Summary & Overview
HCPCS Level II T1030: Nursing Care in Home by Registered Nurse, Per Diem
HCPCS Level II code T1030 designates per diem skilled nursing care provided by a registered nurse in the patients home. This code is used to bill episodic, day-based home nursing services and is a key identifier for tracking utilization of skilled home nursing nationally. Home-based skilled nursing supports transitions from institutional care, ongoing chronic disease management, and efforts to reduce avoidable hospital visits.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on how T1030 is applied across major commercial payers and Medicare, along with benchmarking context, relevant policy issues affecting home nursing reimbursement, and the clinical situations where per diem registered nurse services are typically billed. The publication covers billing practice considerations, common modifier use (listed separately), and where available, payer-specific coverage patterns and documentation expectations.
This summary provides stakeholders—billing professionals, home health agencies, and policy analysts—with an overview of the codes purpose, its role in home-based skilled care, and the topics addressed in the full publication, including benchmarks, policy updates, and clinical context. Data not available in the input will be noted in the detailed sections.
Billing Code Overview
HCPCS Level II code T1030 represents nursing care, in the home, by registered nurse, per diem. This service covers skilled nursing provided by a registered nurse delivered in a patients home setting on a per-day basis. The service type is skilled nursing care. The typical site of service is the patients home or residence.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A homebound adult patient with multiple chronic conditions (for example, congestive heart failure, chronic obstructive pulmonary disease, and limited mobility) receives skilled nursing assessment and treatment delivered by a registered nurse in the patient’s residence. The RN documents a comprehensive per diem plan of care that includes medication teaching, wound inspection and dressing changes, intravenous access assessment, vital signs monitoring, and caregiver education. Visits are coordinated through a home health agency; the RN arrives at the scheduled time, performs the ordered skilled services, records findings in the home health record, communicates changes to the referring physician, and updates the interdisciplinary plan of care. Billing is submitted using T1030 to report nursing care, in the home, by a registered nurse, per diem, with appropriate modifier(s) attached when specific circumstances apply (for example, unusual services, concurrent billing situations, or telehealth attachments). Care coordination often involves communication with primary care, home health aides, physical therapy, and durable medical equipment suppliers as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Used when no additional billing modifier applies to the per diem service |
22 | Increased procedural services | Use when the RN provides substantially greater than normal services during the per diem that are documented and meet payor criteria |
23 | Unusual anesthesia | Not typically used for T1030; included if an unusual anesthesia circumstance is documented and required by payor (rare) |
52 | Reduced services | Use when the per diem nursing visit is partially performed or curtailed and documentation supports reduced service |
53 | Discontinued procedure | Use if the per diem nursing service was initiated but discontinued for documented clinical reasons |
55 | Postoperative management only | Use when the RN documents only postoperative management activities covered under the per diem without other skilled procedures |
56 | Preoperative management only | Rare for home RN per diem; use if only preoperative management is provided in the home setting |
62 | Two surgeons | Not typical for home RN per diem; apply only if an unusual billing arrangement applies per payor guidance |
AS | Physician assistant, surgical assist | Not typical for T1030; include when billing systems require an assist modifier for concurrent provider roles |
CO | Cast care (example) / Contracted care indicator | Use per payor definition where a contract-specific modifier is required to indicate contracted provider relationships |
CQ | Service furnished as part of a public health emergency | Use when per diem nursing care is provided under public health emergency provisions and the payor requires this modifier |
FY | Item or service furnished by resident without faculty | Not typical for home RN per diem; include when supervised trainees provide the service and payor requires this indicator |
GT | Via interactive audio and video telecommunication systems | Use when portions of the nursing per diem include synchronous telehealth nursing services and the payor accepts GT with T1030 |
QX | Qualified non-physician practitioner billing under their own NPI | Use when a qualifying non-physician practitioner bills independently for nursing-related services tied to the per diem encounter |
QY | Attending surgeon or billing practitioner | Use if payor requires designation of the primary billing practitioner in complex care coordination scenarios |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
163W00000X | Home Health Registered Nurse | Primary provider type performing T1030 services in the home setting |
163WF0200X | Wound care nurse | RN specialty commonly providing skilled wound assessment and dressing changes during per diem visits |
163WH0000X | Hospice and Palliative Care Nurse | RN specialty providing home per diem nursing for end-of-life symptom management |
174400000X | Physical Therapist (PT) | Commonly collaborates with RN in home care; may not bill T1030 but is part of the care team |
261QM0800X | Case Manager Nurse | Coordinates visits, communicates with payors and physicians for home per diem services |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.9 | Heart failure, unspecified | Common reason for home nursing visits for monitoring weight, medication adherence, and symptoms |
J44.9 | Chronic obstructive pulmonary disease, unspecified | Home RN monitors respiratory status, oxygen use, and teaches inhaler/oxygen techniques |
Z74.3 | Need for continuous supervision | Indicates functional limitations that justify home nursing per diem services |
Z79.899 | Other long term (current) drug therapy | Documents chronic medication regimens that require RN medication education and monitoring in the home |
L89.309 | Pressure ulcer of sacral region, stage 3, unspecified | Wound care and dressing changes are common skilled tasks performed during per diem nursing visits |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99507 | Home visit for collection of specimens (blood, urine) by medical personnel | RN may collect specimens during the per diem home visit and documentation supports specimen collection billing when applicable |
99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal problems | Low-complexity nursing assessments documented during the home visit can correspond to services similar in intensity to 99211 when local billing policies permit |
96365 | Intravenous infusion, initial, up to 1 hour | RN-delivered IV medication administration in the home may be billed alongside per diem nursing when payor rules permit separate infusion service billing |
97597 | Debridement, open wound, first 20 sq cm or less | Skilled wound debridement performed by an RN during a home visit may be billed when documentation meets clinical and payor requirements |
99499 | Unlisted evaluation and management service | Use for reporting additional unique skilled services performed in the home that are not described by other CPT codes when allowed by payor policy |