Question 1

What is HCPCS code T1031?

Accepted Answer

HCPCS code T1031 is "Lpn home care per diem". Nursing care, in the home, by licensed practical nurse, per diem

Question 2

What category is T1031 in?

Accepted Answer

T1031 belongs to HCPCS Category T (State Medicaid Agency Codes).

Question 3

When should I use HCPCS code T1031?

Accepted Answer

Use T1031 when billing for lpn home care per diem. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is T1031 covered by Medicare?

Accepted Answer

Coverage for T1031 (Lpn home care per diem) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for T1031?

Accepted Answer

Documentation for T1031 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).