HCPCS Modifier Description
H2011 Community Crisis Supports (1 unit = 15 min)
H2015 Comprehensive Community Support Services; per 15 minutes
(24-hour/day unavailable under hourly services) for participants who live in their own home or apartment or live with a non-paid caregiver. This code requires PA.
1 Unit = 15 minutes
H2015 HQ Comprehensive Community Support Services; per 15 minutes
Supported living for two or three participants who live in their own home or apartment or live with a non-paid caregiver. This code requires PA. 1 Unit = 15 minutes
24 hour/day unavailable under hourly serviced.
H2022 Community Based Services, per diem 24 hours per day support and supervision. Provided through a blend of 1:1 and group staffing.
H2016 Comprehensive Community Support Services, per diem
24 hours per day support and supervision.
Typically requires 1:1 staffing but requests for blend of 1:1 and group staffing will be reviewed on a case-by-case basis.
Diagnosis Place of Service
Based on dates of service, enter the ICD-9-CM code V60.4 or ICD-10-CM code Z74.2 for the primary diagnosis.
12 Home (CFH, participant’s own home, or home of unpaid family)
99 Other (Community) This code should only be used when the participant receives hourly supported living to access the community. All other RES/HAB should be coded as Home.
HCPCS Modifier Description
S5100 Day Care Services Adult; per 15 minutes
S5140 Certified Family Home Foster Care Adult; per diem
T2025 Agency – Certified Family Home Affiliation Fee DD Waiver Agency – Certified Family Home Affiliation Fee PA number must be billed on claim for payment consideration
Certified Family Home (CFH) – Agency Affiliation Fee
HCPCS Modifier Description Diagnosis Place of Service
T1005 Respite Care Services, up to 15 minutes 1 Unit = 15 minutes.
(CFH, participant’s own home, or home of unpaid family)
99 Other (Community)
This code should only be used when the participant receives hourly supported living to access the community. All other RES/HAB should be coded as, Home.
S9125 Respite Care, In the Home, per diem 1 Unit = 1 day
Maximum of six hours per day or 24 units.
Based on dates of service, enter the ICD-9-CM code V60.4 or ICD-10-CM code Z74.2 for the primary diagnosis.
For more information on which ICD version to use, refer to ICD-9 and ICD-10 Diagnosis Billing Requirements.
12 Home
