Community Pathways Billing Codes and Limitations Effective July 1, 2013

Procedure
Code / Procedure / Unit of
Service / Billing
Method+ / Limitations
W1742 / Resource Coordination- Comprehensive Assessment† / Daily / PCIS II / Lifetime maximum of two units per person
W1743 / Resource Coordination-Coordination Services / 15 minutes / PCIS II
W0215 / Community Exploration / Daily / CMS 1500 / Not to exceed 7 units within the 180 days in advance of move
W0216 / CSLA I-Retainer Fees* / Daily / FMS / Not to exceed 21 days per FY; cannot be used w/W2101, W2121, W2123
W0217 / CSLA Il-Retainer Fees* / Daily / FMS / Not to exceed 21 days per FY; cannot be used w/W2101, W2121, W2123
W0218 / Employment Discovery & Customization / Daily / CMS 1500 / Cannot use w/W2102, W2103, W2116 or Medical Day Care
W2101 / Residential Habilitation† / Daily / PCIS II / Cannot use w/W0216, W0217, W2105, W2106, W2107,W2108, W2117, W2118, W2121, W2123
W2102 / Day Habilitation / Daily / PCIS II / Cannot use w/W0218, W2103, W2116 or Medical Day Care
W2103 / Supported Employment / Daily / PCIS II / Cannot use w/W0218, W2102, W2116 or Medical Day Care
W2104 / Environmental Accessibility Adaptations / Daily / CMS 1500 / Shares a lifetime maximum of $17,500 w/W2132
W2105 / Respite Care Service / Daily / CMS 1500 / Limit of 28 consecutive days and 45 days in a FY; Cannot use w/W2101, W2121, W2123
W2106 / Family and Individual Support Service (F/ISS) / Monthly / CMS 1500 / Cannot use w/W2101, W2121, W2123
W2107 / Community Supported Living Arrangement I / Daily / PCIS II / Cannot use w/W0216, W0217, W2101, W2118, W2121, W2123
W2108 / Live-In Caregiver / Monthly / CMS 1500 / Cannot use w/W2101, W2121, W2123
W2110 / Assistive Technology and Adaptive Equipment / Daily / CMS 1500
W2111 / Behavioral Consultation / 30 minutes / CMS 1500
W2112 / Behavioral Support Services / 30 Minutes / CMS 1500
W2114 / Behavioral Respite Services / Daily / CMS 1500 / Cannot use w/W2101, W2105, W2121
W2116 / Community Learning Services / Daily / CMS 1500 / Cannot use w/W0218, W2102, W2103 or Medical Day Care
W2117 / Transportation† / Daily / CMS 1500 / Limited to $1,400/FY; Cannot use w/W2101, W2121, W2123, W2131
W2118 / Community Supported Living Arrangement II / Daily / CMS 1500 / Cannot use w/ W0216, W0217, W2101, W2107, W2121, W2123
W2120 / Transition Services / Daily / CMS 1500 / Not to exceed $5,000 per FY
W2121 / Residential Retainer Fees / Daily / PCIS II / Not to exceed 33 days per FY per person; Cannot use w/W0216, W0217, W2101, W2105, W2106, W2107,W2108, W2118, W2123
W2123 / Shared Living† (formerly IFC) / Monthly / CMS 1500 / Cannot use w/W2101, W2105, W2106, W2107, W2108, W2117, W2118, W2121
W2124 / Supports Broker* / Monthly / FMS / Cannot use w/W2101, W2121, W2123
W2125 / Mobile Crisis Intervention / 30 Minutes / CMS 1500 / Limit of 48 units per day per person
W2126 / Behavioral Assessment / Daily / CMS 1500 / Limit one assessment per year per person
W2127 / Environmental Assessment / Daily / CMS 1500 / One assessment annually per individual
W2128 / Individual Goods & Services* / Daily / FMS / Limit of $2,000 per FY
W2131 / Transportation-Self-Directed* / Daily / FMS / Cannot use w/W2117
W2132 / Vehicle Modifications / Daily / CMS 1500 / Shares a lifetime maximum of $17,500 w/W2104; Limit of once every seven years

* For Self-Direction only

† Not available for Self-Direction

+ The FMS submits claims electronically for individuals self-directing their services. Providers may sign up to submit claims electronically for procedures that are billed on the CMS 1500 form.

02/12/15