STAR Health Personal Care Services: Claims Payment Issue Due to Incorrect Modifier Combination

Date: 11/10/21

The Texas Health and Human Services (HHS) has published the updated Electronic Visit Verification (EVV) Service Bill Codes Table that provides current billing codes and details for EVV-relevant services in Long-term, Acute Care and Managed Care programs. A discrepancy was identified in the EVV Service Bill Codes Table for STAR Health T109 service billing combinations, which prevented the correct payment of the EVV services. HHS updated the EVV Service Bill Codes Table to reflect the service billing combinations used according to STAR Health billing guidelines.

To review the latest version, please review the EVV Service Bill Codes Table - version 9.6, found on the HHS EVV webpage.

Note: the revisions only impact STAR Health Personal Care Services (PCS).

See a summary of changes below for the service combination T1019:

Added to STAR Health PCS –

• New service combination T1019 UA (PCS BH Condition - Agency Model)
• New service combination T1019 U7 (PCS - CDS Model)
• New service combination T1019 UB (PCS BH Condition - CDS Model)

Removed from STAR Health PCS –

• T1019 UA, U6 (PCS BH Condition - Agency Model)
• T1019 UC (PCS - CDS Model)
• T1019 UA, UC (PCS BH Condition - CDS Model)

For questions or additional information, please contact AM.LTSS@SuperiorHealthPlan.com.

For additional information, please review the HHS notice: EVV Service Bill Codes Table Version 9.6 Updates for STAR Health.