TMPPM 2007 >42.6.4.1 Nursing Services Billing Table


POS*	Procedure Code	Individual or Group	Unit of Service
1, 2, or 9	1-T1002 with modifier TD	Individual	15 minutes
1, 2, or 9	1-T1002 with modifier TD-UD	Group	15 minutes
1, 2, or 9	1-T1502 with modifier TD		Medication administration, per visit
1, 2, or 9	1-T1002 with modifier U7	Delegation, individual	15 minutes
1, 2, or 9	1-T1002 with modifier U7-UD	Delegation, group	15 minutes
1, 2, or 9	1-T1502 with modifier U7		Delegation, medication administration, per visit
1, 2, or 9	1-T1003 with modifier TE	Individual	15 minutes
1, 2, or 9	1-T1003 with modifier TE-UD	Group	15 minutes
1, 2, or 9	1-T1502 with modifier TE		Medication, administration per visit
*Place of Service: 1=office/school; 2=home; 9=other locations Modifier TD = nursing services provided by an RN or APN Modifier U7 = nursing services delivered through delegation. Modifier TE = nursing services delivered by an LVN/LPN

While the procedure code descriptions specifically state "up to 15 minutes," the Medicaid-allowable fee is determined based on 15-minute increments. Therefore, providers must use a 15-minute unit of service for billing.

All of the nursing services minutes that are delivered to a student during a calendar day must be added together before they are converted to units of service. Do not convert minutes of nursing services separately for each nursing task that was performed.

Minutes of nursing services cannot be accumulated over multiple days. Minutes of nursing services can only be billed per calendar day. If the total number of minutes of nursing services is less than eight minutes for a calendar day, then no unit of service can be billed for that day, and that day's minutes cannot be added to minutes of nursing services from any previous or subsequent days for billing purposes.

The recommended maximum billable time for direct nursing services is four hours per day. The recommended maximum billable units for procedure code 1-T1502 with modifier TD, 1-T1502 with modifier U7, or 1-T1502 with modifier TE is a cumulative of four medication administration visits per day. Providers must submit documentation of the reasons for the additional time, if more than the recommended maximum time is billed.