What is HCPCS code T1019?
T1019 is the Medicaid code for personal care services billed per 15 minutes. The CMS descriptor, who pays, sample 2026 state rates and billing tips.
T1019 is the HCPCS code for personal care services, billed in 15-minute units. Four units equal 1 hour. Medicaid pays for it through state plan personal care and home and community-based services (HCBS) waivers. Medicare does not pay it. Each state sets its own rate, modifiers and rules.
What does the T1019 descriptor say?
The CMS long descriptor reads: “Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)” (CMS HCPCS quarterly update, October 2026 file).
What matters for billing:
- Setting. The client lives at home, not in a hospital, nursing facility or other institution.
- Plan of care. The service has to be part of the client’s individualized plan.
- Who provides it. The code is not for services by a home health aide or certified nurse assistant. Check which code your state uses for aide-level services.
| Field | Value |
|---|---|
| Unit | 15 minutes |
| Code added | July 1, 2002 |
| Medicare coverage code | I (not payable by Medicare) |
| Daily version | T1020 (per diem) |
Who pays for T1019?
State Medicaid programs and Medicaid managed care plans pay it. The usual sources are a state plan personal care benefit or an HCBS waiver for older adults or people with disabilities. Search your state’s programs in the Medicaid waiver lookup.
How do T1019 rates vary by state?
Rates differ widely, and some states add a required modifier.
| State and program | Rate per 15 minutes | Effective |
|---|---|---|
| South Dakota, Personal Care Agency Fee Schedule | $11.17 | July 1, 2026 |
| Utah, Waiver for Individuals 65 and Older, agency-based | $9.30 (U3 modifier required) | July 1, 2026 |
North Carolina raised CAP/CD T1019 from $7.34 to $8.66 per unit effective August 1, 2026, part of an 18% increase for personal care services (CAP/CD fee schedule). Always bill the modifier your state lists, or the claim can deny or pay the wrong rate.
What are the most common T1019 billing mistakes?
A common cause of denials is a mismatch between the claim, the authorization and the EVV record.
- Units that don’t match EVV. T1019 is personal care, so the 21st Century Cures Act requires electronic visit verification. Billed units have to match the check-in and check-out times after your state’s rounding rule.
- Billing past the authorization. Units over the authorized amount, or after the end date, usually aren’t payable. See authorization tracking.
- Missing modifiers. Program, waiver or rural modifiers are set by each state. See home care billing modifiers.
- Wrong code for the service. Companion or homemaker tasks may belong under S5135 or S5130 in your state.
Use the units calculator to convert visit minutes to units.
How Caregiver Scheduling handles this
Caregiver Scheduling warns you when a week goes over a client’s authorized hours (Growth and up). GPS check-in records actual start and end times, the same record your EVV data comes from. $199/month for up to 10 caregivers or $299/month for up to 50, with a 30-day free trial.
FAQ
Is T1019 billed per hour? No. One unit is 15 minutes, so 1 hour is 4 units.
Does Medicare pay T1019? No. CMS lists it with coverage code I, not payable by Medicare. It is a Medicaid code.
Can a home health aide’s visit be billed as T1019? The descriptor says the code may not be used for services provided by a home health aide or certified nurse assistant. Check which code your state uses for aide services.
General information, not billing or legal advice. Check your state Medicaid provider manual and fee schedule.