Does T1000 require prior authorization?

Yes, T1000 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for T1000?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`T1000`, Private duty / independent nursing service(s) - licensed, up to 15 minutes

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation that the child meets an eligible condition per state-defined criteria for developmental delay (medical/diagnostic documentation of developmental delay or high risk).
Individual Family Service Plan (IFSP) for any child recognized as having a disability that interferes with learning from infancy to age 3; IFSP must include specific early intervention services the family and child will receive and a projection of their duration (per Education of the Handicapped Act Amendments requirement).

When applicable, standardized developmental screening and testing results with scoring and documentation (e.g., use of standardized instruments as described by CPT/HCPCS such as 96110, 96112/96113, G0451) including interpretation and report.

Recommended (per ACOG guidance cited in the CPB) components of prenatal care that women considering home birth should be offered (not described as coverage documentation requirements): 'group B Strep screening and treatment, genetic screening, as well as HIV screening.'

Key Coverage Criteria

Private duty nursing services with Skilled Care are covered in certain circumstances.
Early intervention programs (coordinated multidisciplinary care) for children from infancy to 3 years of age who have developmental delays or have a high potential for developmental delay.
Children with biological conditions that may predispose to a developmental delay (eligible for early intervention services).
Children at risk of developing developmental delays attributable to environmental factors (eligible for early intervention services).
Coverage of component services of early intervention programs (such as speech therapy, physical therapy, occupational therapy, psychological counseling for families, nursing care, and physical or social stimulation) when the child presents with an eligible condition.
Provision of services described in an Individual Family Service Plan (IFSP) for a child recognized as having a disability that interferes with learning from infancy to age 3 (IFSP defines specific early intervention services and projected duration).

9 Active Policies

ANTHEM-CG-REHAB-08, Private Duty Nursing in the Home Setting

EVICORE-HPLAN-CIGNA-F5290F1D2F69, Cigna Commercial Home Health Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

UHC-POL-private-duty-nursing-services, Private Duty Nursing Services

AETNA-CPB-0444, Early Intervention Programs

AETNA-CPB-0329, Home Births

AETNA-CPB-0201, Skilled Home Health Care Nursing Services

UMR-POL-UMR-private-duty-nursing-services, Private Duty Nursing Services

SUREST-POL-SUREST-private-duty-nursing-services, Private Duty Nursing Services

`T1000`, Private duty / independent nursing service(s) - licensed, up to 15 minutes

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

T1000, Private duty / independent nursing service(s) - licensed, up to 15 minutes

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`T1000`, Private duty / independent nursing service(s) - licensed, up to 15 minutes