Georgia Electronic Visit Verification (EVV)

In December 2016, Congress enacted the 21st Century Cures Act which requires states to implement Electronic Visit Verification (EVV) for Medicaid-financed Personal Care Services and Home Health Care Services by January 1, 2020 and January 1, 2023, respectively, to avoid a reduction in federal Medicaid funding. The Act contributes to Georgia Medicaid’s mission of providing access to affordable, quality health care services for Medicaid members.

EVV is a technology that automates the gathering of service information by capturing time, attendance and care plan information entered by a home care worker at the point of care. EVV gives providers, care coordinators, and DCH access to service delivery information in real-time to ensure there are no gaps in care throughout the entire course of the service plan. The technology helps to reduce the occurrence of fraud in-home care delivery by removing the elements most closely associated with improper record keeping including paper timesheets and manual billing.

At a minimum, EVV electronically verifies the:

  • Type of service performed;
  • Individual receiving the service;
  • Individual providing the service;
  • Date the service was provided;
  • Location of service delivery; and
  • Time the service begins and ends.

Medicaid-funded Personal Support Services (PSS)/Community Living Supports (CLS) (CPT Codes T1019, T2025, and S9122) for the following waiver programs will be subject to EVV Program requirements:

  • Service Options Using Resources in a Community Environment (SOURCE)
  • Community Care Services Program (CCSP)
  • New Options Waiver (NOW)
  • Comprehensive Supports Waiver Program (COMP)
  • Independent Care Waiver Program (ICWP)
  • Georgia Pediatric Program (GAPP)

See table below for procedure code modifiers:

Electronic Visit Verification (EVV) Home and Community-Based Services (HCBS) Applicable Codes

Elderly and Disabled Waiver (CCSP and SOURCE) 590 and 930
Service Code Modifier 1 Modifier 2 Modifier 3 Modifier 4
Personal Support Service T1019        
Extended Personal Support T1019 TF      
Consumer Directed  PSS T1019 UC      

 

Independent Care Waiver Program (ICWP) 660
Service Code Modifier 1 Modifier 2 Modifier 3 Modifier 4
Personal Support Level 1 T2025 U5 TF    
Personal Support Level II T2025 U5 TG    
Personal Support Consumer Directed T2025 U5 UC    
TBI Personal Support Level 1 T2025 U5 U1 TF  
TBI Personal Support Level II T2025 U5 U1 TG  

 

New Option Waiver (NOW) & Comprehensive Services and Supports (COMP) 680 & 681: COMMUNITY LIVING SUPPORT SERVICES
Service Code Modifier 1 Modifier 2 Modifier 3 Modifier 4
CLS - 1 MEMBER T2025 U4      
CLS - 1 MEMBER T2025 U5      
CLS - 2 MEMBER T2025 U4 UN    
CLS - 2 MEMBER T2025 U5 UN    
CLS - 3 MEMBER T2025 U4 UP    
CLS - 3 MEMBER T2025 U5 UP    

 

New Option Waiver (NOW) & Comprehensive Services and Supports (COMP) 680 & 681: COMMUNITY LIVING SUPPORT SERVICES - SELF-DIRECTED
Service Code Modifier 1 Modifier 2 Modifier 3 Modifier 4
CLS - 1 MEMBER - SELF DIRECTED T2025 U4 UC    
CLS - 1 MEMBER - SELF DIRECTED T2025 U5 UC    
CLS - 2 MEMBER - SELF DIRECTED T2025 U4 UN UC  
CLS - 2 MEMBER - SELF DIRECTED T2025 U5 UN UC  
CLS - 3 MEMBER - SELF DIRECTED T2025 U5 UP UC  
CLS - 3 MEMBER - SELF DIRECTED T2025 U4 UP UC  

 

New Option Waiver (NOW) & Comprehensive Services and Supports (COMP) 680 & 681: COMMUNITY LIVING SUPPORT SERVICES - CO-EMPLOYER
Service Code Modifier 1 Modifier 2 Modifier 3 Modifier 4
CLS - 1 MEMBER - CO-EMPLOYER T2025 U4 UA    
CLS - 1 MEMBER - CO-EMPLOYER T2025 U5 UA    
CLS - 2 MEMBER - CO-EMPLOYER T2025 U4 UN UA  
CLS - 2 MEMBER - CO-EMPLOYER T2025 U5 UN UA  
CLS - 3 MEMBER - CO-EMPLOYER T2025 U5 UP UA  
CLS - 3 MEMBER - CO-EMPLOYER T2025 U4 UP UA  

 

Georgia Pediatric Program (GAPP) 971
Service Code Modifier 1 Modifier 2 Modifier 3 Modifier 4
Skilled Nursing S9122        

 

Home Health Care Services (HHCS): COS 200; Specialty 088 - Home Health Agency Please Note: Prior Authorizations are not required for HHCS services. Physician Orders are required.
Service Code Modifier 1 Units Billed
Speech Therapy 92507   1 unit per day
Physical Therapy 97161   1 unit per day
Physical Therapy 97162   1 unit per day
Physical Therapy 97163   1 unit per day
Physical Therapy 97164   1 unit per day
Occupational Therapy 97165   1 unit per day
Occupational Therapy 97166   1 unit per day
Occupational Therapy 97167   1 unit per day
Occupational Therapy 97168   1 unit per day
Physical Therapy G0151   15 min
Physical Therapy G0151 59 15 min
Occupational Therapy G0152   15 min
Occupational Therapy G0152 59 15 min
Home Health Aide S9122   1 hour
Skilled Nursing S9123   1 hour
Skilled Nursing S9124   1 hour

 

Where can more information be found about Georgia's EVV Implementation?

You can find more details about our EVV implementation along with some printable material to share within the Medicaid community by clicking either of the following links:

Click here for member/member advocacy group information.

Click here for information for service providers.

Click here for DCH's EVV PSS / CLS / Claims Implementation Archive page.

Also, to receive more news and alerts about our efforts towards a successful EVV implementation here in Georgia, you can:

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