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HCPCS T1031: Nursing Care in the Home by Licensed Practical Nurse, Per Diem

HCPCS Level II code T1031 designates per diem nursing care provided in the home by a licensed practical nurse (LPN). This code captures full-day skilled nursing services delivered at patients’ residences and is relevant for home health agencies, home-based care programs, and payers that reimburse domiciliary skilled nursing. Nationally, accurate use of T1031 affects payment for LPN-delivered services and supports billing consistency for home-based skilled nursing.

Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise view of what T1031 represents clinically and operationally, how major payers handle coverage in general terms, and which benchmarks and policy elements commonly appear in payer manuals. The publication outlines service definitions, typical sites of service, common modifiers seen on related claims (listed separately), and contextual notes on documentation and billing practice. It also identifies where input was not provided: associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific reimbursement benchmarks are not included in the input and are noted as unavailable.

This summary is intended for billing managers, compliance officers, and policy analysts who need a clear, national-level description of T1031 for coding, claims review, and program design.

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Billing Code Overview

HCPCS Level II code T1031 describes nursing care, in the home, by a licensed practical nurse, per diem. This service represents a full day of skilled nursing care delivered in a patient’s residence by a licensed practical nurse (LPN). The service type is skilled nursing (LPN-delivered) and the typical site of service is the patient’s home (home health/home-based care).

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HCPCS T1031: Nursing Care in the Home by Licensed Practical Nurse, Per Diem

This summary is intended for billing managers, compliance officers, and policy analysts who need a clear, national-level description of T1031 for coding, claims review, and program design.

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Billing Code Overview

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Clinical & Coding Specifications

Clinical Context

A typical patient receiving T1031 is an adult or pediatric patient who requires licensed practical nurse (LPN/LVN) skilled nursing care in the home on a per diem basis. Example scenario: an elderly patient recently discharged after congestive heart failure exacerbation is homebound and requires daily skilled medication administration, wound dressing changes, and teaching to family caregivers. The clinical workflow begins with a home health agency assessment, physician orders for home nursing services, development of a plan of care, assignment of an LPN/LVN for specified visits per day, documentation of skilled nursing tasks (medication administration, wound care, monitoring vital signs, reporting changes to the supervising RN or physician), and periodic clinical reassessment. Visits are billed per diem under T1031 for the LPN/LVN component of home nursing when state and payer rules allow LPN/LVN per diem billing. Coordination with the supervising registered nurse, primary care provider, and durable medical equipment or therapy services occurs as needed; outcomes documented include symptom control, wound healing progress, medication adherence, and caregiver competency. Typical sites of service: patient residence or private residence of family members, assisted living residence when billed as home health, or other community-based domiciliary settings consistent with home health coverage rules.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work or complexity of the nursing service is substantially greater than typical per diem and payer allows modifier on HCPCS Level II billing.
`23`	Unusual anesthesia	Not commonly used for `T1031`; include only if an anesthesia-related service component is present and documented.
`52`	Reduced services	Use when the LPN/LVN provided fewer services than planned for the billed per diem.
`53`	Discontinued procedure	Use if nursing visit was initiated but discontinued due to patient condition or transfer before meaningful service.
`54`	Surgical care only	Not typically applicable to `T1031`; avoid unless billing split for perioperative nursing care is required by payer.
`55`	Postoperative management only	Not typically applicable; use only if LPN/LVN provided strictly postoperative home management and payer requires modifier.
`56`	Preoperative management only	Uncommon for this code; include only per payer rule.
`62`	Two surgeons	Not applicable to home nursing; rarely used and typically not appended to `T1031`.
`CO`	Catastrophe/disaster related	Use when services are related to a declared disaster and payer recognizes the modifier for claim processing.
`CQ`	Medical direction by a physician: more than four concurrent anesthesia cases	Not applicable to `T1031` unless payer-specific direction codes are required.
`GT`	Via interactive audio and video telecommunication	Use when a portion of nursing management is delivered real-time via telehealth and payer allows telehealth modifier with home health per diem.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable to routine LPN/LVN home nursing.
`QX`	CRNA service: with medical direction by a physician	Not applicable.
`QY`	Surgical care: more than four concurrent anesthesia cases	Not applicable.
`SJ`	Locum tenens	Use when an LPN/LVN employed as temporary staff provides the billed per diem and payer accepts locum designation.

Taxonomy Code	Specialty	Notes
`163W00000X`	Home Health Aide	Provides supportive personal care often coordinated with LPN/LVN skilled services; listed for clarity in team-based domiciliary care.
`3336C0003X`	Home Health Agency	Organizational taxonomy representing agencies that bill and deliver `T1031` home nursing services.
`313E00000X`	Licensed Practical/Vocational Nurse	Primary provider specialty associated with `T1031` billing.
`163W00000X`	Registered Nurse (Home Health)	Supervising RN coordinates LPN/LVN care; included as common collaborative specialty.
`207Q00000X`	Family Medicine	Common referring/source physician managing the plan of care for home health patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.9`	Heart failure, unspecified	Frequent reason for home nursing per diem for medication administration, monitoring weights and vitals, and caregiver teaching.
`J18.9`	Pneumonia, unspecified organism	May require home nursing for inhaled therapies, oxygen monitoring, and medication administration post-discharge.
`E11.9`	Type 2 diabetes mellitus without complications	Home nursing provides wound care, glucose monitoring assistance, and education to prevent complications.
`L89.309`	Pressure ulcer of sacral region, unspecified stage	Commonly associated with skilled home nursing for dressing changes and pressure injury monitoring.
`Z74.01`	Bed confinement status	Indicates homebound or limited mobility status prompting per diem nursing care.
`Z48.02`	Encounter for removal of sutures and staples	Follow-up procedural wound care that may be performed or coordinated during LPN/LVN home visits.
`M19.90`	Osteoarthritis, unspecified site	Mobility limitations and pain management needs that often prompt home nursing support for activities of daily living and medication management.
`R60.0`	Localized edema	Monitoring and leg care assistance frequently provided by home nurses.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99507`	Home visit for evaluation and management of patient, typically 15 minutes	May be performed by clinicians for episodic home E/M visits that complement the per diem nursing services billed under `T1031`.
`99341`	Home visit for established patient, typically 20 minutes	Used for physician or qualified nonphysician practitioner home visits that occur in conjunction with ongoing LPN/LVN home nursing care.
`97597`	Debridement (e.g., high-pressure irrigation) selective removal of devitalized tissue	Performed when advanced wound care is needed; LPN/LVN may assist or provide dressing changes as part of `T1031` but debridement is billed separately if performed by appropriate clinician.
`96372`	Therapeutic, prophylactic, or diagnostic injection (e.g., IM, subcutaneous)	Medication administration performed by LPN/LVN during the per diem visit and may be reported if payer allows concurrent CPT reporting alongside HCPCS per diem.
`99441`	Telephone E/M by a physician or other qualified health care professional, 5-10 minutes of medical discussion	Telephone management by the supervising clinician that documents changes based on LPN/LVN assessment during home visits.

HCPCS Level II T1030: Nursing Care in Home by Registered Nurse, Per Diem

HCPCS-LEVEL-II-T2014-PREVOCATIONAL-HABILITATION-PER-DIEM

HCPCS Level II T2014: Habilitation Prevocational Waiver Per Diem

HCPCS-LEVEL-II-T2020-DAY-HABILITATION-WAIVER-PER-DIEM

HCPCS Level II T2020: Day Habilitation, Waiver; Per Diem

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

HCPCS Level II T2047: Habilitation Prevocational Waiver Service

HCPCS-LEVEL-II-T4535-DISPOSABLE-INCONTINENCE-LINER-PAD

HCPCS Level II T4535: Disposable Incontinence Liner/Pad

HCPCS-LEVEL-II-T4538-REUSABLE-DIAPER-PER-DIAPER

HCPCS Level II T4538: Diaper Service, Reusable Diaper, Each Diaper

HCPCS-T1000-PRIVATE-DUTY-LICENSED-NURSING-15-MIN

HCPCS T1000: Private Duty Licensed Nursing, 15-Minute Units

HCPCS-T1001-NURSING-ASSESSMENT-EVALUATION

HCPCS T1001: Nursing Assessment / Evaluation

HCPCS-T1002-RN-SERVICES-15-MINUTES

HCPCS T1002: Registered Nurse Services, Up to 15 Minutes

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

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

Showing 1–10 of 113

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work or complexity of the nursing service is substantially greater than typical per diem and payer allows modifier on HCPCS Level II billing.
`23`	Unusual anesthesia	Not commonly used for `T1031`; include only if an anesthesia-related service component is present and documented.
`52`	Reduced services	Use when the LPN/LVN provided fewer services than planned for the billed per diem.
`53`	Discontinued procedure	Use if nursing visit was initiated but discontinued due to patient condition or transfer before meaningful service.
`54`	Surgical care only	Not typically applicable to `T1031`; avoid unless billing split for perioperative nursing care is required by payer.
`55`	Postoperative management only	Not typically applicable; use only if LPN/LVN provided strictly postoperative home management and payer requires modifier.
`56`	Preoperative management only	Uncommon for this code; include only per payer rule.
`62`	Two surgeons	Not applicable to home nursing; rarely used and typically not appended to `T1031`.
`CO`	Catastrophe/disaster related	Use when services are related to a declared disaster and payer recognizes the modifier for claim processing.
`CQ`	Medical direction by a physician: more than four concurrent anesthesia cases	Not applicable to `T1031` unless payer-specific direction codes are required.
`GT`	Via interactive audio and video telecommunication	Use when a portion of nursing management is delivered real-time via telehealth and payer allows telehealth modifier with home health per diem.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable to routine LPN/LVN home nursing.
`QX`	CRNA service: with medical direction by a physician	Not applicable.
`QY`	Surgical care: more than four concurrent anesthesia cases	Not applicable.
`SJ`	Locum tenens	Use when an LPN/LVN employed as temporary staff provides the billed per diem and payer accepts locum designation.

Taxonomy Code	Specialty	Notes
`163W00000X`	Home Health Aide	Provides supportive personal care often coordinated with LPN/LVN skilled services; listed for clarity in team-based domiciliary care.
`3336C0003X`	Home Health Agency	Organizational taxonomy representing agencies that bill and deliver `T1031` home nursing services.
`313E00000X`	Licensed Practical/Vocational Nurse	Primary provider specialty associated with `T1031` billing.
`163W00000X`	Registered Nurse (Home Health)	Supervising RN coordinates LPN/LVN care; included as common collaborative specialty.
`207Q00000X`	Family Medicine	Common referring/source physician managing the plan of care for home health patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.9`	Heart failure, unspecified	Frequent reason for home nursing per diem for medication administration, monitoring weights and vitals, and caregiver teaching.
`J18.9`	Pneumonia, unspecified organism	May require home nursing for inhaled therapies, oxygen monitoring, and medication administration post-discharge.
`E11.9`	Type 2 diabetes mellitus without complications	Home nursing provides wound care, glucose monitoring assistance, and education to prevent complications.
`L89.309`	Pressure ulcer of sacral region, unspecified stage	Commonly associated with skilled home nursing for dressing changes and pressure injury monitoring.
`Z74.01`	Bed confinement status	Indicates homebound or limited mobility status prompting per diem nursing care.
`Z48.02`	Encounter for removal of sutures and staples	Follow-up procedural wound care that may be performed or coordinated during LPN/LVN home visits.
`M19.90`	Osteoarthritis, unspecified site	Mobility limitations and pain management needs that often prompt home nursing support for activities of daily living and medication management.
`R60.0`	Localized edema	Monitoring and leg care assistance frequently provided by home nurses.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99507`	Home visit for evaluation and management of patient, typically 15 minutes	May be performed by clinicians for episodic home E/M visits that complement the per diem nursing services billed under `T1031`.
`99341`	Home visit for established patient, typically 20 minutes	Used for physician or qualified nonphysician practitioner home visits that occur in conjunction with ongoing LPN/LVN home nursing care.
`97597`	Debridement (e.g., high-pressure irrigation) selective removal of devitalized tissue	Performed when advanced wound care is needed; LPN/LVN may assist or provide dressing changes as part of `T1031` but debridement is billed separately if performed by appropriate clinician.
`96372`	Therapeutic, prophylactic, or diagnostic injection (e.g., IM, subcutaneous)	Medication administration performed by LPN/LVN during the per diem visit and may be reported if payer allows concurrent CPT reporting alongside HCPCS per diem.
`99441`	Telephone E/M by a physician or other qualified health care professional, 5-10 minutes of medical discussion	Telephone management by the supervising clinician that documents changes based on LPN/LVN assessment during home visits.

HCPCS Level II T1030: Nursing Care in Home by Registered Nurse, Per Diem

HCPCS-LEVEL-II-T2014-PREVOCATIONAL-HABILITATION-PER-DIEM

HCPCS Level II T2014: Habilitation Prevocational Waiver Per Diem

HCPCS-LEVEL-II-T2020-DAY-HABILITATION-WAIVER-PER-DIEM

HCPCS Level II T2020: Day Habilitation, Waiver; Per Diem

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

HCPCS Level II T2047: Habilitation Prevocational Waiver Service

HCPCS-LEVEL-II-T4535-DISPOSABLE-INCONTINENCE-LINER-PAD

HCPCS Level II T4535: Disposable Incontinence Liner/Pad

HCPCS-LEVEL-II-T4538-REUSABLE-DIAPER-PER-DIAPER

HCPCS Level II T4538: Diaper Service, Reusable Diaper, Each Diaper

HCPCS-T1000-PRIVATE-DUTY-LICENSED-NURSING-15-MIN

HCPCS T1000: Private Duty Licensed Nursing, 15-Minute Units

HCPCS-T1001-NURSING-ASSESSMENT-EVALUATION

HCPCS T1001: Nursing Assessment / Evaluation

HCPCS-T1002-RN-SERVICES-15-MINUTES

HCPCS T1002: Registered Nurse Services, Up to 15 Minutes

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

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

Showing 1–10 of 113

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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HCPCS T1031: Nursing Care in the Home by Licensed Practical Nurse, Per Diem

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Billing Code Overview

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HCPCS T1031: Nursing Care in the Home by Licensed Practical Nurse, Per Diem

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS T1031: Nursing Care in the Home by Licensed Practical Nurse, Per Diem

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Billing Code Overview

HCPCS T1031: Nursing Care in the Home by Licensed Practical Nurse, Per Diem

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code T1031 represent?

What is the typical clinical workflow and expected documentation for services billed under T1031?

Which modifiers might be used with T1031 and when are they appropriate?

Are there other codes commonly billed alongside T1031?

Which payers cover T1031 and where can I find payer-specific reimbursement details?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code T1031 represent?

What is the typical clinical workflow and expected documentation for services billed under T1031?

Which modifiers might be used with T1031 and when are they appropriate?

Are there other codes commonly billed alongside T1031?

Which payers cover T1031 and where can I find payer-specific reimbursement details?

References