Electronic Visit Verification (EVV) Place of Service Update

Billing Electronic Visit Verification (EVV) Services with Place of Service (POS) 40, CR 106958   

This update replaces the previous instructions to use POS 10 from February 19, 2021. The use of POS 10 has changed and is no longer available to indicate claims submitted for services rendered in the three scenarios listed below. Please use POS 40 instead. 

You should only use POS 40 in the following scenarios. These services are excluded from EVV record requirements when the claims are submitted using POS 40.  

  • For Section 28 services, when the service is not delivered one-to-one within the member’s home.  
  • For Section 28 services, when the service does not include personal care/skill-building components (e.g. one-to-one for development or completion of a comprehensive assessment).   
  • For Sections 12, 18, 19, 20, 21, 29, and 96 services, when the individual providing the service is a live-in caregiver.   

Providers who wish to correct the POS code on an EVV claim that is currently in pend status may take either of these steps:  

  • Wait for the claim to deny, then resubmit the claim with the corrected information. Do not make a change to the claim that is currently pending.    
  • Submit a new claim with the corrected information; the original claim will eventually deny if the EVV requirements are not met.     

If you have questions, please contact Provider Services by email or phone at 1-866-690-5585, option 3. 

Electronic Visit Verification (EVV) Place of Service (POS) Usage Guidelines Update

Personal Care Services (PCS) claims are included or excluded from EVV record requirements based on the POS code and EVV service codes that are submitted on the CMS 1500 claim form.  

Claims for services delivered in the following locations are subject to EVV and require a verified EVV visit record:    

  • POS 04:   Homeless Shelter 
    • Use this POS for EVV-related services provided in a homeless shelter. The services MUST be provided in the shelter to use this POS. If the MaineCare member is staying in a shelter but they receive the service in the community, providers should use POS 99 as noted below. 
  • POS 12:  Home  
    • Use this POS for EVV-related services provided in the home. 
    • Provider type 86 (Section 28 providers) should use this POS for EVV-related services when the service is provided one-on-one in the member’s home AND when the service includes the delivery of skill building/personal care services to the member. 
  • POS 16:   Temporary Lodging 
    • Use this POS for EVV-related services provided in locations that are not the member’s permanent residence (e.g. motels, hotels, etc.).                                  

Claims for services delivered in the following locations are not subject to EVV and do not require a verified EVV visit record: 

  • POS 02: Telehealth provided other than in a patient’s home
    • Use this POS for Home Support-Remote Support: Monitor Only and Interactive services (including MaineCare policy Sections 18, 19, 20, 21, and 29).
    • Please refer to our additional telehealth billing guidance for PCS.
  • POS 03: School
    • Use this POS when the service is delivered in a school setting.
  • POS 10: Telehealth provided in patient’s home   
  • POS 40: Unassigned (State EVV)
    • Use this POS for:
      • Section 28 services, when the service is not delivered one-to-one within the member’s home.
      • Section 28 services, when the service does not include personal care/skill-building components (e.g. one-to-one for development or completion of a comprehensive assessment).
      • Sections 12, 18, 19, 20, 21, 29, and 96 services, when the individual providing the service is a live-in caregiver.

In most instances, providers should not deliver PCS in the following locations: 

  • 01 - Pharmacy    
  • 11 – Office        
  • 13 – Assisted Living Facility*  
  • 14 – Group Home                                     
  • 53 – Community Mental Health Center
  • 99 – Other Place of Service

*This may be an appropriate POS for section 96 services for members eligible for Private Duty Nursing, level 9. 

Please contact your Provider Relations Specialist if you have any questions about appropriate billing or about allowable service locations.  

Personal Care Services (PCS) Providers: Billing Telehealth on CMS 1500 Claim Form - Place of Service (POS) 10 Added, CR 96215

Telehealth PCS claims are excluded from Electronic Visit Verification (EVV) record requirements. When billing telehealth claims on the CMS 1500 Claim Form, you must use the POS code 02 or 10 and include the GT modifier, as this indicates you are providing services via telehealth and not in-person.

See the table below for affected codes.  UB04 claim lines submitted with telemedicine revenue code 078x are exempt from EVV editing.

Code

Description

 Code

Description

G0151

PT services, home health or hospice, each 15 min    

S5150

Unskilled respite care not hospice per 15 min              

G0152

OT services, home health or hospice, each 15 min    

T1000

Private duty/independent nursing up to 15 min              

G0153

Speech\lang, home health or hospice, each 15 min    

T1004

Services of a qualified nursing aide to 15min              

G0155

Social work service, HH or hospice, each 15 min   

T1005

Respite care services, up to 15 minutes                    

G0156

Home health aide, HH or hospice, each 15 min               

T1019

Personal care serv, per 15 min, not for inpat              

G0299

HHS/hospice of rn each 15 minutes                          

T1502

Administration of oral/IM/subcut med, /visit               

G0300

HHS/hospice of lpn each 15 minutes                          

T2017

Habilitation, residential waiver, per 15 min               

H2021

Community based wrap-around servs, per 15 min              

T2042

Hospice routine home care, per diem                        

S5125

Attendant care services, per 15 min                        

T2043

Hospice continuous home care, per hour                     

Please contact your Provider Relations Specialist with questions.   

 

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