Summary & Overview
HCPCS T1026: Intensive Multidisciplinary Pediatric Clinic Services, Per Hour
HCPCS Level II code T1026 represents intensive, extended multidisciplinary clinic services for children with complex medical, physical, mental and psychosocial impairments, reported on an hourly basis. The code is designed to capture coordinated, extended-duration care delivered by multidisciplinary teams in outpatient clinic settings for pediatric patients with high-acuity, multifactorial needs. Nationally, the code matters because it distinguishes a resource-intensive, team-based outpatient service from standard office visits and enables payers to identify and reimburse comprehensive care models aimed at children with complex chronic conditions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of the clinical context for T1026, the typical service setting, common modifiers and billing considerations, and where available, national benchmarking and payer coverage patterns. The publication also outlines policy and coding considerations relevant to multidisciplinary pediatric clinic services, and highlights areas where additional documentation and care coordination evidence support appropriate use of T1026.
This summary provides a national perspective for clinicians, coding professionals, and payers seeking clarity on when and how T1026 is used and what aspects of service delivery distinguish it from other outpatient codes.
Billing Code Overview
HCPCS Level II code T1026 describes intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, billed per hour. This service type is multidisciplinary intensive care coordination and therapeutic intervention focused on pediatric patients with complex needs. The typical site of service is a clinic or outpatient multidisciplinary pediatric specialty center, where multiple clinicians and allied health professionals provide coordinated, extended-hour services aimed at stabilizing medical, behavioral, and psychosocial conditions.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 7-year-old child with complex medical and developmental needs attends a multidisciplinary clinic for an intensive care coordination visit billed under T1026. The child has a history of spastic quadriplegic cerebral palsy, chronic aspiration with gastrostomy feeding, recurrent pneumonia, and significant behavioral comorbidity requiring coordination among pediatrics, physical therapy, speech-language pathology, social work, and child psychiatry. The clinic visit is scheduled for one hour of face-to-face, intensive, extended multidisciplinary services in the ambulatory clinic setting. Workflow includes pre-visit chart review and care-plan preparation by the clinic nurse, a coordinated team meeting with the family and representatives from at least three disciplines (for example, pediatrician, speech therapist, and social worker), direct assessment and goal-setting, medication and equipment review, and documentation of a multidisciplinary care plan. Time-based documentation captures the total minutes of multidisciplinary activity, identifies team members present, lists family goals, outlines interventions and referrals, and specifies follow-up arrangements. The encounter may include care coordination tasks such as arranging home nursing, durable medical equipment, school-based services, and behavioral health referrals. Billing uses T1026 reported per hour for the intensive multidisciplinary clinic service, with appropriate modifier(s) appended to reflect unusual circumstances or specific payment adjustments when applicable (for example, different payer rules or service-participation modifiers).
Coding Specifications
| Modifier | Description | When to Use |
|---|