The new rates will now separate the pay for RNs and LPNs, adding new codes for RNs, and changing the rate of pay for Home Health workers. Below is a breakdown of the changes.
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 |
Service Code | Old Base | Old Unit | New Base | New Unit |
T1019 (Aide) | 18.61 | 3.00 | 18.10 | 2.86 |
T1002 (RN) | 41.76 | 5.69 | 38.60 | 6.96 |
T1003 (LPN) | 41.76 | 5.69 | 31.65 | 5.57 |
T1000 (PDN-RN) | 41.76 | 5.69 | 38.60 | 6.96 |
T1000 (PDN-LPN) | 41.76 | 5.69 | 31.65 | 5.57 |
S5125 (HCAS Nursing) | 25.89 | 4.17 | 25.95 | 4.43 |
S5125 (HCAS Aide) | 3.00 | 2.86 | ||
T1001 (RN Assessment) | 0.00 | 0.00 | 31.64 | |
T1001 – U9 (RN Consultation) | 0.00 | 0.00 | 6.96 |
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 |
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.
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) |
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 AssessmentAssessments 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:
To bill for RN Assessment use procedure code T1001
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.