Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Home Health, Home Infusion, Hospice)
Referrals and Prior
Authorization
(continued)
11-8
PCA services must be submitted to Blue Plus using one date of
service per claim line. Any claim lines that are submitted with
more than one date of service (date span) will be denied for
improper format. All claim lines should have an individual PCA
associated with the service.
All PCA claim lines (T1019), except for those submitted with the
QP supervision modifier, must include at least one of the
relationship modifiers on each line (UD or U1). All other HCPCS
code and modifier combinations still apply to PCA claims.
Multiple modifiers can be submitted on one line to further identify
services provided. Claims that do not include an appropriate
modifier will be denied. These claims may be reconsidered when
the appropriate modifier is provided.
Participating Home
Health Agencies
Purpose: provide
skilled and nonskilled
care and
supervision
Billing: submit
services on a facility
claim format (837I),
use revenue codes
0570-0579 and
HCPCS code T1019
PCA Code
or Code &
Modifier Code Narrative
Personal Care
Provider
Organization
Purpose: provide
RN/qualified
professional
supervision and
PCA services only
Billing: submit
services on a
professional claim
format (837P) using
the appropriate “T”
HCPCS codes (see
code and modifier
list below)
T1001 Nursing assessment/evaluation
PCA Choice
Providers
Purpose: bill PCA
services for the
member.
Member/RP does all
hiring, training and
supervision of
PCAs.
Billing: submit
services on a
Professional claim
format (837P) using
the appropriate “T”
HCPCS codes (see
code and modifier
list below)
Modifier
Instructions
T1001-52 Same as above The –52 modifier is
submitted to
indicate a service
update.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)