Home and Community-based Services (HCS) Program Billing Guidelines

Section 4000

Specific Requirements for Service Components Based on Billable Activity
Table of Contents

4100
Reserved for Future Use
4200
Specialized Therapies
4210
General Description of Service Component
4220
Billable Activity
4230
Activity Not Billable
4240
Qualified Service Provider
4250
Unit of Service
4260
Written Documentation
4270
Insurance Co-payment and Deductible
4300
Day Habilitation
4310
General Description of Service Component
4320
Requirements of Setting
4330
Billable Activity
4340
Activity Not Billable
4350
Restrictions Regarding Submission of Claims for Day Habilitation
4360
Qualified Service Provider
4370
Unit of Service
4380
Written Documentation
4400
Registered Nursing
4410
General Description of Service Component
4420
Billable Activity
4430
Activity Not Billable
4440
Qualified Service Provider
4450
Unit of Service
4460
Accumulation of Service Times
4470
Written Documentation
4471
Licensed Vocational Nursing
4471.1
General Description of Service Component
4471.2
Billable Activity
4471.3
Activity Not Billable
4471.4
Qualified Service Provider
4471.5
Unit of Service
4471.6
Accumulation of Service Times
4471.7
Written Documentation
4472
Specialized Registered Nursing
4472.1
General Description of Service Component
4472.2
Billable Activity
4472.3
Activity Not Billable
4472.4
Qualified Service Provider
4472.5
Unit of Service
4472.6
Accumulation of Service Times
4472.7
Written Documentation
4473
Specialized Licensed Vocational Nursing
4473.1
General Description of Service Component
4473.2
Billable Activity
4473.3
Activity Not Billable
4473.4
Qualified Service Provider
4473.5
Unit of Service
4473.6
Accumulation of Service Times
4473.7
Written Documentation
4500
Residential Assistance
4510
General Description of Service Component
4520
Restrictions Regarding Submission of Claims for Residential Assistance
4530
Residential Location
4540
Supported Home Living Subcomponent
4550
Foster/Companion Care Subcomponent
4560
Residential Support Subcomponent
4570
Supervised Living Subcomponent
4580
Submitting a Service Claim for Residential Assistance During a Preselection Visit
4600
Respite
4610
General Description of Service Component
4620
Billable Activity
4630
Respite in Residence or During Overnight Stay in Non-residence
4631
Residential Location
4640
Activity Not Billable
4650
Submitting a Service Claim for Respite
4651
Restrictions Regarding Submission of Claims for Respite
4660
Qualified Service Provider
4670
Unit of Service
4680
Payment Limit
4690
Written Documentation
4700
Supported Employment
4710
General Description of Service Component
4720
Requirements of Employment
4730
Billable Activity
4740
Activity Not Billable
4750
Qualified Service Provider
4760
Restrictions Regarding Submission of Claims for Supported Employment
4770
Unit of Service
4780
Written Documentation