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EVV Billing In-Home vs. Out-of-Home For HCS and TxHmL Home Health Care Services (HHCS)

The Texas Health and Human Services Commission (HHSC) has received inquiries from stakeholders on how to bill for HHCS delivered in-home versus out-of-home. Outlined below is information that all HCS and TxHmL stakeholders should review prior to billing their HHCS claims.

 

Refer to the EVV Home Health Care Services Bill Codes Table (PDF) [ [link removed] ] on the HHSC EVV webpage to ensure you’re using the appropriate Healthcare Common Procedure Coding System (HCPCS) and Modifiers before submitting the EVV claim.

 

*Billing Combinations for HHCS *

HHSC created new Long-Term Care billing combinations to submit claims for EVV and non-EVV service delivery locations.


* HCS and TxHmL Own Home/Family Home (OHFH) should be billed as outlined in the EVV HHCS Service Bill Codes Table – version 2.1 (Excel) [ [link removed] ].
* Out-of-home should use the existing billing combinations with the KX modifier found in the HCS and TxHmL Bill Code Crosswalk (Excel) [ [link removed] ].
* Other Residential Types should use the existing billing combinations with the HQ modifier found in the HCS and TxHmL Bill Code Crosswalk (Excel) [ [link removed] ].

 

Services that begin or end in a member’s OHFH setting will require an EVV visit match. Services provided out-of-home in the Community or in Other Residential Type settings will not require an EVV visit match.

 

HHSC has published training resources for program providers and FMSAs to prevent EVV claim mismatches when submitting EVV claims for HCS and TxHmL services:

 


* Best Practices to Avoid Claim Mismatches for HCS and TxHmL (PDF) [ [link removed] ]
* HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (Video) [ [link removed] ]








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