Electronic Visit Verification (EVV) Applicable Billing Codes

  • Billing Codes is also available in Portable Document Format (PDF)

The purpose of this document is to inform Medicaid providers of the Personal Care Services (PCS) and Home Health Care Services (HHCS), and associated billing codes that are subject to Federal and State Electronic Visit Verification (EVV) requirements.

Below are the PCS and HHCS billing codes for Fee for Service (FFS) and Managed Care (MC) Medicaid. The Department is requiring that providers implement and put into use an EVV system to capture the required data points (type of service performed, individual receiving service, date of service, location of service delivery, individual providing service, and time the service begins and ends) for services billed under the codes below and send them to the State’s data aggregator.

NOTE: For HCBS Children´s Waiver Respite EVV Claims, providers must apply Modifier 96 where applicable.

If you have questions, please contact the Department by email at EVVHelp@health.ny.gov.

PROGRAM SERVICE DESCRIPTION RATE CODE
CDPA CDPAP 1 CLIENT, QUARTER HOUR 2422
CDPA CDPAP 2 CLIENTS, PER CLIENT, QUARTER HOUR 2423
CDPA CDPAP 1 CLIENT, ENHANCED RATE, QUARTER HOUR 2424
CDPA CDPAP 2 CLIENTS, PER CLIENT, ENHANCED RATE, QTR HR 2425
CDPA CDPAP 1 CLIENT HOURLY 2401
CDPA CDPAP 2 OR MORE CLIENTS, HOURLY PER CLIENT 2402
CDPA CDPAP 1 CLIENT HOURLY, ENHANCED 2403
CDPA CDPAP 2 OR MORE CLIENTS, HOURLY PER CLIENT ENHANCED 2404
CDPA CONSUMER DIRECT PERSONAL ASSIST 1 CLNT LIVE-IN 2405
CDPA CONS DIR PERS ASSIST 2 OR > CLNTS PER CLNT LIVE-IN 2406
CDPA PCA LEVEL 2, ONE CLIENT, DAILY 2632
CDPA PCA LEVEL 2, 2 CLIENTS, DAILY (PER CLIENT) 2633
HCBS CHILDRENS COMMUNITY HCBS HABILITATION INDIVIDUAL 8012
HCBS CHILDRENS COMMUNITY HCBS HABILITATION GROUP OF 2 8013
HCBS CHILDRENS COMMUNITY HCBS HABILITATION GROUP 3+ 8014
HCBS CHILDRENS PLANNED RESPITE INDIVIDUAL UP TO 6 HOURS 8023
HCBS CHILDRENS PLANNED RESPITE INDIVIDUAL PER DIEM OVER 6 HOURS 8024
HCBS CHILDRENS PLANNED RESPITE INDIVIDUAL 12-24 HOURS 8025
HCBS CHILDRENS PLANNED RESPITE GROUP 6-12 HOURS 8026
HCBS CHILDRENS PLANNED RESPITE GROUP UP TO 6 HOURS 8027
HCBS CHILDRENS CRISIS RESPITE UP TO 6 HOURS 8028
HCBS CHILDRENS CRISIS RESPITE MORE THAN 6 HOURS, LESS THAN 12 HOURS 8029
HCBS CHILDRENS CRISIS RESPITE INDIVIDUAL 12+HOURS, LESS THAN 24 HOURS 8030
NOTE: For HCBS CHILDRENS Respite EVV Claims, providers must apply Modifier 96 where applicable
HCBS NHTD RESPITE, IN HOME (1-DAY MAX) 9768
HCBS NHTD HCSS LEVEL I 9795
HCBS OPWDD COM HAB; CERT FAC RESID; AGY SUP; VOL; IND 4757
HCBS OPWDD COM HAB; CERT FAC RESID; AGY SUP; VOL; GRP 4758
HCBS OPWDD COM HAB; CERT FAC RESID; VIA FI; VOL; IND 4767
HCBS OPWDD COM HAB; CERT FAC RESID; VIA FI; VOL; GRP 4768
HCBS OPWDD COM HAB; CERT FAC RESID; VOL; IND 4796
HCBS OPWDD COM HAB; CERT FAC RESID; VOL; GRP 4797
HCBS OPWDD COM HAB; CERT FAC RESID; STATE; IND 4798
HCBS OPWDD COM HAB; CERT FAC RESID; STATE; GRP 4799
HCBS OPWDD RESPITE; INTENSIVE; VOL 7425
HCBS OPWDD RESPITE; AGY SUP INTENSIVE; VOL 7427
HCBS OPWDD COM HAB; VOL; INDIV;1/4 HR 4722
HCBS OPWDD COM HAB; VOL; GROUP-2 INDIVIDUALS 4723
HCBS OPWDD COM HAB; VOL; GROUP-3 INDIVIDUALS 4724
HCBS OPWDD COM HAB; VOL; GROUP-4+ INDIVIDUALS 4725
HCBS OPWDD COM HAB; STATE; GROUP-1 INDIVIDUAL 4741
HCBS OPWDD COM HAB; STATE; GROUP-2 INDIVIDUALS 4742
HCBS OPWDD COM HAB; STATE; GROUP-3 INDIVIDUALS 4743
HCBS OPWDD COM HAB; AGY SUP; VOL; IND 4755
HCBS OPWDD COM HAB; AGY SUP; VOL; GRP 4756
HCBS OPWDD COM HAB; VIA FI; VOL; IND 4765
HCBS OPWDD COM HAB; VIA FI; VOL; GRP 4766
HCBS OPWDD RESPITE; VIA FI FEE; VOL 4764
HCBS OPWDD RESPITE; IN HOME; VOL 7421
HCBS OPWDD RESPITE; AGY SUP; IN HOME; VOL 7426
HCBS OPWDD RESPITE; IN HOME; VOL; PER DIEM 7428
HCBS OPWDD RESPITE; IN HOME; STATE 7430
HCBS TBI HOME AND COMMUNITY SUPPORT, HOURLY 9879
HCBS TBI HOME AND COMMUNITY SUPPORT, HOURLY 9880
HCBS TBI HOME AND COMMUNITY SUPPORT, HOURLY 9881
HCBS TBI HOME AND COMMUNITY SUPPORT, HOURLY 9882
HCBS TBI RESPITE, IN HOME (24 HOURS) 9875
PCAI PCAI, SHARED AIDE, BASIC, HOURLY 2501
PCAI PCAI, SHARED AIDE, BASIC, QUARTER HOUR 2507
PCAI PCA LEVEL I, 1 CLIENT, QUARTER HOUR 2593
PCAI PCA LEVEL I, 2 CLIENTS, PER CLIENT 1/4 HOUR 2594
PCAI PCA LEVEL I, ONE CLIENT HOURLY 2601
PCAI PCA LEVEL I, 2 CLIENTS, HOURLY (PER CLIENT) 2602
PCAII PCAII, SHARED AIDE, BASIC, HOURLY 2502
PCAII PCAII, SHARED AIDE, BASIC, QUARTER HOUR 2508
PCAII PCA LEVEL II, 1 CLIENT, 1/4 HOUR 2595
PCAII PCA LEVEL II, 2 CLIENTS PER CLIENT 1/4 HOUR 2596
PCAII PCA LEVEL II, 1 CLIENT HARD TO SERVE 1/4 HOUR 2597
PCAII PCA LVL 2, 2 CLNTS/CLNT HARD TO SERVE 1/4 HOUR 2598
PCAII PCA LEVEL 2, ONE CLIENT, HOURLY 2622
PCAII PCA LEVEL 2, TWO CLIENTS, HOURLY (PER CLIENT) 2623
PCAII PCA LEVEL 2, ONE CLIENT, HOURLY-SECONDARY CODE 2626
PCAII PCA LEVEL 2, CLIENTS HOURLY, PER CLNT-SECONDARY CD 2627
PCAII PCA II – NURSING SUPERVISION 2742
PCAII NURSING ASSESSMENT 2787
PROGRAM SERVICE DESCRIPTION PROCEDURE CODE MODIFIER CODE
PCAI PCS LEVEL I MULTIPLE CLIENT S5130 U3
PCAI PCS LEVEL I – 15 MINUTES S5130 U1
PCAI PCS LEVEL I TWO CLIENT S5130 U2
PCAI PCS LEVEL I WEEKEND/HOLIDAY S5130 TV
PCAII PCS LEVEL II WEEKEND/HOLIDAY T1019 TV
PCAII PCS LEVEL II MULTIPLE CLIENT T1019 U3
PCAII PCS LEVEL II BASIC – 15 MINUTES T1019 U1
PCAII PCS LEVEL II BASIC TWO CLIENT T1019 U2
PCAII PCS LEVEL II HARD TO SERVE T1019 U4
PCAII PCS LEVEL II TWO CLIENT HARD TO SERVE T1019 U5
PCAII PCS LEVEL II LIVE-IN T1020 NONE
PCAII PCS LEVEL II LIVE-IN TWO CLIENT T1020 U2
PCAII PCS LEVEL II LIVE-IN WEEKEND/HOLIDAY T1020 TV
PCAII PCS LEVEL II LIVE IN TWO CLIENT HARD TO SERVE T1020 U5
CDPA CDPA BASIC – 15 MINUTES T1019 U6
CDPA CDPA ENHANCED T1019 U8
CDPA CDPA TWO CONSUMER T1019 U7
CDPA CDPA TWO CONSUMER ENHANCED T1019 U9
CDPA CDPA LIVE IN T1020 U6
CDPA CDPA LIVE IN ENHANCED T1020 U8
CDPA CDPA LIVE IN TWO CONSUMER T1020 U7
CDPA CDPA LIVE IN TWO CONSUMER ENHANCED T1020 U9
HCBS CHILDRENS COMMUNITY HCBS HABILITATION INDIVIDUAL H2014 HA
HCBS CHILDRENS COMMUNITY HCBS HABILITATION GROUP OF 2 H2014 HA, UN
HCBS CHILDRENS COMMUNITY HCBS HABILITATION GROUP 3+ H2014 HA, UP
HCBS CHILDRENS PLANNED RESPITE INDIVIDUAL UP TO 6 HOURS S5150 HA
HCBS CHILDRENS PLANNED RESPITE INDIVIDUAL PER DIEM OVER 6 HOURS S5151 HA
HCBS CHILDRENS PLANNED RESPITE GROUP UP TO 6 HOURS S5150 HA, HQ
HCBS CHILDRENS CRISIS RESPITE UP TO 6 HOURS S5150 HA, ET
HCBS CHILDRENS CRISIS RESPITE MORE THAN 6 HOURS, LESS THAN 12 HOURS S5151 HA, ET
HCBS CHILDRENS CRISIS RESPITE INDIVIDUAL 12+HOURS, LESS THAN 24 HOURS S5151 HA, ET, HK
PROGRAM SERVICE DESCRIPTION RATE CODE
CHHA EPS EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1 4810
CHHA EPS EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2 4811
CHHA EPS EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3 4812
CHHA EPS EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4 4813
CHHA EPS EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5 4814
CHHA EPS EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6 4815
CHHA EPS EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1 4816
CHHA EPS EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2 4817
CHHA EPS EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3 4818
CHHA EPS EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4 4819
CHHA EPS EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5 4820
CHHA EPS EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6 4821
CHHA EPS EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1 4822
CHHA EPS EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2 4823
CHHA EPS EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3 4824
CHHA EPS EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4 4825
CHHA EPS EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5 4826
CHHA EPS EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6 4827
CHHA EPS EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1 4828
CHHA EPS EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2 4829
CHHA EPS EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3 4830
CHHA EPS EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4 4831
CHHA EPS EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5 4832
CHHA EPS EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6 4833
CHHA EPS EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1 4834
CHHA EPS EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2 4835
CHHA EPS EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3 4836
CHHA EPS EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4 4837
CHHA EPS EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5 4838
CHHA EPS EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6 4839
CHHA EPS EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1 4840
CHHA EPS EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2 4841
CHHA EPS EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3 4842
CHHA EPS EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4 4843
CHHA EPS EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5 4844
CHHA EPS EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6 4845
CHHA EPS EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1 4846
CHHA EPS EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2 4847
CHHA EPS EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3 4848
CHHA EPS EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4 4849
CHHA EPS EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5 4850
CHHA EPS EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6 4851
CHHA EPS EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1 4852
CHHA EPS EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2 4853
CHHA EPS EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3 4854
CHHA EPS EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4 4855
CHHA EPS EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5 4856
CHHA EPS EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6 4857
CHHA EPS EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1 4858
CHHA EPS EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2 4859
CHHA EPS EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3 4860
CHHA EPS EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4 4861
CHHA EPS EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5 4862
CHHA EPS EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6 4863
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1 4864
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2 4865
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3 4866
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4 4867
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5 4868
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6 4869
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1 4870
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2 4871
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3 4872
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4 4873
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5 4874
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6 4875
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1 4876
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2 4877
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3 4878
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4 4879
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5 4880
CHHA EPS EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6 4881
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1 4882
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2 4883
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3 4884
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4 4885
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5 4886
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6 4887
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1 4888
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2 4889
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3 4890
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4 4891
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5 4892
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6 4893
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1 4894
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2 4895
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3 4896
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4 4897
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5 4898
CHHA EPS EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6 4899
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1 4900
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2 4901
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3 4902
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4 4903
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5 4904
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6 4905
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1 4906
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2 4907
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3 4908
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4 4909
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5 4910
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6 4911
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1 4912
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2 4913
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3 4914
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4 4915
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5 4916
CHHA EPS EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6 4917
CHHA PEDS HOME HEALTH AIDE 2610
CHHA PEDS NURSING 2620
CHHA PEDS OCCUPATIONAL THERAPY 2640
CHHA PEDS PHYSICAL THERAPY 2650
CHHA PEDS SPEECH PATHOLOGY 2662
CHHA PEDS HOME HEALTH AIDE (PER VISIT OR PER HOUR) 2841
CHHA PEDS NURSING 2842
CHHA PEDS OCCUPATIONAL THERAPY 2844
CHHA PEDS PHYSICAL THERAPY 2845
CHHA PEDS SPEECH PATHOLOGY 2847
CHHA PEDS HOME HEALTH AIDE (PER HOUR) 2878
CHHA PEDS MOMS HEALTH SUPPORT SERVICES UNDER 18 1606
CHHA PEDS AIDS NURSING UNDER 18 1607
Program Service Description Rate Code Modifier
HHA HHA - 15 MINUTES S5125 None
HHA HHA – PER HOUR S9122 None
HHA HHA TWO CLIENT – PER 15 MINUTES S5125 U2
HHA HHA LIVE-IN - PER DIEM (13 HOURS) S5126 None
HHA HHA LIVE-IN TWO CLIENT - PER DIEM (13 HOURS) S5126 U2
HHA ADVANCED HOME HEALTH AIDE PER HOUR S9122 U1
NURSING NURSING CARE IN HOME (RN) PER DIEM (13 HOURS) T1030 None
NURSING RN – PER HOUR S9123 None
NURSING RN – 15 MINUTES T1002 None
NURSING NURSING CARE IN HOME (LPN) – PER DIEM (13 HOURS) T1031 None
NURSING LPN – PER HOUR S9124 None
NURSING LPN – 15 MINUTES T1003 None
HHCS OCCUPATIONAL THERAPY – PER VISIT S9129 None
HHCS PHYSICAL THERAPY – PER VISIT S9131 None
HHCS SPEECH THERAPY – PER VISIT S9128 None
HHCS RESPITORY THERAPY– PER 15 MINUTES G0237 None
HHCS RESPITORY THERAPY – PER 5 MINUTES G0238 None
HHCS NUTRITIONAL COUNSELING – PER VISIT S9470 None
HHCS MEDICAL SOCIAL SERVICES – PER VISIT S9127 None
HHCS SIGN LANGUAGE/ORAL INTERPRETER – PER 15 MINUTES T1013 None