HCPCS Code T1019: Personal Care Services, Not for an Inpatient or Resident of a Hospital, Nursing Facility, ICF/MR or IMD, Part of the Individualized Plan of Treatment, for 15 Minutes

Learn the essential aspects of the T1019 personal care services code and how it impacts your care. Read the article for a comprehensive understanding.

Use Code

## **What is HCPCS code T1019?** HCPCS Code T1019 is defined as "Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded (ICF/MR) or institution for mental disease (IMD), as part of the individualized plan of treatment." It is important to note that T1019 cannot be used for services provided by a home health aide or certified nurse assistant. This code falls under the category of Home Health Services in the HCPCS Level II billing codes, which are maintained by CMS and used by Medicare and other insurance providers to process healthcare claims. The time unit for this code is every 15 minutes of service provided, reflecting billing for non skilled services and personal care delivered in short intervals as per an individualized plan of treatment. It may also be part of an individualized plan that requires prior authorization or oversight by a registered nurse or licensed practical nurse depending on payer policies.

## **HCPCS code T1019 documentation requirements** HCPCS code T1019 requires documentation that verifies the medical necessity, type, and extent of care provided. Required documentation should include: - Patient’s name, Medicaid ID, and demographic details - Service dates and actual time units delivered (per 15-minute increments) - Identify services provided (e.g., bathing, grooming, meal prep, mobility assistance) - Care plan or physician’s order authorizing services - Caregiver or provider name, signature, and credentials - Progress notes or visit logs showing services rendered and patient response - Evidence that services were provided in the patient’s home or approved setting - Documentation supporting medical necessity in relation to the patient’s condition

## **T1019 billing guidelines** HCPCS code T1019 billing requirements include the following key elements: - The service must be personal care services delivered outside inpatient or institutional settings such as hospitals or nursing facility ICF MR or IMD. - Billing is based on 15-minute increments of personal care service provided, in accordance with the individualized plan of treatment. - Providers must submit claims using the appropriate HCPCS code T1019 with necessary modifiers if applicable. - Claims must be supported by adequate documentation that substantiates the level and duration of non skilled services rendered. - Providers must comply with any state-specific billing instructions, including encounter reporting mechanisms and adherence to approved billing codes and modifiers. - Consent and prior authorization requirements may be necessary depending on payer policies. These requirements ensure accurate reimbursement and compliance with CMS and Medicaid billing rules.

## **Other related codes** HCPCS code T1019 belongs to a group of related codes that cover personal care services and services provided by home health. Related codes include: - **T1020**: Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) - **T1021**: Home health aide or certified nurse assistant, per visit - **T1022**: Contracted home health agency services, all services provided under contract, per day