Find & Ask › New Jersey › this rule

Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11

New Jerseysub_regulatoryNJ DHS, Division of Medical Assistance & Health Services (DMAHS)

What this rule requires your agency to do

  • 1For DDD Supports/Community Care, the initial unit must be 15 minutes; additional time rounds up if at least half a unit and down if less, counting only services provided that calendar day with supporting documentation.(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)
  • 2A 1-hour HCPCS unit may be billed only if at least 53 minutes is provided; two hourly units require at least 113 minutes (112 minutes rounds down to one unit).(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)
  • 3Billing two 15-minute units requires at least 23 minutes; three units require at least 38 minutes provided.(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)
  • 4Providers must retain the newsletter for future reference.(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)
  • 5A 15-minute HCPCS unit may be billed only if at least 8 minutes of service is provided for the initial unit.(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)
  • 6For units longer than 15 minutes, the final unit is reimbursable only if at least 8 minutes of the final 15-minute increment is provided.(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)
  • 7Only actual face-to-face billable services provided may be billed for reimbursement.(Updated Billing Policy for Home Health & Personal Care Services (EVV Rounding Rules) — Vol. 33 No. 11)

Applies to: cross-cutting

DMAHS EVV billing rounding rules effective 10/1/2023 setting minimum service minutes required to bill 15-minute and hourly HCPCS units for home health, PCA, and PDN services.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.