Service Codes | Service Management | True Care System Documentation

Understanding Service Codes

A Service Code is a value used to identify a specific type of service. The code may be referenced when creating authorizations, scheduling care, recording visits, submitting EVV data, preparing billing records, and generating reports.

Service Codes must be configured carefully because an incorrect code may cause a service to be scheduled, authorized, transmitted, billed, or reported incorrectly.

Internal Identifier and Official Code

True Care System may use an internal service identifier together with an official billing or procedure code.

Code Type	Example	Description
Internal Service Identifier	HCSS	A short name used within True Care System to identify the general service type, such as HCSS, PCA, LPN, BSS, or RESP.
Official Billing Code	Provider-configured	The official procedure, billing, or program code entered according to the Provider's approved service configuration.
Service Code per Level	Provider-configured	A detailed code assigned to a specific ratio, zone, service level, unit, or service variation.
Modifier	When applicable	An additional value used to distinguish service conditions, levels, locations, staff qualifications, or payer rules.

Important

Internal identifiers such as PCA, HCSS, LPN, BSS, or RESP are not automatically universal billing codes. The Provider must enter the official code applicable to its approved service.

Provider Responsibility

Each Provider is responsible for confirming the correct code before activating or using a service.

Code verification may require review of:

Provider enrollment documentation.
State or federal program requirements.
Waiver documentation.
Payer contracts.
Fee schedules.
Service authorizations.
Procedure code references.
Modifiers.
EVV specifications.
Billing instructions.

True Care System stores and processes the code configured by the Provider. The system does not replace the Provider's obligation to verify that the code is accurate and authorized.

Codes May Differ by Provider

Providers may offer similar services but use different codes because of differences in enrollment, payer, program, state, waiver, modifier, level, location, or unit structure.

For example, two Providers may both offer In-Home and Community Support Services, but their approved codes may differ when:

They participate in different programs.
They bill different payers.
They use different staff-to-individual ratios.
They provide services in different locations.
They use different billing units.
One service requires a modifier.
One service is subject to EVV and another is not.
The service is delivered under a different waiver.

Service Code Components

Component	Example	Description
Service Name	Companion Services	Identifies the support or professional service delivered by the Provider.
Primary Billing Code	Provider-configured	Stores the primary billing or procedure code associated with the service.
Program	Provider-selected	Identifies the program or waiver under which the service is delivered.
Payer	Provider-selected	Identifies the organization responsible for payment or reimbursement.
Modifier	Optional	Provides additional code-level detail when required by the payer or program.
Level Type	Ratio or Zone	Determines whether the service code is associated with a ratio-based or zone-based configuration.
Level	1:1	Identifies the selected ratio, zone, or other approved service level.
Unit Format	Unit (15 min)	Defines how the service is measured for authorization, billing, and reporting.
Effective Date	Provider-defined	Indicates when the code becomes valid for operational use.
Status	Active	Controls whether the code is available for new operational activity.

Example Service Code Relationships

The values below are examples of how internal service identifiers may relate to Provider-configured codes. They are not universal billing-code assignments.

Identifier	Service Name	Official Code	Configuration Note
PCA	Personal Care Assistant	Provider-entered	Enter the code applicable to the Provider's approved Personal Care Assistant service.
HCSS	In-Home & Community Support Services	Provider-entered	The code may differ according to ratio, level, program, payer, or unit.
LPN	Licensed Practical Nurse	Provider-entered	Confirm the approved nursing code, modifier, unit, and rate.
RN	Registered Nurse	Provider-entered	Enter the code applicable to the Provider's approved RN service.
BSS	Behavior Support Services	Provider-entered	Confirm the behavior support code and any required professional-level modifier.
RESP	Respite Services	Provider-entered	Confirm whether the approved code is based on unit, hour, day, location, or service level.
COMP	Companion Services	Provider-entered	Enter the code approved for the Provider's Companion Services program.
TRAN	Non-Emergency Transportation	Provider-entered	Confirm whether the code uses mileage, trip, zone, or another approved billing format.
PT	Physical Therapy	Provider-entered	Confirm the professional service code, unit, and applicable modifier.
OT	Occupational Therapy	Provider-entered	Enter the code approved for Occupational Therapy under the applicable payer or program.
ST	Speech Therapy	Provider-entered	Confirm the applicable speech therapy code and billing unit.
HMK	Homemaker Services	Provider-entered	Enter the code applicable to the Provider's approved Homemaker Services.

Primary Billing Code

The Primary Billing Code identifies the general procedure or service used for billing-related workflows.

Before entering the code:

Confirm the service name.
Confirm the applicable program or waiver.
Confirm the payer.
Review the Provider's enrollment record.
Confirm the approved procedure code.
Determine whether a modifier is required.
Confirm the service unit.
Confirm the effective date.

Service Code per Level

A service may require different codes for different levels, ratios, zones, or service configurations.

Examples include:

A different code for 1:1 service.
A different code for 1:2 service.
A different code for 1:3 service.
A different code for a transportation zone.
A different code for mileage.
A different code for professional and assistant-level care.
A different code for residential and non-residential service.

The Service Code per Level should be configured only when the applicable payer or program requires a level-specific code.

Modifiers

A modifier provides additional information about the service being delivered or billed.

A modifier may identify:

Service level.
Staff qualification.
Service location.
Special service condition.
Professional or assistant-level care.
Group or individual service.
Program-specific billing treatment.

Modifier Accuracy

Do not add, remove, or change a modifier unless the applicable payer, program, authorization, or official billing instruction supports the change.

Code and Unit Relationship

A Service Code must be configured together with the correct unit format.

Unit Format	Example Use	Code Review
15-Minute Unit	Time-based support service	Confirm that the code is authorized for 15-minute billing.
Hourly	Hourly professional or support service	Confirm that the code is billed per hour.
Daily	Residential, respite, or day-based service	Confirm that the service code supports a daily unit.
Mileage	Transportation service	Confirm that the code is authorized for mileage billing.
Trip	Transportation event	Confirm that the code is billed per trip rather than per mile.
Event	One-time or event-based service	Confirm that the service code supports event-based billing.

Code and Rate Relationship

The configured service rate must correspond to the code, unit, level, payer, and applicable effective period.

Before applying a rate:

Confirm the correct Service Code.
Confirm the billing unit.
Confirm the service level.
Confirm the payer.
Confirm the approved fee schedule or contract.
Confirm the effective date.
Confirm whether a modifier changes the rate.

Rate configuration is described in more detail in the Service Rates documentation.

Code Use Across the System

After a code is assigned to a service, it may be used throughout multiple True Care System workflows.

Module	Code Use	Risk of Incorrect Code
Authorization	Connects approved services and units to the individual.	The authorization may not match the delivered service.
Schedule	Identifies the service assigned to the scheduled shift.	Employees may be assigned to the wrong service.
Mobile EVV	Identifies the service delivered during check-in and check-out.	EVV data may be rejected or associated incorrectly.
Visit Maintenance	Displays the service associated with the visit.	Visit review and correction may use incorrect service data.
Billing	Supports claim and invoice preparation.	Claims may be rejected, denied, or paid incorrectly.
Payroll	May support employee compensation calculations.	Payroll classification or rate calculations may be affected.
Reports	Groups service activity for operational and financial reporting.	Reports may contain inaccurate totals or classifications.

Adding a Service Code

When creating a new service:

Select the correct Service Type.
Confirm the Service Name.
Enter the Primary Billing Code, when applicable.
Select the appropriate Category.
Select Ratio or Zone.
Select the applicable service level.
Enter the Service Code per Level, when required.
Select the correct unit format.
Enter the approved rate.
Confirm billable status.
Review the configuration.
Save the service.

Code Validation Checklist

Complete the following review before activating a service code:

The Provider is approved to deliver the service.
The code matches the service name.
The payer is correct.
The program or waiver is correct.
The modifier is correct, when required.
The ratio or zone is correct.
The service level is correct.
The unit format is correct.
The rate is correct.
The effective date is correct.
The billable setting is correct.
The EVV requirement has been reviewed.
The authorization requirement has been reviewed.

Updating an Existing Code

Code changes should be handled carefully because an existing code may already be referenced by authorizations, schedules, visits, billing records, claims, or reports.

Before changing an existing code:

Review whether the code has already been used.
Identify all modules referencing the service.
Confirm the effective date of the new code.
Determine whether historical records must retain the old code.
Determine whether a new service record is required.
Review current authorizations.
Review scheduled and open visits.
Review pending billing records.

Historical Accuracy

When a code changes materially, creating a new service record may be safer than replacing the code on an existing service. This helps preserve accurate historical records.

Effective-Date Management

Code changes may become effective on a specific date. The Provider should maintain a clear distinction between:

The previous code and its historical effective period.
The new code and its new effective period.
Authorizations created under the previous code.
Visits delivered before the code change.
Visits delivered after the code change.
Claims or submissions pending under either code.

Do not apply a new code retroactively unless the Provider has confirmed that retroactive correction is authorized and operationally appropriate.

Inactive and Retired Codes

When a code should no longer be used, change the associated service status to Inactive or create a replacement service as appropriate.

Inactivation helps preserve historical relationships while preventing the code from being selected for new operational activity.

Do not permanently delete a service code when it has been used by:

Authorizations.
Schedules.
Visits.
EVV submissions.
Billing records.
Claims.
Payroll records.
Reports.

Common Code Errors

Error	Example	Possible Impact
Wrong Service Code	Code does not match the service	Authorization, EVV, or billing may fail.
Missing Modifier	Required modifier not entered	The payer may reject or misclassify the service.
Wrong Unit	Hourly code configured as 15-minute units	Authorized and billed units may be inaccurate.
Wrong Level	1:1 code used for 1:2 service	Rate, billing, and service classification may be incorrect.
Wrong Payer	Code copied from another payer	Claims or EVV submissions may be rejected.
Expired Code	Old code used after its valid period	Billing and reporting may use an invalid service code.
Duplicate Service	Same service and code created more than once	Users may select the wrong record and reporting may split.

Service Code Best Practices

Verify every code against an approved source.
Do not guess a service code.
Do not copy a code from another Provider without verification.
Confirm the payer and program before activating the code.
Confirm the modifier and service level.
Confirm the unit and rate.
Use clear service names and internal identifiers.
Avoid duplicate service records.
Preserve historical codes when configuration changes.
Inactivate old services instead of deleting records already used.
Document the official source used to verify the code.
Review service codes periodically.

Security

Only authorized users should create or modify service codes.
Access to code, modifier, rate, and billing configuration should be limited according to job responsibilities.
Code changes should be reviewed by approved administrative or billing personnel.
Service code changes may be recorded in Audit Logs.
Unauthorized code changes may affect care delivery, billing, reimbursement, and reporting.

HIPAA Considerations

Service code records should not contain unnecessary individual Protected Health Information.
Access to services connected to individuals and visits should follow the minimum necessary principle.
Do not place individual names, diagnoses, or private information in the Service Code field.
Protect service, authorization, visit, and billing relationships from unauthorized modification.
Maintain accurate historical records for audit and compliance review.

Troubleshooting

The correct code is unknown.

Review Provider enrollment documentation.
Review the applicable payer instructions.
Review the program or waiver documentation.
Review the service authorization.
Confirm whether a modifier is required.
Contact authorized billing or compliance personnel.
Do not enter an unverified code.

The service code does not appear.

Confirm that the service was saved successfully.
Confirm that the service is Active.
Search using the Service Name.
Search using the internal identifier.
Clear active search filters.
Refresh the page.

The code is rejected during EVV or billing.

Confirm the Provider identifier.
Confirm the payer and program.
Confirm the procedure code.
Confirm the modifier.
Confirm the unit.
Confirm the service date falls within the valid period.
Confirm the authorization uses the same service code.

A code was changed after visits were completed.

Review whether completed visits must retain the previous code. Creating a new service record for future visits may be necessary to preserve historical accuracy.

Two services use the same code.

Review the payer, program, modifier, unit, level, rate, category, and effective dates. Similar codes may be valid when other configuration details differ, but duplicate records should be avoided when no meaningful distinction exists.

Frequently Asked Questions

Is the internal service identifier the official billing code?

Not necessarily. An internal identifier such as HCSS, PCA, LPN, or BSS helps identify the service type. The Provider must enter the official code applicable to its approved service.

Can the same service have different codes?

Yes. Codes may differ according to payer, program, waiver, ratio, zone, level, modifier, location, or unit.

Can different Providers use different codes?

Yes. Each Provider must use the codes applicable to its own enrollment, contracts, programs, and approvals.

Can I copy a code from another Provider?

No code should be copied without verification. A code valid for one Provider may not be valid for another Provider.

What is a Service Code per Level?

It is a detailed code associated with a specific ratio, zone, service level, or service configuration.

What happens when a code changes?

Review the effective date and historical use. A new service record may be required so previous authorizations, visits, billing records, and claims retain the original code.

Should an old code be deleted?

Normally, no. Inactivate the associated service when historical records reference the code.

Why was a claim rejected even though the service name is correct?

The billing code, modifier, payer, program, level, unit, rate, or authorization may not match the claim requirements.

Who should verify a Service Code?

Verification should be completed by authorized Provider personnel using official enrollment, payer, program, authorization, contract, or fee-schedule information.