CurrentCignaPolicy A012

Custodial, Non-Skilled Services

Defines custodial, non-skilled services and states coverage stance under standard Cigna benefit plans, including when services may be covered under Home Health Services benefits; applies to administration of Cigna health benefit plans.

Policy Summary

PayerCigna

PolicyCustodial, Non-Skilled Services

Policy CodePolicy A012

Change TypeNo material changes

Effective DateSep 15, 2025

Next Review DateSep 15, 2026

Key ActionWhen custodial services are provided in the home, verify applicability of the Home Health Services benefit and document if home health aide support is directly tied to skilled services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1Policy number

2025-09-15Effective date

9/15/2026Next review

T1019,T1020Example not-covered codes

Coverage Criteria

Coverage criteria for custodial, non-skilled services

Covered when ALL of the following reflect the policy position:

ALL of the following

Custodial, non-skilled services are specifically excluded under most benefit plans.

ALL of the following

When provided in the home, coverage for custodial, non-skilled services is subject to the terms, conditions and limitations of the applicable benefit plan's Home Health Services benefit.
Under some benefit plans, limited coverage for home health aides may be available when in direct support of skilled services.

Examples — services considered custodial and not covered

Policy Summary

PayerCigna

PolicyCustodial, Non-Skilled Services

Policy CodePolicy A012

Change TypeNo material changes

Effective DateSep 15, 2025

Next Review DateSep 15, 2026

Key ActionWhen custodial services are provided in the home, verify applicability of the Home Health Services benefit and document if home health aide support is directly tied to skilled services.

SourceLink

On This Page

ANY of the following

Administration of long-term oxygen therapy
Administration of nebulizer and intermittent positive pressure breathing (IPPB) treatments
Bowel training or management
Care of the incontinent individual
Changing a non-infected postoperative dressing
Changing a non-sterile dressing
General maintenance care of a stable colostomy or ileostomy
Preparing and administration of oral medications, eye drops, ointments or suppositories
Services to maintain satisfactory functioning of an indwelling bladder catheter
Stable/routine uncomplicated feeding by gastric, percutaneous endoscopic gastrostomy (PEG), or jejunostomy
Supportive foot and nail care

Coding and Code Notes

Not covered HCPCS codesHCPCSNot Covered

T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant).
T1020	Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant).

Code list completeness note

Scope of code listCode list may not be all-inclusive; AMA and CMS code updates may occur more frequently than policy updates.

Deleted or inactive codesDeleted codes and codes not effective at the time the service is rendered may not be eligible for reimbursement.

Responsibility for verificationProviders should verify current code status with AMA/CMS prior to billing since policy updates may lag behind coding changes.

Provider Actions and Prior Authorization

Prior Authorization

Prior authorization and coverage stance

Custodial, non-skilled services are excluded under most Cigna benefit plans. If these services are provided in the home, coverage is determined by the terms, conditions, and limitations of the member's Home Health Services benefit; some plans may allow limited coverage for home health aides only when they are in direct support of skilled services.

Excluded under most benefit plans.
In-home custodial services are subject to the applicable Home Health Services benefit terms, conditions, and limitations.
Limited coverage for home health aides may be available only when directly supporting skilled services under some benefit plans.

Definitions

Custodial, non-skilled services (definition & examples)

DefinitionServices intended to maintain a safe living environment without active treatment of medical conditions; may be performed in the home, nursing home, or assisted living.

Typical settingsHome, nursing home, or assisted living facility.

Examples of activities includedAssistance with ADLs such as bathing, dressing, transferring, preparing foods, and walking.

Supportive non-medical care examplesAdministration of long-term oxygen, nebulizer/IPPB treatments, bowel training, incontinence care, changing non-sterile dressings, routine ostomy care, oral medication preparation/administration, bladder catheter maintenance, routine PEG/jejunostomy feeding, and supportive foot and nail care.

Prudent layperson

DefinitionA person possessing an average knowledge of health and medicine.

ContextUsed by Cigna to define 'prudent layperson' in relation to who may perform non-skilled services.

ImplicationServices that do not require supervision by trained or licensed healthcare professionals can be performed by a prudent layperson, family member, or the patient themselves.