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T1017

PAYER POLICY CHANGES

T1017 Insurance Policy Changes

HCPCS T1017 is officially defined as "Targeted case management, each 15 minutes." HCPCS T1017 is referenced in 15 tracked payer policy changes from Nebraska Medicaid, L.A. Care Health Plan, and 10 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS T1017 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Nebraska Medicaid · Effective Jan 1, 2027High impact
Targeted Case Management Program for Chronic Diseases (TCMP CD) - LB 527
Nebraska Medicaid is implementing a new Targeted Case Management Program for Chronic Diseases (TCMP CD) effective January 1, 2027, paying qualified PCMH-certified providers $75 per member per month for managing beneficiaries with diabetes and chronic kidney disease stage 3 or higher. Providers must enroll as a new PCMH provider type by March 31, 2027, and may submit backdated claims for services provided January 1–March 31, 2027, if filed by October 31, 2027.
L.A. Care Health Plan · Effective Jan 1, 2027High impact
Unsatisfactory Immigration Status (UIS) Member Transition
Effective January 1, 2027, L.A. Care Health Plan members with Unsatisfactory Immigration Status (UIS) will transition from Medi-Cal managed care to Medi-Cal Fee-for-Service (FFS). Providers must be enrolled in Medi-Cal FFS through PAVE by January 1, 2027 to continue serving these patients and receive reimbursement. Billing workflows must shift from managed care to FFS processes, and providers should familiarize themselves with FFS billing requirements, rates, and newly available care management billing codes.
Anthem BCBS · Effective Jan 1, 2027High impact
[California] Medi-Cal Managed Care fee-for-service transition for members with unsatisfactory immigration status
Effective January 1, 2027, Anthem Medi-Cal Managed Care members with unsatisfactory immigration status (UIS) will transition to Medi-Cal fee-for-service (FFS) delivery. Providers must be enrolled in Medi-Cal FFS through PAVE by January 1, 2027, to continue serving these members and receive reimbursement. Billing workflows must shift from managed care to FFS processes, including Treatment Authorization Requests (TARs) and FFS-specific billing codes.
Molina Healthcare · Effective Jan 1, 2027High impact
07-29-2026 DHCS policy guide for transition of the unsatisfactory immigration status population from managed care to Medi-Cal fee-for-service – Version 1.0 IE LA SAC SD
Effective January 1, 2027, Medi-Cal members with unsatisfactory immigration status (UIS) will transition from managed care plans to Medi-Cal Fee-for-Service (FFS). Providers must enroll in Medi-Cal FFS through DHCS to continue serving these patients and receive reimbursement. Billing workflows, care coordination processes, and prior authorization procedures will shift from managed care to FFS requirements.
Utah Medicaid · Effective Nov 1, 2026High impact
November 2026 Medicaid Information Bulletin
This is the Utah Medicaid November 2026 bulletin, which bundles 15 changes. Several took effect November 1, 2026 (dental fluoride dispensing and topical fluoride, periodontal maintenance prior authorization removed, and flu vaccine routing), while most behavioral health, maternity and electronic prior authorization changes take effect January 1, 2027, with subacute crisis enrollment opening December 17, 2026. Because the bulletin was issued in November 2026 and the November 1 changes have already taken effect, confirm current applicability in the Utah Medicaid PRISM code lookup tool before billing.
Colorado Medicaid · Effective Oct 1, 2026High impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600542 - 09/2026)
Health First Colorado added daily limits and same day billing limits for a list of behavioral health and supportive service codes, active since Aug. 1, 2026 for some codes and effective Oct. 1, 2026 for others, and Regional Accountable Entities (RAEs) enforce them. Claims with dates of service of Aug. 1, 2026 or later deny if an updated provider license is not on file, and a recovery residence policy takes effect Oct. 1, 2026. This bulletin also covers a number of other changes with dates from Aug. 31, 2026 through Jan. 1, 2027, including the APR-DRG Version 42 update that moved to Jan. 1, 2027.
Virginia Medicaid - DMAS · Effective Jan 30, 2026High impact
Clarification on Intellectual and Developmental Disability Targeted Case Management and FAMIS
Virginia Medicaid clarifies that Intellectual and Developmental Disability targeted case management services (codes T2023 and T1017) are only covered for Medicaid members, not FAMIS benefit plan members. Claims for FAMIS members will be denied, and providers must verify eligibility before providing services.
Colorado Medicaid · Identified Jul 1, 2026High impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600540 - 07/2026)
A 2% across-the-board Health First Colorado provider rate reduction applies to dates of service beginning July 1, 2026, with exemptions for managed care, pharmacy, RHCs, FQHCs, pediatric behavioral therapy, select NICU and neonatal services, select maternity services, and family planning services. Procedure codes 97535 and 97537 are no longer covered as of July 1, 2026, and CPT 77063 became a covered benefit that must be billed on the same claim as CPT 77067. Effective August 1, 2026, PT 25 and PT 16 claims will be denied when billed for certain behavioral health supportive and team-based services in fee-for-service or to the Regional Accountable Entities.
Wisconsin Medicaid (ForwardHealth) · Effective Apr 1, 2026Medium impact
Compliance Guide for Wisconsin Correctional Facilities Serving Medicaid-Enrolled Youths Who Are Incarcerated
Beginning April 1, 2026, correctional facilities and their staff can enroll with Wisconsin Medicaid as providers. Enrolled facilities can bill HealthCheck screenings and targeted case management (TCM) for Medicaid-enrolled youths who are post-adjudicated and incarcerated in public state prisons or correctional facilities, and those youths must be under 21 or former foster care youths under 26 and eligible for Wisconsin Medicaid before or during incarceration. Facilities that choose not to enroll must submit one of two attestation forms instead.
Indiana Medicaid (IHCP) · Effective Mar 17, 2026Medium impact
BT202637: IHCP presents an updated status of claim-processing payment of impacted CCBHC claims
Indiana Medicaid has resolved multiple claim processing issues affecting CCBHC and non-CCBHC providers that began with a system implementation on Jan 28, 2026. Claims have been automatically reprocessed and will appear on remittance advices dated March 18, 2026, with no action required from providers.
Indiana Medicaid (IHCP) · Effective Mar 10, 2026Medium impact
BT202633: IHCP presents an updated status of claim-processing payment of impacted CCBHC claims
Indiana Health Coverage Programs has resolved multiple claim processing issues that affected CCBHC and non-CCBHC providers since January 28, 2026. Claims with incorrect denials, payment errors, and processing issues for specific procedure codes have been automatically reprocessed or adjusted with no action required from providers.
Indiana Medicaid (IHCP) · Effective Jan 28, 2026Medium impact
BT202629: IHCP presents status of claim-processing payment of impacted CCBHC claims
Indiana Medicaid experienced multiple system issues from January 28, 2026 affecting CCBHC and non-CCBHC claims processing, including incorrect denials and suspensions. Most issues have been resolved and claims automatically reprocessed, with no provider action required.
Pennsylvania Medicaid (DHS) · Effective Oct 12, 2025Medium impact
MAB2025112001
Pennsylvania opened procedure code G9012 effective October 12, 2025 for physical health targeted case management (TCM) services to eligible juveniles, both before release from a carceral setting (place of service 09) and after release. Behavioral health TCM uses procedure code T1017, opened for pre-release services effective October 12, 2025 and for post-release services effective January 1, 2025. Specialty 233 (Targeted Case Manager) is opened for physical health TCM within 30 days of release and for at least 30 days after release, and for behavioral health TCM within 30 days of release.
Health Net · Identified Jun 20, 2026Medium impact
25-607 Use Correct CPT Codes and Modifiers When Billing for Mobile Crisis Services
Health Net California requires specific CPT codes, HIPAA modifiers, and Place of Service 15 (Mobile Unit) for behavioral health mobile crisis services to receive in-network reimbursement rates. Claims not using the specified codes and modifiers will apply standard out-of-network benefits and cost sharing.
Kansas Medicaid (KanCare) · Effective Jan 1, 2026Low impact
KMAP BULLETIN: Consolidated Appropriations Act Incarcerated Youth
Starting January 1, 2026, Kansas will provide Medicaid and CHIP coverage for case management and screening services for incarcerated youth in the 30 days before and after their release from prison. These services will be paid fee-for-service using specific T-codes with place of service 09 (prison/correctional facility).

Watch T1017

Get one email when a payer policy names T1017, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

Centene · Effective December 31, 2025
Prior authorization required
Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements
Fidelis Care · Effective December 31, 2025
Prior authorization required
Fidelis Care CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Centene require prior authorization for T1017?

Centene lists T1017 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Fidelis Care require prior authorization for T1017?

Fidelis Care lists T1017 on Fidelis Care CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS T1017?

There are 15 tracked policy changes affecting HCPCS T1017, including updates from Nebraska Medicaid, L.A. Care Health Plan, Anthem BCBS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS T1017?

Payers that have issued tracked updates for HCPCS T1017 include: Nebraska Medicaid, L.A. Care Health Plan, Anthem BCBS, Molina Healthcare, Utah Medicaid, Colorado Medicaid, Virginia Medicaid - DMAS, Wisconsin Medicaid (ForwardHealth), Indiana Medicaid (IHCP), Pennsylvania Medicaid (DHS), Health Net, Kansas Medicaid (KanCare).

How do I get notified when HCPCS T1017 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS T1017. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS T1017?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for T1017

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for T1017 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

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Targeted Case Management Program for Chronic Diseases (TCMP CD) - LB 527

Unsatisfactory Immigration Status (UIS) Member Transition

[California] Medi-Cal Managed Care fee-for-service transition for members with unsatisfactory immigration status

07-29-2026 DHCS policy guide for transition of the unsatisfactory immigration status population from managed care to Medi-Cal fee-for-service – Version 1.0 IE LA SAC SD

November 2026 Medicaid Information Bulletin

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600542 - 09/2026)

Clarification on Intellectual and Developmental Disability Targeted Case Management and FAMIS

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600540 - 07/2026)

Compliance Guide for Wisconsin Correctional Facilities Serving Medicaid-Enrolled Youths Who Are Incarcerated

BT202637: IHCP presents an updated status of claim-processing payment of impacted CCBHC claims

BT202633: IHCP presents an updated status of claim-processing payment of impacted CCBHC claims

BT202629: IHCP presents status of claim-processing payment of impacted CCBHC claims

MAB2025112001

25-607 Use Correct CPT Codes and Modifiers When Billing for Mobile Crisis Services

KMAP BULLETIN: Consolidated Appropriations Act Incarcerated Youth

Prior authorization required