`T1003` Lpn/lvn services up to 15min

Lpn/lvn services, up to 15 minutes

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for T1003

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for T1003

58 of 60 payer prior-auth lists that name T1003 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Texas, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required		Jul 1, 2025	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required		Jul 1, 2025	Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of New Mexico	Turquoise Care (New Mexico Medicaid)	NM	prior auth required		Oct 1, 2026	New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
HealthSpring	Medicare Advantage	All	prior auth required		Jan 1, 2026	2026 Q4 Prior Authorization List
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Humana	Humana LTSS (Dual/integrated plan)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated (HMO D-SNP) Illinois long-term services and supports prior authorization and notification list
Humana	Humana LTSS (Healthy Horizons)	VA	prior auth required		Jul 1, 2025	Humana Healthy Horizons® in Virginia Long-Term Services and Supports (LTSS) Prior Authorization and Notification List
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of Idaho	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Exchange	MI	prior auth required		Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required		Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of Nevada	Medicaid	NV	prior auth required		Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicaid	NM	prior auth required	Prior authorization is required for all home health services	Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required	*Waiver Service Plan required	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Texas	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth required		Jul 1, 2026	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth under conditions	PA after 6 snv	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth under conditions	site of care: home, outpatient	Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth required		Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Surest	Surest health plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Complete (Individual & Family plans)	All	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community Plan	AHCCCS Complete Care (ACC)	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	District of Columbia LTSS	DC	prior auth required		Oct 1, 2026	Prior Authorization Requirements for District of Columbia LTSS Effective October 1, 2026
UnitedHealthcare Community Plan	KanCare	KS	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Massachusetts OneCare	MA	prior auth required		Nov 1, 2025	Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO)	MA	prior auth required		Nov 1, 2025	CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO) and OneCare	MA	prior auth required		Oct 1, 2026	Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	Missouri Medicaid	MO	prior auth under conditions	Prior authorization only required	Jul 1, 2026	Prior authorization requirements for Missouri Medicaid Effective July 1, 2026
UnitedHealthcare Community Plan	Nebraska Heritage Health	NE	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United
UnitedHealthcare Community Plan	New Jersey FamilyCare	NJ	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	TennCare	TN	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community Plan	Texas CHIP	TX	prior auth required		Jan 1, 2015	Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community Plan	Texas STAR	TX	prior auth required		Jan 1, 2015	Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community Plan	Texas STAR+PLUS	TX	prior auth required		Jan 1, 2015	Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Hawaii (QUEST Integration)	HI	prior auth under conditions	Prior authorization only required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	Virginia Cardinal Care LTSS	VA	prior auth required		Oct 1, 2026	Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026
UnitedHealthcare Community Plan	Virginia Cardinal Care Medicaid	VA	prior auth required		Oct 1, 2026	Prior authorization requirements for Virginia Cardinal Care Effective October 1, 2026
UnitedHealthcare Community Plan	Wisconsin BadgerCare Plus and Medicaid SSI	WI	prior auth required		Sep 1, 2026	Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name T1003

T1003 appears in 24 coverage policies from Aetna, Anthem, Premera Blue Cross, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Early Intervention Programs (0444)	not covered	Jul 1, 2026	payer document
Aetna	Home Births (0329)	not covered (range T1000-T1003)	May 21, 2026	payer document
Aetna	Skilled Home Health Care Nursing Services (0201)	covered if criteria are met	Apr 22, 2026	payer document
Aetna	Skilled Home Private Duty Nursing Care (0136)	listed, no stance	Apr 7, 2026	payer document
Anthem	Home Health (CG-MED-23)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Private Duty Nursing in the Home Setting (CG-REHAB-08)	covered if criteria are met	Aug 13, 2026	payer document
Premera Blue Cross	Non-covered Services and Procedures Page \| 20 of 30 \| ∞	not covered	Jun 1, 2026	payer document
UnitedHealthcare	Home Health Care Services (for Kentucky Only) (CS137KY.12)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (CS137.X)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (MP.022.28)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Idaho Only) (CS137ID.D)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Kansas Only) (CS137KS.04)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Nebraska Only) (CS137NE.V)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for New Jersey Only) (CS137NJ.X)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for New Mexico Only) (CS137NM.D)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for North Carolina Only) (CSNC.MP.022.08)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Ohio Only) (CS137OH.E)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Tennessee Only) (CS137TN1.J)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (CS102.V)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Florida Only) (CS102FL.J)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Kansas Only) (CS102KS.03)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Nebraska Only) (CS102NE.Q)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for New Jersey Only) (CS102NJ.I)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for New Mexico Only) (CS102NM.D)	listed, no stance	Aug 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jul 1, 2026: conditions changed, Passport by Molina Healthcare (Kentucky)
Nov 1, 2025: PA added, Blue Cross and Blue Shield of Illinois
Mar 1, 2025: PA added, Rocky Mountain Health Plans
Mar 1, 2025: PA added, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in IN, OH, VA.

AZ: $15.75 (behavioral, AHCCCS PT 18), effective Oct 1, 2026
KS: $10.00 (default), effective Sep 1, 2002
LA: $10.00 (epsdt), effective Mar 20, 2019
ND: $15.76 (physician), effective Aug 1, 2026
VA: $8.70 (medical, Aids Waiver), effective Jul 1, 2026
WA: $3.76 (school_based), effective Jul 1, 2026
WY: $18.86 (professional), effective Jul 1, 2021

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

T1003 Lpn/lvn services up to 15min