HCPCS Level II › T codes T1021 Hh aide or cn aide per visitHome health aide or certified nurse assistant, per visit
Medicare coverage: Not payable by Medicare Status: active (October 2026 file) Medicare pricing for T1021 Physician Fee Schedule (CY 2026, RVU26D) Status I: not valid for Medicare (Medicare uses another code).
Payer policies and prior authorization for T1021 17 of 17 payer prior-auth lists that name T1021 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, HealthSpring, Humana, Molina Healthcare of Iowa, Molina Healthcare of Utah, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source 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 Aug 1, 2026 2026 Q4 Prior Authorization List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana Healthy Horizons FL prior auth required Jan 1, 2027 1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List Humana Humana Healthy Horizons KY prior auth required Jan 1, 2027 please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. Humana Humana Healthy Horizons SC prior auth required Jan 1, 2027 Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Molina Healthcare of Iowa Medicaid IA prior auth required Jul 1, 2023 IA Prior Authorization Matrix, effective Q3 2023 Molina Healthcare of Utah Medicaid UT prior auth under conditions State exception; PA after 6 visit Jan 1, 2025 Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 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 North Carolina Medicaid NC prior auth required Oct 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024 UnitedHealthcare Community Plan UnitedHealthcare Community Plan of Florida FL prior auth under conditions site of care: home, outpatient Oct 1, 2026 Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026 UnitedHealthcare Community Plan UnitedHealthcare Community Plan of Kentucky KY prior auth required Jul 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 UnitedHealthcare Community Plan Washington Apple Health WA prior auth under conditions site of care: home, outpatient Oct 1, 2026 Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023 UnitedHealthcare Community Plan Wisconsin BadgerCare Plus and Medicaid SSI WI prior auth under conditions site of care: home, outpatient 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 T1021 T1021 appears in 16 coverage policies from Aetna, Anthem, Premera Blue Cross, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Home Health Aides (0218) covered if criteria are met Sep 10, 2026 payer document Aetna Skilled Home Health Care Nursing Services (0201) listed, no stance Apr 22, 2026 payer document Aetna Skilled Home Private Duty Nursing Care (0136) listed, no stance Apr 7, 2026 payer document Aetna Wound Care: Home or Outpatient Setting (1054) listed, no stance Dec 23, 2025 payer document Anthem Home Health (CG-MED-23) covered if criteria are met Nov 6, 2025 payer document Premera Blue Cross Non-covered Services and ProceduresPage | 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 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
Recent prior-auth changes Aug 1, 2026: PA added, HealthSpring Apr 1, 2026: PA removed, UnitedHealthcare Apr 1, 2026: PA removed, HealthSpring Apr 1, 2026: PA removed, UnitedHealthcare Jan 1, 2024: PA removed, humana:pa:commercial Medicaid fee-for-service Prior authorization required or conditional in IN, VA.
KS: $40.00 (default), effective Dec 1, 2005 ND: $20.56 (physician), effective Aug 1, 2026 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.