What insurance policy changes affect HCPCS T1019?

There are 17 tracked policy changes affecting HCPCS T1019, including updates from Sentara Health Plans, Kansas Medicaid (KanCare), Mississippi Medicaid (DOM). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS T1019?

Payers that have issued tracked updates for HCPCS T1019 include: Sentara Health Plans, Kansas Medicaid (KanCare), Mississippi Medicaid (DOM), UnitedHealthcare, Anthem BCBS, Harvard Pilgrim Health Care, Wisconsin ForwardHealth, Health Net, Missouri Medicaid (MO HealthNet), Kentucky Medicaid.

How do I get notified when HCPCS T1019 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS T1019. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS T1019?

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.

T1019 — Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant): Insurance Policy Changes

T1019 Insurance Policy Changes

HCPCS T1019 is officially defined as "Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)." HCPCS T1019 is referenced in 17 tracked payer policy changes from Sentara Health Plans, Kansas Medicaid (KanCare), and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS T1019 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Medical and Clinical Policy Updates - Effective October 1, 2026

Sentara Health Plans·Effective Oct 1, 2026

Effective October 1, 2026, Sentara Health Plans is implementing multiple coverage and prior authorization changes across Virginia for Commercial, Medicaid, and Medicare products. Key changes include: new prior authorization requirements for common orthopedic procedures (knee/hip arthroplasty, ankle revision), home health nursing services with benefit restrictions, new non-covered services (personal care, habilitation waivers, certain vaccines), and specific oncology lab work requiring OncoHealth contact. Billing teams must immediately update systems to enforce these requirements to avoid claim denials.

T1019 Insurance Policy Changes

Medical and Clinical Policy Updates - Effective October 1, 2026

KMAP BULLETIN: HCBS Rate Changes for Fiscal Year 2027

HCBS Rate Updates effective 1/1/2026

Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees

Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees

[Virginia] Updated LTSS authorization and care management training material

Point32Health Medical Necessity Guideline updates

ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases

KMAP BULLETIN: Updated - HCBS Rate Increase for Fiscal Year 2026

KMAP BULLETIN: Implementation of Virtual Delivery of Services Across All HCBS Waivers

KMAP BULLETIN: EVV HCBS Activity Code Cleanup

KMAP BULLETIN: Non-Waiver Mental Health Attendant Care (STC Authority) T1019HE – Activity Code List

KMAP BULLETIN: Community Mental Health Centers Attendant Care

22-1039m Help Members Live Independently with Personal Care and Homemaker Services

22-1040m Help Members Live Independently with Personal Care and Homemaker Services

Financial Management Services (FMS)

Appendix K Supplemental Rate