CFSS Agency and Budget Model billing for Goods and Services (T5999)

Revised: August 5, 2026

Community First Services and Supports (CFSS) Goods and Services (T5999) Agency Model

If the member chooses the agency service model and chooses to purchase goods or services, the member must also select a financial management service (FMS) provider to facilitate the purchase of goods and services. The CFSS agency cannot bill for the goods and services.

The FMS provider will use the HCPCS procedure code and modifier in the table to bill the cost of the goods or services and for their FMS fee. An FMS fee can be added to the cost of the good or service, based on the agencies advertised fee schedule, when billing for an agency model goods or services.

Service Name	HCPCS Procedure Code and Modifier	Authorization Required	Service Unit
CFSS, Agency, Goods	T5999 U9 CFSS Agencies must not bill for the goods or services. The member must choose an FMS provider to bill for the goods and services.	Yes	1 unit per good or service. If multiple purchases occur on the same date, use the total amount of the purchases for the line-item charge and bill only one unit.

CFSS Goods and Services (T5999) Budget Model

If the member chooses the budget service model and chooses to purchase goods or services, the member’s financial management service (FMS) provider will purchase and bill for the goods and services.

The FMS provider will use the HCPCS procedure code and modifier in the table to bill the cost of the good or service in the budget service model. For billing the FMS fee for the budget model, refer to CFSS Billing for FMS Fee and Failed Background Study (T2040).

Service Name	HCPCS Procedure Code and Modifier	Authorization Required	Service Unit
CFSS, Budget, Goods	T5999 UB	Yes	1 unit per good or service. If multiple purchases occur on the same date, use the total amount of the purchases for the line-item charge and bill only one unit.

CFSS Goods and Services (T5999) and Third Party Liability (TPL) Insurance

MHCP considers third party liability (TPL) primary coverage for CFSS goods and services. Providers must bill and receive payment from primary coverage to the fullest extent possible before billing MHCP. MHCP will not pay for the good or service if the TPL does not attribute charges to patient responsibility or a noncovered service.

FMS providers must:

· Bill the primary TPL first and then submit your claim to MHCP and document the other insurance payments on the claim, or

· Document any services not covered by TPL and keep documentation (such as a denial, information from the policy manual and detailed phone contact information) in the member’s file verifying the TPL does not cover a good or service. 

FMS providers must document other insurance payments or noncovered services on their claim by:

· Completing the coordination of benefits (COB) information. Entering Coordination of Benefits with Third Party Liability into a Claim

· Using appropriate claim adjustment reasons and remark codes. Use adjustment amounts found on the explanation of benefits (EOB) sent by the TPL or use the External Code Lists | X12 to look up the HIPPA-compliant claim adjustment reasons and remark codes.

· Including any TPL paid amounts or noncovered charges.