OLTL Home and Community Based Waiver Services — Fee Schedule (Rates Effective July 1, 2026)
Customize your policy alerts
Sign up for all Pennsylvania Insurance Department policy alerts
Know when Pennsylvania Insurance Department releases new policies or updates existing guidance.
Monitor payer policy activity
Lists procedure codes, service descriptors, modifiers, units, and four-region fee rates for Pennsylvania OLTL Home and Community Based Waiver Services effective July 1, 2026; applies to providers billing these waiver services to the Pennsylvania Insurance Department.
No material clinical or coverage changes in this revision.
Coverage & Fee Schedule Entries
Fee schedule entries
Listed services and rates (no explicit coverage criteria shown in these pages).
Sample rate entries
Rate entries (service, code/modifier, unit, and dollar amount) — examples from the excerpt:
ALL of the following
- Home Health - Occupational Therapy (T2025 GO) — 15 Minutes — $16.55 (example column values shown)
- Home Health - Physical Therapy (T2025 GP) — 15 Minutes — $20.20
- Home Health - Speech & Language Therapy (T2025 GN) — 15 Minutes — $21.72
- PAS (Agency) (W1793) — 15 Minutes — $4.83 (region/variant values shown)
- Residential Habilitation 1-3 (W0100) — 1 Day — $272.32
Reimbursement rate items
Rates and billed units shown (no authorization rules or medical necessity criteria present in these chunks).
ALL of the following
- W0100 — Residential Habilitation 1-3 — 1 Day — $272.32
- W0101 U4 — Residential Habilitation 1-3 Support 1:1 — 1 Hour — $19.79
- W0101 U5 — Residential Habilitation 1-3 Support 2:1 — 1 Hour — $39.58
- W0102 — Residential Habilitation 4-8 — 1 Day — $255.33
- T2025 GP U4 — Home Health PT Assistant — 15 Minutes — $11.51
- T2025 GN — Home Health Speech & Language — 15 Minutes — $21.72
- W1793 — PAS (Agency) — 15 Minutes — $4.83–$5.38 (variants shown)
- W1792 — PAS (Consumer) — 15 Minutes — $4.18–$4.90 (variants shown)
- W1792 TU — PAS (Consumer Overtime) — 15 Minutes — $6.00–$7.35 (variants shown)
waiver_fee_schedule_lines
Reimbursement rates and units for OLTL waiver services (effective date shown).
ALL of the following
- W0100 — Residential Habilitation 1-3 — 1 Day — $272.32
- W0101 U4 — Residential Habilitation 1-3 Support 1:1 — 1 Hour — $19.79
- W0101 U5 — Residential Habilitation 1-3 Support 2:1 — 1 Hour — $39.58
- W0102 — Residential Habilitation 4-8 — 1 Day — $255.33
- W0103 U4 — Residential Habilitation 4-8 Support 1:1 — 1 Hour — $19.62
- W0103 U5 — Residential Habilitation 4-8 Support 2:1 — 1 Hour — $39.23
- W1792 — PAS (Consumer) — 15 Minutes — $4.18
- W1792 TU — PAS (Consumer Overtime) — 15 Minutes — $6.27
- W1793 — PAS (Agency) — 15 Minutes — $4.83
- T2025 GN — Speech & Language Therapy — 15 Minutes — $21.72
- T2025 GP U4 — PT Assistant — 15 Minutes — $11.51
Waiver service rates (excerpt)
Rate and billing unit information for listed waiver services.
ALL of the following
- W0100 — Residential Habilitation 1-3 — 1 Day — $272.32
- W0101 U4 — Residential Habilitation 1-3 Support 1:1 — 1 Hour — $19.79
- W0101 U5 — Residential Habilitation 1-3 Support 2:1 — 1 Hour — $39.58
- W0102 — Residential Habilitation 4-8 — 1 Day — $255.33
- W0103 U4 — Residential Habilitation 4-8 Support 1:1 — 1 Hour — $19.62
- W0103 U5 — Residential Habilitation 4-8 Support 2:1 — 1 Hour — $39.23
- W1792 TU — PAS (Consumer Overtime) — 15 Minutes — $6.27 (examples show other values)
- W1793 TT — PAS (CSLA) — 15 Minutes — $4.91 (examples show other values)
- T1005 — Respite (Agency) — 15 Minutes — $4.29–$4.78
- S5150 — Respite (Consumer) — 15 Minutes — $3.20–$3.93
- S5150 TU — Respite (Consumer Overtime) — 15 Minutes — $4.80–$5.90
- W1011 — Service Coordination — 15 Minutes — $18.49–$21.47
Rates only
Fee schedule entries (no clinical coverage criteria present in this excerpt).
Reimbursement entries
Each line lists a code, four numeric rate columns, time unit, and applicability flags.
Rates and billing units
Reimbursement rates and units for OLTL Home and Community Based Waiver Services (effective July 1, 2026):
Rate lines only
Listed services and rates (no explicit clinical criteria present in this excerpt).
Payment schedule excerpt
Listed services and codes with associated payment rates and unit definitions for OLTL Home and Community Based Waiver.
Payment entries
Rate and unit information by code:
Rate entries
Rate and billing-unit information for specific services (no explicit coverage limitations included in this segment).
ALL of the following
- W0170 — Teleservice Nutritional Consultation — 15 Minutes — $13.77
- S9470 AE U4 — Nutritional Counseling — 15 Minutes — $13.77
- W0175 — Teleservice Counseling — 15 Minutes — $11.83
- W7337 — Transition Service Coordination — 15 Minutes — $18.49–$21.47 (multiple column rates shown)
- W0138 — Assistive Technology — Per Purchase — rate N/A in table
- W7341 — Financial Management Services — 1 Month / Start-up (U4) — rate N/A in table
- W0140 — Home Adaptations < $6,000 — Per Purchase — rate N/A in table
- W0141 — Home Adaptations > $6,000 — Per Purchase — rate N/A in table
Rate entries and billing units
Service entries and billing units
ALL of the following
- W0170 — Teleservice Nutritional Consultation — 15 Minutes — $13.77
- W7337 — Transition Service Coordination — 15 Minutes — $18.49, $20.21, $18.78, $21.47 (columns shown)
- W0138 — Assistive Technology — Per Purchase — listed as per purchase in table
- W7336 — Community Transition Services (Health Safety) — One Time — listed in table
Listed covered HCBS waiver services (table entries)
Services and billing units shown as covered for OLTL HCBS waiver programs (table format).
ALL of the following
- W7336 — Community Transition Services (Health Safety) — One Time — listed as covered in table
- W7332 — Community Transition Services (Household Supplies) — One Time — listed as covered in table
- W7333 — Community Transition Services (Moving Expenses) — One Time — listed as covered in table
- W7334 — Community Transition Services (Security Deposit) — One Time — listed as covered in table
- W7335 — Community Transition Services (Set-Up Fees) — One Time — listed as covered in table
- W7341 — Financial Management Services — 1 Month (and start-up U4 shown as 1 Time) — listed in table
- W0140 — Home Adaptations < $6,000 — Per Purchase — listed in table
- W0141 — Home Adaptations > $6,000 — Per Purchase — listed in table
- W6110 — Non-Medical Transportation — Per Trip/One Way — listed in table
- W0138 — Assistive Technology — Per Purchase — listed in table
- W1894 — PERS Installation — Per Purchase — listed in table
- W1895 — PERS Monthly Maintenance — Per Purchase — listed in table
Rate table entries
Service entries and billing units from the OLTL HCBS rates table (partial).
Procedure, HCPCS and Modifier Codes
| S5102 | Adult Daily Living (and variants with U5/U4/U3 modifiers for half day/enhanced) |
| 97537 | Community Integration (procedure code listed) |
| W1740 | Employment Benefits Counseling |
| W1710 | Teleservice Benefits Counseling |
| W1732 | Employment - Career Assessment |
| W1728 | Employment - Employment Skills Development (1:1) |
| W1729 | Employment - Employment Skills Development (1:2 to 1:3) |
| W1741 | Employment - Employment Skills Development (1:15) |
| W1733 | Employment - Job Coaching 1:1 |
| W1734 | Employment - Job Coaching 1:2 to 1:4 (Intensive) |
| W0100 | Residential Habilitation 1-3 — $272.32 per day |
| W0102 | Residential Habilitation 4-8 — $255.33 per day |
| W0101 U4 | Residential Habilitation 1-3 Support 1:1 — $19.79 per hour |
| W0101 U5 | Residential Habilitation 1-3 Support 2:1 — $39.58 per hour |
| T2025 GP U4 | Home Health - Physical Therapy Assistant — $11.51 per 15 minutes |
| T2025 GN | Home Health - Speech & Language Therapy — $21.72 per 15 minutes |
| W1793 | PAS (Agency) — $4.83–$5.38 per 15 minutes (variants shown) |
| W1792 | PAS (Consumer) — $4.18–$4.90 per 15 minutes (variants) |
| W1792 TU | PAS (Consumer Overtime) — $6.00–$7.35 per 15 minutes (variants) |
| W1793 TT | PAS (CSLA) — $4.91–$5.48 per 15 minutes (variants) |
| T2025 GN | Speech & Language Therapy — 15-minute rate $21.72 |
| T2025 GP U4 | Physical Therapy Assistant — 15-minute rate $11.51 (modifier U4 shown) |
| W1792 | PAS (Consumer) — 15-minute rate $4.18 |
| W1792 TU | PAS (Consumer Overtime) — 15-minute rate $6.27 |
| W1793 | PAS (Agency) — 15-minute rate shown (e.g., $4.83) |
| W0100 | Residential Habilitation 1-3 — daily rate $272.32 |
| W0101 U4 | Residential Habilitation 1-3 Support 1:1 — hourly $19.79 |
| W0101 U5 | Residential Habilitation 1-3 Support 2:1 — hourly $39.58 |
| W0102 | Residential Habilitation 4-8 — daily rate $255.33 |
| W0103 U4 | Residential Habilitation 4-8 Support 1:1 — hourly $19.62 |
| W0100 | Residential Habilitation 1-3 (1 Day) |
| W0101 U4 | Residential Habilitation 1-3 Support 1:1 (1 Hour) |
| W0101 U5 | Residential Habilitation 1-3 Support 2:1 (1 Hour) |
| W0102 | Residential Habilitation 4-8 (1 Day) |
| W0103 U4 | Residential Habilitation 4-8 Support 1:1 (1 Hour) |
| W0103 U5 | Residential Habilitation 4-8 Support 2:1 (1 Hour) |
| W1792 TU | PAS (Consumer Overtime) (15 Minutes) |
| W1793 TT | PAS (CSLA) (15 Minutes) |
| T1005 | Respite (Agency) (15 Minutes) |
| S5150 | Respite (Consumer) (15 Minutes) |
| W0101 U4 | Residential Habilitation 1-3 support 1:1 — 1 hour — $19.79 |
| W0101 U5 | Residential Habilitation 1-3 support 2:1 — 1 hour — $39.58 |
| W0102 | Residential Habilitation 4-8 — 1 day — $255.33 |
| W0103 U4 | Residential Habilitation 4-8 support 1:1 — 1 hour — $19.62 |
| W0103 U5 | Residential Habilitation 4-8 support 2:1 — 1 hour — $39.23 |
| T1005 | Respite (Agency) — 15 minutes — $4.29 |
| S5150 | Respite (Consumer) — 15 minutes — $3.34 |
| S5150 TU | Respite (Consumer Overtime) — 15 minutes — $5.01 |
| W1011 | Service Coordination — 15 minutes — $18.49 |
| W0104 | Structured Day Habilitation Group — 1 hour — $34.56 |
| T1005 | Respite (Agency) - 15 minutes |
| S5150 | Respite (Consumer) - 15 minutes |
| S5150 TU | Respite (Consumer Overtime) - 15 minutes / TU modifier noted |
| W1011 | Service Coordination - 15 minutes |
| W0104 | Structured Day Habilitation Group - 1 hour |
| W0105 U4 | Structured Day Habilitation 1:1 - 1 hour |
| W0105 U5 | Structured Day Habilitation 2:1 - 1 hour |
| H2019 | Behavior Therapy - 15 minutes |
| W1711 | Teleservice Behavior Therapy - 15 minutes |
| 92507 SE | Cognitive rehabilitation (speech) - 15 minutes |
| W0104 | Structured Day Habilitation Group — 1 Hour |
| W0105 U4 | Structured Day Habilitation 1:1 — 1 Hour |
| W0105 U5 | Structured Day Habilitation 2:1 — 1 Hour |
| H2019 | Behavior Therapy — per 15 minutes |
| W1711 | Teleservice Behavior Therapy — per 15 minutes |
| 92507 SE | Cognitive Rehabilitation — per 15 minutes |
| W0176 | Teleservice Cognitive Rehabilitation — per 15 minutes |
| W0093 | Counseling Services — per 15 minutes |
| W0175 | Teleservice Counseling Services — per 15 minutes |
| S9470 AE U4 | Nutritional Counseling — per 15 minutes |
| W0176 | Teleservice Cognitive Rehabilitation |
| 92507 | Therapy & Counseling Services- Cognitive Rehabilitation (listed with modifier SE) |
| W0093 | Therapy & Counseling Services- Counseling Services |
| W0175 | Teleservice Counseling Services |
| S9470 | Therapy & Counseling Services- Nutritional Counseling |
| W0170 | Teleservice Nutritional Consultation |
| W7337 | Transition Service Coordination |
| W0138 | Assistive Technology |
| W7336 | Community Transition Services- Health Safety |
| W7332 | Community Transition Services- Household Supplies |
| W0093 | Counseling Services — 15 minutes |
| W0175 | Teleservice Counseling Services — 15 minutes |
| S9470 AE U4 | Nutritional Counseling — 15 minutes |
| W0170 | Teleservice Nutritional Consultation — 15 minutes |
| W0176 | Teleservice Cognitive Rehabilitation — 15 minutes |
| W7337 | Transition Service Coordination — 15 minutes |
| W0138 | Assistive Technology — per purchase |
| W7336 | Community Transition Services - Health Safety — one time |
| W7332 | Community Transition Services - Household Supplies — one time |
| W7333 | Community Transition Services - Moving Expenses — one time |
| W0170 | Teleservice Nutritional Consultation — 15 Minutes; rate $13.77 shown |
| W7337 | Transition Service Coordination — 15 Minutes; rates $18.49, $20.21, $18.78, $21.47 shown in table |
| W0138 | Assistive Technology — Per Purchase |
| W7336 | Community Transition Services - Health Safety — One Time |
| W7332 | Community Transition Services - Household Supplies — One Time |
| W7333 | Community Transition Services - Moving Expenses — One Time |
| W7334 | Community Transition Services - Security Deposit — One Time |
| W7335 | Community Transition Services - Set-Up Fees — One Time |
| W7341 | Financial Management Services — 1 Month; start-up shown with modifier U4 (1 Time) |
| W0140 | Home Adaptations < $6,000 — Per Purchase |
| W0170 | Teleservice Nutritional Consultation (15 minutes) - $13.77 |
| S9470 AE U4 | Nutritional Counseling (15 minutes) - $13.77 |
| W0175 | Teleservice Counseling Services (15 minutes) - $11.83 |
| W7337 | Transition Service Coordination (15 minutes) - listed rates $18.49, $20.21, $18.78, $21.47 |
| W0138 | Assistive Technology - Per Purchase |
| W7341 | Financial Management Services - monthly or startup (per month or one-time) |
| W0140 | Home Adaptations < $6,000 - Per Purchase |
| W0141 | Home Adaptations > $6,000 - Per Purchase |
| W7332 | Community Transition Services - Household Supplies - One Time |
| W7333 | Community Transition Services - Moving Expenses - One Time |
| W7337 | Transition Service Coordination (15 Minutes) |
| W0138 | Assistive Technology (Per Purchase) |
| W7336 | Community Transition Services - Health Safety (One Time) |
| W7332 | Community Transition Services - Household Supplies (One Time) |
| W7333 | Community Transition Services - Moving Expenses (One Time) |
| W7334 | Community Transition Services - Security Deposit (One Time) |
| W7335 | Community Transition Services - Set-Up Fees (One Time) |
| W7341 | Financial Management Services (1 Month); W7341 U4 for Start Up (1 Time) |
| W0140 | Home Adaptations < $6,000 (Per Purchase) |
| W0141 | Home Adaptations > $6,000 (Per Purchase) |
Billing Notes and Provider Highlights
Fee schedule — OLTL HCBS rates effective Jul 01, 2026
Fee schedule listings for OLTL Home and Community Based Waiver services showing procedure codes, unit types (1 Day, 1 Hour, 15 Minutes, Per Purchase, One Time, Per Trip/One Way, 1 Month) and region-specific fee columns; rates are effective July 01, 2026 and appear in the OLTL HCBS rates tables.
- Rates effective July 01, 2026 shown in header and table rows.
- Unit types in the table include 1 Day, 1 Hour, 15 Minutes, Per Purchase, One Time, Per Trip/One Way, and 1 Month.
- Four regional rate columns (Rate Region 1–4) are presented for each service line.
Rate table excerpts — employment, nursing, therapy
Rate table entries list service codes and corresponding per-unit payment amounts or unit descriptors (examples include employment supports W1734/W1735, home health nursing T1002/T1003, and home health therapy T2025 with 15-minute rates).
- T2025 (GO/GP/GN/U4 variants) shown with 15-minute rates (examples: GP 20.20; GP U4 11.51; GN 21.72).
- Employment codes W1734 (job coaching) and W1735 (job finding) appear with unit descriptors and rate columns.
Billing codes and actions — use listed codes and units
When billing OLTL waiver services, use the exact HCPCS/W/CPT codes and unit designations shown in the fee schedule rows (examples: W0100 for Residential Habilitation 1-3 per day; W1792/W1793 variants for PAS per 15 minutes; T2025 GN/GP U4 for therapy per 15 minutes).
- Residential Habilitation: W0100 (1 Day), W0101 U4/U5 (1 Hour support rates).
- PAS: W1792 (consumer), W1793 (agency), and overtime TU/TT variants listed with 15-minute rates.
- Home health therapy: T2025 variants with 15-minute rates and modifiers (GN, GP, U4).
Rate codes and provider billing units — bill per listed unit/modifier
Follow the rate codes and billing units shown in the schedule when submitting claims; each listed service line shows its billing unit (15 Minutes, 1 Hour, 1 Day, Per Purchase, One Time, Per Trip/One Way, 1 Month) and applicable modifiers where indicated (e.g., U4, SE, TU).
- Modifiers shown in table rows (examples: U4 for start-up or assistant modifier; SE for speech modifier).
- Billing unit must match the unit shown on the rate line (claims for W0100 billed as 1 Day, W1011 billed per 15 Minutes, W0138 billed Per Purchase).
Rates table — no prior authorization rules in excerpt
The excerpted rate tables do not include prior authorization rules; the file presents fee schedule lines only—providers must follow other program instructions for any authorization requirements not shown here.
- Rate rows show payment amounts and units but no explicit prior authorization guidance in these pages.
Waiver service rates table (excerpt) — selected lines
Fee schedule excerpts include multiple waiver service lines with unit rates and billing units (examples shown include respite, service coordination, structured day habilitation, and therapy codes with per-15-minute or per-hour rates).
Rates Effective Notice — effective Jul 01, 2026
Rates are effective July 01, 2026; providers must use the listed effective date for claims processing and rate application.
- Document header and table rows explicitly state 'Rates Effective July 01 2026.'
Provider billing codes and rates (selected) — therapy & counseling
Selected billing rules in the schedule identify per-unit payments for therapy, counseling, cognitive rehabilitation, teleservices, and transition coordination—use the exact code-to-unit mapping when billing (examples: W0175/W0093 counseling per 15 minutes; 92507/W0176 cognitive rehabilitation per 15 minutes; H2019/W1711 behavior therapy per 15 minutes).
Rates Effective — apply Jul 01, 2026 fee schedule
The rate schedule header and multiple table entries reiterate that OLTL Home and Community Based Waiver Services rates are effective July 01, 2026; providers should apply these rates beginning on that date.
- Multiple table headers and rows repeat the July 01, 2026 effective date.
- Apply the four regional rate columns as shown for the member's rate region.
Rate table — selected service codes (teleservice & nutrition)
When billing teleservice nutritional consultation and related counseling/nutrition codes, use the listed 15-minute unit rates (example: W0170 and S9470 AE U4 show $13.77 per 15 minutes; W0175 shows $11.83 per 15 minutes).
- W0170 (Teleservice Nutritional Consultation) — $13.77 per 15 minutes.
- S9470 AE U4 (Nutritional Counseling) — $13.77 per 15 minutes.
- W0175 (Teleservice Counseling) — $11.83 per 15 minutes.
Rate table — selected HCPCS/W codes and unit descriptors
Provider billing codes for community transition, assistive technology, home adaptations, financial management, and non-medical transportation are listed with their billing unit descriptors—bill the service using the unit type shown (e.g., W0138 Per Purchase; W0140/W0141 Per Purchase for home adaptations; W7332–W7336 One Time; W6110 Per Trip/One Way; W7341 1 Month or 1 Time for startup U4).
- Assistive Technology: W0138 — Per Purchase.
- Home Adaptations: W0140 (< $6,000) and W0141 (> $6,000) — Per Purchase.
- Community Transition Services: W7332–W7336 — One Time unit descriptors.
- Non-Medical Transportation: W6110 — Per Trip/One Way.
- Financial Management Services: W7341 — 1 Month; W7341 U4 for start-up (1 Time).
Transition Service Coordination (W7337) — bill per 15 minutes
The fee schedule includes a per-15-minute rate range for Transition Service Coordination (W7337); claims must use the W7337 code billed in 15-minute increments and the applicable regional column rate (examples in the table include $18.49, $20.21, $18.78, $21.47).
- W7337 (Transition Service Coordination) — per 15 minutes; example column rates include $18.49, $20.21, $18.78, $21.47.
- Bill W7337 in 15-minute increments as shown in the schedule.
Provider billing codes and unit descriptors — use table unit types
Provider billing table rows list covered HCBS waiver service codes alongside unit descriptors; use the exact code and unit shown on the table when submitting claims (examples: W7332–W7336 One Time community transition items; W0140/W0141 Per Purchase home adaptations; W1894 Per Purchase PERS installation).
- Community Transition Services (W7332–W7336) — One Time billing.
- Personal Emergency Response System installation (W1894) — Per Purchase.
- Home adaptations and assistive technology billed Per Purchase where indicated.
Terms, Units and Thresholds
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.