`T2016` Habil res waiver per diem

Habilitation, residential, waiver; per diem

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

Medicare pricing for T2016

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for T2016

1 of 1 payer prior-auth lists that name T2016 require prior authorization or set conditions: Molina Healthcare of California.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Molina Healthcare of California	Medicaid	CA	prior auth required	State exception	Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026

Payer coverage policies that name T2016

T2016 appears in 1 coverage policy from Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Premera Blue Cross	Non-covered Services and Procedures Page \| 21 of 30 \| ∞	not covered	Jun 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, VA.

IN: $253.81 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2023
MS: $138.18 (comprehensive), effective Jul 1, 2023
WY: $0.00 (professional), effective May 1, 2022

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.

T2016 Habil res waiver per diem