Home care billing
Every visit matched to its authorization and its EVV record before the claim goes out.
We bill non-medical home care the way Medicaid pays it: authorized units of personal care, attendant and homemaker codes, each visit matched to an accepted EVV record, and every claim kept inside the authorization.
- Full-service rate
- 3% to 6% of collections
- Common codes
- T1019, S5125, S5130, by state
- Medicaid visits
- EVV record matched to claim
- New & smaller practices
- Flexible monthly minimum
What makes home care billing different
A home care claim is a count of authorized time. The state or a Medicaid plan approves a number of hours of personal care, attendant care or homemaker services, you bill them in 15-minute units or by the day, and for Medicaid every unit has to match an electronic visit verification (EVV) record.
Your payers are Medicaid programs, Medicaid managed care plans, VA, insurers and families. Medicare does not pay for long-term care, which includes help with dressing, bathing and using the bathroom, so Original Medicare is not a payer for a non-medical agency.
We bill it inside our full revenue cycle service at 3% to 6% of collections. Still opening the agency? Our page on billing and credentialing for new home health and home care agencies covers licensing, payer order and the first 90 days.
Who pays for home care, and what each one needs
Names, rates and rules differ by state; we work from your state’s manuals.
- Medicaid 1915(c) waiversState waivers for people who would otherwise need institutional care. They cover personal care, homemaker and respite services under a person-centered plan.
- State plan personal careMedicaid personal care outside a waiver, authorized by a physician’s plan of treatment or a state-approved service plan. A legally responsible relative cannot be the paid caregiver.
- Medicaid managed careWhere the state uses plans for long-term services, each plan authorizes hours, sets its billing rules and pays the claims.
- VAHomemaker and home health aide care for enrolled Veterans who qualify, through an agency with a VA contract, authorized in advance on a VA referral.
- Long-term care insuranceEach policy sets its own claim terms, so we confirm them with the insurer for each client.
- Private payFamilies pay under your service agreement.
Billing by authorized units: the codes home care uses
Home care is commonly billed with HCPCS Level II codes, in 15-minute units or per day. These descriptors come from the CMS HCPCS file for October 2026:
- T1019: personal care services, per 15 minutes (T1020 per diem). The descriptor excludes services by a home health aide or certified nursing assistant.
- S5125: attendant care services, per 15 minutes (S5126 per diem).
- S5130: homemaker service, per 15 minutes (S5131 per diem).
- S5135 adult companion care and S5150 unskilled respite care, per 15 minutes, and T1005 respite care, up to 15 minutes.
Each state picks the code for each program and adds its own modifiers and units. In the Texas EVV bill code table, attendant care for a STAR+PLUS plan member is S5125 with modifier U3 in the HCBS program and U5 outside it, while the state’s fee-for-service Community Attendant Services bills S5125 per hour. On a 15-minute code, a 3-hour visit is 12 units.
EVV: the visit record behind every Medicaid claim
Section 12006 of the 21st Century Cures Act requires states to use EVV for Medicaid personal care services from January 1, 2020 and home health services from January 1, 2023. Medicaid.gov lists the programs covered: state plan personal care, services under sections 1915(c), (i), (j) and (k), and section 1115 demonstrations.
How a visit reaches the claim depends on your state’s system. Under the Texas EVV policy handbook, visits must be accepted in the state’s EVV Aggregator before you bill, and each claim line must match an accepted visit on Medicaid ID, date, provider ID, HCPCS code, modifiers and, for many services, units. If one differs, the payer denies the claim or recoups it later. We check every claim line against the accepted visit before it goes out.
Authorizations, plans of care and caregiver records
Every Medicaid home care service starts from a plan. 42 CFR 440.167 requires state plan personal care to be authorized by a physician’s plan of treatment or a state-approved service plan, and 1915(c) waiver services must follow an individualized, person-centered plan of care. The state or Medicaid plan turns it into an authorization: a service code, units or hours per week or month, and start and end dates.
The claim has to fit inside it. We track units used against units approved every week and flag renewals before the end date, so caregivers are not scheduled for hours that will not be paid. For each visit, the EVV record and the caregiver’s task notes should show the care in the plan was given.
Why home care claims deny
Common denials, and what sits behind them:
- No matching EVV visit: a missing clock-out, unfinished visit edits, or a code, modifier or unit count that differs from the visit
- Units over the authorization: more hours billed in the week or month than were approved
- Expired or missing authorization: care after the end date, or before the approval was in place
- Eligibility lapse: the client lost Medicaid at renewal or moved to a different managed care plan
- Wrong code or modifier for the program, such as a waiver modifier on a state plan service
- A caregiver the program cannot pay, such as a legally responsible relative under state plan personal care
Each goes through our denial management process: the visit, authorization or eligibility is fixed first, then the claim is corrected and resubmitted or appealed.
How we run home care billing
Load every authorization
Service codes, units, modifiers and dates for each client, by payer and program, before the first visit.
Check eligibility monthly
Each client’s Medicaid status and managed care plan are confirmed, so claims go to the right payer.
Match EVV before billing
Every claim line is checked against an accepted visit record, and visit edits are finished first.
Work what comes back
Denials and short payments are worked by payer and reason until they are paid or closed with a reason.
Report monthly
Units authorized, billed and paid, denials by reason and expiring authorizations, by payer and client.
Credentialing for home care agencies
Enroll in order. Start with your state’s home care license, if your state requires one, then enroll with the state Medicaid agency for each program you will bill. Under 42 CFR 438.602, the state screens and enrolls every network provider of its Medicaid managed care plans, and a plan may contract with you for up to 120 days while that is pending. Each plan is its own application after the state.
VA’s homemaker and home health aide program uses aides who work for an organization with a VA contract and are supervised by a registered nurse. Under VA’s provider claims rules, non-urgent care needs VA authorization in advance, and the referral (VA Form 10-7080) says where to file: the Community Care Network administrator, or VA under a Veterans Care Agreement. Our provider credentialing service handles each enrollment at $189 per payer application, less in bulk.
Not sure your units match your EVV records? Send us a month of home care claims with the visit data and we’ll check them, free.
The common ones are T1019 for personal care, S5125 for attendant care and S5130 for homemaker services, each per 15 minutes, with per diem versions (T1020, S5126 and S5131). Respite and companion care have their own codes. Your state Medicaid program decides which code each program uses, the modifiers it requires and whether a unit is 15 minutes, an hour or a day.
The payer could not match the claim line to an accepted visit record. In Texas, for example, the Medicaid ID, date, provider ID, HCPCS code, modifiers and, for many services, the units must all match. Fix the visit in the EVV system first, confirm the state accepted it, then send a corrected claim.
No. Units past the approved amount for the week or month are denied, even when the care was given. If a client needs more hours, ask the case manager or plan for a new or increased authorization before you schedule them, and keep the request and the approval with the client’s records.
VA buys homemaker and home health aide care from agencies with a VA contract, for enrolled Veterans who qualify and are eligible for community care. Care needs VA authorization before it starts, and the referral, VA Form 10-7080, says where the claim goes: the Community Care Network administrator for your region, or VA itself under a Veterans Care Agreement.
Our full-service rate is 3% to 6% of monthly collections, set by your volume, with no setup or onboarding fees and flexible monthly-minimum plans for new and smaller practices. It covers eligibility checks, prior authorizations, coding, claims, payment posting, denials and A/R follow-up, plus EVV matching and authorization tracking. Your exact rate comes after a free A/R review. Our guide to medical billing costs shows how to compare quotes.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
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The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
Get credentialed with insurance
Every step from NPI to a loaded contract, in the order that saves weeks, with what goes wrong at each one and how to keep it from happening to your file.
Send us your last 90 days of home care claims.
We’ll review them free and show you where EVV mismatches, units or authorizations are costing you money.