T1000 Guidance with UA Modifier

Date: November 3, 2022 Attention: Private Duty Nursing Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to provide guidance on the billing requirements for T1000 with the UA modifier, as outlined in the Home Health Nursing and Private Duty Nursing handbook, of the Texas Medicaid Provider Manual. How this impacts providers: An appropriate diagnosis from the table below must be submitted when modifier UA is used to obtain additional reimbursement for clients with a tracheostomy or who are ventilator dependent.

Diagnosis Codes for use with Modifier UA only
J9500	J9501	J9502	J9503	J9504	J9509	J95850	Z430
Z930	Z990	Z9911	Z9912	Z9912	Z9981	Z9989

Next steps for providers: Providers should share this guidance with their staff and ensure claims are billed appropriately to prevent denials. As a reminder, providers can submit corrected claims within 120 days from claim disposition date. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.