Skilled and Private Duty Nursing Rate Update effective July 1, 2021
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The purpose of this bulletin is to inform providers that rates for skilled and private duty nursing services will increase, effective July 1, 2021. In accordance with Item 313.DDDD of the 2021 Virginia Acts of Assembly, skilled and private duty nursing rates will be increased to 80% of the benchmark rate developed by Burns and Associates. The skilled and private duty nursing rate update applies to DD Waivers, CCC Plus, and EPSDT programs for Fee-For-Service as well as Managed Care. Please find the new rates for nursing services in the table below.
|
Code |
Modifier |
Location |
Code Description |
Rates |
Units |
Effective Date |
|
S9123 |
|
NOVA |
Private Duty Nursing (RN) |
$48.64 |
Hour |
7/1/2021 |
|
S9123 |
|
ROS |
Private Duty Nursing (RN) |
$38.50 |
Hour |
7/1/2021 |
|
S9123 |
|
NOVA |
Skilled Nursing (RN) |
$14.70 |
15 minutes |
7/1/2021 |
|
S9123 |
|
ROS |
Skilled Nursing (RN) |
$11.82 |
15 minutes |
7/1/2021 |
|
S9124 |
|
NOVA |
Private Duty Nursing (LPN) |
$35.26 |
Hour |
7/1/2021 |
|
S9124 |
|
ROS |
Private Duty Nursing (LPN) |
$28.66 |
Hour |
7/1/2021 |
|
S9124 |
|
NOVA |
Skilled Nursing (LPN) |
$10.97 |
15 minutes |
7/1/2021 |
|
S9124 |
|
ROS |
Skilled Nursing (LPN) |
$9.09 |
15 minutes |
7/1/2021 |
|
T1002 |
|
NOVA |
Private Duty Nursing (RN) |
$12.16 |
15 minutes |
7/1/2021 |
|
T1002 |
|
ROS |
Private Duty Nursing (RN) |
$9.62 |
15 minutes |
7/1/2021 |
|
T1002 |
|
NOVA |
Private Duty Nursing (RN) |
$48.64 |
Hour |
7/1/2021 |
|
T1002 |
|
ROS |
Private Duty Nursing (RN) |
$38.50 |
Hour |
7/1/2021 |
|
Code |
Modifier |
Location |
Code Description |
Rates |
Units |
Effective Date |
|
T1003 |
|
NOVA |
Private Duty Nursing (LPN) |
$8.82 |
15 minutes |
7/1/2021 |
|
T1003 |
|
ROS |
Private Duty Nursing (LPN) |
$7.17 |
15 minutes |
7/1/2021 |
|
T1003 |
|
NOVA |
Private Duty Nursing (LPN) |
$35.26 |
Hour |
7/1/2021 |
|
T1003 |
|
ROS |
Private Duty Nursing (LPN) |
$28.66 |
Hour |
7/1/2021 |
|
T1000 |
U1 |
NOVA |
Congregate Nursing (RN) |
$29.39 |
Hour |
7/1/2021 |
|
T1000 |
U1 |
ROS |
Congregate Nursing (RN) |
$23.63 |
Hour |
7/1/2021 |
|
T1001 |
U1 |
NOVA |
Congregate Nursing (LPN) |
$22.13 |
Hour |
7/1/2021 |
|
T1001 |
U1 |
ROS |
Congregate Nursing (LPN) |
$19.35 |
Hour |
7/1/2021 |
|
S9125 |
TE |
NOVA |
Private Duty Nursing (LPN) |
$35.26 |
Hour |
7/1/2021 |
|
S9125 |
TE |
ROS |
Private Duty Nursing (LPN) |
$28.66 |
Hour |
7/1/2021 |
|
S9125 |
TD |
NOVA |
Private Duty Nursing (RN) |
$48.64 |
Hour |
7/1/2021 |
|
S9125 |
TD |
ROS |
Private Duty Nursing (RN) |
$38.50 |
Hour |
7/1/2021 |
|
T1030 |
TD |
NOVA |
Congregate Nursing (RN) |
$29.39 |
Hour |
7/1/2021 |
|
T1030 |
TD |
ROS |
Congregate Nursing (RN) |
$23.63 |
Hour |
7/1/2021 |
|
T1031 |
TE |
NOVA |
Congregate Nursing (LPN) |
$22.13 |
Hour |
7/1/2021 |
|
T1031 |
TE |
ROS |
Congregate Nursing (LPN) |
$19.35 |
Hour |
7/1/2021 |
|
G0493 |
|
NOVA |
Congregate Nursing (RN) |
$29.39 |
Hour |
7/1/2021 |
|
G0493 |
|
ROS |
Congregate Nursing (RN) |
$23.63 |
Hour |
7/1/2021 |
|
G0494 |
|
NOVA |
Congregate Nursing (LPN) |
$22.13 |
Hour |
7/1/2021 |
|
G0494 |
|
ROS |
Congregate Nursing (LPN) |
$19.35 |
Hour |
7/1/2021 |
SFY 2022 Rates
This memo serves as the official notification that rates for SFY 2022 are posted on the DMAS website at https://www.dmas.virginia.gov/for-providers/long-term-care/waivers/ . Corrections or revisions will be noted at the bottom of the official rate sheet. If you have any questions regarding nursing rates please contact the DMAS Helpline at 1-800-552-8627.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
1-800-884-9730 or 1-800-772-9996 |
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KEPRO Service authorization information for fee-for-service members.
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Provider Appeals DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal. |
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |