Last week’s NC Medicaid bulletin included updates to procedure codes that home care agencies should be aware of.
As North Carolina Medicaid enters 2026, providers are navigating multiple policy updates, from CPT table corrections to ongoing rate and service-definition changes in long-term services and supports (LTSS). While recent CPT bulletins focus on correcting code tables, the core procedure codes used for attendant care and homemaker-type services remain consistent across the State Plan and CAP waivers.
Attendant Care: Hands-On Assistance with ADLs and Personal Care
In NC Medicaid, “attendant care” is typically delivered and billed as:
- Personal Care Services (PCS) under the State Plan, or
- In-Home Aide–type services under CAP waivers
Although the wording differs by program, the service’s intent is the same: hands-on assistance with activities of daily living (ADLs) and personal care.
NC Medicaid State Plan – Personal Care Services (PCS)
Core PCS Code
CPT 99509 – Personal care services, per 15 minutes
This remains the foundational code for PCS statewide.
In-Home PCS Modifiers
For PCS delivered in a participant’s private residence, bill 99509 with:
- HA or HB
These modifiers:
- Identify in-home PCS
- Are most commonly associated with Electronic Visit Verification (EVV) requirements
- Must align with member eligibility and authorization details
PCS in Congregate Settings
PCS delivered in licensed or supervised residential settings still uses 99509, with modifiers identifying the setting type.
Common modifiers include:
- HC – Adult Care Homes
- TT – Combination Homes
- SC – Special Care Units
- HQ – Family Care Homes
- HH / HI – Supervised or supported living facilities
The modifier, not the base code, signals where the service is provided.
CAP Waivers: Attendant Care and In-Home Aide Services
For many providers, CAP waivers most closely resemble traditional attendant care programs. NC Medicaid has continued to emphasize these services through rate and policy updates affecting PCS-like waiver codes.
Key CAP Attendant Care–Related Codes
- S5125 – In-Home Aide (15-minute units)
Primary code for hands-on aide services in the home
- S5125 + UN – In-Home Aide (Congregate Setting)
Used when aide services are delivered in approved congregate or residential environments
- S5150 – Respite, In-Home Aide
Covers aide/attendant-type staffing when delivered as respite rather than ongoing PCS
These codes remain central to CAP/DA, CAP/C, and other waiver programs when billing for personal assistance services.
Homemaker Services: Household Help and Environmental Supports
NC Medicaid does not consistently define a single State Plan service labeled “homemaker.” Instead, homemaker-type tasks are often:
- Bundled within PCS (99509) under the State Plan, or
- Included in In-Home Aide (S5125) services under CAP waivers
When homemaker services are separated into distinct waiver service categories, most commonly in CAP/DA, specific HCPCS codes apply.
Homemaker / Chore-Specific Codes
- T1020 – Chore Services
Includes cleaning, laundry, decluttering, and similar household support activities
- S5170 – Meal Preparation and Delivery
Homemaker-adjacent support for members unable to safely prepare meals
These services typically support, but do not replace, hands-on personal care.
Key Takeaways for Providers
- PCS and attendant care are defined by program and setting, not by a single label
- 99509 remains the core PCS code, with modifiers doing the heavy lifting
- CAP waivers provide the clearest structure for attendant care–style services
- Homemaker services are often embedded unless explicitly separated under a waiver
Using the correct procedure codes and the correct modifiers supports compliance, accurate reimbursement, and continuity of care for members who rely on these essential services.
If you need your procedure codes reviewed or are exploring a software partner to support billing, compliance, and operations, we invite you to schedule a meeting with one of our Agency Strategists to see how we can help.
