Missouri EVV - Service and Service Codes

Missouri EVV - Service and Service Codes

Missouri EVV - Service & Service Codes

Administrator

Missouri EVV has specific requirements to send the Medicaid Procedure Codes to Sandata instead of the CIMOR code. Follow the instructions below to learn how to set these up in your SETWorks site to ensure a seamless integration with Sandata for EVV services. 

Medicaid Procedure Codes versus CIMOR Codes

You’re likely familiar with CIMOR codes (e.g., T1019) at your organization, whereas Sandata accepts Medicaid Procedure Codes (e.g., T1019 HI) which takes the individual’s waiver type into consideration.

Referring to this Sandata Resource (page 8 & 9), these are the services and codes accepted by Sandata. The Service Description shows abbreviations (e.g., PFH, MOCD, COMP, etc.) at the beginning that indicate waivers (e.g., Partnership for Hope, etc.).

Example: If your individual is receiving Personal Assistant Individual Agency/Contractor services funded by the Comprehensive waiver (COMP), the service would have a code of T1019, modifier H1. 

Below is an old DDD resource that translates CIMOR codes to Medicaid Procedure codes.


If you're unsure of the Medicaid Procedure Codes needed for your services, contact your Provider Relations resource from DMH. 

Adding Services to SETWorks

In the case you need to add more Personal Assistance services to your SETWorks system to accommodate Medicaid Procedure Codes and waiver types: 

NOTE:  Check this service as a 'Group Service' in the Service/Phase Utility
NOTE:  Check this service as 'Required for EVV' in the Service/Phase Utility



Process the Medicaid Procedure Code within the Billing Code (HCPCS) field and the Modifiers field(s). Each service requires their own code; If you're providing Personal Assistance services to individual's funded by different waivers, they will each require a service processed with the corresponding code and modifier(s).





Once services have been processed:
1) Proceed to individual profiles and process new authorizations with the correct service, department, hours, funders, etc. 
2) Attach Outcome, Goals, and Strategies/Steps as required. 
3) Add Intervention/Assessment keys to the new services. 
4) Assign the Protocol/Custom Plan questions to the new services, as applicable. 
5) Use the SETWorks Transfer tool to move over old activity records to the new authorization with the correct service and Medicaid Procedure Code. 

Contact Support@SETWorks.com for assistance. 

Codes and Modifiers
Personal Assistant T1019
Personal Assistant Group T1019 HQ
Personal Assistant Medical T1019 SC
Community Support Waiver U1
Partnership for Hope HX
Comprehensive HI
MO Children's Developmental Disabilities HA

Commonly Used Service Codes

INDIVIDUAL
Personal Assistant Individual CSW T1019 U1
Personal Assistant Individual PFH T1019 HX
Personal Assistant Individual COMP T1019 HI
Personal Assistant Individual MOCDD T1019 HA

GROUP
Personal Assistant Group CSW T1019 HQ U1
Personal Assistant Group PFH T1019 HQ HX
Personal Assistant Group COMP T1019 HQ HI
Personal Assistant Group MOCDD T1019 HQ HA

MEDICAL
Personal Assistant Medical CSW T1019 SC U1
Personal Assistant Medical PFH T1019 SC HX
Personal Assistant Medical COMP T1019 SC HI
Personal Assistant Medical MOCDD T1019 SC HA​

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