Page reviewed: 02/22/10

Page updated: 3/24/15

Healthcare Common Procedure Coding System (HCPCS): Set of health care procedure codes based on Current Procedural Technology (CPT) codes.

Rate: Fixed charge per unit of a commodity or service.

The Medicaid Management Information System (MMIS) stores all rate limits in the system’s reference file. View the complete set of rates and rate maximums on DHS – Long-term services and supports rates changes.

For home care MA state plan services, lead agencies use published reference rate file limits to purchase services.

DHS uses HCPCS codes to identify home care and HCBS program goods and services.

HCPCS codes also indicate service units, which DHS uses to authorize and pay claims. Providers use HCPCS codes to submit claims for goods and services rendered. HCPCS service unit types are:

DHS publishes new home care and HCBS program service rates with instructions for lead agencies when the rates change due to legislative action.

Lead agencies need to account for a leap year when calculating rates for services based on units of less than one month (e.g., “visits,” “15-minute,” “daily,” etc.) The lead agency enters the correct number of units based on the number of days in the service agreement line item, including February 29 where applicable. For monthly and semi-monthly codes, the lead agency enters the contracted monthly or semi-monthly rates.

Centers for Medicare & Medicaid Services – HCPCS general information
CBSM – Disability Waiver Rate System (DWRS)
CBSM – Financial Management of BI, CAC and CADI waivers
CBSM – Financial Management of the DD Waiver
CBSM – Rate Management System (RMS)