Children’s Long-Term Support Program Code Crosswalk Update
Effective: May 1, 2025
The Wisconsin Department of Health Services has updated the Children's Long-Term Support (CLTS) Program Code Crosswalk, P-02293, effective May 1, 2025.
Services: all CLTS Program services
Change: Allowable places of service (POS) have been added for all CLTS Program services available on the CLTS Program Benefit Code Crosswalk, P-02283. Previously, the POS column in the code crosswalk only indicated if a service supported optional remote service delivery. The column now displays all locations where CLTS Program services may be delivered. Please note that claims submitted using an unallowable POS code will be denied.
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for information on allowable POS by service, and refer to the Children’s Long-Term Support Program Place of Service Codes (PDF) companion guide on the ForwardHealth Portal. The guide includes definitions of each POS code and allowable POS codes for each CLTS Program service.
Services: multiple CLTS Program services
Change: A CG modifier indicating transitional support services has been added to the CLTS Program Benefit Code Crosswalk, P-02283 for a variety of CLTS Program services. The code indicates when a service has been rendered by a county waiver agency (CWA) or delivered as a transitional support prior to a participant’s enrollment in the program.
Action: CWAs and CWA subcontractors should review the CLTS Program Benefit Code Crosswalk, P-02283 for updated CLTS coding notes for services that include the CG modifier. For more information on the new CG modifier and its use in CLTS transitional support services and/or CWA-rendered services, please consult the ForwardHealth Federal Procedure Code Limitations on Claims for County Waiver Agencies (PDF) companion guide.
Service: virtual equipment and supports
Change: The Healthcare Common Procedure Coding System (HCPCS) code for the virtual equipment and supports service has changed from G2012 to 98016, effective for dates of service on and after January 1, 2025. This change aligns the CLTS Program Benefit Code Crosswalk, P-02283 with the most up-to-date Centers for Medicare & Medicaid Services (CMS) procedure codes for virtual communication.
Action: Prior authorizations (PAs) submitted by CWAs for virtual equipment and supports with dates of service in 2025 should use HCPCS Code 98016.
Service: support and service coordination
Change: A U5 modifier has been added to HCPCS code T1016, case management, 15 minutes, to indicate when the service will be delivered by a CWA-subcontractor provider. Including the U5 modifier on a T1016 PA for case management services will allow for manual PA pricing. If the service will be delivered by a CWA and not a CWA-subcontractor, the U5 modifier should not be used.
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for the updated CLTS Program coding notes for support and service coordination and begin using modifier U5 when applicable.
Service: counseling and therapeutic services
Change: A 59 modifier has been added to HCPCS code G0176, activity therapy, per session. Using the modifier indicates that more than one session of services has been delivered to a CLTS Program participant in a single day.
Additionally, the CLTS Program coding notes for counseling and therapeutic services, G0176, have been updated to clarify that one “session” unit is defined as 45 minutes or more of service.
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for updated CLTS Program coding notes for counseling and therapeutic services and begin using modifier 59 when applicable.
Service: empowerment and self-determination supports
Change: The U8 “period unit” modifier has been removed from HCPCS code S9445,patient education, not otherwise classified, per session. Using a modifier is no longer required on PAs or claims for this service.
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for the updated CLTS Program coding notes for empowerment and self-determination supports.
Services: adult family home placement; respite care, institutional
Change: The CLTS Program Coding Notes for adult family home placement and respite care, institutional, have been updated to clarify that CWAs must include only the Federal Revenue Code on the PA while the rendering provider must include both the revenue code and HCPCS code on the institutional claim when billing for these services.
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for the updated CLTS Program coding notes for adult family home placement and respite care, institutional.
Services: CLTS Program services with group rates
Change: The CLTS Program Coding Notes for all services that include group rates have been updated to clarify that, in instances where the service is delivered in a group setting, the CWA submits only the group modifier HQ on the PA while the rendering provider must submit both the HQ modifier and the group size modifier UN (two participants) or UP (three participants) on the claim.
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for the updated CLTS Program coding notes.
Services: respite care; personal supports
Change: The CLTS Program coding notes for all iterations of respite care and personal supports have been updated to clarify that PAs and claims for approved CLTS Program outliers must include only the outlier modifier (U4 and/or U5) and not the participant’s care level modifier (U1, U2, or U3).
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for the updated CLTS Program coding notes for respite care and personal supports.
Service: child care
Change: The CLTS Program Coding Notes for HCPCS codes T2026 and T2027–specialized childcare, waiver, per-diem and 15-minutes–have been updated to clarify that PAs and claims for approved CLTS outliers must include both the outlier modifier (U4 and/or U5) and the participant’s age modifier (U1, U2, or U3).
Action: Review the CLTS Program Benefit Code Crosswalk, P-02283 for the updated CLTS Program coding notes for child care.
The CLTS Program Benefit Code Crosswalk, P-02283, has been updated to reflect the changes.
If you have any questions, please contact the Gainwell CLTS Operations Team at 844-942-5870 or CLTSOperations@GainwellTechnologies.com.
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