EVV Billing In-Home vs. Out-of-Home for HCS and TxHmL Home Health Care Services (HHCS)

Date: August 27, 2024
Attention: Home and Community-Based Services (HCS) and TxHmL Stakeholders

Call to action: Texas Children’s Health Plan (TCHP) would like to share guidance from Health and Human Services Commission (HHSC) regarding 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.

Resource: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.

How this impacts providers: Billing Combinations for HHCS 

HHSC created new Long-Term Care billing combinations to submit claims for EVV and non-EVV service delivery locations.

• HCS and TxHmL Own Home/Family Home (OHFH) should be billed as outlined in the EVV HHCS Service Bill Codes Table – version 2.1 (Excel).

• Out-of-home should use the existing billing combinations with the KX modifier found in the HCS and TxHmL Bill Code Crosswalk (Excel).

• Other Residential Types should use the existing billing combinations with the HQ modifier found in the HCS and TxHmL Bill Code Crosswalk (Excel).

Services that begin or end in a member’s own home or family home 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.

Next step for Providers: Providers should share this communication with their staff and utilize the following training resources from HHSC, if needed, for program providers and FMSAs to prevent EVV claim mismatches when submitting EVV claims for HCS and TxHmL services:

•  Best Practices to Avoid Claim Mismatches for HCS and TxHmL (PDF)

• HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (Video)

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

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