MedicaidBilling CodesMedium impact
MAB2022092601
Pennsylvania Medicaid (DHS)·PA · Pediatrics·Provider Bulletin
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is adding new procedure codes T1002 and T1003 to allow home health agencies to bill for private duty nursing services for beneficiaries under 21 in 15-minute increments instead of only hourly billing. Both codes require prior authorization and have the same $12.50 per unit rate with a maximum of 96 units per day.
Action Required
By October 1, 2022: Home health agencies billing pediatric shift nursing must update billing systems to include new codes T1002 (RN) and T1003 (LPN) for 15-minute increment billing at $12.50 per unit. Submit MA 97 forms for prior authorization identifying either the new T1002/T1003 codes or existing S9123/S9124 codes - cannot mix both code sets in same calendar month. Ensure EVV systems accept all four procedure codes for Electronic Visit Verification compliance.