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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) 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.
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:
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