MedicaidBilling CodesHigh impact
Reminder: Billing In-Home Respite Services in CLASS and DBMD Programs
Texas Medicaid·TX · Geriatrics, Palliative Care·Billing
We identified it
Sep 10, 2026
Summary
Texas HHSC issued a billing reminder for in-home respite services under CLASS and DBMD programs, emphasizing strict compliance with unit-of-service conversion tables (dividing by 24 hours) and requiring matching EVV documentation. Providers billing without proper unit conversion or without accepted EVV records will face overpayment recoupment.
Action Required
Immediately: Billing team must verify that all CLASS and DBMD in-home respite service claims (G0100) are using the correct unit-of-service conversion formula (dividing service hours by 24, not billing raw hours). Review billing software and EDI submission rules to enforce this calculation. Before next claim submission: Audit recent claims for CLASS (Service Group 211) and DBMD (Service Group 161) to identify any overpayments resulting from incorrect unit calculations (e.g., billing 2.25 units instead of .09 units for 2 hours 15 minutes). Coordinate with providers to ensure all G0100 claims have matching accepted EVV visit transactions in the EVV Aggregator for the date of service. If incorrect billing is identified, report to HHSC CLASS Policy or HHSC DBMD Policy contacts and prepare for potential recoupment recovery. Failure to comply will result in claim denials and recoupment of overpayments.