Pay Rate Changes are here!

Agency Provider Rates

Service Code	Old Base	Old Unit	New Base	New Unit
T1019 (Aide)	23.26	3.00	22.45	3.73
T1002 (RN)	52.20	5.69	45.40	8.32
T1003 (LPN)	52.20	5.69	37.90	6.82
T1000 (PDN-RN)	52.20	5.69	45.40	8.32
T1000 (PDN-LPN)	52.20	5.69	37.90	6.82
G0154 (RN)	52.20	5.69	45.40	8.32
G0154 (LPN)	52.20	5.69	37.90	6.82
G0156 (Aide)	23.26	3.00	22.45	3.73
T1001 (RN Assessment)	0.00	0.00		37.08
T1001 – U9 (RN Consultation)	0.00	0.00		8.32

New Modifiers

Along with changes to rates of pay there are now three new modifiers to use when billing for Nursing services:

Modifier	Description	Use With Procedure Codes
TD	RN Visit	G0154, T1000
TE	LPN Visit	G0154, T1000
U9	RN Consultation	T1001

Changes in Rate Calculation

The current method for calculating the Base Rate of pay is simple. The first four (4) units, or 60 minutes, of a visit are all paid the same amount. So if you bill 1 unit or 4 units you would still get paid the same. This was done to build into your pay rate a cushion for your travel expenses incurred while getting to a patient’s home.

The new method for calculating the Base Rate is more complicated. Don’t worry, we’ll take the trouble out of billing it but you will see a change in your pay if you perform short visits.

• If your visit is 15 minutes or less you will be paid the Unit Rate for one unit.
• If your visit is 34 minutes or less you will be paid the Unit Rate for two units.
• If your visit is between 35-60 minutes you will be paid the Base Rate.

And as always, if your visit is 61+ minutes you will be paid the Base Rate plus the Unit Rate for each additional Unit.

Here’s a few examples of how this new calculation would work if you were an RN during the first hour:

Visit Length	Units	Total Pay
1-15 min	1	$6.96
1-15 min	2	$13.92
35-45 min	3	$38.60
46-60 min	4	$38.60
61-74 min	5	$45.56	(Base Rate + 1 Unit)

To see how these changes will affect you use our handy dandy converter:

Independent Provider   Home Health Agency

Procedure Code:

Select ProcedureCode T1019 (Aide) T1002 (RN) T1003 (LPN) G0156 (Aide) G0154-TD (Nursing Visit RN) G0154-TE (Nursing Visit LPN) T1000-TD (PDN RN) T1000-TE (PDN LPN) T1001 (RN Assessment) T1001 – U9 (RN Consultation)

Procedure Code:

Select ProcedureCode T1019 (Aide) T1002 (RN) T1003 (LPN) S5125 (HCAS Nursing) S5125 (HCAS Aide) T1000-TD (PDN RN) T1000-TE (PDN LPN) T1001 (RN Assessment) T1001 – U9 (RN Consultation)

Average Units per visit (1 Unit = 15 min):

Modifiers

HQ

U8

Show me my new paycheck

Your Old Paycheck Total: $

Your New Paycheck Total: $

New Codes for RNs

Along with all the changes in pay rates two new procedure codes are being implemented for RNs. These will also go into effect on 7/1/2015 and will be available to both agencies and independent providers.

RN Assessment

Assessments will be conducted prior to the initiation of service and before any changes are made to an individual’s existing service package. An assessment will also be administered should an individual’s condition change significantly.

These services will be subject to RN assessments:

• Home Health Services
• Private Duty Nursing (PDN)
• Waiver Nursing
• Personal Care Services (Provided by an agency)
• HOME Choice Nursing Services

To bill for RN Assessment use procedure code T1001

RN Consultation

Consultations may be conducted face-to-face or by phone. A consultation will be required in the event that individual’s condition changes significantly and required the modification of the care plan.

Previously, LPNs were required to make their own payment arrangements for a consulting RN. This will become a Medicaid reimbursable service and the financial responsibilities will no longer be on the LPN.

To bill for RN Consultation use procedure code T1001 with the U9 modifier.