T1019 Personal Care Billing: Units, Codes and EVV

T1019 is the HCPCS code for personal care services, per 15 minutes. Its full descriptor adds three conditions: the person is not an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD; the service is part of the individualized plan of treatment; and the code may not be used for services provided by a home health aide or a certified nurse assistant.

That last condition matters for agencies that employ both kinds of staff. Personal care is help with daily living, such as bathing, dressing, eating, moving around the home and the household tasks around them. Work performed as a home health aide or a certified nurse assistant falls outside this code, and the plan's manual says what to use instead.

T1019 is a T code. CMS describes T codes as made primarily for Medicaid state agencies, usable by private insurers too, and not payable by Medicare. Its sister code T1020 describes the same personal care services billed per diem instead of per 15 minutes. Which of the two a plan pays is set by the state and the plan, not by the agency.

One unit of T1019 is 15 minutes of care. A two-hour visit is eight units; a three-hour visit is twelve. On the claim, the units go in column 24G of the CMS-1500, or the matching units field of the 837P, next to the date of service and the code.

Units also drive the authorization. A plan typically approves a number of units per week or per month for a set period, and every visit draws them down. Billing more units than were approved is the classic personal care denial, and it usually comes from a schedule that grew while the authorization did not.

A home care agency rarely bills T1019 alone. These related services appear in the same CMS HCPCS file, all not payable by Medicare, with the labels Florida's long-term care policy gives them.

Each service usually has its own line on the authorization and its own count of units. A visit that mixes personal care and homemaking is billed as two lines under two codes, each drawing on its own approval.

Section 12006 of the 21st Century Cures Act requires states to use electronic visit verification for Medicaid personal care services and home health care services that require an in-home visit. It covers personal care delivered under the state plan and under 1915(c), 1915(i), 1915(j), 1915(k) and 1115 authorities. States had to comply for personal care by January 1, 2020, and for home health by January 1, 2023, or face a reduction of their federal matching rate.

1. The type of service performed.
2. The individual receiving the service.
3. The date of the service.
4. The location of service delivery.
5. The individual providing the service.
6. The time the service begins and ends.

Those six elements are what each visit must record. CMS has also said the requirement does not apply when the caregiver and the person served live together, since that is not an in-home visit, although a state may still choose to apply it, and that it does not read the requirement as applying to PACE program services.

How a state runs EVV, which system collects the visits and how plans compare them with claims, differs from state to state. Ask each plan you bill how it matches visits to claims, and keep the visit start and end times consistent with the units you bill.

1. Units billed beyond what the authorization approved for the week or month.
2. Visits billed after the authorization ended, while the renewal was pending.
3. Units that do not match the visit's verified start and end times.
4. Home health aide or CNA services billed under T1019.
5. The wrong code for the plan: per 15 minutes when the plan pays per diem, or the reverse.
6. A member who changed plans, billed to the old one.

Most of these are visible before the claim is sent, if the authorization, the visits and the claims sit in the same place. Once the claim has left, each one costs a rejection, a correction and a second wait.

Zeumatic keeps each patient's record, authorizations and claims side by side. AI reads the authorization PDF, including the service, the units and the dates, and the team confirms it; Zeumatic warns before it expires. Claims for personal care, homemaker, companion and respite services are built under their codes and sent through Availity, and acknowledgments and 835 remittances are matched to them automatically.

Caregiver clock-in and clock-out with EVV records is coming soon to Zeumatic, so visits will land on the same record as the authorization and the claim. Until then, agencies use Zeumatic for records, authorizations, claims and payments alongside their state's EVV system.