HCPCS/ Modifiers | HCPCS/Modifier Description | BRASS Service | Tier Level |
For more information on Waiver Provider Standards Tier level requirements, see Bulletin #13-56-04 entitled “County/Tribal Review & Oversight of Non-Enrolled Tier 2 and Tier 3 Home and Community-Based Services Waiver/Alternative Care Service Providers.” Tier 1 – Enrollment required for these services. Tier 2 (Market Services) – A non-enrollment option assures optimal access statewide for these services. Tier 3 (Receipt Services) – Involve strictly the purchase of items as reimbursable goods and services. | |||
Added End date 12/31/2013 to the following HCPCS/Modifiers. | |||
H2032 | Independent living skills, maintenance | 147 - Independent living skills 647 - Independent living skills | 1 |
S5126 TG | DD, in home family support (day) | 531 - In-home family support services | 1 |
S5135 UB | 24-hour emergency assistance (15 minutes) | 118- Health-related services 145 - Social and recreational 564 - Adult supported living services 565 - Child supported living services 618 - Health-related services 622 - Companion services test new description 627 - Assisted living/customized living/residential care 645- Social and recreational service | 1 |
S5136 | Personal support | 145 - Social and recreational 564 - Adult supported living services 565 - Child supported living services 622 - Companion services test new description 645 - Social and recreational service | 1 |
S5136 UB | 24-hour emergency assistance (day) | 145 - Social and recreational 564- Adult supported living services 565 - Child supported living services 645 - Social and recreational service | 1 |
S5141 | Foster care, adult (month) | 681 - Adult foster care | 1 |
S5141 U9 | Foster care, adult, corporate (month) | 681 - Adult foster care | 1 |
S5146 | Foster care, child (month) | 181 - Child family foster care | 1 |
S5150 | Respite care, in home (15 minutes) | 118 - Health-related services 189 - Respite care 589 - Respite care 689 - Respite care | 1 |
T2002 | DT&H, non-pilot, transportation | 566 - Day Training and Habilitation (DAC) | 1 |
T2018 | Supported employment (day) | 538 - Extended Supported Employment 638 - Extended employment | 1 |
T2018 U5 | Supported employment (partial day) | 538 - Extended Supported Employment | 1 |
T2020 U5 | DT&H, non-pilot | 566 - Day Training and Habilitation (DAC) | 1 |
T2021 TF | DT&H pilot, Rate B | 566 - Day Training and Habilitation (DAC) | 1 |
T2021 TG | DT&H pilot, Rate A | 566 - Day Training and Habilitation (DAC) | 1 |
T2021 UB | DT&H pilot, Rate C | 566 - Day Training and Habilitation (DAC) | 1 |
T2030 | Customized living services (monthly) | 627 - Assisted living/customized living/residential care | 1 |
T2030 TG | 24-hour customized living (monthly) | 627 - Assisted living/customized living/residential care | 1 |
T2030 TG U9 | 24-hour customized living (corporate) | 627 - Assisted living/customized living/residential care | 1 |
T2032 | Supported living services, adult (semi-monthly) | 564- Adult supported living services | 1 |
T2032 | Supported living services, adult (month) | 564 - Adult supported living services | 1 |
T2032 HA | Supported living services, child (semi-monthly) | 565 - Child supported living services | 1 |
T2032 HA | Supported living services, child (month) | 565 - Child supported living services | 1 |
T2032 U9 | Supported living services, adult, corporate AFC (semi-monthly) | 564 - Adult supported living services | 1 |
T2032 U9 | Supported living services, adult, corporate AFC (monthly) | 564 - Adult supported living services | 1 |
T2038 TF | Housing access coordination | 564 - Adult supported living services 565 - Child supported living services | 1 |
HCPCS/ Modifiers | HCPCS/Modifier Description | BRASS Service | Tier Level |
Added Service Association End date 12/31/2013 to the following HCPCS/Modifiers. | |||
H0025 | Behavioral Support, by analyst | 118 - Health-related services 618- Health-related services | 1 |
H0025 TF | Behavioral Support, by specialist | 118 - Health-related services 618- Health-related services | 1 |
H0025 TG | Behavioral Support, by professional | 118 - Health-related services 618- Health-related services | 1 |
H2032 HQ | Independent living skills, group therapy | 147 - Independent living skills 647 - Independent living skills | 1 |
H2032 TF | Independent living skills, counseling | 147 - Independent living skills 647 - Independent living skills | 1 |
H2032 TG | Independent living skills, individual therapy | 147 - Independent living skills 647 - Independent living skills | 1 |
S5100 | Day care services, adult (15 minutes) | 649 – Adult day care | 1 |
S5100 TF | Adult day care bath | 649 – Adult day care | 1 |
S5100 U7 | Family adult day services (FADS) (15 minutes) | 649 – Adult day care | 1 |
S5102 | Day care services, adult (day) | 649 – Adult day care | 1 |
S5102 U7 | Family adult day services (FADS) (day) | 649 – Adult day care | 1 |
S5125 | DD, in home family support (15 minutes) | 531 - In-home family support services | 1 |
S5131 | Homemaker Services (day) | 625 - Homemaking services | 1 |
S5135 | Companion care, adult/Personal support | 145 - Social and recreational 645 - Social and recreational service 622 - Companion services test new description 564 - Adult supported living services 565 - Child supported living services 618 - Health-related services 627 - Assisted living/customized living/residential care | 1 |
S5135 UA | BI night supervision | 118 - Health-related services 145 - Social and recreational 564 - Adult supported living services 565 - Child supported living services 618 - Health-related services 622 - Companion services test new description 627 - Assisted living/customized living/residential care 645 - Social and recreational service | 1 |
S5140 | Foster care, adult (day) | 681 - Adult foster care | 1 |
S5140 U9 | Foster care, adult, corporate (day) | 681 - Adult foster care | 1 |
S5141 HQ | Foster care, adult (month) | 681 - Adult foster care | 1 |
S5145 | Foster care, child (day) | 181 - Child family foster care | 1 |
S5170 | Home delivered meals | 628 - Home delivered meals | 1 |
S9125 | Crisis respite (day) | 589 - Respite care | 1 |
S9470 | Nutritional counseling, diet | 118 - Health-related services 618 - Health-related services | 1 |
T1005 | Crisis respite (15 minutes) | 589 - Respite care | 1 |
T1005 TG | Crisis respite, specialized | 589 - Respite care | 1 |
T2013 | Specialist service | 564 - Adult supported living services 565- Child supported living services | 1 |
T2014 | Prevocational services (day) | 649 - Adult day care | 1 |
T2015 | Prevocational services (hour) | 649 - Adult day care | 1 |
T2016 | Supported living services, adult (day) | 564 - Adult supported living services | 1 |
T2016 HA | Supported living services, child (day) | 565 - Child supported living services | 1 |
T2016 U9 | Supported living services, adult, corporate AFC (day) | 564 - Adult supported living services | 1 |
T2017 | Supported living services, adult (15 minutes) | 564 - Adult supported living services | 1 |
T2017 HA | Supported living services, child (15 minutes) | 565 - Child supported living services | 1 |
T2017 U9 | Supported living services, adult, corporate AFC (15 minutes) | 564 - Adult supported living services | 1 |
T2019 | Supported employment (15 minutes) | 538 - Extended Supported Employment 638 - Extended employment | 1 |
T2020 | DT&H, non-pilot/Structured day program | 566 - Day Training and Habilitation (DAC) 618 - Health-related services | 1 |
T2021 | DT&H pilot, Rate D/Structured day program | 566 - Day Training and Habilitation (DAC) 618 - Health-related services | 1 |
T2028 U1 | CDCS - Personal assistance | 158 - Approved pilot projects 558 - Approved pilot projects 658 - Approved pilot projects | 1 |
T2028 U2 | CDCS - Treatment and training | 158 - Approved pilot projects 558 - Approved pilot projects 658 - Approved pilot projects | 1 |
T2028 U3 | CDCS - Environmental modifications and provisions | 158 - Approved pilot projects 558 - Approved pilot projects 658 - Approved pilot projects | 1 |
T2028 U4 | CDCS - Self direction support activities | 158 - Approved pilot projects 558 - Approved pilot projects 658 - Approved pilot projects | 1 |
T2028 U8 | CDCS - Flexible case management | 158 - Approved pilot projects 558 - Approved pilot projects 658 - Approved pilot projects | 1 |
T2031 | Customized living services (daily) | 627 - Assisted living/customized living/residential care | 1 |
T2033 | Residential care services (Day) | 627 - Assisted living/customized living/residential care | 1 |
T2040 | CDCS - Background check | 158 - Approved pilot projects 558 - Approved pilot projects 658 - Approved pilot projects | 1 |
HCPCS/ Modifiers | HCPCS/Modifier Description | BRASS Service | Tier Level |
Added Service Association End date 06/30/2014 to the following HCPCS/Modifiers. | |||
H0045 | Respite care services, not in home | 189- Respite care 489- Child Respite care 589- Respite care 689- Respite care | 1 |
S5150 UB | Respite care, out of home | 189 - Respite care 589 - Respite care 689 - Respite care | 1 |
S5151 | Respite care, in home (day) | 189 - Respite care 589 - Respite care 689 - Respite care | 1 |
Changed the HCPCS/Modifier Description for the following HCPCS (13.4 release) | Tier Level | ||
HCPCS | Old Description | New Description | |
S5110 | Family counseling/training | Family Training | 3 |
S5130 | Homemaker services (15 minutes) | Homemaker service – cleaning only (15 minutes) | 2 |
S5165 | Environmental accessibility adaptations | Environmental accessibility adaptations, Home Modifications/Install and Expenses | 2 |
HCPCS/ Modifiers | HCPCS/ Modifier Description | HCPCS unit type | Start Date/ End Date | Claim Category | Diagnosis Req | Include Time | Include Payments | BRASS Services | Activi-ties | Tier Level |
Added the following HCPCS/Modifiers | ||||||||||
S5150 | Respite care, in home (15 minutes) | 15 minutes | 01/01/2014 | Waiver and AC | Yes | Yes | No | 689 - Respite care | 107 – Service delivery, in home | 1 |
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