New Rates for Personal Assistance and Day Activity Adult Day Care

New Rates for Personal Assistance and Day Activity Adult Day Care

New Rates for Personal Assistance and Day Activity Adult Day Care Services – Effective
Sept. 1, 2014
Effective Sept. 1, 2014, The Texas Health and Human Services Commission increased and added rates for
Personal Assistance and Day Activity Adult Day Care Services.
All claims for services delivered on or after Sept. 1, 2014, will be processed using the new payment rate shown
in the following chart. If you have already billed for claims after this date, please re-bill with new rates. All other
requirements and guidelines remain the same.
If you have any questions, please call Customer Service at 888-887-9003.
Long Term Service and Support Service Care Rates – Effective Sept. 1, 2014
HCPC Codes
S5125
Mod
1
Mod
2
U7
U5
S5125
U3
U3
S5125
U3
U5
S5125
S5125
S5125
S5125
S5125
S5125
S5101
99
U3
U3
99
U3
U3
99
99
U5
99
99
U5
Mod
3
Mod
4
Units
Service Description
1 hour
= 1 unit
1 hour
= 1 unit
1 hour
= 1 unit
99
99
99
99
99
99
UC
UC
UC
US
US
US
What Changed?
Personal Assistance Services
(PAS) Agency Model
Non-STAR+PLUS Waiver
(SPW)
PAS Agency Model (SPW)
PAS Protective Supervision
Agency Model (SPW)
1 hour
= 1 unit
PAS Consumer Directed
Services (CDS) (Non-SPW)
1 hour
= 1 unit
PAS (CDS) (SPW)
1 hour
= 1 unit
PAS Protective Supervision
(CDS) (SPW)
1 hour
= 1 unit
PAS Service Responsibility
Option (SRO) (Non-SPW)
1 hour
= 1 unit
PAS (SRO) (SPW)
1 hour
= 1 unit
PAS Protective Supervision
(SRO) (SPW)
3-6
Hours =
1 unit,
over 6
Hours =
2 units
Day Activities and Health
Services (3-6 hours)
Added codes and
modifiers for PAS
Protective
Supervision
Added codes and
modifiers for PAS
Protective
Supervision
Added codes and
modifiers for PAS
Protective
Supervision
Old Rate
New Rate
$11.08
$11.28
$11.30
$11.33
New
$11.33
$11.08
$10.48
$10.96
$10.99
New
$10.99
$11.08
$11.28
$11.30
$11.33
New
$11.33
$14.09
$14.24
To review other provider alerts, go to www.UHCCommunityPlan.com. Select For Healthcare Professionals
then Texas. From the left menu select Bulletins and then Provider Alerts. For complaints and appeals, write:
Complaints and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364
PCA14428_20141013