Effective June 1, 2011, the PCS and PCS-Plus programs will end, and be replaced by two new In-home care (IHC) programs. The memo from CCME regarding this is available at
http://www.thecarolinascenter.org/documents/IHCInformationSheetforProviders201105v.3.pdf
Basically, the billing process is the same, but the codes used for services will change. The HCPCS code will still be S5125, but with modifiers to identify whether the patient is under 21 years old or not. (HA is child/under 21, HB is adult/over 21)
In order to implement this change in Barnestorm, you need to do three things:
(1) make sure the patient’s date of birth is correct;
(2) set up a new job code for IHCC with HCPCS = S5125 and modifier HA, a start date of 6/1/11 and the same rate you currently charge for PCS;
(3) set up a new job code for IHCA with HCPCS = S5125 and modifier HB, a start date of 6/1/11 and the same rate you currently charge for PCS.
Before June 1, you will continue to bill using PCS and PCS-Plus codes:
Service Code Modifier Description End Date
PCS S5125 None Up to 60 hours per month May 31, 2011
PCS-Plus 99509 None More than 60 hours per month May 31, 2011
After June 1, you will bill using IHC codes:
Service Code Modifier Description Effective Date
IHCC S5125 HA Attendant Care Services; per
15 minutes June 1, 2011
IHCA S5125 HB Attendant Care Services; per
15 minutes June 1, 2011
As charges are being keyed, the patient’s age on the date of service will be used to match against the modifier HA or HB to make sure the correct job code is being used, and to make sure that either HA or HB is being used. This only applies to payer codes with a Format = E, which will still be used to identify PCS/IHC patients.