Assistive Care Services and Assisted Living for the Elderly Waiver

Assistive Care Services and Assisted Living for the Elderly Waiver Services
Coverage and Limitations Handbook
PART I
CHAPTER 3
ASSISTIVE CARE SERVICES
PROCEDURE CODES AND FEES
Overview
Introduction
This chapter provides and describes the procedure codes and approved fees
for the Assistive Care Services (ACS) program.
In this Chapter
This chapter contains:
TOPIC
PAGE
Reimbursement Information 3-1
Appendix A: Procedure Code Table and Fees A-1
Appendix B: Appeal Rights and Fair Hearing Process B-1
Appendix C: Optional Certification of Medical Necessity
Form
Appendix D: Optional ACS Service Plan From and
Instructions
Appendix E: Optional Resident Service Log and
Instructions
C-1
D-1
E-1
Reimbursement Information
Introduction
Medicaid reimburses for assistive care services procedure code based on the
Healthcare Common Procedure Coding System (HCPCS), Level III
procedure codes and locally assigned codes that have been approved by
CMS, formerly known as HCFA. Locally assigned codes are identified by a
“W” prefix.
July 2001 3-1