Summary & Overview
HCPCS T2051: Brokerage and Self-Directed Waiver Support, Per Diem
HCPCS Level II code T2051 represents per diem reimbursement for services that support brokerage, self-directed care, and waiver program participation. Nationally, this code is used to capture costs associated with helping individuals identify, arrange and manage services under self-directed and Medicaid waiver models—an increasingly important area as states and payers expand community-based long-term services and supports. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical and billing context for T2051, typical sites of service, and the role this code plays in tracking per diem brokerage and self-direction supports within waiver frameworks. The publication outlines common billing considerations, how T2051 aligns with community-based service delivery, and where stakeholders typically see this code applied across payer types. It also summarizes available benchmarks and policy updates relevant to per diem brokerage services where noted. Data not available in the input for associated taxonomies, ICD-10 mappings, and related codes.
Billing Code Overview
HCPCS Level II code T2051 describes services that support brokerage, self-directed, and waiver programs and is billed on a per diem basis. The service type is supportive services for members managing self-directed care or participating in Medicaid waiver programs, focusing on brokerage functions that help individuals secure and manage services. The typical site of service is community-based or home- and community-based settings where members receive supports related to self-direction and waiver participation.
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Clinical & Coding Specifications
Clinical Context
A Medicaid waiver enrollee with intellectual disability and mobility limitations is authorized for self-directed supports brokerage services billed to the waiver program. The service is provided on a per diem basis by a certified supports broker who assists the enrollee and their legally authorized representative to develop and manage the person-centered plan, recruit and train direct care workers, manage budgets, and handle payroll and vendor relationships. Typical workflow: referral from a case manager or county behavioral health authority → verification of waiver eligibility and authorization period → initial intake and brokerage plan meeting (in-person at the enrollee's home or a community location, or via secure telehealth) → documentation of individualized support plan, budget reconciliation, and recruitment actions → ongoing daily or weekly per diem activities recorded in the broker’s service log and summary notes → periodic reassessments and coordination with the payer (for example, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) to confirm continued authorization and billing. Encounters commonly occur in the enrollee’s residence, community settings, or an administrative office and may include travel and remote coordination activities covered within the per diem rate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when unanticipated extra administrative or training time substantially increases the complexity of brokerage activities beyond typical per diem expectations. |