| 8 | Other (must include description in Comments section) | All |
| 20 | COVID-19: Provider Cancellation | All |
| 21 | COVID-19: Provider No-Show | All |
| 22 | COVID-19: Caregiver unable to staff due to COVID-related symptoms/quarantine | All |
| 23 | COVID-19: Caregiver unable to staff because of childcare issues | All |
| 24 | COVID-19: Enrollee Cancellation | All |
| 25 | COVID-19: Enrollee refused, receiving service through informal supports | All |
| 26 | COVID-19: Enrollee No-Show | All |
| 27 | COVID-19: Other ( If selecting COVID-19: Other, please provide additional details in the Note section) | All |
| 28 | PDN Hours Refused by parent/guardian |
Children's Medical Services, Sunshine Health |
| 29 | PDN Hours Not Delivered Due to Hospitalization (or Inpatient) |
Children's Medical Services, Sunshine Health |
| 30 | PDN Hours Not Delivered Due to PPEC (Prescribed Pediatric Extended Care) |
Children's Medical Services, Sunshine Health |
| 31 | PDN Hours Not Delivered as Child's Condition Improved |
Children's Medical Services, Sunshine Health |
| 32 | PDN Hours Not Delivered as Child Moved Out of State |
Children's Medical Services, Sunshine Health |
| 33 | PDN Hours Not Delivered due to Duplicate Authorizations |
Children's Medical Services, Sunshine Health |
| 34 | PDN Hours Not Delivered as Child Lives in Rural or Remote Location |
Children's Medical Services, Sunshine Health |
| 35 | PDN Hours Not Delivered as Nurses Feel Mistreated |
Children's Medical Services, Sunshine Health |
| 36 | PDN Hours Not Delivered as Nurses Have Safety Concerns |
Children's Medical Services, Sunshine Health |
| 37 | PDN Hours not Delivered as Nurse Did Not Appear as Scheduled |
Children's Medical Services, Sunshine Health |
| 38 | PDN Hours Not Delivered as Preferred Provider was Not Available and Parent Declined Alternate Provider |
Children's Medical Services, Sunshine Health |
| 39 | PDN Hours Not Delivered as Child Passed Away |
Children's Medical Services, Sunshine Health |
| 40 | PDN Hours Not Delivered - Other |
Children's Medical Services, Sunshine Health |
Procedure Codes
The following table provides Procedure Codes (Service Codes) and descriptions.
AHCA
Added 09/16/2024
| Service Code | Description | HHAeXchangeService Type |
|---|---|---|
|
S9122 |
Personal Care Services - Home Health Aid |
PCA |
|
S9122:TT |
Personal Care Services - Home Health Aid (1+ Recipient) |
PCA |
|
S9122:UF |
Personal Care Services - Home Health Aid (1+ Provider) |
PCA |
|
S9122:TT:UF |
Personal Care Services - Home Health Aid (1+ Recipient, Provider) |
PCA |
|
S9122:SK |
MFC - Personal Care Services - Home Health Aid |
PCA |
|
S9122:SK:TT |
MFC - Personal Care Services - Home Health Aid (1+ Recipient) |
PCA |
|
S9122:SK:UF |
MFC - Personal Care Services - Home Health Aid (1+ Provider) |
PCA |
|
S9122:SK:TT:UF |
MFC - Personal Care Services - Home Health Aid (1+ Recipient, Provider) |
PCA |
|
S9123 |
Private Duty Nursing - Registered Nurse |
RN |
|
S9123:TT |
Private Duty Nursing - Registered Nurse (1+ Recipient) |
RN |
|
S9123:UF |
Private Duty Nursing - Registered Nurse (1+ Provider) |
RN |
|
S9123:TT:UF |
Private Duty Nursing - Registered Nurse (1+ Recipient, Provider) |
RN |
|
S9124 |
Private Duty Nursing - LPN |
LPN |
|
S9124:TT |
Private Duty Nursing - LPN (1+ Recipient) |
LPN |
|
S9124:UF |
Private Duty Nursing - LPN (1+ Provider) |
LPN |
|
S9124:TT:UF |
Private Duty Nursing - LPN (1+ Recipient, Provider) |
LPN |
|
T1030 |
Registered Nurse Visit |
RN |
|
T1030:TT |
Registered Nurse Visit (1+ Recipient) |
RN |
|
T1031 |
Licensed Practical Nurse Visit |
LPN |
|
T1031:TT |
Licensed Practical Nurse Visit (1+ Recipient) |
LPN |
|
T1021 |
Home Health Aid Visit - Non-Skilled |
HHA |
|
T1021:TD |
Home Health Aid Visit - Skilled |
Other (Skilled) |
|
T1021:TT |
Home Health Aid Visit - Non-Skilled |
Other (Non Skilled) |
|
T1021:GY |
Home Health Aid Visit - Non-Skilled (DER) |
Other (Non Skilled) |
|
T1021:TD:TT |
Home Health Aid Visit - Skilled (1+ Recipient) |
Other (Skilled) |
|
T1021:TT:GY |
Home Health Aid Visit - Non-Skilled (1+Recipient) |
Other (Non Skilled) |
|
S9123:SQ |
PDNO - Private Duty Nursing - Reg Nurse |
RN |
|
S9123:SQ:TT |
PDNO - Private Duty Nursing - Reg Nurse (1+Recipient) |
RN |
|
S9123:SQ:UF |
PDNO - Private Duty Nursing - Reg Nurse (1+Provider) |
RN |
|
S9123:SQ:TT:UF |
PDNO - Private Duty Nursing - Reg Nurse (1+Recipient,Provider) |
RN |
|
S9124:SQ |
PDNO - Licensed Practical Nurse |
LPN |
|
S9124:SQ:TT |
PDNO - Licensed Practical Nurse (1+Recipient) |
LPN |
|
S9124:SQ:UF |
PDNO - Licensed Practical Nurse (1+Provider) |
LPN |
|
S9124:SQ:TT:UF |
PDNO - Licensed Practical Nurse |
LPN |
Children’s Medical Services Procedure Codes
| Service Code | Description | HHAeXchangeService Type |
|---|---|---|
| S5125 | Attendant Care | Other (Skilled) |
| S5125U2 | Attendant Care (PDO) | Other (Skilled) |
| S5130 | Homemaker (Non-Skilled) | HMK |
| S5130U2 | Homemaker (Non-Skilled) | HMK |
| S5135 | Companion (Non-Skilled) | COMP |
| S5135U2 | Companion (Non-Skilled) | COMP |
| S5150 | Unskilled Respite Care | RESP |
| S9122 | Personal care rendered by a home health service provider | PCA |
| S9122TT | Personal Care rendered by a home health service provider (1 to 24 hours per day) provided to more than one recipient in the same setting | Other (Non Skilled) |
| S9123 | Registered Nurse (Skilled) | RN |
| S9123TT | Private Duty Nursing (RN services) provided to more than one recipient in the same setting | Other (Skilled) |
| S9124 | Licensed Practical Nurse (Skilled) | LPN |
| S9124TT | Licensed Practical Nurse (Skilled) | LPN |
| T1002 | Registered Nurse (Skilled) | RN |
| T1003 | Licensed Practical Nurse (Skilled) | LPN |
| T1004 | Personal Care Assistant (Non-Skilled) | PCA |
| T1005 | Respite (Non-Skilled) | RESP |
| T1019 | Personal Care Services, PDO | PCA |
| T1021 | HHA or CNA, providing personal care in home, bath visit | PCA |
| T1021TT | Home Health Aide (HHA) Visit unassociated with skilled nursing to more than one recipient in the same setting | Other (Non Skilled) |
| T1030 | Nursing care in home by RN (Skilled Nursing-RN) | RN |
| T1030TT | Registered Nurse (RN) visit provider to more than one recipient in the same setting | Other (Skilled) |
| T1031 | Licensed Practical Nurse (LPN) Visit | Other (Skilled) |
| T1031TT | Licensed Practical Nurse (LPN) Visit provide to more than one recipient in the same setting | Other (Skilled) |
Florida Community Care Procedure Codes
Updated as of 03/12/2025
| Service Code | Description | HHAeXchangeService Type |
|---|---|---|
| S5125 | Attendant care service /15m | Other (Skilled) |
| S5125U2 | Attendant care service /15m | Other (Skilled) |
| S5125CG | Attendant Care PDO | Other (Skilled) |
| S5125UA | Attendant Care | Other (Skilled) |
| S5130 | Homaker service nos per 15m | HMK |
| S5130U2 | Homemaker Services | HMK |
| S5130CG | Homemaker Services PDO | HMK |
| S5130HM | Homemaker Services | HMK |
| S5130U1 | Homemaker Services | HMK |
| S5130UC | Homemaker Services | HMK |
| S5130UCS1 | Personal Support-Quarter Hour 18-20 1:1 | SPC |
| S5130UCS2 | Personal Support-Quarter Hour 18-20 1:2 | SPC |
| S5130UCS3 | Personal Support-Quarter Hour 18-20 1:3 | SPC |
| S5130UCSCS1 | Personal Support-Day 1:1 | SPC |
| S5130UCSCS2 | Personal Support-Day 1:2 | SPC |
| S5130UCSCS3 | Personal Support-Day 1:3 | SPC |
| S5130US | Homemaker Services | HMK |
| S5131 | Homemaker service nos /diem | HMK |
| S5135 | Adult companioncare per 15m | COMP |
| S5135U2 | Adult Companion | COMP |
| S513576 | Adult Companion | COMP |
| S5135CG | Adult Companion Care PDO | COMP |
| S5135U5 | Adult Companion | COMP |
| S5135UA | Adult Companion | COMP |
| S5135UC | Adult Companion | COMP |
| S5135UCS2 | Life Skills Development - Level 1 Companion 1:2 | COMP |
| S5135UCS3 | Life Skills Development - Level 1 Companion 1:3 | COMP |
| S5136 | Adult companioncare per diem | COMP |
| S5150 | Unskilled respite care /15m | RESP |
| S515012 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5150U2 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5151 | Unskilled respitecare /diem | RESP |
| S5151UCSCS1 | Respite Day (under 21 only) 1:1 | RESP |
| S5151UCSCS2 | Respite Day (under 21 only) 1:2 | RESP |
| S5151UCSCS3 | Respite Day (under 21 only) 1:3 | RESP |
| S5151UCS1 | Respite - Quarter Hour (under 21 years of age only) 1:1 | RESP |
| S5151UCS2 | Respite - Quarter Hour (under 21 years of age only) 1:2 | RESP |
| S5151UCS3 | Respite - Quarter Hour (under 21 years of age only) 1:3 | RESP |
| S9122 | Home health aide or certifie | PC |
| S9122TT | Personal care rendered by a home health service provider (1 to 24 hours per day)* (mutual 1st member 100% rate) | PC |
| S9122TT | Personal care rendered by a home health service provider (1 to 24 hours per day)* (mutual 2nd member 50% rate) | PC |
| S9122TT | Personal care rendered by a home health service provider (1 to 24 hours per day)* (mutual member #3+ 25% rate) | PC |
| S9122TTUF | Personal care rendered by a home health service provider (1 to 24 hours per day)* (mutual 1st member 100% rate) | PC |
| S9122TTUF | Personal care rendered by a home health service provider (1 to 24 hours per day)* (mutual 2nd member 50% rate) | PC |
| S9122TTUF | Personal care rendered by a home health service provider (1 to 24 hours per day)* (mutual member #3+ 25% rate) | PC |
| S9122UF | Personal care rendered by a home health service provider (1 to 24 hours per day)* provided by more than one provider in the same setting | PC |
| S9123 | Nursing care in home rn | RN |
| S9123TT | Private duty nursing rendered by a RN (2 to 24 hours per day)* (mutual 1st member 100% rate) | RN |
| S9123TT | Private duty nursing rendered by a RN (2 to 24 hours per day)* (mutual 2nd member 50% rate) | RN |
| S9123TT | Private duty nursing rendered by a RN (2 to 24 hours per day)* provided to more than one recipient in the same setting.** | RN |
| S9123TTUF | Private duty nursing rendered by a RN (2 to 24 hours per day)* (mutual 1st member 100% rate) | RN |
| S9123TTUF | Private duty nursing rendered by a RN (2 to 24 hours per day)* (mutual 2nd member 50% rate) | RN |
| S9123TTUF | Private duty nursing rendered by a RN (2 to 24 hours per day)*(mutual member #3+ 25% rate) | RN |
| S9123UF | Private duty nursing rendered by a RN (2 to 24 hours per day)* provided by more than one provider in the same setting*** | RN |
| S9124 | Nursing care, in the home; b | LPN |
| S9124TT | Private duty nursing rendered by a LPN (2 to 24 hours per day)* (mutual 1st member 100% rate) | LPN |
| S9124TT | Private duty nursing rendered by a LPN (2 to 24 hours per day)* (mutual 2nd member 50% rate) | LPN |
| S9124TT | Private duty nursing rendered by a LPN (2 to 24 hours per day)* (mutual member #3+ 25% rate) | LPN |
| S9124TTUF | Private duty nursing rendered by a LPN (2 to 24 hours per day)*(mutual 1st member 100% rate) | LPN |
| S9124TTUF | Private duty nursing rendered by a LPN (2 to 24 hours per day)*(mutual 2nd member 50% rate) | LPN |
| S9124TTUF | Private duty nursing rendered by a LPN (2 to 24 hours per day)* (mutual member #3+ 25% rate) | LPN |
| S9124UF | Private duty nursing rendered by a LPN (2 to 24 hours per day)* provided by more than one provider in the same setting | LPN |
| T1002 | Rn services up to 15 minutes | RN |
| T1002TD | Registered Nurse/RN visit | RN |
| T1002CG | RN PDO visit | RN |
| T1003 | Lpn/lvn services up to 15min | LPN |
| T1003CG | LPN/LVN PDO visit | LPN |
| T1005 | Respite care service 15 min | RESP |
| T1005UCTES1 | Skilled Respite - LPN - Quarter Hour 1:1 | LPN |
| T1005UCTES2 | Skilled Respite - LPN - Quarter Hour 1:2 | LPN |
| T1019 | Personal care ser per 15 min | PCA |
| T1019TT | Personal Care Services (mutual 1st member 100% rate) | PCA |
| T1019TT | Personal Care Services (mutual 2nd member 50% rate) | PCA |
| T1019TT | Personal Care Services (mutual member #3+ 25% rate) | PCA |
| T101912 | Personal Care Services | PCA |
| T101976 | Personal Care Services | PCA |
| T1019CG | Personal Care Services PDO | PCA |
| T1019U2 | Personal Care Services | PCA |
| T1019U5 | Personal Care Services | PCA |
| T1019UA | Personal Care Services | PCA |
| T1019UC | Personal Care Services | PCA |
| T1021 | HH aide or cn aide per visit | HHA |
| T1021TT | Home Health Aide (HHA) Visit-unassociated with skilled nursing services (mutual 1st member 100% rate) | HHA |
| T1021TT | Home Health Aide (HHA) Visit-unassociated with skilled nursing services (mutual 2nd member 50% rate) | HHA |
| T1021TT | Home Health Aide (HHA) Visit-unassociated with skilled nursing services (mutual member #3+ 25% rate) | HHA |
| T1021GY | Home Health Aide (HHA) Visit-unassociated with skilled nursing services to a Dually Eligible Recipient | HHA |
| T1021TD | Home Health Aide (HHA) Visit-associated with skilled nursing services | HHA |
| T1021TDTT | Home Health Aide (HHA) Visit-associated with skilled nursing services (mutual 1st member 100% rate) | HHA |
| T1021TDTT | Home Health Aide (HHA) Visit-associated with skilled nursing services (mutual 2nd member 50% rate) | HHA |
| T1021TDTT | Home Health Aide (HHA) Visit-associated with skilled nursing services (mutual member #3+ 25% rate) | HHA |
| T1021TTGY | Home Health Aide (HHA) Visit-unassociated with skilled nursing services (mutual 1st member 100% rate) | HHA |
| T1021TTGY | Home Health Aide (HHA) Visit-unassociated with skilled nursing services (mutual 2nd member 50% rate) | HHA |
| T1021TTGY | Home Health Aide (HHA) Visit-unassociated with skilled nursing services(mutual member #3+ 25% rate) | HHA |
| T1030 | Rn home care per diem | RN |
| T1030TT | Rn home care per diem (mutual 1st member 100% rate) | RN |
| T1030TT | Rn home care per diem (mutual 2nd member 50% rate) | RN |
| T1030TT | Rn home care per diem (mutual member #3+ 25% rate) | RN |
| T1031 | Lpn home care per diem | LPN |
| T1031TT | Lpn home care per diem (mutual 1st member 100% rate) | LPN |
| T1031TT | Lpn home care per diem (mutual 2nd member 50% rate) | LPN |
| T1031TT | Lpn home care per diem (mutual member #3+ 25% rate) | LPN |
Little Havana Procedure Codes
Updated as of 02/20/2020
| Service Code | Description | HHAeXchange Service Type |
|---|---|---|
| G0238 | Respiratory Therapist (Skilled) Treatment | RT |
| H2010 | Medication Management | Other (Skilled) |
| S5108 | Caregiver/Family Training | Other (Non Skilled) |
| S5125 | Other (Non-Skilled) Attendant Care | Other (Non Skilled) |
| S5125CG | Other (Non-Skilled) | Other (Non Skilled) |
| S5125U2 | Other (Non-Skilled) | Other (Non Skilled) |
| S5130 | Homemaker (Non-Skilled) | HMK |
| S5130CG | Homemaker (Non-Skilled) | HMK |
| S5130U2 | Homemaker (Non-Skilled) | HMK |
| S5135 | Companion (Non-Skilled) | COMP |
| S5135CG | Companion (Non-Skilled) | COMP |
| S5135U2 | Companion (Non-Skilled) | COMP |
| S5180 | Respiratory Therapist (Skilled) Initial Eval | RT |
| S9123 | Registered Nurse (Skilled) | RN |
| S9123TT | Registered Nurse (Skilled) | RN |
| S9123TTUF | Registered Nurse (Skilled) | RN |
| S9123UF | Registered Nurse (Skilled) | RN |
| S9124 | Licensed Practical Nurse (Skilled) | LPN |
| S9124TT | Licensed Practical Nurse (Skilled) | LPN |
| S9124TTUF | Licensed Practical Nurse (Skilled) | LPN |
| S9124UF | Licensed Practical Nurse (Skilled) | LPN |
| S9128 | Speech Therapist (Skilled) | ST |
| S9129 | Occupational Therapist (Skilled) | OT |
| S9131 | Physical Therapist (Skilled) | PT |
| S9470 | Nutritionist (Skilled) | NT |
| T1002 | Registered Nurse (Skilled) | RN |
| T1003 | Licensed Practical Nurse (Skilled) | LPN |
| T1004 | Personal Care Assistant (Non-Skilled) | PCA |
| T1005 | Respite (Non-Skilled) | RESP |
| T1030 | Nursing care in home by RN (Skilled Nursing-RN) | RN |
| T1031 | Nursing care in home by LPN (Skilled Nursing- LPN) | LPN |
| T1502 | Medication Administration | Other (Skilled) |
Humana Procedure Codes
Updated as of 02/20/2020
| Service Code | Description | HHAeXchange Service Type |
|---|---|---|
| 29799 | Unlisted Procedure casting or strapping | PT |
| 29799HA | Application of Casting or Strapping | PT |
| 92507 | Speech Therapy Visit | ST |
| 92507HM | Speech Therapy Visit Provided by a Speech Therapy Assistant | ST |
| 92508 | Treatment of speech language voice communication and/or auditory processing disorder group 2 or more individuals | ST |
| 92508HA | Group Speech Therapy per child in the group per 15 minutes | ST |
| 92521 | Evaluation/ Re-evaluation of speech fluency (e.g., stuttering, cluttering) | ST |
| 92522 | Evaluation/ Re-evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) | ST |
| 92523 | Evaluation/ Re-evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) | ST |
| 92524 | Evaluation/ Re-evaluation Behavioral and qualitative analysis of voice and resonance | ST |
| 92597 | AAC Initial Evaluation Provided by a Speech-Language Pathologist | ST |
| 92597GN | AAC Re-Evaluation Provided by a Speech-Language Pathologist | ST |
| 92597GO | AAC Initial Evaluation Provided by an Occupational Therapist | OT |
| 92597GP | AAC Initial Evaluation Provided by a Physical Therapist | PT |
| 92609 | AAC Fitting, Adjustment, and Training Visit | ST |
| 92610 | Evaluation of oral and pharyngeal swallowing function | ST |
| 97003 | Occupational Therapy Visit (enrollee over 21) | OT |
| 97110 | Physical Therapy Treatment Visit | PT |
| 97110HM | Physical Therapy Visit Provided by a Physical Therapy Assistant | PT |
| 97161 | Physical Therapy Evaluation, Low Complexity | PT |
| 97162 | Physical Therapy Evaluation, Moderate Complexity | PT |
| 97163 | Physical Therapy Evaluation, High Complexity | PT |
| 97164 | Physical Therapy Re-Evaluation | PT |
| 97165 | Occupational Therapy Evaluation, Low Complexity | OT |
| 97166 | Occupational Therapy Evaluation, Moderate Complexity | OT |
| 97167 | Occupational Therapy Evaluation, High Complexity | OT |
| 97168 | Occupational Therapy Re- Evaluation | OT |
| 97530 | Occupational Therapy Treatment Visit | OT |
| 97530HM | Occupational Therapy Visit Provided by an Occupational Therapy Assistant | OT |
| 97542 | Wheelchair Evaluation | PT |
| 97542GO | Wheelchair Evaluation and Fitting by an Occupational Therapist | OT |
| 97542GP | Wheelchair Evaluation and fitting by a physical therapist | PT |
| 97802 | Nutritional Assessment/Risk Reduction Services | NT |
| 99503 | Respiratory Therapy, Treatment Regular (enrollee over 21) | RT |
| 99504 | Respiratory Therapy, Treatment Mechanical Vent Care | RT |
| H2010 | Medication Management, Comprehensive | Other (Skilled) |
| H2010HN | Medication Management, Comprehensive (BSN) | Other (Skilled) |
| H2010T2 | Medication Management, Comprehensive | Other (Skilled) |
| H2010TD | Medication Management, Comprehensive (RN) | Other (Skilled) |
| H2010TE | Medication Management, Comprehensive (LPN) | Other (Skilled) |
| H2014 | Life Skills Training | Other (Non Skilled) |
| S5110 | Caregiver Training (Group) | Other (Skilled) |
| S5125 | Attendant Care | Other (Skilled) |
| S5125CG | Attendant Care PDO | Other (Skilled) |
| S5125U2 | Attendant Care | Other (Skilled) |
| S5125UA | Attendant Care | Other (Skilled) |
| S5130 | Homemaker Services | HMK |
| S5130CG | Homemaker Services PDO | HMK |
| S5130HM | Homemaker Services | HMK |
| S5130U1 | Homemaker Services | HMK |
| S5130U2 | Homemaker Services | HMK |
| S5130UC | Homemaker Services | HMK |
| S5130US | Homemaker Services | HMK |
| S5135 | Adult Companion | COMP |
| S513576 | Adult Companion | COMP |
| S5135CG | Adult Companion Care PDO | COMP |
| S5135U2 | Adult Companion | COMP |
| S5135U5 | Adult Companion | COMP |
| S5135UA | Adult Companion | COMP |
| S5135UC | Adult Companion | COMP |
| S5150 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S515012 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5150U2 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5180 | Initial Evaluation/Reevaluation - Rendered by a Registered Respiratory Care Practitioner | RT |
| S9122 | Personal care rendered by a home health service provider (1 to 24 hours per day)* | PC |
| S9122TT | Personal care rendered by a home health service provider (1 to 24 hours per day)* provided to more than one recipient in the same setting. | PC |
| S9122TTUF | Personal care rendered by a home health service provider (1 to 24 hours per day)* provided to more than one recipient by more than one provider in the same setting. | PC |
| S9122UF | Personal care rendered by a home health service provider (1 to 24 hours per day)* provided by more than one provider in the same setting | PC |
| S9123 | Private duty nursing rendered by a RN (2 to 24 hours per day)* | RN |
| S9123TT | Private duty nursing rendered by a RN (2 to 24 hours per day)* provided to more than one recipient in the same setting.** | RN |
| S9123TTUF | Private duty nursing rendered by a RN (2 to 24 hours per day)* provided to more than one recipient by more than one provider in the same setting.**,*** | RN |
| S9123UF | Private duty nursing rendered by a RN (2 to 24 hours per day)* provided by more than one provider in the same setting*** | RN |
| S9124 | Private duty nursing rendered by a LPN (2 to 24 hours per day)* | LPN |
| S9124TT | Private duty nursing rendered by a LPN (2 to 24 hours per day)* provided to more than one recipient in the same setting. | LPN |
| S9124TTUF | Private duty nursing rendered by a LPN (2 to 24 hours per day)* provided to more than one recipient in the same setting. | LPN |
| S9124UF | Private duty nursing rendered by a LPN (2 to 24 hours per day)* provided by more than one provider in the same setting | LPN |
| T1002 | Registered Nurse/RN visit | RN |
| T1002CG | RN PDO visit | RN |
| T1002TD | Registered Nurse/RN visit | RN |
| T1003 | LPN/LVN visit | LPN |
| T1003CG | LPN/LVN PDO visit | LPN |
| T1004 | Services of a qualified nursing aide, up to 15 minutes | PCA |
| T1005 | Respite care services, up to 15 minutes | RESP |
| T1019 | Personal Care Services | PCA |
| T101912 | Personal Care Services | PCA |
| T101976 | Personal Care Services | PCA |
| T1019CG | Personal Care Services PDO | PCA |
| T1019TT | Personal Care Services | PCA |
| T1019U2 | Personal Care Services | PCA |
| T1019U5 | Personal Care Services | PCA |
| T1019UA | Personal Care Services | PCA |
| T1019UC | Personal Care Services | PCA |
| T1020 | ACS for Non-ALE Waiver recipients | Other (Skilled) |
| T1020U3 | ACS for ALE Waiver Recipients | Other (Skilled) |
| T1021 | Bath Visit | Other (Non Skilled) |
| T1021GY | Home Health Aide (HHA) Visit-unassociated with skilled nursing services to a Dually Eligible Recipient | HHA |
| T1021TD | Home Health Aide (HHA) Visit-associated with skilled nursing services | HHA |
| T1021TDTT | Home Health Aide (HHA) Visit-associated with skilled nursing services provided to more than one recipient in the same setting. | HHA |
| T1021TT | Home Health Aide (HHA) Visit-unassociated with skilled nursing services provided to more than one recipient in the same setting. | HHA |
| T1021TTGY | Home Health Aide (HHA) Visit-unassociated with skilled nursing services to a Dually Eligible Recipient provided to more than one recipient in the same setting. | HHA |
| T1022 | Live in Daily | HHA |
| T1030 | Registered Nurse (RN) Visit | RN |
| T1030TT | Registered Nurse (RN) Visit provided to more than one recipient in the same setting | RN |
| T1031 | Licensed Practical Nurse (LPN) Visit | LPN |
| T1031TT | Licensed Practical Nurse (LPN) Visit provided to more than one recipient in the same setting. | LPN |
| T1502 | Medicaid Administration, administration of oral, intramuscular, and/or subcutaneous medication | Other (Skilled) |
| T1502HN | Medicaid Administration, administration of oral, intramuscular, and/or subcutaneous medication (BSN) | Other (Skilled) |
| T1502TD | Medicaid Administration, administration of oral, intramuscular, and/or subcutaneous medication (RN) | Other (Skilled) |
| T1502TE | Medicaid Administration, administration of oral, intramuscular, and/or subcutaneous medication (LPN) | Other (Skilled) |
| T1503HN | Medication Administration, administration of medication, other than oral and/or injectable (BSN) | Other (Skilled) |
| T1503TD | Medication Administration, administration of medication, other than oral and/or injectable (RN) | Other (Skilled) |
| T1503TE | Medication Administration, administration of medication, other than oral and/or injectable (LPN) | Other (Skilled) |
Molina Procedure Codes
Updated 02/20/2020
| Service Code | Description | HHAeXchange Service Type |
|---|---|---|
| 92507 | Speech Therapy Visit | ST |
| 92521 | Evaluation/ Re-evaluation of speech fluency (e.g., stuttering, | ST |
| 92522 | Evaluation/ Re-evaluation of speech sound production (e.g., articulation, p | ST |
| 92523 | phonological process, apraxia, dysarthria); with evaluation of language, co | ST |
| 92524 | Evaluation/ Re-evaluation Behavioral and qualitative analysis of voice and | ST |
| 92610 | Evaluation of oral and pharyngeal swallowing function | ST |
| 97003 | Occupational Therapy Visit (enrollee over 21) | OT |
| 97110 | Physical Therapy Treatment Visit | PT |
| 97161 | Physical Therapy Evaluation, Low Complexity | PT |
| 97162 | Physical Therapy Evaluation, Moderate Complexity | PT |
| 97163 | Physical Therapy Evaluation, High Complexity | PT |
| 97164 | Physical Therapy Re-Evaluation | PT |
| 97165 | Occupational Therapy Evaluation, Low Complexity | OT |
| 97166 | Occupational Therapy Evaluation, Moderate Complexity | OT |
| 97167 | Occupational Therapy Evaluation, High Complexity | OT |
| 97168 | Occupational Therapy Re- Evaluation | OT |
| 97530 | Occupational Therapy Treatment Visit | OT |
| 97542 | Wheelchair Evaluation | Other (Non Skilled) |
| 97542GO | Wheelchair Evaluation and Fitting by an Occupational Therapist | OT |
| 97542GP | Wheelchair Evaluation and fitting by a Physical Therapist | PT |
| 97802 | Nutritional Assessment/Risk Reduction Services | NT |
| 99503 | Respiratory Therapy, Treatment Regular (enrollee over 21) | RT |
| 99504 | Respiratory Therapy, Treatment Mechanical Vent Care | RT |
| H2010 | Medication Management, Comprehensive | Other (Skilled) |
| H2010HN | Medication Management, Comprehensive (BSN) | Other (Skilled) |
| H2010T2 | Medication Management, Comprehensive | Other (Skilled) |
| H2010TD | Medication Management, Comprehensive (RN) | Other (Skilled) |
| H2010TE | Medication Management, Comprehensive (LPN) | Other (Skilled) |
| H2014 | Life Skills Training | Other (Non Skilled) |
| S5108 | Caregiver/Family Training | Other (Non Skilled) |
| S5110 | Caregiver Training (Group) | Other (Skilled) |
| S5125CG | Attendant Care PDO | Other (Skilled) |
| S5125U2 | Attendant Care | Other (Skilled) |
| S5125UA | Attendant Care | Other (Skilled) |
| S5130 | Homemaker Services | HMK |
| S5130CG | Homemaker Services PDO | HMK |
| S5130HM | Homemaker Services | HMK |
| S5130U1 | Homemaker Services | HMK |
| S5130U2 | Homemaker Services | HMK |
| S5130UC | Homemaker Services | HMK |
| S5130US | Homemaker Services | HMK |
| S5135 | Companion (Non-Skilled) | COMP |
| S513576 | Adult Companion | COMP |
| S5135CG | Adult Companion Care PDO | COMP |
| S5135U2 | Adult Companion | COMP |
| S5135U5 | Adult Companion | COMP |
| S5135UA | Adult Companion | COMP |
| S5135UC | Adult Companion | COMP |
| S5150 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S515012 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5150U2 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5180 | Initial Evaluation/Reevaluation - Rendered by a Registered Res | RT |
| s9122 | Home health aide or certified nurse assistant, providing care in the home; per hour | Other (Non Skilled) |
| S9123 | Private duty nursing rendered by a RN (2 to 24 hours per day) | RN |
| S9123TT | Registered Nurse (Skilled) | RN |
| S9123TTUF | Registered Nurse (Skilled) | RN |
| S9123UF | Registered Nurse (Skilled) | RN |
| S9124 | Private duty nursing rendered by a LPN (2 to 24 hours per day | LPN |
| S9124TT | Licensed Practical Nurse (Skilled) | LPN |
| S9124TTUF | Licensed Practical Nurse (Skilled) | LPN |
| S9124UF | Licensed Practical Nurse (Skilled) | LPN |
| S9128 | Speech Therapist (Skilled) | Other (Skilled) |
| S9129 | Occupational Therapist (Skilled) | OT |
| S9131 | Physical Therapist (Skilled) | PT |
| S9338 | Home Infusion Therapy including Supplies & equipment (drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| s9348 | Home Infusion Therapy (drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9374 | Hydration 1 Liter per diem hydration therapy; 1 liter per day (drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9470 | Nutritionist (Skilled) | NT |
| S9501 | Home Infusion Therapy antibiotic, antiviral, or antifungal therapy; once every 12 hours ((drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9502 | Home Infusion Therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours (drugs and nursing visits coded separately), per diem | Other (Skilled) |
| T1002 | Registered Nurse (Skilled) | RN |
| T1002CG | RN PDO visit | RN |
| T1002TD | Registered Nurse/RN visit | RN |
| T1003 | LPN/LVN visit | LPN |
| T1003CG | LPN/LVN PDO visit | LPN |
| T1004 | Services of a qualified nursing aide, up to 15 minutes | HHA |
| T1005 | Respite care services, up to 15 minutes | RESP |
| T1019 | Personal Care Services | PC |
| T101912 | Personal Care Services | PC |
| T1019CG | Personal Care Services PDO | PC |
| T1019TT | Personal Care Services | PC |
| T1019U2 | Personal Care Services | PC |
| T1019U5 | Personal Care Services | PC |
| T1019UA | Personal Care Services | PC |
| T1019UC | Personal Care Services | PC |
| T1020 | ACS for Non-ALE Waiver Recipients | Other (Non Skilled) |
| T1020U3 | ACS for ALE Waiver Recipients | Other (Non Skilled) |
| T1021 | Bath Visit | Other (Non Skilled) |
| T1021GY | Home Health Aide (HHA) Visit unassociated with skilled nursing | Other (Non Skilled) |
| T1021TD | Home Health Aide (HHA) Visit-associated with skilled nursing | Other (Non Skilled) |
| T1021TDTT | Home Health Aide (HHA) Visit-associated with skilled nursing | Other (Non Skilled) |
| T1021TT | Home Health Aide (HHA) Visit unassociated with skilled nursing | Other (Non Skilled) |
| T1021TTGY | Home Health Aide (HHA) Visit unassociated with skilled nursing | Other (Non Skilled) |
| T1022 | Live in Daily | Other (Non Skilled) |
| T1030 | Registered Nurse (RN) Visit. | RN |
| T1030TT | Registered Nurse (RN) Visit provided to more than one recipient | RN |
| T1031 | Licensed Practical Nurse (LPN) Visit. | LPN |
| T1031TT | Licensed Practical Nurse (LPN) Visit provided to more than one | LPN |
| T1502 | Medicaid Administration, administration of oral, intramuscular | RN |
| T1502HN | Medicaid Administration, administration of oral, intramuscular | RN |
| T1502TD | Medicaid Administration, administration of oral, intramuscular | RN |
| T1502TE | Medicaid Administration, administration of oral, intramuscular | RN |
| T1503TD | Medication Administration, administration of medication, other | RN |
| T1503TE | Medication Administration, administration of medication, other | RN |
| G0238 | Respiratory Therapist (Skilled) | RT |
| S5125 | Attendant Care | Other (Skilled) |
| T101976 | Personal Care Services | PC |
Molina MMA Procedure Codes
Added 02/20/2020
| Service Code | Description | HHAeXchange Service Type |
|---|---|---|
| 92507 | Speech Therapy Visit | ST |
| 92521 | Evaluation/ Re-evaluation of speech fluency (e.g., stuttering, | ST |
| 92522 | Evaluation/ Re-evaluation of speech sound production (e.g., articulation, p | ST |
| 92523 | phonological process, apraxia, dysarthria); with evaluation of language, co | ST |
| 92524 | Evaluation/ Re-evaluation Behavioral and qualitative analysis of voice and | ST |
| 92610 | Evaluation of oral and pharyngeal swallowing function | ST |
| 97003 | Occupational Therapy Visit (enrollee over 21) | OT |
| 97110 | Physical Therapy Treatment Visit | PT |
| 97161 | Physical Therapy Evaluation, Low Complexity | PT |
| 97162 | Physical Therapy Evaluation, Moderate Complexity | PT |
| 97163 | Physical Therapy Evaluation, High Complexity | PT |
| 97164 | Physical Therapy Re-Evaluation | PT |
| 97165 | Occupational Therapy Evaluation, Low Complexity | OT |
| 97166 | Occupational Therapy Evaluation, Moderate Complexity | OT |
| 97167 | Occupational Therapy Evaluation, High Complexity | OT |
| 97168 | Occupational Therapy Re- Evaluation | OT |
| 97530 | Occupational Therapy Treatment Visit | OT |
| 97542 | Wheelchair Evaluation | Other (Non Skilled) |
| 97542GO | Wheelchair Evaluation and Fitting by an Occupational Therapist | OT |
| 97542GP | Wheelchair Evaluation and fitting by a Physical Therapist | PT |
| 97802 | Nutritional Assessment/Risk Reduction Services | NT |
| 99503 | Respiratory Therapy, Treatment Regular (enrollee over 21) | RT |
| 99504 | Respiratory Therapy, Treatment Mechanical Vent Care | RT |
| G0238 | Respiratory Therapist (Skilled) | RT |
| H2010 | Medication Management, Comprehensive | Other (Skilled) |
| H2010HN | Medication Management, Comprehensive (BSN) | Other (Skilled) |
| H2010T2 | Medication Management, Comprehensive | Other (Skilled) |
| H2010TD | Medication Management, Comprehensive (RN) | Other (Skilled) |
| H2010TE | Medication Management, Comprehensive (LPN) | Other (Skilled) |
| H2014 | Life Skills Training | Other (Non Skilled) |
| S5108 | Caregiver/Family Training | Other (Non Skilled) |
| S5110 | Caregiver Training (Group) | Other (Skilled) |
| S5125 | Attendant Care | Other (Skilled) |
| S5125CG | Attendant Care PDO | Other (Skilled) |
| S5125U2 | Attendant Care | Other (Skilled) |
| S5125UA | Attendant Care | Other (Skilled) |
| S5130 | Homemaker Services | HMK |
| S5130CG | Homemaker Services PDO | HMK |
| S5130HM | Homemaker Services | HMK |
| S5130U1 | Homemaker Services | HMK |
| S5130U2 | Homemaker Services | HMK |
| S5130UC | Homemaker Services | HMK |
| S5130US | Homemaker Services | HMK |
| S5135 | Companion (Non-Skilled) | COMP |
| S513576 | Adult Companion | COMP |
| S5135CG | Adult Companion Care PDO | COMP |
| S5135U2 | Adult Companion | COMP |
| S5135U5 | Adult Companion | COMP |
| S5135UA | Adult Companion | COMP |
| S5135UC | Adult Companion | COMP |
| S5150 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S515012 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5150U2 | Unskilled respite care, not hospice; per 15 minutes | RESP |
| S5180 | Initial Evaluation/Reevaluation - Rendered by a Registered Res | RT |
| S9122 | Home Health Aide or Certified Nurse Assistant, providing care in the home; per hour | Other (Non Skilled) |
| S9123 | Private duty nursing rendered by a RN (2 to 24 hours per day) | RN |
| S9123TT | Registered Nurse (Skilled) | RN |
| S9123TTUF | Registered Nurse (Skilled) | RN |
| S9123UF | Registered Nurse (Skilled) | RN |
| S9124 | Private duty nursing rendered by a LPN (2 to 24 hours per day | LPN |
| S9124TT | Licensed Practical Nurse (Skilled) | LPN |
| S9124TTUF | Licensed Practical Nurse (Skilled) | LPN |
| S9124UF | Licensed Practical Nurse (Skilled) | LPN |
| S9128 | Speech Therapist (Skilled) | Other (Skilled) |
| S9129 | Occupational Therapist (Skilled) | OT |
| S9131 | Physical Therapist (Skilled) | PT |
| S9338 | Home Infusion Therapy including Supplies & equipment (drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9348 | Home Infusion Therapy (drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9374 | Hydration 1 Liter per diem hydration therapy; 1 liter per day (drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9470 | Nutritionist (Skilled) | NT |
| S9501 | Home Infusion Therapy antibiotic, antiviral, or antifungal therapy; once every 12 hours ((drugs and nursing visits coded separately), per diem) | Other (Skilled) |
| S9502 | Home Infusion Therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours (drugs and nursing visits coded separately), per diem | Other (Skilled) |
| T1002 | Registered Nurse (Skilled) | RN |
| T1002CG | RN PDO visit | RN |
| T1002TD | Registered Nurse/RN visit | RN |
| T1003 | LPN/LVN visit | LPN |
| T1003CG | LPN/LVN PDO visit | LPN |
| T1004 | Services of a qualified nursing aide, up to 15 minutes | HHA |
| T1005 | Respite care services, up to 15 minutes | RESP |
| T1019 | Personal Care Services | PC |
| T101912 | Personal Care Services | PC |
| T101976 | Personal Care Services | PC |
| T1019CG | Personal Care Services PDO | PC |
| T1019TT | Personal Care Services | PC |
| T1019U2 | Personal Care Services | PC |
| T1019U5 | Personal Care Services | PC |
| T1019UA | Personal Care Services | PC |
| T1019UC | Personal Care Services | PC |
| T1020 | ACS for Non-ALE Waiver Recipients | Other (Non Skilled) |
| T1020U3 | ACS for ALE Waiver Recipients | Other (Non Skilled) |
| T1021 | Bath Visit | Other (Non Skilled) |
| T1021GY | Home Health Aide (HHA) Visit unassociated with skilled nursing | Other (Non Skilled) |
| T1021TD | Home Health Aide (HHA) Visit-associated with skilled nursing s | Other (Non Skilled) |
| T1021TDTT | Home Health Aide (HHA) Visit-associated with skilled nursing s | Other (Non Skilled) |
| T1021TT | Home Health Aide (HHA) Visit unassociated with skilled nursing | Other (Non Skilled) |
| T1021TTGY | Home Health Aide (HHA) Visit unassociated with skilled nursing | Other (Non Skilled) |
| T1022 | Live in Daily | Other (Non Skilled) |
| T1030 | Registered Nurse (RN) Visit. | RN |
| T1030TT | Registered Nurse (RN) Visit provided to more than one recipient | RN |
| T1031 | Licensed Practical Nurse (LPN) Visit. | LPN |
| T1031TT | Licensed Practical Nurse (LPN) Visit provided to more than one | LPN |
| T1502 | Medicaid Administration, administration of oral, intramuscular | RN |
| T1502HN | Medicaid Administration, administration of oral, intramuscular | RN |
| T1502TD | Medicaid Administration, administration of oral, intramuscular | RN |
| T1502TE | Medicaid Administration, administration of oral, intramuscular | RN |
| T1503TD | Medication Administration, administration of medication, other | RN |
| T1503TE | Medication Administration, administration of medication, other | RN |
Staywell Coastal Procedure Codes
Updated 02/20/2020
| Service Code | Description | HHAeXchange Service Type |
|---|---|---|
| 92507 | Speech Therapy Visit | ST |
| 92521 | Evaluation/Re-evaluation of speech fluency | ST |
| 92522 | Evaluation/Re-evaluation of speech sound production | ST |
| 92523 | Evaluation/Re-evaluation of speech sound production; evaluation with language comprehension and expression | ST |
| 92524 | Evaluation/Re-evaluation Behavioral and qualitative analysis of voice and resonance | ST |
| 92610 | Evaluation of oral and pharyngeal swallowing function | ST |
| 97110 | Physical Therapy Treatment Visit | PT |
| 97110HM | Physical Therapy Treatment Visit by a PTA | PT |
| 97161 | Physical Therapy Evaluation, Low Complexity | PT |
| 97162 | Physical Therapy Evaluation, Moderate Complexity | PT |
| 97163 | Physical Therapy Evaluation, High Complexity | PT |
| 97164 | Physical Therapy Re-Evaluation | PT |
| 97165 | Occupational Therapy Evaluation, Low Complexity | OT |
| 97166 | Occupational Therapy Evaluation, Moderate Complexity | OT |
| 97167 | Occupational Therapy Evaluation, High Complexity | OT |
| 97168 | Occupational Therapy Re-Evaluation | OT |
| 97530 | Occupational Therapy Treatment Visit | OT |
| 97530HM | Occupational Therapy Treatment Visit By an OTA | OT |
| G0155 | Clinical Social Worker Visit | MSW |
| T1021 | Home Health Aide Visit | HHA |
| T1021TD | Home Health Aide Visit (Associated with skilled nursing services) | HHA |
| T1030 | Registered Nurse Visit | RN |
| T1031 | License Practical Nurse Visit | LPN |
Staywell Procedure Codes
Updated 02/20/2020
| Service Code | Description | HHAeXchange Service Type |
|---|---|---|
| 97802 | Nutritional Assessment/Risk Reduction Services | Other (Skilled) |
| G9002 | Care Coordination/Case Management | Other (Skilled) |
| G9012 | PMPM billing | Other (Non Skilled) |
| H2010 | Comprehensive Medication Services | Other (Skilled) |
| H2010HN | Medication Administration | Other (Skilled) |
| H2010TD | Medication Administration | Other (Skilled) |
| H2010TE | Medication Administration | Other (Skilled) |
| S5110 | Caregiver Training - Group | Other (Non Skilled) |
| S5120 | Chore Services | Other (Non Skilled) |
| S5125 | Attendant Care | Other (Skilled) |
| S5125U2 | Attendant Care | Other (Skilled) |
| S5130 | Homemaker Services | Other (Non Skilled) |
| S5130U2 | Homemaker Services | Other (Non Skilled) |
| S5135 | Adult Companion Care | Other (Non Skilled) |
| S5135U2 | Adult Companion Care | Other (Non Skilled) |
| S5150 | Respite Care | Other (Non Skilled) |
| S9122 | Personal Care | Other (Non Skilled) |
| S9122TT | Personal Care | Other (Non Skilled) |
| S9122TTUF | Personal Care | Other (Non Skilled) |
| S9122UF | Personal Care | Other (Non Skilled) |
| S9123 | Private Duty Nursing - RN | Other (Skilled) |
| S9123TT | Private Duty Nursing (RN services) provided to more than one recipient in the same setting | Other (Skilled) |
| S9123TTUF | Private Duty Nursing (RN services) provided to more than one recipient in the same setting by more than one provider | Other (Skilled) |
| S9123UF | Private Duty Nursing (RN services) provided by more than one provider in the same setting | Other (Skilled) |
| S9124 | Private Duty Nursing - LPN | Other (Skilled) |
| S9124TT | Intermittent and Skilled Nursing | Other (Skilled) |
| S9124TTUF | Intermittent and Skilled Nursing | Other (Skilled) |
| S9124UF | Intermittent and Skilled Nursing | Other (Skilled) |
| T1002 | Intermittent and Skilled Nursing | Other (Skilled) |
| T1002HN | Intermittent and Skilled Nursing | Other (Skilled) |
| T1002TF | Intermittent and Skilled Nursing | Other (Skilled) |
| T1002TFKO | Medication Administration | Other (Skilled) |
| T1003 | Intermittent and Skilled Nursing | Other (Skilled) |
| T1019 | Personal Care | Other (Non Skilled) |
| T1021 | Intermittent and Skilled Nursing | Other (Non Skilled) |
| T1021GY | Intermittent and Skilled Nursing | Other (Non Skilled) |
| T1021TD | Intermittent and Skilled Nursing | Other (Non Skilled) |
| T1021TDTT | Intermittent and Skilled Nursing | Other (Non Skilled) |
| T1021TT | Intermittent and Skilled Nursing | Other (Non Skilled) |
| T1021TTGY | Intermittent and Skilled Nursing | Other (Non Skilled) |
| T1023 | Background Screening | Other (Non Skilled) |
| T1028 | Billing for setup fees | Other (Non Skilled) |
| T1030 | Intermittent and Skilled Nursing | Other (Skilled) |
| T1030TT | Intermittent and Skilled Nursing | Other (Skilled) |
| T1031 | Intermittent and Skilled Nursing | Other (Skilled) |
| T1031TT | Intermittent and Skilled Nursing | Other (Skilled) |
| T1502HN | Medication Administration | Other (Skilled) |
| T1502TD | Medication Administration | Other (Skilled) |
| T1502TE | Medication Administration | Other (Skilled) |
| T1503HN | Medication Administration | Other (Skilled) |
| T1503TD | Medication Administration | Other (Skilled) |
| T1503TE | Medication Administration | Other (Skilled) |
| T1003KO | Medication Administration | Other (Skilled) |
Sunshine Health Procedure Codes
Updated 02/20/2020
| Service Code | Description | HHAeXchangeService Type |
|---|---|---|
| 92507 | Speech Therapy visit | ST |
| 92521 | Evaluation/Re-evaluation of Speech fluency | ST |
| 92523 | Evaluation, Speech sound production | ST |
| 92524 | Evaluation/Re-evaluation Behavioral and qualitative analysis of voice and resonance | Other (Skilled) |
| 92526 | Special Otorhinolarygngologic Services & Procedures | ST |
| 97100 | Therapeutic Procedure, Exercises | PT |
| 97110 | Physical Therapy, treatment visit | PT |
| 97530 | Occupational Therapy, treatment visit | OT |
| 97597 | Debridement, high pressure | Other (Skilled) |
| 97802 | Nutritional Assessment/Risk Reduction Services | NT |
| 99503 | Home Visit for Respiratory Care | RT |
| 99512 | Home Visit for Hemodialysis | Other (Skilled) |
| G0238 | Respiratory Therapist (Skilled) Treatment | RT |
| H2010 | Medication Management | Other (Skilled) |
| H2014 | Life Skills Training, Skills training & development | Other (Skilled) |
| H2019 | Therapeutic Behavior Services | Other (Skilled) |
| H2019HS | Caregiver Therapy / Therapeutic Behavior Services | Other (Skilled) |
| H2020 | Behavioral Management- Initial | Other (Skilled) |
| S5108 | Caregiver/Family Training | Other (Non Skilled) |
| S5120 | Chore Services | HMK |
| S5125 | Other (Skilled) | Other (Skilled) |
| S5125CG | Other (Skilled) | Other (Skilled) |
| S5125U2 | Other (Skilled) | Other (Skilled) |
| S5130 | Homemaker (Non-Skilled) | HMK |
| S5130CG | Homemaker (Non-Skilled) | HMK |
| S5130U2 | Homemaker (Non-Skilled) | HMK |
| S5135 | Companion (Non-Skilled) | COMP |
| S5135CG | Companion (Non-Skilled) | COMP |
| S5135U2 | Companion (Non-Skilled) | COMP |
| S5150 | Unskilled Respite Care | RESP |
| S5180 | Respiratory Therapist (Skilled) | RT |
| S9122 | Personal Care rendered by a home health service provider | PCA |
| S9123 | Registered Nurse (Skilled) | RN |
| S9123TT | Registered Nurse (Skilled) | RN |
| S9123TTUF | Registered Nurse (Skilled) | RN |
| S9123UF | Registered Nurse (Skilled) | RN |
| S9124 | Licensed Practical Nurse (Skilled) | LPN |
| S9124TT | Licensed Practical Nurse (Skilled) | LPN |
| S9124TTUF | Licensed Practical Nurse (Skilled) | LPN |
| S9124UF | Licensed Practical Nurse (Skilled) | LPN |
| S9128 | Speech Therapist (Skilled) | ST |
| S9129 | Occupational Therapist (Skilled) | OT |
| S9131 | Physical Therapist (Skilled) | PT |
| S9420 | Nutritional Assessment/Risk | NT |
| S9470 | Nutritionist (Skilled) | NT |
| T1001 | Nursing Assessment/Evaluation | RN |
| T1002 | Registered Nurse (Skilled) | RN |
| T1004 | Personal Care Assistant (Non-Skilled) | PCA |
| T1005 | Respite (Non-Skilled) | RESP |
| T1019 | Personal Care Services, PDO | PCA |
| T1020 | Personal Care Services | PCA |
| T1021 | HHA or CNA, providing personal care in home, bath visit | PCA |
| T1025U1 | Onsite Visit/PDO Device & Data- Onsite Visit | Other (Non Skilled) |
| T1025U2 | Onsite Visit/PDO Device & Data- PDO Device & Data | Other (Non Skilled) |
| T1028 | Assessment of Home, physical & family environment, (PDO) | Other (Non Skilled) |
| T1030 | Nursing care in home by RN (Skilled Nursing-RN) | RN |
| T1031 | Nursing care in home by LPN (Skilled Nursing- LPN) | LPN |
| T1502 | Medication Administration | Other (Skilled) |
| T2025U1 | Waiver services, Onsite Visit | Other (Non Skilled) |
| T2025U2 | PDO Device & Data | Other (Non Skilled) |
| T1003 | Licensed Practical Nurse (Skilled) | LPN |
Required Fields by Import File Type
There are required fields per file document which must be in specific format. The following table provides the applicable required fields per EDI Import File Type. This EDI Import Interface supports the following import operations into HHAeXchange.
| If record needs to be imported as a… | Then, the following fields must be provided: |
|---|---|
|
Billed Visit |
*The EVV fields are required if visit was confirmed via EVV or IVR. Visit Edit and Action Taken codes are required if visit was manually edited. |
|
Confirmed Visit |
*The EVV fields are required if visit was confirmed via EVV or IVR. Visit Edit and Action Taken codes are required if visit was manually edited. |
|
Delete a Schedule |
|
|
Missed Visit |
|
|
Rebilled Visit |
*The EVV fields are required if visit was confirmed via EVV or IVR. Visit Edit and Action Taken codes are required if visit was manually edited. |
|
Schedule |
|
|
TPL Billing |
*Totals for columns BS – BY must add up to total field amount provided. *The EVV fields are required if visit was confirmed via EVV or IVR. Visit Edit and Action Taken codes are required if visit was manually edited. |
State Specific Requirements
Visits will be required to split at midnight if the visit crosses multiple calendar days. Overnight visits that do not meet the requirements specified below will fail to process successfully into the HHAeXchange system.
The following fields need to be split at midnight if the visit crosses multiple calendar days: Schedule Start/End Time, Visit Start/End Time, and EVV Start/End Time.
Sample overnight shift from 1/1/21 11pm to 1/2/21 7am:
-
Visit 1: 1/1/2021; 11pm – 11:59PM
-
Schedule Start: 23:01
-
Schedule End: 23:59
-
Visit Start: 23:01
-
Visit End: 23:59
-
EVV Start: 23:01
-
EVV End: 23:59
-
-
Visit 2: 1/2/2021; 12:00am – 7am
-
Schedule Start: 00:00
-
Schedule End: 06:58
-
Visit Start: 00:00
-
Visit End: 06:58
-
EVV Start: 00:00
-
EVV End: 06:58
-
Visit Edit Action Taken Codes
The following tables provide the codes and descriptions for the Visit Edit Action Taken fields for the following EDI Import Interface files: Confirmed Visits and Billed Visits.
| Code | Description |
|---|---|
| 10 | Confirmed visit with the client or the client's family member/representative and documented |
| 11 | Supervisor approved change |
| 12 | Updated client's phone number and documented |
| 13 | Changed verification collection method and documented |
| 14 | Timesheet received and signed by supervisor |
| 15 | Visit rescheduled |
| 16 | Updated client's address and documented |
| 17 | Unverified visit; this service cannot be billed |
| 18 | Service(s) cancelled or suspended until further notice |
| 19 | Change in schedule |
| 20 | Unspecified Action |
| 21 | Other |
Visit Edit Reason Codes
The following tables provide the codes and descriptions for the Visit Edit Reason fields for the following EDI Import Interface files: Confirmed Visits and Billed Visits.
| Code | Description |
|---|---|
| 105 | Services Provided Outside the Home – Supported by Service Plan |
| 110 | Fill-in for Regular Attendant or Assigned Staff |
| 115 | Client requested to change/cancel scheduled visit Scheduled visit has been cancelled due to the client's services being suspended |
| 120 | Attendant's identification number (s) does not match the scheduled shift |
| 121 | Attendant failed to report to client's home |
| 125 | Multiple Calls for One Visit |
| 130 | Disaster or Emergency |
| 135 | Confirm Visits with no Schedule (Warning: May result in audit) |
| 200 | Fixed location device on order or pending placement in the home |
| 205 | Small Alternative Device Pending Installation (Warning: May result in audit) |
| 210 | Missing Small Alternative Device (Warning: May result in audit) |
| 215 | Reversal of Call In/Out Times (Warning: May result in audit) |
| 300 | Client's phone line not working (technical issue or natural disaster) |
| 305 | Attendant unable to connect to internet or EVV system down; Attendant entered invalid fixed location device code(s) |
| 310 | Attendant unable to use mobile device |
| 400 | Individual/Member Does Not Have Home Phone |
| 405 | Phone in use by client or individual in client's home |
| 410 | Client won't let attendant use phone |
| 700 | COVID-19: Disaster or Emergency Requiring Caregivers Immediate Attention |
| 701 | COVID-19: Fill-in for Regular Attendant or Assigned Staff (Caregiver Not Registered for Mobile App) |
| 702 | COVID-19: Services Provided Outside the Home – Supported By Service Plan |
| 800 | Address did not link to the client (GPS) |
| 900 | Attendant failed to call in |
| 905 | Attendant failed to call out |
| 910 | Attendant failed to call in and out |
| 915 | Wrong Phone Number – Verified Services Were Delivered |
| 916 | HHAeXchange EVV Mobile App Down (Note required: Support ticket number) (Warning: May result in audit) |
| 917 | HHAeXchange EVV IVR Down (Note required: Support ticket number) (Warning: May result in audit) |
| 918 | HHAeXchange Scheduled EVV System Downtime (Warning: May result in audit) |
| 919 | EDI EVV Mobile App Down (Note required: Vendor support ticket number) (Warning: May result in audit) |
| 920 | EDI EVV IVR Down (Note required: Vendor support ticket number) (Warning: May result in audit) |
| 921 | EDI Vendor Scheduled EVV System Downtime (Note required: Vendor support ticket number) (Warning: May result in audit) |
| 922 | Member not active in HHAeXchange - member not placed or member discharged at time of service (Warning: May result in audit) |
| 998 | PDO Only: Live-in caregiver, EVV not required. (*Self-Direction only). |
| 999 | Other (Warning: May result in audit) |