Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.mass.gov/dma

MASSHEALTH
TRANSMITTAL LETTER HHA-35
December 2003
TO:      Home Health Agencies Participating in MassHealth
FROM:      Beth Waldman, Acting Commissioner!
RE:      Home Health Agency Manual (Revisions to Service Codes and Descriptions)
This letter transmits revisions to service codes and descriptions in Subchapter 6 of the Home Health Agency Manual. The Centers for Medicare and Medicaid Services (CMS) has revised the Healthcare Common Procedure Coding System (HCPCS). New national service codes have been added and MassHealth local service codes have been deleted from Subchapter 6. The attached Subchapter 6 contains the new national codes. These revisions are effective for dates of service on or after January 1, 2004.
Billing Guidelines
Each Visit Reported on a Separate Claim Line
“From-through” billing is no longer allowed for home health agency visits. Instead, please follow these instructions.
■	Each individual claim line must contain only one visit for only one date of service.
■	Multiple visits provided on the same date of service must be billed on separate claim lines.
■	Visits provided on multiple dates of service must be reported on a single claim line for each date of service.
15-Minute Increment Reporting
Home health agencies must report in 15-minute units the actual time spent during each home health visit. Time should be rounded up to the nearest 15-minute unit.
Visits will be reimbursed according to the applicable fee schedule of the Division of Health Care Finance and Policy (DHCFP).

MASSHEALTH
TRANSMITTAL LETTER HHA-35 December 2003 Page 2
Electronic Billing
Home health agencies must use both revenue codes and service codes when billing 837 Institutional (837I) electronic transactions. Do not use revenue codes on paper claim no. 09 forms. The following table demonstrates the revenue codes that providers must use with service codes when billing 837 Institutional (837I) electronic transactions.

Revenue Code	Service Code	Service Description	
0551	G0154	Services of a skilled nurse in a home health setting	
0551	99058	Office services provided on an emergency basis	
0570	G0156	Services of a home health aide in a home health setting	
0421	G0151	Services of a physical therapist in a home health setting	
0431	G0152	Services of an occupational therapist in a home health setting	
0441	G0153	Services of a speech therapist in a home health setting	
Personal Care Attendant Emergency Codes
Certain MassHealth members who do not qualify for home health services are eligible for the personal care attendant (PCA) emergency plan. Please see Home Health Agency Bulletin 34 for information on eligibility criteria for this emergency plan.
Effective January 1, 2004, the MassHealth local service code for emergency PCA services provided by a home health aide (X0022) has been replaced with 99509. The MassHealth local service code for nursing oversight of these emergency services (X0021) has been replaced with G0154.
Unused-Hours Reporting for Private Duty Nursing Services
Effective November 1, 2003, the Division no longer requires home health agencies to report unused hours for private duty nursing services. However, providers should continue to submit reports of unused private duty nursing hours for all the months through October 31, 2003.

MASSHEALTH
TRANSMITTAL LETTER HHA-35 December 2003 Page 3
If you have any questions about this transmittal letter, please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Home Health Agency Manual
Pages 6-1 and 6-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Home Health Agency Manual
Pages 6-1 and 6-2 — transmitted by Transmittal Letter HHA-34

Home Health Agency Provider
Service Code Crosswalk
Effective for dates of service beginning January 1, 2004

Transmittal Letter HHA-35 Attachment

Service Type	Obsolete Code	Description	Billing Instructions	Billing Guidelines	

	
	Paper Claim 09/EMC	837-Institutional (837I) Claim Transaction	Please Note: All home health visits must	

	
		
	be reported on separate claim lines in order	

	
	New Service Code-Modifier	Description                                     Revenue Code (four digits)
Loop 2400; Field SV201	New Service Code-Modifier	to receive correct reimbursement. This applies to all skilled nursing, physical therapy, occupational therapy, and speech therapy visits.	
Home Health Agency Visits		
		
	X0031	Nursing care visit	G0154	Services of skilled nurse in home health setting, each 15 minutes	0551   Skilled nursing, visit charge	G0154	Actual time spent for each visit must be reported in 15-minute increments using G0154. Reimbursement remains at a per-visit rate.	

	X0032	Nursing visit, office	99058	Office services provided on an emergency basis	0551   Skilled nursing, visit charge	99058		

	X0037	Home health aide services (per six-minute unit)	G0156        Services of home health aide in home health setting, each 15 minutes	0570   Home health aide, general	G0156	Home health aide services are reimbursed in 15-minute increments.	

	X0038	Physical therapy visit	G0151	Services of physical therapist in home health setting, each 15 minutes	0421   Physical therapy, visit charge	G0151	Actual time spent for each visit must be reported in 15-minute increments using G0151. Reimbursement remains at a per-visit rate.	

	X0039	Speech/language therapy visit	G0153	Services of speech and language    0441   Speech language pathologist in home health setting,               pathology, visit charge each 15 minutes	G0153         Actual time spent for each visit must be reported in 15-minute increments using G0153. Reimbursement remains at a per-visit rate.	

	X0040	Occupational therapy visit	G0152	Services of occupational therapist    0431   Occupational therapy, in home health setting, each 15                   visit charge minutes	G0152         Actual time spent for each visit must be reported in 15-minute increments using G0152. Reimbursement remains at a per-visit rate.	
Temporary Emergency Personal Care Attendant (PCA) Services Provided by Home Health Agency		
		
	X0021	Nursing care visit for PCA services	G0154	Services of skilled nurse in home health setting, each 15 minutes	0551   Skilled nursing, visit charge	G0154	Reimbursement at the per-visit rate for nursing supervision of home health aide providing emergency PCA services.
Actual time spent during the visit must be reported in 15-minute increments using G0154.	
	X0022    Home health aide services for            99509         Home visit for assistance with          0579   Other home health aide          99509 PCA services                                                           activities of daily living and
personal care	Do not use a modifier for PCA services provided by a home health aide.	

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
HOME HEALTH AGENCY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
HHA-35	DATE
01/01/04	
601	Explanation of Abbreviation
The abbreviation "P.A." indicates that Division authorization is required (see program regulations in Subchapter 4 of the Home Health Agency Manual).
602	Definitions
With nursing service codes T1002 and T1003, nursing services provided on a “weekend” or “holiday” will be automatically reimbursed in accordance with the applicable fee schedule of the Division of Health Care Finance and Policy (DHCFP). Providers must use a service code that accurately reflects the nursing service provided.
(A)	Day – the hours from 7:00 A.M. to 2:59 P.M., Sunday through Saturday.
(B)	Night – the hours from 3:00 P.M. to 6:59 A.M., Sunday through Saturday.
(C)	Nursing modifiers:

(1)	UJ—night
(2)	TT—one nurse to two members (day)
(3)	U1—one nurse to two members (night)
(4)	U2—one nurse to three members (day)
(5)	U3—one nurse to three members (night)
603	Service Codes and Descriptions: Home Health Aide, Personal Care Worker, Therapy, and Nursing
Services

Service Code-Modifier

Service Description

G0154 99058 G0156 T1019

Nursing (for a Visit of Two Hour or Less), Home Health Aide, and Personal Care
Services of skilled nurse in home health setting, each 15 minutes Office services provided on an emergency basis Services of home health aide in home health setting, each 15 minutes Personal care services, per 15 minutes

G0151 G0152 G0153

Therapy
Services of physical therapist in home health setting, each 15 minutes Services of occupational therapist in home health setting, each 15 minutes Services of speech and language pathologist in home health setting, each 15 minutes

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
HOME HEALTH AGENCY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-2	

	TRANSMITTAL LETTER
HHA-35	DATE
01/01/04	
603   Service Codes and Descriptions: Home Health Aide, Personal Care Worker, Therapy, and Nursin Services (cont.)

Service
Code-Modifier     Service Description
Nursing Services (More Than a Two-Hour Visit)
Individual Patient Nursing
The following service codes must be used for nursing care provided by one nurse to one member.
T1002 T1003 T1002-UJ T1003-UJ
RN services, up to 15 minutes (day) (P.A.) LPN/LVN services, up to 15 minutes (day) (P.A.) RN services, up to 15 minutes (night) (P.A.) LPN/LVN services, up to 15 minutes (night) (P.A.)
Multiple-Patient Nursing
The following service codes are to be used for nursing care provided by one nurse simultaneously to two members.
T1002-TT T1003-TT T1002-U1 T1003-U1
RN services, up to 15 minutes (day) (each member) (P.A.) LPN/LVN services, up to 15 minutes (day) (each member) (P.A.) RN services, up to 15 minutes (night) (each member) (P.A.) LPN/LVN services, up to 15 minutes (night) (each member) (P.A.)
The following service codes are to be used for nursing care provided by one nurse simultaneously to three members.
T1002-U2 T1003-U2 T1002-U3 T1003-U3
RN services, up to 15 minutes (day) (each member) (P.A.) LPN/LVN services, up to 15 minutes (day) (each member) (P.A.) RN services, up to 15 minutes (night) (each member) (P.A.) LPN/LVN services, up to 15 minutes (night) (each member) (P.A.)