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2025 HCPCS code T2024

Service assessment/plan of care development, waiver.

This code is specifically for use in waiver programs and is not recognized by Medicare. Use of this code may vary by payer, so it's crucial to verify coverage and coding guidelines with specific payers before billing.

Medical necessity is established by the patient's condition requiring multiple services or treatment modalities to address complex or interrelated health issues. The waiver program's criteria for eligibility must also be met.

In simple words: This code is used for creating and managing a care plan when someone needs care from several different healthcare providers or types of treatment, all coordinated through a special Medicaid program. The healthcare professional makes sure everyone is working together, checks on the patient's progress, talks with the patient and their family about the plan, and makes changes to the plan as needed.

This code represents the assessment and development of a care plan for a patient who requires services from multiple providers or treatment modalities under a waiver program. The provider coordinates care, reviews patient status and test results, communicates with the patient/family/caretaker, and modifies the care plan as needed. Waiver programs are Medicaid-authorized methods used by states to deliver and pay for healthcare services in Medicaid and CHIP, often involving managed care, long-term care in home or community settings, and services for the elderly and disabled.

Example 1: A patient with paraplegia and pressure ulcers requires physical therapy, dermatology, nutritional services, and nursing care. Code T2024 is used for the development and coordination of the comprehensive care plan involving all these disciplines., An elderly individual with Alzheimer's disease needs in-home care, medication management, and cognitive therapy. T2024 represents the assessment and ongoing management of their care plan, coordinating the various services provided., A child with autism receives behavioral therapy, speech therapy, and occupational therapy. T2024 is used to document the development and oversight of their care plan, ensuring all therapies are coordinated and addressing the child's individual needs.

Documentation should support the medical necessity of the coordinated care plan, the patient's need for multiple services or treatment modalities, and the provider's involvement in assessment, coordination, and ongoing management. This may include progress notes, care plan documentation, and communication records.

** This code is intended for state Medicaid agencies and some private insurers. Medicare does not recognize this code.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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