T1017 Targeted Case Management Reimbursement

HCPCS Level II code T1017 represents targeted case management billed in 15-minute increments, a time-based mechanism for documenting focused care coordination services. Targeted case management is used when care managers or qualified staff provide discrete, need-based interventions—such as service planning, linkage to community resources, and monitoring—to specific patient populations. Nationally, this code matters because it standardizes reimbursement for non-clinical but clinically relevant activities that support patient access, adherence, and transitions of care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how T1017 is defined and used, what typical service settings look like, and which payers are relevant for coverage considerations. The publication also outlines the types of benchmarks and policy updates to expect, including utilization patterns, time-based billing practices, and coverage guidance trends. Clinical context explains the role of targeted case management within care teams and its relevance for populations with complex social and medical needs. Data gaps in the input are noted where applicable; specific modifier, taxonomy, and diagnosis mappings are not provided in the source material. This summary is intended for a national audience of health policy analysts, billing professionals, and care program leads seeking a clear briefing on HCPCS Level II code T1017.

Billing Code Overview

HCPCS Level II code T1017 denotes targeted case management, billed in increments of each 15 minutes. This service represents focused care coordination and case management activities directed at specific patient needs, typically delivered by care managers, social workers, or other qualified staff.

Service type: Targeted case management and care coordination services delivered in time-based units
Typical site of service: Community-based settings, outpatient clinics, patient homes, or other non-acute care environments where case management activities occur

Data not available in the input.

Clinical Context

A care coordinator provides T1017 Targeted case management in 15-minute increments for a community-dwelling adult with complex behavioral health and social needs. The patient is a 42-year-old with serious mental illness and unstable housing who requires linkage to housing services, coordination of behavioral health appointments, medication adherence support, and communication with the patient’s primary care and community mental health team. The workflow begins with an initial assessment by the case manager (telephonic or face-to-face), development of a focused care plan, targeted contacts to arrange behavioral health or social services, documentation of barriers and progress, and periodic reassessment. Each documented 15-minute unit of direct case management time applying problem-focused activities such as care coordination, resource referral, benefit assistance, and appointment scheduling is billed as one unit of T1017. Typical sites of service include outpatient clinics, community mental health centers, patient homes, and telehealth settings where non-clinical case management is provided.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the case management required substantially greater effort or time than typical and documentation supports unusual complexity.

Taxonomy Code	Specialty	Notes
`251B00000X`	Mental Health Counselor	Common providers delivering targeted case management for behavioral health populations.
`251L00000X`	Social Worker	Frequently performs care coordination, resource linkage, and benefits assistance.
`174400000X`	Community Health Worker	Performs outreach, navigation, and home-based case management activities.
`2084P0800X`	Behavioral Health & Social Service Providers	Includes case managers working within community behavioral health programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F20.9`	Schizophrenia, unspecified	Serious mental illness commonly requiring targeted case management for medication adherence and social supports.
`F32.9`	Major depressive disorder, single episode, unspecified	Depression with functional impairment that benefits from coordination of behavioral health services.
`F33.1`	Major depressive disorder, recurrent, moderate	Recurrent mood disorder often requiring linkage to therapy and community resources via case management.
`F29`	Unspecified psychosis not due to a substance or known physiological condition	Psychotic symptoms that necessitate targeted care coordination and monitoring.
`Z59.0`	Homelessness	Social determinant frequently addressed by case management through housing linkage and support services.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation	May precede targeted case management when initial psychiatric assessment is required to determine service needs.
`90832`	Psychotherapy, 30 minutes with patient	Can be provided alongside case management on the same day as a distinct therapeutic service.
`99406`	Smoking and tobacco-use cessation counseling, intermediate, 3-10 minutes	Example of a brief counseling service that may be billed during coordinated visits when separately documented.
`99407`	Smoking and tobacco-use cessation counseling, intensive, greater than 10 minutes	Used when more intensive counseling occurs in addition to case management and is separately documented.
`99354`	Prolonged service in the outpatient setting, direct patient contact; first hour (list separately in addition to code for outpatient E/M)	May be reported when prolonged face-to-face care management time is provided beyond usual service time, documented separately from `T1017` billing.

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Summary & Overview

HCPCS T1017: Targeted Case Management, 15-Minute Unit