T1023 Insurance Policy Changes

HCPCS T1023 is officially defined as "Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter." HCPCS T1023 is referenced in 7 tracked payer policy changes from Michigan Medicaid - MDHHS, Connecticut Medicaid (HUSKY Health), and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS T1023 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Michigan Medicaid - MDHHS · Effective Dec 1, 2026High impact
MMP 26-47: Maternal Infant Health Program Rate Increase and Update to Care Coordination Requirements
Effective December 1, 2026, Michigan Medicaid will increase reimbursement rates for Maternal Infant Health Program (MIHP) services (HCPCS codes H1000, H2000, T1023, T2022) and update care coordination requirements. The minimum time threshold for billable care coordination services increases from 30 minutes to 60 minutes per calendar month, and documentation must now include start/end times and detailed activity descriptions signed by an LSW or RN.
Connecticut Medicaid (HUSKY Health) · Effective Jul 1, 2026High impact
2026.33 - Provider Bulletin - Reimbursement Update for Early Intervention Services under the Special Services - Birth to Three Years Fee Schedule
Connecticut DSS is updating reimbursement rates for five Early Intervention Services billing codes under the HUSKY Health program (HUSKY A and B) effective July 1, 2026. Rates for skills training (H2014), screening (T1023), family training (T1027), home assessment (T1028), and service assessment (T2024) are being adjusted. Billing teams must update their fee schedules and systems to reflect the new rates to avoid claim rejections.
Anthem BCBS · Effective Apr 1, 2026High impact
[Ohio] OH Medicaid Doula claim submission FAQ
Ohio Medicaid has established a comprehensive FAQ for doula service claim submission effective April 1, 2026. Claims must be submitted electronically via EDI through an approved trading partner or via Availity Essentials Direct Data Entry; paper claims are no longer accepted. Billing teams must use specific HCPCS codes (T1032, T1033, T1023) with designated diagnosis codes (Z32.2, Z32.3) and append the GT modifier for telehealth services.
UnitedHealthcare · Effective Jan 1, 2026High impact
Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
Effective January 1, 2026, Massachusetts Medicaid members in Senior Care Options (SCO) and One Care plans who lose MassHealth eligibility will have Medicaid-covered services discontinued, with only Medicare benefits continuing during a 60-day deeming period. Providers must verify eligibility through the UnitedHealthcare Provider Portal and establish separate payment agreements with members if continuing Medicaid-only services during the deeming period.
UnitedHealthcare · Effective Jan 1, 2026High impact
Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
Effective January 1, 2026, Massachusetts SCO and One Care members who lose MassHealth Medicaid eligibility will have only Medicare benefits covered during a 60-day deeming period. Providers must verify eligibility through the UnitedHealthcare portal and will not be reimbursed for Medicaid-only services during this period.
Nevada Medicaid · Effective May 4, 2026Medium impact
Attention Provider Type 34 (Therapy) Specialty 28 (Occupational Therapy): Rates for Assessment Codes Have Been Corrected
Nevada Medicaid corrected rates for three assessment codes (A0160, T1015, T1023) for occupational therapy providers that were paying incorrectly since January 2025. Claims will be automatically reprocessed with correct payments appearing on future remittance advice.
Pennsylvania Medicaid (DHS) · Effective Nov 18, 2025Medium impact
MAB2025111801
Pennsylvania updated its School-Based ACCESS Program (SBAP) provider handbook for local education agencies (LEAs) enrolled in Medical Assistance. The updates add modifiers to procedure codes for services rendered by Certified Registered Nurse Practitioners (CRNPs), give CRNPs and physician assistants prescriptive authority for assistive devices, and give Licensed Clinical Social Workers prescriptive authority and a role as providers of social work and counseling services. Licensed Social Workers are removed as providers with prescriptive authority for social work and counseling services, and a procedure code for hearing aid checks and maintenance is added.

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REFERENCE DATA

Payers with rules3

Payers requiring prior auth3

Anthem BCBS · Effective February 11, 2026
Prior authorization required
List of items and services that require prior authorization (Medicare)
CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for T1023?

Anthem BCBS lists T1023 on List of items and services that require prior authorization (Medicare) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for T1023?

CalViva Health lists T1023 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for T1023?

Community Health Plan of Imperial Valley lists T1023 on Community Health Plan of Imperial Valley 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 T1023?

There are 7 tracked policy changes affecting HCPCS T1023, including updates from Michigan Medicaid - MDHHS, Connecticut Medicaid (HUSKY Health), Anthem BCBS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS T1023?

Payers that have issued tracked updates for HCPCS T1023 include: Michigan Medicaid - MDHHS, Connecticut Medicaid (HUSKY Health), Anthem BCBS, UnitedHealthcare, Nevada Medicaid, Pennsylvania Medicaid (DHS).

How do I get notified when HCPCS T1023 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS T1023. 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 T1023?

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 T1023

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for T1023 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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MMP 26-47: Maternal Infant Health Program Rate Increase and Update to Care Coordination Requirements

2026.33 - Provider Bulletin - Reimbursement Update for Early Intervention Services under the Special Services - Birth to Three Years Fee Schedule

[Ohio] OH Medicaid Doula claim submission FAQ

Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees

Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees

Attention Provider Type 34 (Therapy) Specialty 28 (Occupational Therapy): Rates for Assessment Codes Have Been Corrected

MAB2025111801

Prior authorization required

Prior authorization required

Prior authorization required

Does Anthem BCBS require prior authorization for T1023?

Does CalViva Health require prior authorization for T1023?

Does Community Health Plan of Imperial Valley require prior authorization for T1023?

What insurance policy changes affect HCPCS T1023?

Which payers have updated policy for HCPCS T1023?

How do I get notified when HCPCS T1023 policy changes?

Why do payers change policies for HCPCS T1023?