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 associated billing codes that are subject to Federal and State Electronic Visit Verification (EVV) requirements.

Below are the PCS 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.

Fee-For-Service (FFS) EVV Applicable Rate Codes
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
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
CDPA PCA LEVEL 2, ONE CLIENT, DAILY 2632
CDPA PCA LEVEL 2, 2 CLIENTS DAILY (PER CLIENT) 2633
PCAII PCA II – NURSING SUPERVISION 2742
PCAII NURSING ASSESSMENT 2787

Managed Care EVV Applicable Procedure Codes
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 GROUP OVER 6 HOURS UP TO 12 S5150 HA, HK, HQ
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