Skip to main content
NC Medicaid logo NC Medicaid

Topical Navigation

  • Home
  • Beneficiaries
  • Meetings & Notices
  • Find a Doctor
  • Providers
  • Counties
  • Reports
  • FAQs and Resources
  • ABOUT US
  • NC.GOV
  • NCDHHS
  • SERVICES
NC Medicaid »   Home »   blog

Electronic Visit Verification Personal Care Services Upcoming Claims Reprocessing Rate increase for EVV PCS claims

June 2, 2022

This bulletin is to provide notice to Personal Care Services (PCS) providers of the pending reprocessing of PCS claims subject to the 10% rate increase to the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) Home- and Community-based Services (HCBS) waivers. The rate increase comes with adherence to Electronic Visit Verification (EVV) for PCS claims. 

NC Medicaid successfully implemented EVV as required by the 21st Century Cures Act with an effective date of Jan. 1, 2021. 

NC Medicaid will systematically reprocess CAP/C and CAP/DA claims for providers subject to the EVV mandate. Claims submitted with dates of service on or after Jan. 1, 2021 will be reprocessed to include the 10% EVV rate increase in three separate checkwrites: July 12, 2022, July 19, 2022 and July 26, 2022.

In addition, NC Medicaid will append EVV data to previously processed claims subject to the EVV requirements that were not captured during the pay and report period. The EVV data validation completed during this reprocessing effort will not impact paid claims but will assist NC Medicaid in measuring its key performance indicators for the EVV requirements.

The 10% increased unit rate applies to the PCS types included in the CAP/C and CAP/DA HCBS waivers, including participants using consumer direction (CAP/CD), to ensure parity across state Medicaid programs. The CAP PCS are included in the table below:

Procedure Code

Program

Program Description

Billing Unit

PCS EVV 10% Increase Effective  01/01/2021

S5125

CAP/C

In-Home Aide

15 Min

$4.96

S5150

CAP/C

Respite Care In-Home Aide

15 Min

$4.96

S9122TG

CAP/C

Congregate CAP/C Pediatric Nurse Aide Services

15 Min

$4.43

S9122TF

CAP/C

Congregate CAP/C Personal Care Services

15 Min

$3.30

T1004

CAP/C

Pediatric Personal Care Respite

15 Min

$5.91

T1019

CAP/C

Pediatric Personal Care

15 Min

$5.91

T2027

CAP/C

Personal Care Assistance Services

15 Min

$4.96

T2027TF

CAP/C

Personal Care Assistance Congregate Services

15 Min

$4.43

T2040

CAP/C

Financial Management Services

Month

$107.42

S5125

CAP/CD

In-Home Aide

15 Min

$4.96

S5125 UN

CAP/CD

In-Home Aide Congregate Services

15 Min

$4.43

S5135

CAP/CD

Personal Assistance Services

15 Min

$4.96

S5135 UN

CAP/CD

Personal Assistance Congregate Services

15 Min

$4.43

S5150

CAP/CD

Respite- In-Home Aide

15 Min

$4.96

T20410

CAP/CD

Financial Management Services (CAP/CD Only)

Month

$107.42

S5125

CAP/DA

CAP In-Home Aide

15 Min

$4.96

S5125 UN

CAP/DA

In-Home Aide Congregate Services

15 Min

$4.43

S5150

CAP/DA

Respite- In-Home Aide

15 Min

$4.96

 

CONTACT

NCTracks Contact Center 800-688-6696

This blog is related to:

  • Bulletins
  • Community Alternatives Program (CAP/C & CAP/DA) Providers
  • Personal Care Services Providers

Related Articles

  • SPECIAL BULLETIN COVID-19 #255: Mandatory Coverage of COVID-19-Related Treatment Under the American Rescue Plan Act of 2021
  • Increase in Copay Amounts for Medicaid Services
  • Community Alternatives Program for Disabled Adults Waiver Amendment
  • SPECIAL BULLETIN COVID-19 #254: Pfizer-BioNTech Pediatric Vaccine
  • SPECIAL BULLETIN COVID-19 #253: Nursing Facility Program Updates
  • SPECIAL BULLETIN COVID-19 #252: Updates to Current Temporary COVID-19 Rate Increases
  • Pharmacy Behavioral Health Clinical Edits
  • UPDATE: Prior Authorizations End-dated When a Beneficiary Transitions to Managed Care
  • Additional Healthy Opportunities Services Now Available
  • SPECIAL BULLETIN COVID-19 #251: Sunsetting of Temporary COVID-19 Flexibilities Tied to the NC State of Emergency
  • Tailored Plan 101: Ready, Set, Launch Series
  • SPECIAL BULLETIN COVID-19 #250: Planning for the Transition out of the Appendix K Public Health Emergency for CAP/C and CAP/DA Waivers
  • Prior Approval Requirements Resume for Children’s Developmental Services Agency Providers
  • NC Medicaid Managed Care Provider Update - June 7, 2022
  • Updates to Requirements for the Consent for Sterilization Form

Share this page:

  • Facebook
  • Twitter
  • Email
Back to top

Contact Information

NC Medicaid
Division of Health Benefits

2501 Mail Service Center
Raleigh, NC 27699-2501
 
NC Medicaid Contact Center
Phone: 888-245-0179
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays. 
 
Visit RelayNC for information about TTY services. 
 
More
 

Recent Tweets

Tweets by @ncdhhs

Follow Us

  • Facebook
  • Twitter
  • YouTube
  • LinkedIn
  • EMPLOYEE DIRECTORY
  • TRANSLATION DISCLAIMER
  • Accessibility
  • Terms of Use
  • Privacy Policy
  • Open Budget
NC Medicaid
https://medicaid.ncdhhs.gov/blog/2022/06/02/electronic-visit-verification-personal-care-services-upcoming-claims-reprocessing