| Procedure Code and Description (Limited to Medicaid-Covered Service) |
State-Defined Modifier |
State-Defined Start-of-Shift Modifier |
| 92507—Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual [per visit]
[ForwardHealth guidance: Indicate for home health speech therapy.] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| 97139—Unlisted therapeutic procedure (specify) [per visit]
[ForwardHealth guidance: Indicate for home health occupational therapy.] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| 97799—Unlisted physical medicine/rehabilitation service or procedure [per visit]
[ForwardHealth guidance: Indicate for home health physical therapy.] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| 99504—Home visit for mechanical ventilation care [per hour]
[ForwardHealth guidance: Indicate for private duty nurse—ventilation care.] |
TE—LPN/LVN |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| 99504—Home visit for mechanical ventilation care [per hour]
[ForwardHealth guidance: Indicate for private duty nurse—ventilation care.] |
TD—RN |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG —Afternoon (12–5:59 p.m.)
UH — Evening (6–11:59 p.m.) |
| 99600—Unlisted home visit service or procedure [per visit]
[ForwardHealth guidance: Indicate for home health intermittent skilled nursing visit.] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| 99600—Unlisted home visit service or procedure [per visit]
[ForwardHealth guidance: Indicate for home health intermittent skilled nursing visit.] |
TS—Follow-up service |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| S9123—Nursing care, in the home; by registered nurse, per hour
[ForwardHealth guidance: Indicate for private duty registered nurse.] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| S9124—Nursing care, in the home; by licensed practical nurse, per hour
[ForwardHealth guidance: Indicate for private duty licensed practical nurse.] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| T1001—Nursing assessment/evaluation [per visit] |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| T1021—Home health aide or certified nurse assistant, per visit |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| T1021—Home health aide or certified nurse assistant, per visit |
TS—Follow-up service |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |
| T1502—Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit |
None |
UJ—Night (12–5:59 a.m.)
UF—Morning (6–11:59 a.m.)
UG—Afternoon (12–5:59 p.m.)
UH—Evening (6–11:59 p.m.) |