Date: July 11, 2013

ADvantage Adult Day Health code with Modifier

Per the ADvantage Provider Update dated June 10, 2013, the maximum authorization for ADvantage Adult Day Health services will incrase from 24 units (6 hours) per day to 32 units (8 hours) per day. Effective July 1, 2013, the current code (S5100) will be utilized with a modifier of U1 for all requests for Adult Day Health.

Waiver Adult Day Health Code - S5100-U1 (modifier required)

Unit of service: 15 minutes

Unit rate: $1.88

Existing Adult Day Health service lines will remain in effect as currently authorized.

Requests for an increase in Adult Day Health services should be made using the code S5100-U1. If the U1 modifier is not included on the Service Plan Cost Sheet or Service Plan Cost Sheet Addendum, the AAU will administratively authorize the service as S5100-U1 through 8August 31, 2013. At the end of this timeframe, submissions received without the U1 modifier will not be authorized until the code has been corrected by the case manager.

More comprehensive service plan goals are also required with all new or revised requests for Adult Day Health services. in addition to the assistance provided, service plan goals should reflect the number of days per week and hours per day the Member will attend Adult Day health.

Please implement these changes for Adult Day Health services effective immediately.

If you have any questions regarding the information provided above, please contact us at Provider Questions via your Smarter Mail account.