Summary & Overview
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.
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).
Data not available in the input.
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 |
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