HCPCS Code T1017: Targeted Case Management, Each 15 Minutes

## **T1017 documentation requirements** The documentation requirements for HCPCS code T1017 (TCM) include detailed progress notes and supporting records that demonstrate the delivery of case management services. Specifically, the documentation must include: - Date of service, start and stop times (duration of the session), and place of service. - Mode of treatment (face-to-face or telehealth). - Signature, date, and credentials of the provider. - Separate progress notes for each encounter that describe key activities such as assessment of the consumer's needs, development and revision of an individualized service plan, referral and related activities, and monitoring and follow-up. - The progress notes must clearly indicate which case management activities were performed during the session, such as assessment, planning, referral/linkage, or monitoring. - The documentation should also include significant observations about the consumer’s situation or condition, coordinated efforts to secure services, and the consumer’s engagement and progress. - Collateral contacts (indirect activities) generally are not billable and thus not included in billed service time. - Case management excludes time spent transporting the consumer or waiting during appointments. - Service plans should be individualized, specifying goals and actions, and updated periodically, at least annually, based on reassessments. These requirements ensure that each billed unit (usually in 15-minute increments) of T1017 is supported by clear, contemporaneous documentation showing the time spent and the services provided in managing and coordinating care for the consumer.

## **T1017 billing requirements** The billing requirements for HCPCS code T1017 generally include the following key points: - **Billing in 15-minute increments**: Each unit of T1017 represents 15 minutes of case management services provided, so providers must total the actual time spent coordinating and managing care in these increments. One hour equals 4 units. - **Use of appropriate modifiers**: Different modifiers indicate specific target populations or service programs. The correct modifier must be placed on the claim to identify the service population. - **Restrictions on diagnosis codes**: Reimbursement of T1017 is limited to certain diagnosis codes relevant to targeted case management services, so claims must align with approved diagnoses. - **No billing for non-TCM activities**: Providers cannot bill for time spent on transportation, waiting, or collateral contacts; only direct case management activities count. - **Claims must reflect actual services rendered**: Span-dated claims must cover consecutive service days with uniform units per day; claims with gaps or variable units per day should be billed separately by date. - **Timely filing and eligibility**: Providers must bill within required timeframes, ensuring service authorization, eligibility, and adherence to benefit limits. Prior authorization may be required if service limits are exceeded. - **Distinct billing from other services**: T1017 cannot be billed in combination with certain other codes for the same recipient on the same date of service. - **Documentation to support claims**: Detailed progress notes and service records must substantiate billed time and activities (though this is more relevant to documentation than billing per se).

## **Other relevant codes** Other relevant codes include the following: T1016: Case management, each 15 minutes. A similar code for general case management services. - **H2015**: Comprehensive community support services, per 15 minutes. - **H2010**: Comprehensive medication services, per 15 minutes. - **T2023**: Targeted case management per month. - **H2011**: Crisis intervention service, per 15 minutes. - **H201**9: Therapeutic behavioral services, per 15 minutes. - **S5125**: Attendant care services, per 15 minutes. - **H0039**: Assertive community treatment, face-to-face, per 15 minutes. - **T1002**: Registered nurse services, up to 15 minutes.