Pennsylvania 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.
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 – T1019 | Personal Care |
| 134 | Bathing | Personal Care |
| 135 | Bathing | Personal Care |
| 137 | Lotion/Ointment | Personal Care |
| 138 | Laundry | Personal Care |
| 139 | Reading/Writing | Personal Care |
| 140 | Supervision/Coaching/Cueing | Personal Care |
| 141 | Incontinence Care | Personal Care |
| 142 | Catheter Care | Personal Care |
| 143 | Wound Care | Personal Care |
| 144 | G-Tube Feeding | Personal Care |
| 201 | In Person (SCE) | Personal Care |
| 202 | Via Telephone (SCE) | Personal Care |
| 203 | Other (SCE) | Personal Care |
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 |
|---|---|
| 17470 | AmeriHealth Caritas of PA |
| 28162 | Amerihealth EPSDT |
| 73799 | Centene PA Health & Wellness HHCS |
| 16999 | Centene PA Health Wellness |
| 28160 | Health Partners Plan |
| 89056 | Highmark Wholecare |
| 28164 | Keystone EPSDT |
| 20154 | Keystone First CHC |
| 27773 | United Healthcare of Pennsylvania, Inc. |
| 14475 | UPMC LTSS |
| 28242 | UPMC Home Health/Home Nursing |
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).
| Payer | Code | Description |
|---|---|---|
|
50 | Confirmed with the client or the client's family member/representative and documented |
|
51 | Contact MCO for Backup Plan initiation |
|
52 | Replacement Worker Assigned |
|
53 | Service(s) cancelled by participant |
|
54 | Service(s) suspended by participant |
|
55 | Unverified visit: this service cannot be billed |
|
56 | Visit rescheduled by agency |
|
57 | Visit rescheduled by participant |
|
58 | Other- Please provide details |
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).
| Payer | Code | Description |
|---|---|---|
|
508 | UN – Agency is unable to staff the case |
|
510 | AR – Participant/Family refused or unavailable |
|
511 | HU – Hospitalization unplanned |
|
512 | IS - COVID-19: Participant refused, receiving service through informal supports |
|
513 | SI - COVID-19: Participant refused, self-isolating, not receiving service |
|
514 | FA - COVID-19: Participant is in hospital or Nursing Facility |
|
517 | TX - COVID-19: Worker switched to cover another case |
|
519 | CV - COVID-19: All other cases where the agency could not staff due to COVID-19 (Note: If selecting this reason, please provide additional details in the Notes section) |
|
520 | UN - Agency is unable to staff the case |
|
521 | NA -The assigned staff could not cover the shift because of illness or some other reason |
|
522 | H - Did not need covered because the member is in the hospital |
|
523 | FR/FD - The family refused the services that were offered / Family deferred the scheduled hours so they can be provided at a different time |
|
524 | OA - A different agency provided the services |
|
525 | PI - Private insurance is covering these hours |
The following table provides Procedure Codes (Service Codes) and descriptions.
Service codes marked with an asterisk* do not necessitate authorization. For service codes that do not require authorization, ensure that the office NPI is included in the visit import file.
| Service Code | Description | Payer |
|---|---|---|
| *92551 | Screening Test, Pure Tone, Air Only | All EPSDT Payers, Highmark Wholecare |
| *92552 | Pure tone audiometry (threshold); air only | All Payers |
| *99500 | Home Visit Prenatal (Non HBP) Assessment | Highmark Wholecare |
| *99501 | Home Visit Postnatal (Non HBP) Follow-up Care | Highmark Wholecare |
| 97127SE | Cognitive Rehabilitation | All Payers Except PHW HHCS |
| 97537 | Community Integration | All Payers Except PHW HHCS |
| 97537SE | Community Integration | All Payers Except PHW HHCS |
| *99500:AT | Home Visit Prenatal (Non HBP) Assessment | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *99500AT | Home Visit Prenatal (Non HBP) Assessment | UPMC HC |
| *99501:AT | Home Visit Postnatal (Non HBP) Follow-up Care | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *99501AT | Home Visit Postnatal (Non HBP) Follow-up Care | UPMC HC |
| *99501:AT:GT | Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video | All EPSDT Payers Except UPMC HC |
| *99501ATGT | Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video | UPMC HC |
| *G0108 | Diabetes Outpatient Training Service, individual | All Payers |
| *G0109 | Diabetes Outpatient Training, group | All EPSDT Payers, Highmark Wholecare |
| *G0151 | Physical Therapy (Days 1-28) by a PT | All EPSDT Payers, Highmark Wholecare |
| *G0151:U8 | HHCP-SERV OF PT,EA 15 Mins | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *G0151U8 | HHCP-SERV OF PT,EA 15 Mins | UPMC HC |
| *G0151:UD | Physical Therapy (Day 29 and beyond) by a PT | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *G0151UD | Physical Therapy (Day 29 and beyond) by a PT | UPMC HC |
| *G0152 | Occupational Therapy (Days 1- 28) by an OT | Highmark Wholecare, UPMC HC |
| *G0152:U8 | HHCP-SERV OF OT,EA 15 Mins | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *G0152U8 | HHCP-SERV OF OT,EA 15 Mins | UPMC HC |
| *G0152:UD | Occupational Therapy (Day 29 and beyond) by a OT | All EPSDT Payers |
| *G0152UD | Occupational Therapy (Day 29 and beyond) by a OT | UPMC HC |
| *G0153 | Speech Therapy (Days 1-28) by a Speech Therapist | All Payers |
| *G0153:UD | Speech Therapy (Day 29 and beyond) by a ST | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *G0153UD | Speech Therapy (Day 29 and beyond) by a ST | UPMC HC |
| *G0154 | HHCP - SVS OF RN, EA 15MIN | All EPSDT Payers Except HP |
| *G0155 | HHCP-SVS OF CSW,EA 15 MIN | All Payers |
| *G0156 | Home Health – Aide (Under 21) | All EPSDT Payers, Highmark Wholecare |
| *G0156:AT | Aide in Home Health or Hospice - 15 Mins - AT | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *G0156AT | Aide in Home Health or Hospice - 15 Mins - AT | UPMC HC |
| G0156:TT | Home Health – Aide (Under 21) | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0156TT | Home Health – Aide (Under 21) | UPMC HC |
| G0156:U7 | Services of home health/hospice aide in home health or hospice setting, each 15 minutes | AH/KS EPSDT & HP, Highmark Wholecare |
| G0156U7 | Services of home health/hospice aide in home health or hospice setting, each 15 minutes | UPMC HC |
| G0156:U7:SC | Services of home health/hospice aide in home health or hospice setting, each 15 minutes | AH/KS EPSDT & HP, Highmark Wholecare |
| G0156U7SC | Services of home health/hospice aide in home health or hospice setting, each 15 minutes | UPMC HC |
| G0156:U7:SC:TG | Services of home health/hospice aide - LRR - 15 Mins - TG | Highmark Wholecare |
| G0156:U7:SC:TK | Services of home health/hospice aide - LRR - 15 Mins - TK | Highmark Wholecare |
| G0156:U7:SC:TT | Services of home health/hospice aide in home health or hospice setting, each 15 minutes - TT | AH EPSDT & KS EPSDT, Highmark Wholecare |
| G0156:U7:SC:TV | Services of home health/hospice aide - LRR - 15 Mins - TV | Highmark Wholecare |
| G0156:U7:SC:U3 | Services of home health/hospice aide - LRR - 15 Mins - U3 | Highmark Wholecare |
| G0156:U7:SC:UC | Services of home health/hospice aide - LRR - 15 Mins - UC | Highmark Wholecare |
| G0156:U7:SC:UN | Services of home health/hospice aide - LRR - 15 Mins - UN | Highmark Wholecare |
| G0156:U7:SC:UP | Services of home health/hospice aide - LRR - 15 Mins - UP | Highmark Wholecare |
| G0156:U7:TK | Services of home health/hospice aide - 15 Mins - TK | Highmark Wholecare |
| G0156U7SCTT | Services of home health/hospice aide in home health or hospice setting, each 15 minutes - TT | UPMC HC |
| G0156:U7:TT | Services of home health/hospice aide in home health or hospice setting, each 15 minutes - TT | AH/KS EPSDT & HP, Highmark Wholecare |
| G0156:U7:TV | Services of home health/hospice aide - 15 Mins - TV | Highmark Wholecare |
| G0156:U7:U3 | Services of home health/hospice aide - 15 Mins - U3 | Highmark Wholecare |
| G0156:U7:UC | Services of home health/hospice aide - 15 Mins - UC | Highmark Wholecare |
| G0156:U7:UN | Services of home health/hospice aide - 15 Mins - UN | Highmark Wholecare |
| G0156:U7:UP | Services of home health/hospice aide - 15 Mins - UP | Highmark Wholecare |
| G0156U7TT | Services of home health/hospice aide in home health or hospice setting, each 15 minutes - TT | UPMC HC |
| *G0156:U8 | HHA visit to patient's home (Day 1-28) by a HH Aide | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0156U8 | HHA visit to patient's home (Day 1-28) by a HH Aide | UPMC HC |
| G0156:U8:TT | HHA visit to patient's home (Day 1-28) by a HH Aide - TT | Highmark Wholecare |
| G0156:U8:UD | HHA visit to patient's home (Day 29 and beyond) by a HH Aide | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0156:U8:UD:TT | HHA visit to patient's home (Day 29 and beyond) by a HH Aide - TT | Highmark Wholecare |
| G0156U8UD | HHA visit to patient's home (Day 29 and beyond) by a HH Aide | UPMC HC |
| G0156U9 | Aide in Home Health or Hospice - 15 Mins - U9 | All EPSDT Payers, Highmark Wholecare |
| G0156:UD | Aide in Home Health or Hospice - 15 Mins - UD | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0156UD | Aide in Home Health or Hospice - 15 Mins - UD | UPMC HC |
| *G0299 | DIR SNS RN HH/HOSPICE SET | All EPSDT Payers, Highmark Wholecare |
| *G0299:U8 | HHA visit to a patient's home (Day 1-28) by a RN | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| *G0299U8 | HHA visit to a patient's home (Day 1-28) by a RN | UPMC HC |
| G0299:U8:TT | HHA visit to a patient's home (Day 1-28) by a RN - TT | Highmark Wholecare |
| *G0299:U8:UD | HHA visit to patient's home (Day 29 and beyond) by a RN | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0299:U8:UD:TT | HHA visit to patient's home (Day 29 and beyond) by a RN - TT | Highmark Wholecare |
| G0299U8UD | HHA visit to patient's home (Day 29 and beyond) by a RN | UPMC HC |
| *G0299:UB | Dir SNS RN HH/Hospice Set - UB | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0299UB | Dir SNS RN HH/Hospice Set - UB | UPMC HC |
| *G0300 | DIR SNS LPN HH/HOSPICE SET | All EPSDT Payers, Highmark Wholecare |
| *G0300:U8 | HHA visit to a patient's home (Day 1-28) by a LPN | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0300U8 | HHA visit to a patient's home (Day 1-28) by a LPN | UPMC HC |
| G0300:U8:TT | HHA visit to a patient's home (Day 1-28) by a LPN - TT | Highmark Wholecare |
| *G0300:U8:UD | HHA visit to patient's home (Day 29 and beyond) by a LPN | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| G0300:U8:UD:TT | HHA visit to patient's home (Day 29 and beyond) by a LPN - TT | Highmark Wholecare |
| G0300U8UD | HHA visit to patient's home (Day 29 and beyond) by a LPN | UPMC HC |
| *G0300:UB | Dir SNS LPN HH/Hospice Set - UB | UPMC HC, Highmark Wholecare |
| G0300UB | Dir SNS LPN HH/Hospice Set - UB | All EPSDT Payers Except UPMC HC |
| S9122 | Home Health – Aide (Under 21) | All EPSDT Payers Except United |
| S9122TK | Home Health – Aide (Under 21) | AH/KS EPSDT & UPMC HC |
| S9122:TT | Home Health – Aide (Under 21) | AH/KS EPSDT |
| S9122:UD | Aide In Home Care - Hr - UD | All EPSDT Payers Except UPMC HC |
| S9122UD | Aide In Home Care - Hr - UD | UPMC HC |
| S9123 | EPSDT - Registered Nurse (Pediatric Shift Care) | All EPSDT Payers |
| S9123:TT | Home Health - Nursing (RN), Hr - TT | All EPSDT Payers Except UPMC HC |
| S9123TT | Home Health - Nursing (RN), Hr - TT | UPMC HC |
| S9124 | EPSDT - Licensed Practical Nurse PDN (Pediatric Shift Care) | All Payers |
| S9124:TT | Home Health - Nursing (LPN), Hr - TT | All EPSDT Payers Except UPMC HC |
| S9124TT | Home Health - Nursing (LPN), Hr - TT | UPMC HC |
| S9127 | Social Work Visit, In the Home, Per Diem | Highmark Wholecare, UPMC HC |
| S9128 | Speech Therapy, In The Home | All Payers |
| S9129 | Occupational Therapy, In The Home | All EPSDT Payers, Highmark Wholecare |
| S9131 | Physical Therapy, In The Home | All Payers |
| T1000 | Private Duty/Independent Nursing | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| T1000:TT | Private Duty/Independent Nursing - TT | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| T1002 | Home Health - Nursing (RN), 15 Mins | All Payers |
| T1002:SE | Home Health - Nursing (RN), 15 Mins - SE | Highmark Wholecare, United & HP |
| T1002:TG | Home Health - Nursing (RN), 15 Mins - SE | Highmark Wholecare |
| T1002:TT | Home Health - Nursing (RN), 15 Mins - TT | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| T1002TT | Home Health - Nursing (RN), 15 Mins - TT | Highmark Wholecare, UPMC HC |
| T1003 | Home Health - Nursing (LPN), 15 Mins | All EPSDT Payers, Highmark Wholecare |
| T1003:SE | Home Health - Nursing (LPN), 15 Mins - SE | Highmark Wholecare, United & HP |
| T1003:TG | Home Health - Nursing (LPN), 15 Mins - SE | Highmark Wholecare |
| T1003:TT | Home Health - Nursing (LPN), 15 Mins - TT | All EPSDT Payers Except UPMC HC, Highmark Wholecare |
| T1003TT | Home Health - Nursing (LPN), 15 Mins - TT | UPMC HC |
| T1005 | Respite Agency | All Payers Except PHW HHCS |
| T1016 | Case Management | All Payers Except PHW HHCS |
| T1016U2 | Care Gap Closure: Annual Wellness Visit, Annual Dental Visit, Mammogram, Hypertension/Managing HBP, Cervical Cancer Screening, Diabetes Care - BP, Diabetes Care - Eye Exam, Diabetes Care - HbA1c<8, Flu Vaccine, Covid19 Vaccine | PHW |
| T1016U3 | Goal B Post Transition 3 Months (P4P) | PHW |
| T1016U4 | Goal C Post Transition 6 Months (P4P) | PHW |
| T1016U5 | Goal E: Flu Vaccination | PHW |
| T1016U6 | Goal D: COVID-19 Vaccination or COVID-19 Booster | PHW |
| T1016U7 | Goal F: SNAP Application or LIHEAP Application | PHW |
| T1019 | Home Health – Personal Care Services | All EPSDT Payers |
| T1019TK | Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment | UPMC HC |
| T1019:TT | Home Health – Personal Care Services Mutual Code | United, AH/KS EPSDT |
| T1019TT | Home Health – Personal Care Services Mutual Code | UPMC HC |
| T1019:UN | Home Health – Personal Care Services Multiple Patients (2) | HP |
| T1019:UP | Home Health – Personal Care Services Multiple Patients (3) | HP |
| T2025 | Home Health – Aide | HP |
| T2025:GN | Speech/Language Therapy-15 Mins | United & HP |
| T2025:GO | Occupational Therapy-15 Mins | United & HP |
| T2025:GO:U4 | Home Health – Occupational Therapy Assistant | United & HP |
| T2025:GP | Physical Therapy-15 Mins | United & HP |
| T2025:GP:U4 | Physical Therapy Assistant -15 Mins | United & HP |
| W1011 | Service Coordination | All Payers Except PHW HHCS |
| W1793 | PAS (Agency) | All Payers Except PHW HHCS |
| W1793TT | PAS (CSLA) | All Payers Except PHW HHCS |
| W7337 | Transition Service Coordination | All Payers Except PHW HHCS |
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. *The Clock In/Out Latitude/Longitude fields are required if the visit is confirmed Clock-In/Out EVV Other Info. |
| 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. *The Clock In/Out Latitude/Longitude fields are required if the visit is confirmed Clock-In/Out EVV Other Info. |
| Delete a Schedule |
|
| Missed Visit | PA Missed Visit Specs. |
| 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. *The Clock In/Out Latitude/Longitude fields are required if the visit is confirmed Clock-In/Out EVV Other Info. |
| Schedule |
Agency Tax ID Payer ID Medicaid Number Caregiver Code Schedule ID Procedure Code Schedule Start Time Schedule End Time
|
In alignment with the 21st Century Cures Act mandate, effective May, 23, 2022, 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 below 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: 00:00
-
Visit Start: 23:01
-
Visit End: 00:00
-
EVV Start: 23:01
-
EVV End: 00:00
-
-
Visit 2: 1/2/2021; Midnight – 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
-
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.
| Payer | 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 | Confirmed visit with outside entity and documented. |
|
16 | Visit rescheduled. |
|
17 | Updated client's address and documented. |
|
18 | New attendant assigned to client. |
|
19 | Unverified visit; this service cannot be billed. |
|
20 | Service(s) cancelled or suspended until further notice. |
|
21 | Timesheet Verified. |
|
22 | Mutual Case/ or Cluster Case/ or Live-in Case. |
|
23 | Change in schedule. |
|
26 | Other |
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.
| Payer | Code | Description |
|---|---|---|
|
100 | Phone number did not link to the client. |
|
101 | Client will not let attendant use phone. |
|
102 | Client does not have a phone in home. |
|
103 | Phone in use by client or individual in client's home. |
|
104 | Client received services outside of the home. |
|
105 | Client's phone line not working (technical issue or natural disaster). |
|
106 | Client requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the client's services being suspended. |
|
107 | Address did not link to the client (GPS). |
|
108 | Attendant failed to call in. |
|
109 | Attendant failed to call out. |
|
110 | Attendant failed to call in and out. |
|
111 | Attendant called in to or out of the EVV system early or late. |
|
112 | Attendant's identification number(s) does not match the scheduled shift. |
|
113 | Attendant entered invalid fixed location device code(s). |
|
114 | Attendant failed to report to client's home. |
|
115 | Fixed location device on order or pending placement in the home. |
|
116 | Fixed location device malfunctioned. |
|
117 | Attendant unable to use mobile device. |
|
118 | Attendant unable to connect to internet or EVV system down. |
|
119 | Data Entry Error |
|
120 | Agency unable to provide replacement coverage (no show, no replacement). |
|
121 | Timesheet Received |
|
122 | Other |
|
123 | Clock-in Start Date does not match Visit Date |