Minnesota Minnesota

Provider Manual

Provider Manual


Agency and Budget Model Billing for CFSS Personal Care Services (T1019)

Revised: August 8, 2025

Use the following information to bill for Community First Services and Supports (CFSS) personal care services for members using either the CFSS agency or budget model:

  • · Bill on 837P claim format. Refer to Completing a MN–ITS Interactive Professional (837P) claim for CFSS.
  • · Enter a diagnosis code when submitting CFSS claims. Use the most current and approved diagnosis code on the service authorization (SA).
  • · Enter the approved SA number in the claim.
  • · Enter one line per date of service, per HCPCS or procedure code (T1019) and modifier combination.
  • · Add the unique Minnesota provider identifier or national provider identifier for the rendering CFSS worker on the service line per date of service.
  • · Service unit count 1 unit equals 15 minutes of service.
  • · Review PCA and CFSS tiered rates and wage floors to include tiered increases into the usual and customary line-item charge amounts for providers using the agency and budget model.
  • · To determine the total line-item charge:
  • · For the agency model, multiply the number of units by your usual and customary charge (Minnesota Statutes, 62A.61) (include tiered rates).
  • · For the budget model, calculate the total payroll cost (such as wages, PTO and other payroll costs).
  • · For the budget model, the financial management service (FMS) provider can include the fee paid for a passed background study as a cost on the individual CFSS worker’s first claim submission. Refer to FMS provider requirements for CFSS under the billing section for more policy information on billing for required employer expenses.

    • Enhanced or Complex Rate
    If a member is eligible for the enhanced rate, the lead agency authorizes CFSS services at the enhanced rate on the service authorization with a TG modifier (CFSS agency complex for members using the agency model or CFSS budget complex for members using the budget model).

  • · The CFSS worker who is providing CFSS services to members approved for enhanced services will also need to take qualifying trainings. Refer to PCA, CFSS, and CSG enhanced rate/budget for qualified trainings and how to submit documentation of training completion. Once the CFSS worker has completed the qualifying trainings, the CFSS provider agency or FMS provider can verify that a worker is qualified for the enhanced rate by following the steps in the PCA Providers A – Z list.
  • · If the CFSS worker who delivered the services completed qualifying trainings, DHS reimburses the CFSS agency at the enhanced rate. If the CFSS worker did not complete the qualifying trainings, DHS will pay the claim at the CFSS base rate.

    • Agency Model HCPCS Procedure Code and Modifiers

    Service Name

    HCPCS Procedure Code and Modifiers

    Authorization
    Required

    Service Unit

    CFSS, Agency,1:1

    T1019 U9

    Yes

    15 Minutes

    CFSS, Agency,1:2

    T1019 U9 UN

    Yes

    15 Minutes

    CFSS, Agency,1:3

    T1019 U9 UP

    Yes

    15 Minutes

    CFSS, Agency, 45-day temp start

    T1019 U8

    Yes

    15 Minutes

    CFSS, Agency, Complex, 1:1

    T1019 U9 TG

    Yes

    15 minutes

    CFSS, Agency, Complex, 1:2

    T1019 U9 TG UN

    Yes

    15 minutes

    CFSS, Agency, Complex, 1:3

    T1019 U9 TG UP

    Yes

    15 minutes

    CFSS, Agency, Complex, 45-day temp start

    T1019 U8 TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Continuation of Benefits, 1:1

    T1019 U9 U4 TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Continuation of Benefits, 1:2

    T1019 U9 U4 UN TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Continuation of Benefits, 1:3

    T1019 U9 U4 UP TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Extended, 1:1

    T1019 U9 UC TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Extended, 1:2

    T1019 U9 UC UN TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Extended, 1:3

    T1019 U9 UC UP TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Reduction, 1:1

    T1019 U9 U5 TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Reduction, 1:2

    T1019 U9 U5 TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Reduction, 1:3

    T1019 U9 U5 TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Temporary Increase, 1:1

    T1019 U9 U6 TG

    Yes

    15 Minutes

    CFSS, Agency, Complex, Temporary Increase, 1:2

    T1019 U9 U6 TG UN

    Yes

    15 Minutes

    CFSS, Agency, Complex, Temporary Increase, 1:3

    T1019 U9 U6 TG UP

    Yes

    15 Minutes

    CFSS, Agency, Continuation of Benefits, 1:1

    T1019 U9 U4

    Yes

    15 Minutes

    CFSS, Agency, Continuation of Benefits, 1:2

    T1019 U9 U4 UN

    Yes

    15 Minutes

    CFSS, Agency, Continuation of Benefits, 1:3

    T1019 U9 U4 UP

    Yes

    15 Minutes

    CFSS, Agency, Extended, 1:1

    T1019 U9 UC

    Yes

    15 Minutes

    CFSS, Agency, Extended, 1:2

    T1019 U9 UC UN

    Yes

    15 Minutes

    CFSS, Agency, Extended, 1:3

    T1019 U9 UC UP

    Yes

    15 Minutes

    CFSS, Agency, Reduction, 1:1

    T1019 U9 U5

    Yes

    15 Minutes

    CFSS, Agency, Reduction, 1:2

    T1019 U9 U5 UN

    Yes

    15 Minutes

    CFSS, Agency, Reduction, 1:3

    T1019 U9 U5 UP

    Yes

    15 Minutes

    CFSS, Agency, Temporary Increase, 1:1

    T1019 U9 U6

    Yes

    15 Minutes

    CFSS, Agency, Temporary Increase, 1:2

    T1019 U9 U6 UN

    Yes

    15 Minutes

    CFSS, Agency, Temporary Increase, 1:3

    T1019 U9 U6 UP

    Yes

    15 Minutes

    Budget Model HCPCS Procedure Code and Modifiers

    Service Name

    HCPCS Procedure Code and Modifiers

    Authorization
    Required

    Service Unit

    CFSS, Budget,1:1

    T1019 UB

    Yes

    15 Minutes

    CFSS, Budget,1:2

    T1019 UB UN

    Yes

    15 Minutes

    CFSS, Budget,1:3

    T1019 UB UP

    Yes

    15 Minutes

    CFSS, Agency, 45-day temp start

    T1019 U8

    Yes

    15 Minutes

    CFSS, Budget, Complex, 1:1

    T1019 UB TG

    Yes

    15 minutes

    CFSS, Budget, Complex, 1:2

    T1019 UB TG UN

    Yes

    15 minutes

    CFSS, Budget, Complex, 1:3

    T1019 UB TG UP

    Yes

    15 minutes

    CFSS, Budget, Complex, 45-day temp start

    T1019 U8 TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Continuation of Benefits, 1:1

    T1019 UB U4 TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Continuation of Benefits, 1:2

    T1019 UB U4 UN TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Continuation of Benefits, 1:3

    T1019 UB U4 UP TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Extended, 1:1

    T1019 UB UC TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Extended, 1:2

    T1019 UB UC UN TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Extended, 1:3

    T1019 UB UC UP TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Reduction, 1:1

    T1019 UB U5 TG

    Yes

    15 Minutes

    CFSS, Budget, Complex Reduction, 1:2

    T1019 UB U5 TG UN

    Yes

    15 Minutes

    CFSS, Budget, Complex, Reduction, 1:3

    T1019 UB U5 TG UP

    Yes

    15 Minutes

    CFSS, Budget, Complex, Temporary Increase, 1:1

    T1019 UB U6 TG

    Yes

    15 Minutes

    CFSS, Budget, Complex, Temporary Increase, 1:2

    T1019 UB U6 TG UN

    Yes

    15 Minutes

    CFSS, Budget, Complex, Temporary Increase, 1:3

    T1019 UB U6 TG UP

    Yes

    15 Minutes

    CFSS, Budget, Continuation of Benefits, 1:1

    T1019 UB U4

    Yes

    15 Minutes

    CFSS, Budget, Continuation of Benefits, 1:2

    T1019 UB U4 UN

    Yes

    15 Minutes

    CFSS, Budget, Continuation of Benefits, 1:3

    T1019 UB U4 UP

    Yes

    15 Minutes

    CFSS, Budget, Extended, 1:1

    T1019 UB UC

    Yes

    15 Minutes

    CFSS, Budget, Extended, 1:2

    T1019 UB UC UN

    Yes

    15 Minutes

    CFSS, Budget, Extended, 1:3

    T1019 UB UC UP

    Yes

    15 Minutes

    CFSS, Budget, Reduction, 1:1

    T1019 UB U5

    Yes

    15 Minutes

    CFSS, Budget, Reduction, 1:2

    T1019 UB U5 UN

    Yes

    15 Minutes

    CFSS, Budget, Reduction, 1:3

    T1019 UB U5 UP

    Yes

    15 Minutes

    CFSS, Budget, Temporary Increase, 1:1

    T1019 UB U6

    Yes

    15 Minutes

    CFSS, Budget, Temporary Increase, 1:2

    T1019 UB U6 UN

    Yes

    15 Minutes

    CFSS, Budget, Temporary Increase, 1:3

    T1019 UB U6 UP

    Yes

    15 Minutes

    Note: The modifiers UN and UP will not appear on the service authorization. Providers must refer to the “Agency Model HCPCS Procedure Code and Modifiers” table or the “Budget Model HCPCS Procedure Code and Modifiers” table to determine if they need to add the modifiers on their CFSS claims.

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