601 Explanation Of Definitions
Commonwealth of Massachusetts
SUBCHAPTER NUMBER AND TITLE
PAGE
Division of Medical Assistance
6 SERVICE CODES AND DESCRIPTIONS
6-1
Provider Manual Series
TRANSMITTAL LETTER
DATE
DAY HABILITATION PROGRAM
MANUAL
DHP-24
10/16/03
601 Explanation of Definitions
A day habilitation member is rated as a “low-need,” “moderate-need,” or “high-need” member based
on his or her score on the Client Severity Profile Form.
(A) Low-Need Member — scores between one and 41.
(B) Moderate-Need Member — scores between 42 and 71.
(C) High-Need Member — scores 72 or higher.
602 Service Codes and Descriptions
Service
Code Modifier Service Description
Community-Based Services
Code H2014 (including use with all modifiers) is billable in 15-minute units. The minimum allowable
unit(s) for day habilitation services is one unit. The maximum allowable unit(s) for day habilitation services
is 24 units. Providers must report the actual time spent by the member in the day habilitation program.
These minimum and maximum allowable units apply to day habilitation service codes only. See Service
Code T2003 for minimum/maximum units allowed for in-facility transportation services.
H2014
Skills training and development, per 15 minutes (day habilitation, low need)
H2014 TF
Skills training and development, per 15 minutes, intermediate level of care
(day habilitation, moderate need)
H2014 TG
Skills training and development, per 15 minutes, complex/high tech level of care
(day habilitation, high need)
H2014 22
Skills training and development, per 15 minutes, unusual procedural services
(supplemental staffing for members who reside in a nursing facility and attend a
community-based day habilitation program)
In-Facility Services
H2014 U2
Skills training and development, per 15 minutes (Use modifier U2 to denote day
habilitation in a nursing facility with a staff-to-participant ratio of 1:1.)
H2014 U1
Skills training and development, per 15 minutes (Use modifier U1 to denote day
habilitation in a nursing facility with a staff-to-participant ratio of 1:2 or 1:3.)
T2003
Nonemergency transportation; encounter/trip (Staff transportation to nursing facility, bill
per one-way trip up to a maximum of two trips. Use this in conjunction with H2014 TG
and TF only when services occur in a nursing facility.)
This publication contains codes that are copyrighted by Ingenix, Inc. Certain terms used in the service
descriptions for HCPCS codes are defined in the Ingenix HCPCS Level II code book.
Commonwealth of Massachusetts
SUBCHAPTER NUMBER AND TITLE
PAGE
Division of Medical Assistance
6 SERVICE CODES AND DESCRIPTIONS
6-2
Provider Manual Series
TRANSMITTAL LETTER
DATE
DAY HABILITATION PROGRAM
MANUAL
DHP-24
10/16/03
This page is reserved.
