Community First Choice (CFC) Procedure Codes & Modifiers for Children under Age 21

Date: 05/03/16

The Texas Health and Human Services Commission (HHSC) has provided guidance for providers delivering Community First Choice (CFC) services for Superior’s STAR Health members or STAR+PLUS members under the age of 21.

Effective June 1, 2016, providers will be required to bill using the procedure codes and modifiers noted below:

Procedure Code	Moddifier 1	Modifier 2	Modifier 3	Modifier 4	Units	Service Description
T1019	UD				15 minutes= 1 unit	Attendants Only
T1019	U3				15 minutes= 1 unit	PCS Consumer Directed Services (CDS) Attendant Care
T1019	U1				15 minutes= 1 unit	PCS Service Responsibility Option Model

Procedure Code	Moddifier 1	Modifier 2	Modifier 3	Modifier 4	Units	Service Description
T1019	U9				15 minutes= 1 unit	Habilitation
T1019	U4				15 minutes= 1 unit	Habilitation Consumer Directed Option
T1019	U2				15 minutes= 1 unit	Habilitation Service Responsibility Option Model

Superior will update existing authorizations from June 1 forward to accommodate the new procedure codes immediately following the effective date. References: A complete listing of CFC procedure codes and modifiers can be found on the LTSS Billing Matrix (STAR+PLUS) or the Fee Schedule (STAR Health) with the exception of PCS. For questions, please contact Provider Services at 1-877-391-5921. For a complete listing of provider trainings and resources, please visit SuperiorHealthPlan.com.