Summary & Overview
HCPCS T1023: Screening for Program or Protocol Participation
HCPCS Level II code T1023 denotes a one-encounter screening to determine whether an individual is appropriate for participation in a specified program, project, or treatment protocol. This code captures the evaluative work of intake screening distinct from provision of ongoing treatment and is relevant for programs that require formal eligibility determinations prior to enrollment. Nationally, clear capture of screening encounters affects program staffing, billing compliance, and the tracking of access to specialized services.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what T1023 represents, typical sites of service, and which payers commonly recognize screening services. The publication outlines benchmarks and billing considerations where available, summarizes common modifier usage patterns, and provides clinical context for when a discrete screening encounter would be billed separately from subsequent program services.
The content is intended for billing professionals, program administrators, and policy analysts seeking a national perspective on coding for program eligibility screening. Data not available in the input is clearly identified where applicable.
Billing Code Overview
HCPCS Level II code T1023 describes a screening encounter to determine an individual’s appropriateness for participation in a specified program, project, or treatment protocol. The service type is screening and eligibility assessment for program or protocol participation. The typical site of service is an outpatient clinic or program intake setting, including specialty program enrollment offices and community-based service sites where initial screening and eligibility determination are conducted.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient contacts a community mental health center seeking enrollment in an intensive outpatient program for substance use disorder. The clinic schedules a screening encounter to determine eligibility for the program. During the visit a licensed clinician reviews the patient’s medical and psychiatric history, conducts a substance use assessment, evaluates current medical stability, documents contraindications to program participation, reviews program requirements (frequency, group vs individual components), and determines whether additional medical clearing or specialist referral is required. The screening encounter typically lasts 30–60 minutes and may include standardized instruments, brief physical assessment, and coordination with the patient’s primary care clinician or insurer to confirm coverage and authorization. If appropriate, the clinician completes intake paperwork and schedules the patient for program initiation; if not appropriate, the clinician documents reasons for exclusion and refers the patient to alternative services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the screening required substantially greater effort, time, or intensity than typical and documentation supports the medical necessity for increased work. |
23 |