T1022 Contracted Home Health (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS T1022: Contracted Home Health Agency Services, Per Day

HCPCS Level II code T1022 designates a per‑day payment for contracted home health agency services, capturing all services furnished under a contractual arrangement. Nationally, this code matters because it identifies bundled daily care provided in the patient’s home or residential setting and is used in claims to reflect contract-based home health arrangements rather than individual line-item home health visits. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what T1022 represents clinically and operationally, which payers commonly accept or process the code, and how the code is applied in the context of home-based care delivery. The publication outlines national benchmarks where available, summarizes relevant policy considerations and billing guidance, and provides clinical context for use of per‑day contracted home health reporting. Data not available in the input for associated taxonomies, ICD‑10 diagnoses, and related codes is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareT1022HCPCS Level IIhome healthcontracted servicesper day billinghome carebilling guidelinesclaims coding

Billing Code Overview

HCPCS Level II code T1022 represents contracted home health agency services, all services provided under contract, per day. This code denotes a daily payment for a full range of home health services delivered by a contracted home health agency under a single contract.

Service type: Home health agency services provided under contract, encompassing routine skilled and non-skilled services delivered as part of a contracted arrangement.
Typical site of service: Patient home or residential setting where home health services are furnished under contract.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient is a homebound older adult with multiple chronic conditions (for example, congestive heart failure, advanced chronic obstructive pulmonary disease, or post-acute surgical recovery) enrolled in a contracted home health agency program. The patient requires daily oversight, skilled nursing visits for medication management, wound care, and intermittent therapy services delivered under a contractual arrangement between the home health agency and a payer or provider. The clinical workflow begins with a physician or authorized clinician ordering home health services and certifying the need for skilled care. A contracted home health agency is activated under the contract; an intake nurse conducts an initial home assessment, documents baseline vital signs, medication reconciliation, and develops the plan of care. Daily services billed under T1022 reflect all services provided by the agency on that calendar day under the contract, including skilled nursing visits, therapy visits, homemaker assistance covered under the contract, care coordination, and necessary supplies. Nursing notes, therapy documentation, and progress reports are maintained in the patient record; any skilled encounters supporting medical necessity are dated and signed. Utilization review and billing staff aggregate per-day service details to support the T1022 claim, attaching applicable modifiers for unusual circumstances or cost sharing as required by the payor contract. Typical sites of service are the patient’s private residence, assisted living residence, or licensed group home when services are delivered under the contracted home health agency arrangement.

Coding Specifications

Modifier	Description	When to Use

HCPCS T1024: Integrated Specialty Team Evaluation and Treatment for Severely Handicapped Children

HCPCS-T2013-HABILITATION-EDUCATIONAL-WAIVER-HOURLY

HCPCS Level II T2013: Habilitation Educational Waiver, Per Hour

HCPCS-T1013-SIGN-LANGUAGE-ORAL-INTERPRETATION-15-MIN

HCPCS Level II T1013: Sign Language or Oral Interpretive Services, per 15 Minutes

HCPCS-T1003-LPN-LVN-SERVICES-15-MINUTES

HCPCS T1003: LPN/LVN Services, Up to 15 Minutes

HCPCS-T4544-ADULT-DISPOSABLE-INCONTINENCE-PULL-ON-ABOVE-XL

HCPCS T4544: Adult Disposable Protective Underwear, Above Extra Large

HCPCS-T2010-PASRR-LEVEL-I-IDENTIFICATION-SCREEN

HCPCS T2010: PASRR Level I Identification Screening

HCPCS-T1502-MEDICATION-ADMINISTRATION-ORAL-IM-IM-SC-PER-VISIT

HCPCS T1502: Administration of Oral, IM, or SC Medication per Visit

HCPCS-T2001-NON-EMERGENCY-TRANSPORTATION-PATIENT-ESCORT

HCPCS Level II T2001: Non-Emergency Transportation, Patient Attendant

HCPCS-T2019-HABILITATION-SUPPORTED-EMPLOYMENT-WAIVER

HCPCS T2019: Habilitation Supported Employment, Per 15 Minutes

HCPCS-LEVEL-II-T2047-HABILITATION-PREVOCATIONAL-WAIVER

HCPCS Level II T2047: Habilitation Prevocational Waiver Service

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`22`	Increased procedural services	Use when the contracted agency provides services with substantially greater complexity or resources than typical for the day and documentation supports higher intensity.
`23`	Unusual anesthesia	Rarely used; apply if anesthesia-related services within the day are unusual and documented (very uncommon for standard home health billing).
`52`	Reduced services	Use when the agency provides fewer services than initially planned for the day but still bills the contracted daily rate adjusted per payer rules.
`53`	Discontinued procedure	Apply if planned home health services for the day were started but discontinued due to patient or clinical reasons; documentation must support discontinuation.
`54`	Surgical care only	Not commonly applicable to `T1022`; use only if billing pertains to surgical care component within the contracted service day and payer allows.
`55`	Postoperative management only	Use when only postoperative management is provided under the contract for that day and separate surgical services are billed elsewhere.
`56`	Preoperative management only	Use when only preoperative management is provided under the contract for that day.
`62`	Two surgeons	Use when two distinct contracted agencies or practitioners provide services requiring coordination and both meet payer criteria for shared service reporting.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Rare for home health; use only if applicable per payer contract when advanced practice clinicians assist in a procedural event covered during the day.
`CO`	Services provided by an employed provider of the beneficiary	Use when the contracted agency is employed by the beneficiary or closely affiliated and payer policy requires cost-based modifier reporting.
`CQ`	Service furnished under a federal qualified health center (FQHC) look-alike	Use when the contracted agency services meet FQHC look-alike status and payer requires this designator.
`FX`	Service provided by a nonparticipating physician	Use when a nonparticipating contracted provider furnishes services under the agency contract and payer rules require this modifier.
`FY`	Service provided by a nonparticipating or out-of-network provider	Use when the contracted agency or practitioner is out-of-network and payer requires explicit reporting.
`HO`	Service provided under a home health value-based care arrangement	Use when services are part of a home health value-based payment model and payer requires this modifier.
`QX`	Qualified non-physician practitioner service: modifier to indicate NPI QX/QY/QK reporting	Use when services are delivered by a qualified non-physician practitioner under contract and payer requires identification of the supervising/incident NP/PA.

Taxonomy Code	Specialty	Notes
251B00000X	Home Health Agency	Primary supplier of skilled nursing and therapy services in the home setting.
363L00000X	Physical Therapist	Provides home-based physical therapy visits included in the contracted daily service mix.
367A00000X	Occupational Therapist	Provides home-based occupational therapy for activities of daily living under the contract.
3336A0002X	Registered Nurse	Skilled nursing assessments and care management performed in the home.
207Q00000X	Physician (Family Medicine)	Referring and certifying clinician overseeing the home health plan of care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z74.3`	Need for continuous supervision	Common reason for contracting comprehensive home health daily services when patients require ongoing supervision.
`Z74.01`	Bed confinement status	Relevant for patients who are homebound and receive contracted daily home health services.
`I50.9`	Heart failure, unspecified	Patients with heart failure frequently require daily nursing and monitoring through contracted home health services.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	COPD patients often receive home-based skilled care and respiratory therapy under a daily contract.
`M86.9`	Osteomyelitis, unspecified	Complex wound or infection management at home may be included in contracted daily services for skilled nursing.
`Z51.89`	Encounter for other specified aftercare	Follow-up care after hospitalization or surgery that is delivered under a contracted home health daily service.
`R69`	Illness, unspecified	Used when specific diagnosis is evolving but daily contracted home health oversight is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99500`	Home visit for expansion of services (emergency or urgent)	May be performed by agency clinicians for urgent home visits that fall within the contracted daily services billed under `T1022`.
`99501`	Home visit for expansion of services (non-emergency)	Used for non-emergent additional home visits by clinicians that complement the per-day contracted services.
`97597`	Debridement; selective debridement, open wound, without anesthesia	Wound care procedures performed by home health clinicians during the contracted service day; billed separately if payer allows.
`96161`	Developmental testing, first hour (e.g., for case management/screening)	Assessment services that may be provided as part of the multidisciplinary contracted care during a day; bill per payer rules.
`99341`	Home visit for established patient, typically 20 minutes	Face-to-face visits by physicians in the home that may accompany or support home health agency services; billed separately from `T1022` when applicable.
`G0154`	Services performed by a qualified social worker in the home health or hospice setting	Social work or care coordination services delivered under the contract and billed per payer rules, often accompanying `T1022`.

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