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Personal Care Services in MH Residental Fac.


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This question is for anyone working in a state medicaid agency.

I was asked this by the MH program staff.

Do any states pay for personal care services provided in a community-based MH residential setting and if so what code they use?


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Arizona bills T1019 & T1020

This looks like an old post, but Arizona's Behavioral Health Covered Services Guide http://www.azdhs.gov/bhs/pdf/CovBHsvsGuide.pdf states that:

T1019 –Personal Care Services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant): Personal care services (see general definition above) provided to a person for a period of time (up to 11¾ hours).

T1020 for 12 or more hours

Billing Limitations:
Personal care services provided in an Office of Behavioral Health License (OBHL) licensed inpatient, residential or day program setting are included in the rate for those settings and cannot be billed separately, with certain exceptions. (See footnote 3) This service is also included in the Home Care Training to Home Care Client (HCTC) service rate and thus cannot be billed separately for persons receiving HCTC services.