ppatche 5 years ago in Codes/Rates/Diagnosis Modules updated by Jeremy Roelofs-Lynch 4 years ago 10

Has anyone been successful in setting up code T1016 in Procentive and getting paid by insurances?

I'm looking into this code today.  Any update?  I'm curious if anyone else is billing Case Coordination, and for which programs, to which payers.

It looks like there is verbiage in the claim manuals for this code in Medica, CCS, UCare, BCBS, and PW.  Limited and somewhat confusing info from DHS on this code, but was linked to the chapter 12 update of the Medicare Claims Processing Manual with SUID that went out on 11/30/18.  

This is really the only info I could find.

We are getting payment on T1016 from CCDTF, most counties and a few PMAPs. Still going back and forth with a few payers who are not using it. 

We are also getting paid for Care Coordination.  The most trouble we have had is with Commercial BCBS


Hi Kelly,

Have you had any luck with BCBS Commercial paying this code?


Awesome!  Is there anything specific I need to know to use it?  I know it's in 15 min increments.  For CD do you use the HF mod?  And is anyone using it for programs other than ChemDep?

T1016 U8 HN but make sure you are using the correct Rev code

Are we able to get reimbursement for this code on the same DOS and provider as an H0001?

Hi Kim - we have received payment on the same day as the H0001. We do have open cases with DHS right now because for some reason their system was denying the H0038 when done on the same day as H0001.

Thank you Jeremy. We will be billing the T1016 code, but should work as well?

Yes, we have not had problems with the T1016 code.