How Do 15-Minute Medicaid Billing Units Work for Home Care?
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
By Caregiver Scheduling Team ·
Most Medicaid home and community-based services are billed in 15-minute units: 4 units equal 1 hour. An authorization for 120 units a week is 30 hours of care. Each state sets its own rounding rule for partial units, so a 52-minute visit might be 3 units in one state and 4 in another. Check your state’s provider manual and EVV rules before you bill.
How do you convert units to hours?
Divide units by 4 to get hours. Multiply hours by 4 to get units.
| Units | Hours | Units | Hours |
|---|---|---|---|
| 1 | 0.25 | 40 | 10 |
| 4 | 1 | 80 | 20 |
| 8 | 2 | 120 | 30 |
| 16 | 4 | 160 | 40 |
The rate on a state fee schedule is per unit, not per hour. South Dakota’s Personal Care Agency Fee Schedule, effective July 1, 2026, lists T1019 personal care at $11.17 per 15 minutes, which is $44.68 an hour. When a case manager says “the rate is $11.17,” confirm whether that means a unit or an hour before you build your budget.
Which HCPCS codes do home care agencies use?
Five codes cover most non-medical visits, and all five are 15-minute codes.
| Code | Description | Unit |
|---|---|---|
| T1019 | Personal care services | Per 15 minutes |
| S5125 | Attendant care services | Per 15 minutes |
| S5130 | Homemaker service, not otherwise specified | Per 15 minutes |
| S5135 | Companion care, adult | Per 15 minutes |
| S5150 | Unskilled respite care | Per 15 minutes |
States add modifiers and sometimes use different codes for the same service. Use the code, modifier and rate on the authorization and in your state’s fee schedule. Look up your state’s waivers in the Medicaid waiver lookup.
How does rounding work for partial units?
There is no single federal rounding rule for Medicaid personal care; each state sets its own. The “8-minute rule” people quote comes from Medicare, not Medicaid. It is in the Medicare Claims Processing Manual, chapter 5, section 20.2, and it governs Medicare Part B outpatient therapy codes: one unit for 8 through 22 minutes, two units for 23 through 37, and so on. It does not apply to Medicaid personal care unless your state adopted the same math.
Some states did. Texas HHSC’s EVV Policy Handbook, section 8020, rounds actual hours worked to the nearest quarter hour: 8 minutes or more past the last quarter hour rounds up, 7 minutes or less rounds down. So 0 to 7 minutes bills as 0.00 hours, 8 to 22 minutes as 0.25, 23 to 37 as 0.50, and 2 hours 53 minutes rounds up to 3 hours. Texas also splits a visit that crosses midnight into two transactions and rounds each one separately.
Other states use one of these approaches instead:
- Full units only: bill only complete 15-minute units.
- Total-time rounding: add up the day’s minutes for the member, then convert.
- Visit-level midpoint rounding: the Texas method above.
The EVV check-in and check-out times have to support the units you bill. If EVV shows 50 minutes and you bill 4 units under a full-units-only rule, the claim can be recouped in an audit. See EVV claim denials.
How do you stay inside the authorization?
Check remaining units before you approve any schedule change. An authorization sets the units approved for a period, often weekly or monthly, and for a date range. The usual ways agencies go over:
- Schedule creep. The family asks for a few extra minutes each visit, and rounding turns those minutes into units.
- Extra visits. A visit is added to cover a call-out without checking remaining units.
- Expired authorizations. Visits continue after the end date while renewal is pending.
- Month boundaries. A monthly authorization is used up early and the last week isn’t covered.
Hours provided over the authorization usually can’t be billed to Medicaid. In most programs you can’t bill the client for them either. See home care authorization tracking.
What does weekly unit tracking look like?
| Item | Example |
|---|---|
| Authorized units this week | 120 (30 hours) |
| Scheduled visits | 5 × 6 hours = 30 hours = 120 units |
| Used through Wednesday | 72 units |
| Remaining | 48 units = 12 hours |
Run this check against actual EVV hours, not the schedule. A caregiver who stays 10 extra minutes a day under a Texas-style rule adds a unit most days, and the week ends 4 or 5 units over.
How Caregiver Scheduling handles this
On Growth and up, each client’s authorized hours are checked as you schedule, and a week that would go over is flagged before the visit is booked. EVV check-ins record actual start and end times to back up the units you bill. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.
FAQ
How many minutes is one Medicaid unit? For most home care services, 15 minutes. Four units make an hour.
Is T1019 billed per hour? No. T1019 is per 15 minutes, so one hour is 4 units.
Does the 8-minute rule apply to Medicaid personal care? Not by itself. It’s a Medicare Part B therapy rule. Some states, including Texas, use the same 8-minute threshold in their own EVV rounding rules.
What happens if I provide more hours than authorized? Those hours usually can’t be billed to Medicaid. Ask the case manager to increase the authorization before providing more care.
This article is general information, not billing or legal advice. Check your state’s Medicaid provider manual.