EVV Service Codes
EVV Service Codes
EVV Service Codes
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Program (bold)/<strong>Service</strong><br />
SERVICE<br />
GROUP<br />
<strong>EVV</strong> <strong>Service</strong> <strong>Codes</strong><br />
Bill Code DESCRIPTION<br />
SERVICE<br />
CODE<br />
Community Based<br />
Alternatives (CBA)<br />
respite 3 G0101 RESPITE - IN-HOME 11<br />
CBA PAS 3 G0701 PERSONAL ASSISTANCE SERVICES - 17<br />
CBA CDS-respite 3 G0171 IN HOME RESPITE CDS<br />
CDS-PERSONAL ASSISTANCE SERVICES<br />
11<br />
CBA CDS-PAS<br />
Community Living<br />
Assistance and Support<br />
<strong>Service</strong>s (CLASS)<br />
3 G0717 (PAS) - IND 17V<br />
habilitation 2 S0101 HABILITATION - ADL'S 10<br />
CLASS habilitation 2 S0100 HABILITATION - TRAINING<br />
HABILITATION ATTENDANT CARE<br />
10<br />
CLASS habilitation 2 S0105 SERVICES - DELEGATED NURSING<br />
HABILITATION - SUPPORTIVE EMPLOY<br />
10A<br />
CLASS habilitation 2 S0106 EMPLOYMENT 10B<br />
CLASS habilitation 2 S0107 HABILITATION - PREVOCATIONAL 10B<br />
CLASS respite 2 G0100 RESPITE-IN HOME RESPITE-DSA 11<br />
CLASS CDS habilitation 2 G0722 PAS - CLIENT DIRECTED SERVICES 27A<br />
CLASS CDS respite<br />
Medically Dependent<br />
Children Program<br />
2 G0197 CDS RESPITE IN-HOME 11PV<br />
(MDCP) respite<br />
RESPITE - PERSONAL ASSISTANCE<br />
(attendant) 18 G0121 SERVICES 11<br />
MDCP respite (attendant-<br />
RESPITE-PERSONAL ASSISTANCE<br />
delegated)<br />
MDCP adjunct support<br />
18 G0164 SERVICES-DELEGATED 11Q<br />
(attendant)<br />
MDCP adjunct support<br />
18 G0168 ADJUNCT - PAS HCSS 11U<br />
(attendant)<br />
MDCP adjunct support<br />
18 G0168 ADJUNCT - PAS HCSS CHORE SERVICE 11U<br />
(attendant) 18 G0168 ADJUNCT - PAS HCSS - HOMEMAKER SERVIC 11U<br />
December 9, 2010
MDCP adjunct support<br />
(attendant) 18 G0168 ADJUNCT - PAS HCSS COMPANION CARE-AD 11U<br />
MDCP adjunct support<br />
(attendant-delegated) 18 G0169 ADJUNCT - PAS HCSS-delegated 11V<br />
MDCP CDS respite<br />
(attendant) 18 G0182 CDS - RESPITE-IN-HOME - IND 11ZV<br />
MDCP CDS adjunct<br />
support (attendant) 18 G0192 CDS - ADJUNCT PAS HCSS - IND chore 11UV<br />
MDCP CDS adjunct<br />
support (attendant) 18 G0192 CDS - ADJUNCT PAS HCSS - IND homemaker 11UV<br />
MDCP CDS adjunct<br />
support (attendant) 18 G0192 CDS - ADJUNCT PAS HCSS - IND companion 11UV<br />
Primary Home Care<br />
(PHC) 7 G0702<br />
PHC 7 G0701<br />
PHC CDS<br />
Community Attendant<br />
7 G0717<br />
<strong>Service</strong>s (CAS) 7 G0743<br />
CAS 7 G0742<br />
CAS CDS 7 G0749<br />
CAS CDS 7 G0748<br />
PERSONAL ASSISTANCE SERVICES -<br />
LEVEL 1 - NON-PRIORITY 17<br />
PERSONAL ASSISTANCE SERVICES -<br />
LEVEL 2 - PRIORITY 17<br />
CDS-PERSONAL ASSISTANCE SERVICES<br />
(PAS) - IND 17V<br />
PAS COMMUNITY ATTENDANT SERVICES<br />
(1929B) - LVL 1 (NON-PRIORITY) 17D<br />
PAS COMMUNITY ATTENDANT SERVICES<br />
(1929B) - LVL 2 (PRIORITY) 17D<br />
CDS Community Attendant <strong>Service</strong>s (1929b) -<br />
Level 1 (Non-Priority) 17DV<br />
CDS Community Attendant <strong>Service</strong>s (1929b) -<br />
Level 2 (Priority) 17DV<br />
Family Care (FC) 7 G0741 PAS FAMILY CARE - LVL 1 (NON-PRIORITY) 17C<br />
FC 7 G0740 PAS FAMILY CARE - LVL 2 (PRIORITY)<br />
PARTICIPANT PAS FAMILY CARE CDS - LVL<br />
17C<br />
FC CDS 7 G0746 1 (NON-PRIORITY)<br />
PARTICIPANT - PAS FAMILY CARE CDS -<br />
17CV<br />
FC CDS 7 G0745 LVL 2 (PRIORITY) 17CV<br />
Source: Long-term care bill code crosswalk<br />
http://www.dads.state.tx.us/providers/hipaa/billcodes/index.html#ltc<br />
December 9, 2010
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