JOIN US! Highmark Wholecare 2024 HHCS EVV Visit Data Mandate & Townhall
Dear Pennsylvania Highmark Wholecare Providers:
Congress enacted the 21st Century Cures Act in December 2016. Section 12006 of the Act requires States to implement Electronic Visit Verification (EVV) for Medicaid-covered Personal Care Services (PCS) and Home Health Care Services (HHCS) by January 1, 2020 and January 1, 2023, respectively. In November 2022, Highmark Wholecare received notice of the good-faith extension from the state of Pennsylvania extending the expectation of a full go-live to January 1, 2024.
Highmark Wholecare is committed to working with members, providers, and Alternate EVV vendors to meet training needs and implement a quality EVV solution for HHCS. EVV technology will improve the care provided to our members, ensuring there are no gaps in care throughout the member’s service plan and follow our commitment to care for the whole person in all communities where the need is the greatest.
As we approach the January 1, 2024 mandate for HHCS, Highmark Wholecare will be mandating HHCS Phase 1 service codes on August 1, 2023. Phase 1 codes include:
EVV Service Description | Procedure Code |
Home Visit Prenatal (Non HBP) Assessment | 99500 |
Aide In Home Care - Hr - UD | S9122 |
Home Health - Nursing (RN), Hr | S9123 |
Home Health - Nursing (RN), Hr - TT | S9123 |
Home Health - Nursing (LPN), Hr | S9124 |
Home Health - Nursing (LPN), Hr - TT | S9124 |
Private Duty/Independent Nursing | T1000 |
Private Duty/Independent Nursing - TT | T1000 |
Home Health - Nursing (RN), 15 Mins - SE | T1002 |
Home Health - Nursing (RN), 15 Mins | T1002 |
Home Health - Nursing (RN), 15 Mins - TT | T1002 |
Home Health - Nursing (LPN), 15 Mins | T1003 |
Home Health - Nursing (LPN), 15 Mins - TT | T1003 |
Home Health - Nursing (LPN), 15 Mins - SE | T1003 |
Highmark Wholecare will be mandating HHCS Phase 2 service codes on October 1, 2023. Phase 2 service codes include:
EVV Service Description | Procedure Code |
Social Work Visit, In the Home, Per Diem | S9127 |
Speech Therapy, In The Home | S9128 |
Occupational Therapy, In The Home | S9129 |
Physical Therapy, In The Home | S9131 |
Physical Therapy (Day 1-28) by a PT | G0151 |
Physical Therapy (Day 29 and beyond) by a PT | G0151 |
HHCP-SERV OF PT,EA 15 Mins | G0151 |
Occupational Therapy (Day 1-28) by a OT | G0152 |
Occupational Therapy (Day 29 and beyond) by a OT | G0152 |
HHCP-SERV OF OT,EA 15 Mins | G0152 |
Speech Therapy (Day 1-28) by a ST | G0153 |
Speech Therapy (Day 29 and beyond) by a ST | G0153 |
HHCP - Svs of RN, EA 15 Mins | G0154 |
Speech/Language Therapy-15 Mins | T2025 |
Occupational Therapy-15 Mins | T2025 |
Home Health - Occupational Therapy Assist. | T2025 |
Physical Therapy-15 Mins | T2025 |
Physical Therapy Assistant -15 Mins | T2025 |
Home Visit Postnatal (Non HBP) Follow-up Care | 99501 |
Home Visit Postnatal (Non HBP) Follow-up Care Audio/Video | 99501 |
Social Worker | G0155 |
HHA visit to patient's home (Day 1-28) by a HH Aide | G0156 |
HHA visit to patient's home (Day 29 and beyond) by a HH Aide | G0156 |
Aide in Home Health or Hospice - 15 Mins | G0156 |
Aide in Home Health or Hospice - 15 Mins - AT | G0156 |
Aide in Home Health or Hospice - 15 Mins - TT | G0156 |
Aide in Home Health or Hospice - 15 Mins - U9 | G0156 |
Aide in Home Health or Hospice - 15 Mins - UD | G0156 |
Dir SNS RN HH/Hospice Set | G0299 |
Dir SNS RN HH/Hospice Set - UB | G0299 |
HHA visit to a patient's home (Day 1-28) by a RN | G0299 |
HHA visit to patient's home (Day 29 and beyond) by a RN | G0299 |
Postpartum Home Nursing Care | G0299 |
HHA visit to a patient's home (Day 1-28) by a LPN | G0300 |
HHA visit to patient's home (Day 29 and beyond) by a LPN | G0300 |
Dir SNS LPN HH/Hospice Set | G0300 |
Dir SNS LPN HH/Hospice Set - UB | G0300 |
PLEASE NOTE: All service providers - It is important you register ALL your service locations. Every NPI & Provider ID (Medicaid ID) should be unique for both home health and personal care services. You will NOT be able to bill Highmark Wholecare for your Medicaid EVV service codes unless all of your service locations for PCS and HHCS are registered through Netsmart and you are completing EVV Visits.
Click here to view instructions on
Self-registering your agency with your designated System Administrator account.
Accessing Training
Click here to Self-Register your agency.
Highmark Wholecare PCS Providers went live with EVV on December 21, 2020. This user group will continue using EVV and should not experience any changes in their workflow.
Netsmart is hosting a LIVE training session to help all HHCS Providers prepare for mandatory compliance with EVV visit data collection.
Please CLICK HERE to register for a LIVE virtual townhall.
Townhalls are scheduled for:
September 13, 2023 at 2:30 PM ET
Click here to view the August 17, 2023 townhall PowerPoint presentation
Click here to find the State Medical Assistance Bulletin.
Thank you,
The Netsmart Team