## **What is HCPCS code T1023?**
HCPCS code T1023 is a screening code used to determine if an individual is an appropriate candidate for a specific program, project, or treatment protocol. This code is generally designated for use by State Medicaid agencies and is not typically used by Medicare. It is a per-encounter code, meaning it's billed once for each screening encounter.
## **HCPCS code T1023 documentation requirements**
Accurate documentation is critical for billing T1023. The medical record must clearly justify the medical necessity of the screening. Key documentation requirements often include:
- **Provider information**: Name, NPI, and contact information.
- **Patient demographics**: Beneficiary's name and ID number.
- **Reason for screening**: A clear explanation of why the screening is necessary, including the patient's symptoms, conditions, and the specific program or treatment being considered.
- **Evaluation details**: A description of the assessment performed, which may involve a thorough interview, review of medical history, and preliminary diagnostic assessments.
- **Results and recommendations**: Documentation of the findings from the screening and the professional's recommendation regarding the patient's suitability for the program.
- **Plan of care**: An outline of the plan of care, including the frequency of visits and how the services will help the patient manage their condition.
- **Justification of need**: An explanation of why the patient, or their primary caregiver, cannot provide these services on their own and what other community resources have been explored and exhausted.
## **T1023 billing requirements**
Billing for T1023 requires adherence to specific guidelines, which can vary by state and payer. Here are some general rules:
- **Payer-Specific rules**: T1023 is a "T" code, part of a code set established for State Medicaid agencies. It's crucial to check with the specific state's Medicaid provider manual for billing instructions, as each state may have its own policies on coverage, reimbursement rates, and required modifiers.
- **Unit of service**: T1023 is billed on a per-encounter basis, regardless of the time spent.
- **Modifiers**: Depending on the service location (e.g., telehealth), specific modifiers may be required to indicate the service was provided remotely.
- **Prior authorization**: Some payers may require prior authorization for services billed with T1023, especially if there are visit limits. For example, some states may limit the use of this code to a certain number of visits per calendar year.
## **Other related codes**
- **T1023-T1029**: Screenings, Assessments, and Treatments, Individual and Family
- **T1024**: Evaluation and treatment by an integrated, specialty team for children with complex needs.
- **T1028**: Assessment of the home, physical, and family environment to determine suitability for meeting a patient's medical needs.
Frequently asked questions
