Florida EDI Codes

For Humana FL EDI Providers that need to submit secondary billing, please see the Secondary Billing Guide. This will be a temporary manual workflow until the V5 EDI integration is modified to accept the EOB file name.

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 Closed

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
201	In Person	Patient Support Activities
202	Via Telephone	Patient Support Activities
203	Other	Patient Support Activities
401	Shopping (Grocery, Supplies, Personal Items, Etc.)	Home Management
402	Travel Accompaniment of Appointments	Home Management
403	Housekeeping/Cleaning	Home Management
405	Take Blood Pressure	Treatment / Special Needs
406	Weigh Patient	Treatment / Special Needs
407	Record Output (Urine/BM)	Treatment / Special Needs
408	Assist with Catheter care	Treatment / Special Needs
409	Empty foley bag Daily or when 1/2 Full	Treatment / Special Needs
410	Assist with Ostomy care	Treatment / Special Needs
411	Remind to take medication	Treatment / Special Needs
412	Assist with Treatment	Treatment / Special Needs
499	Other	Home Management
500	Change bed linen	Patient Support Activities
501	PDN-LPN Monitoring Vitals	Nursing Care
501	Patient Laundry	Patient Support Activities
502	PDN-LPN Nursing Care	Nursing Care
502	Light Housekeeping	Patient Support Activities
503	PDN-LPN Managing Medications	Nursing Care
505	Clean Patient Care Equipment	Patient Support Activities
506	Do Patient shopping and errands	Patient Support Activities
508	Accompany Patient to medical appointment	Patient Support Activities
509	Diversional Activities-Speak/Read	Patient Support Activities
511	Monitor Patient Safety	Patient Support Activities
599	PDN-LPN Other	Nursing Care
601	PDN-RN Monitoring Vitals	Nursing Care
602	PDN-RN Nursing Care	Nursing Care
603	PDN-RN Managing Medications	Nursing Care
699	PDN-RN Other	Nursing Care
701 (Molina-specific)	Oxygen/ Ventilator management	Treatment / Special Needs
702 (Molina-specific)	Oxygen/ Ventilator management	Nursing Care
703 (Molina-specific)	Ostomy Care	Treatment / Special Needs
704 (Molina-specific)	Peritoneal Dialysis Management	Treatment / Special Needs
705 (Molina-specific)	Chest physiotherapy	Treatment / Special Needs
706 (Molina-specific)	Blood Draw	Treatment / Special Needs
707 (Molina-specific)	Blood Draw	Nursing Care
708 (Molina-specific)	Infusion access or specialty medication management	Treatment / Special Needs
709 (Molina-specific)	Wound Care/ Skin Breakdown Prevention	Treatment / Special Needs
710 (Molina-specific)	Tracheostomy Management	Treatment / Special Needs
799	Other	Respite Care

MCO/Payer ID Closed

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
20062	Sunshine Health Plan
20135	Humana
22921	Molina Healthcare
24141	Little Havana (LHANC)
24281	Molina Healthcare - MMA
41185	Children's Medical Services
62527	Florida Community Care
90466	AHCA FFS

Missed Visit Action Taken Closed

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 Closed

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
41	Enrollee Hospitalized	Florida Community Care

Procedure Codes Closed

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 Closed

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
S9122SK	Personal care rendered by a home health service provider	HC
S9122SKTT	Personal care rendered by a home health service provider	HC
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 Closed

Updated as of 10/29/2025

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
S9122SK	Family Home Health Aide Visit-(under 21 only) (up to 8 hours per day)1 unit = 1 hour 1:1	PC
S9122SKS2	Family Home Health Aide Visit-(under 21 only) (up to 8 hours per day)1 unit = 1 hour 1:2	PC
S9122SKS3	Family Home Health Aide Visit-(under 21 only) (up to 8 hours per day)1 unit = 1 hour 1:3	PC
S9122SKUF	Family Home Health Aide Visit-(under 21 only) (up to 8 hours per day)provided by more than one provider in the same setting 1 unit = 1 hour 1:1	PC
S9122SKS2UF	Family Home Health Aide Visit-(under 21 only) (up to 8 hours per day)provided by more than one provider in the same setting 1 unit = 1 hour 1:2	PC
S9122SKS3UF	Family Home Health Aide Visit-(under 21 only) (up to 8 hours per day)provided by more than one provider in the same setting 1 unit = 1 hour 1:3	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
T1002CG	RN PDO visit	RN
T1002HN	Intermittent and skilled nursing. BSN HN modifier is for bachelor’s degree level	RN
T1002TD	Registered Nurse/RN 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 Closed

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 Closed

Updated as of 11/19/2025

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
S9122SKTTUF	Family Home Health Aide Visit (up to 8 hours per day) provided to more than one recipient by more than one provider in the same setting	HC
S9122SKUF	Family Home Health Aide Visit (up to 8 hours per day) provided by more than one provider in the same setting	HC
S9122SKTT	Family Home Health Aide Visit (up to 8 hours per day) provided to more than one recipient in the same setting	HC
S9122SK	Family Home Health Aide Visit (up to 8 hours per day)	HC
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 Closed

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)
S9122SK	Family Home Health Aide Visit (up to 8 hours per day)	Other (Skilled)
S9122SKTT	Family Home Health Aide Visit (up to 8 hours per day) provided to more than one recipient in the same setting*	Other (Skilled)
S9122SKTTUF	Family Home Health Aide Visit (up to 8 hours per day) provided to more than one recipient by more than one provider in the same setting***	Other (Skilled)
S9122SKUF	Family Home Health Aide Visit (up to 8 hours per day) provided by more than one provider in the same setting**	Other (Skilled)
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)
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.	PCA
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.	PCA
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
T1002U1	Assessment/Eval RN	RN
T1002U2	High Tech IV Eval RN	RN
T1002U3	High Tech IV Skilled Nursing 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 Closed

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)
S9122SK	Family Home Health Aide Visit (up to 8 hours per day)	Other (Skilled)
S9122SKTT	Family Home Health Aide Visit (up to 8 hours per day) provided to more than one recipient in the same setting*	Other (Skilled)
S9122SKTTUF	Family Home Health Aide Visit (up to 8 hours per day) provided to more than one recipient by more than one provider in the same setting***	Other (Skilled)
S9122SKUF	Family Home Health Aide Visit (up to 8 hours per day) provided by more than one provider in the same setting**	Other (Skilled)
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)
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.	PCA
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.	PCA
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 Closed

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

Sunshine Health Procedure Codes Closed

Updated 11/19/2025

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
S9122SK	Personal care rendered by a home health service provider	HC
S9122SKTT	Personal care rendered by a home health service provider	HC
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 Closed

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	Agency Tax ID Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Clock-In Service Location Address Clock-Out Service Location Address Invoice Number Medicaid Number Payer ID Procedure Code Schedule End Time Schedule ID Schedule Start Time Visit End Time Visit Start Time *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	Agency Tax ID Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Clock-In Service Location Address Clock-Out Service Location Address Medicaid Number Payer ID Procedure Code Schedule End Time Schedule ID Schedule Start Time Visit End Time Visit Start Time *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	Agency Tax ID Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Is Deletion (Value should be “Y”) Medicaid Number Payer ID Procedure Code Schedule End Time Schedule ID Schedule Start Time
Missed Visit	Agency Tax ID Caregiver Code Medicaid Number Missed Visit (Value should be "Y") Missed Visit Action Taken Code Missed Visit Reason Code Payer ID Procedure Code Schedule ID
Rebilled Visit	Agency Tax ID Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Clock-In Service Location Address Clock-Out Service Location Address Invoice Number Medicaid Number Payer ID Procedure Code Schedule End Time Schedule ID Schedule Start Time Submission Type TRN Number Visit End Time Visit Start Time *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	Agency Tax ID Caregiver Code Medicaid Number Payer ID Procedure Code Schedule End Time Schedule ID Schedule Start Time
TPL Billing	Agency Tax ID Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Clock-In Service Location Address Clock-Out Service Location Address Enable Secondary Billing Invoice Number Medicaid Number Other Subscriber ID Paid Date Payer ID Primary Payer ID Primary Payer Name Primary Payer Policy or Group Number Plan Type Procedure Code Relationship to Insured Total Paid Amount Total Paid Units Schedule ID Schedule End Time Schedule Start Time Visit Start Time Visit End Time 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 Closed

Visits is required to split at midnight if the visit crosses multiple calendar days. Overnight visits that do not meet the requirements specified below fails 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 Closed

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 Closed

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
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
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)