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Erroneous Payment Correction for EPSDT Home Health Nursing Local Codes

September 9, 2019

A previously published NewsFlash article titled “Correction: Nursing Local Codes Are Reimbursable for EPSDT Home Health” announced a change in billing instructions for suggested HIPAA-compliant national code equivalents to the previously used HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health Services.

Providers were advised not to bill HCPCS Level II codes T1030 and T1031 (nursing care, in the home) per diem codes and to instead continue to bill local codes Z5805 (EPSDT shared nursing RN) and Z5807 (EPSDT shared nursing LVN) in order to receive the previous hourly rate.

Claims for codes T1030 and T1031 with dates of service on or after July 1, 2018 will be reprocessed via an Erroneous Payment Correction (EPC). Providers should continue to submit claims in a timely manner.