Updated Information Billing Procedure Update for Adult Care Home Personal Care Services (ACH/PCS) Claims

Note: This announcement updates the previously posted information regarding ACH/PCS claims billing procedures. The effective date has been changed from Jan. 1, 2025, to April 1, 2025, and additional procedure code modifiers have been included in this update.

Effective with dates of service on and after April 1, 2025, Adult Care Home Personal Care Services will reimburse a single date of service per line based on approved prior authorization (per diem pricing). 

Providers should modify claims with procedure code 99509 and modifiers SC, HC, TT, HQ, HH, or HI to show one unit representing a single service date. Claims billed with a span of dates or more than one unit per service date on a claim line will deny.  

Related DHB Resources

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24358-R-2768 (2)