Summary & Overview
HCPCS T2024: Service Assessment and Plan of Care Development, Waiver
HCPCS Level II code T2024 denotes a service assessment and plan of care development tied to waiver programs that support home- and community-based services. This code captures the professional activity of evaluating a beneficiary’s needs and documenting a tailored plan to enable waiver-funded supports. Nationally, accurate use of T2024 affects program compliance, care coordination, and appropriate billing for care-planning resources within waiver systems.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what T2024 represents, typical sites of service, and the context for billing care-planning services under waiver programs. The publication outlines common modifiers associated with this code and highlights the role of T2024 in documenting and justifying waiver-related care coordination.
This summary prepares readers to understand benchmarks and billing practices related to waiver assessment and plan development, relevant policy considerations, and clinical workflow implications for home- and community-based care settings. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code T2024 represents service assessment and plan of care development for waiver services. The procedure denotes a structured assessment and the creation of a plan of care specifically tied to waiver programs that support individuals in community- or home-based settings. The service type is an assessment and care planning activity. The typical site of service is home or community-based waiver program settings.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult applying for a Home and Community-Based Services waiver or other program-required functional eligibility review. The patient may have chronic disabilities such as stroke-related hemiparesis, spinal cord injury, advanced multiple sclerosis, severe intellectual or developmental disability, or progressive neurodegenerative disease. The clinical workflow begins with a referral from case management or a payor (for example, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) requesting a formal service assessment and individualized plan of care development to determine waiver eligibility and ongoing support needs. A licensed clinician (nurse practitioner, clinical social worker, physician, or rehabilitation therapist) performs a comprehensive face-to-face or telehealth assessment covering medical history, functional status (ADLs/IADLs), mobility, cognitive and behavioral needs, medication review, environmental safety, and caregiver supports. The clinician documents findings, formulates measurable goals, recommends services and frequency, and creates a written plan of care for waiver submission. Documentation includes time, assessment tools used, risk stratification, and coordination notes with case management or payors. The encounter may be billed using T2024 when the service specifically represents assessment and plan-of-care development required by a waiver program; supporting CPT codes for time-based or therapy services may be billed separately where appropriate and allowed by payor policy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when the assessment required substantially greater work than typical for a waiver plan-of-care visit, documented with rationale and time. |
23 | Unusual Anesthesia | Rarely applicable; use only if unusual anesthesia is required during an in-person assessment visit and documented. |
52 | Reduced Services | Use when the assessment/service is partially performed or truncated and documentation explains the reduction. |
53 | Discontinued Procedure | Use if the assessment was started but discontinued due to patient instability or other documented reason. |
54 | Surgical Care Only | Not commonly used; include only if a clinician bills separately for surgical care components distinct from the waiver assessment. |
55 | Postoperative Management Only | Use if only postoperative management is provided and the waiver assessment is unrelated. |
56 | Preoperative Management Only | Use if only preoperative management is performed separate from the waiver assessment. |
62 | Two Surgeons | Use when two clinicians of different specialties share responsibility for the assessment/plan and documentation supports shared work. |
AS | Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist Assisting | Use when an assistant clinician from the listed categories participates and payor policy allows modifier for the service. |
CO | Items and Services Furnished as a Result of a Work-Related Injury/Illness | Use when the assessment/plan is for a work-related condition covered by workers' compensation. |
CQ | Service Delivered Under an Approved Opioid Treatment Program (OTP) by a OTP Clinician | Use only if the waiver assessment is delivered as part of an OTP-certified program and documentation supports this. |
FX | Physician Non-Surgical First Assist (nonstandard; example regional modifier) | Use per payor/local policy when an assistant provides non-surgical first assist services related to care coordination during the assessment. |
QK | Medical Direction of Two, Three, or Four Certified Registered Nurse Anesthetists (CRNAs) | Not typically applicable; include only when anesthesia medical direction is part of the documented encounter. |
QX | CRNA Service: CRNA with Medical Direction by a Physician | Not typically applicable; use only if anesthesia elements are present during assessment and documented. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
163W00000X | Physical Medicine & Rehabilitation Physician | Performs functional assessments and medical oversight of rehabilitation-focused waiver plans. |
208000000X | Family Medicine Physician | Provides comprehensive medical assessment and coordinates waiver-related primary care needs. |
207Q00000X | Nurse Practitioner | Commonly performs face-to-face assessments, documents plan of care, and coordinates with payors and case managers. |
1041C0700X | Clinical Social Worker | Conducts psychosocial assessments, care planning, and linkage to community resources for waiver eligibility. |
225100000X | Occupational Therapist | Performs detailed ADL/IADL functional assessments and contributes to the plan of care for waiver services. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z59.0 | Homelessness | Social determinants like housing instability affect waiver needs and service planning. |
G83.4 | Monoplegia of lower limb | Represents functional motor deficit requiring assessment and individualized waiver plan for mobility supports. |
G37.9 | Demyelinating disease of central nervous system, unspecified | Progressive neurologic conditions often require waiver assessment for long-term support and care planning. |
F84.0 | Autistic disorder | Developmental disorders commonly require specialized care planning and waiver service coordination. |
N31.9 | Neuromuscular dysfunction of bladder, unspecified | Medical dysfunctions impacting daily care needs and durable medical equipment recommendations within the plan of care. |
M62.81 | Muscle weakness (generalized) | Generalized weakness influences functional status evaluation and service intensity recommendations. |
Z74.1 | Need for assistance with personal care | Directly relevant to waiver eligibility determinations and plan of care elements. |
R41.3 | Other amnesia | Cognitive impairment findings that affect care planning, supervision needs, and safety recommendations. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99354 | Prolonged service in the office or other outpatient setting, requiring direct patient contact beyond the usual service; first hour | May be used when the waiver assessment and plan-of-care development require extended face-to-face time beyond the typical evaluation. |
96161 | Administration of standardized cognitive performance testing by a technician, with interpretation and report | Used when formal cognitive testing informs the functional assessment and plan of care for waiver eligibility. |
97165 | Occupational therapy evaluation: low complexity, typically 20 minutes face-to-face | Occupational therapy evaluations frequently precede or accompany T2024 to document ADL/IADL deficits used in the plan of care. |
97110 | Therapeutic exercises to develop strength and endurance, range of motion and flexibility | May be part of recommended services in the plan of care and billed separately when therapy is initiated following the assessment. |
99406 | Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes | Example of a brief behavioral intervention that may be documented as part of the comprehensive plan of care when indicated. |