Revisions have been made to the Health and Human Services Commission (HHSC) Electronic Visit Verification (EVV) Reason Codes.

Effective Dec. 1, 2016, provider agencies required to use an HHSC approved EVV system, must begin using the revised and new reason codes on Dec. 1, 2016. Failure to use the revised and new reason codes may result in claim denial, recoupment or contract action.

Provider agencies must use the most appropriate reason code(s). If HHSC or the appropriate MCO determines a provider agency misused a reason code, the provider agency may be subject to:

  • Contract Actions
  • Corrective Action Plan
  • Liquidated Damages
  • Medicaid Fraud Referral

New Reason Codes

Reason Code 121 – Attendant or Assigned Staff - No Call and No Show

  • Selected when there is a planned schedule entered in the EVV system and the attendant or assigned staff failed to report to work and did not inform the provider agency until after the missed schedule visit.
  • All situations that require documentation must be documented according to program policy.
  • This is a preferred reason code.

Reason Code 135 – Confirm Visit with No Schedule

  • Selected when the attendant or assigned staff provides services, as requested by the individual/member, but there was no schedule in the EVV system.
  • All situations that require documentation must be documented according to program policy.
  • This is a preferred reason code.

Reason Code 215 – Reversal of Call-In / Call-Out Times

  • Selected when an attendant or assigned staff reverses a call-in for a call-out or a call-out for a call-in.
  • This applies to SADs and Landlines.
  • This is a preferred reason code.

Revisions to Current Reason Codes

Revisions are italicized. "Assigned Staff" was added to all reason codes.

Reason Code 100 – Schedule Variation

  • Selected when the attendant or assigned staff provides more or fewer hours of service than scheduled or provides services at a different time of day than scheduled, as requested by the individual/member.
  • This reason code cannot be used when an attendant or assigned staff fails to clock-in and/or clock-out, unless the appropriate non-preferred reason code (RC 900, 905, or 910) is also saved to the visit.
  • Misuse of this preferred reason code may result in contract action(s).

Reason Code 105 – Services Provided Outside the Home – Supported By Service Plan

  • Selected when the attendant or assigned staff cannot call-in or call-out because some or all of the scheduled services were provided outside of the home in accordance with program policy.

Reason Code 115 – Individual or Member Agreed or Requested Attendant or Assigned Staff Not Work Schedule

  • Selected when the attendant or assigned staff does not work and the individual/member was contacted and agreed, or the individual/member contacted the agency and requested the attendant or assigned staff not work.

Reason Code 120 – Invalid Attendant or Assigned Staff or Individual or Member ID Entered – Verified Services Were Delivered

  • Selected when an attendant or assigned staff did not accurately or completely enter their employee EVV ID or the individual/member's EVV ID into the EVV system.

Reason Code 200 – Small Alternative Device Has Been Ordered – (Initial or Replacement Order)

  • Selected when a small alternative device has been ordered, but the provider has not yet received the device. Misuse of this preferred reason code may result in contract action(s).

Reason Code 210 – Missing Small Alternative Device

  • Selected when the SAD cannot be located in the individual/member's home. If the SAD is not located within 14 calendar days, the provider agency must request a replacement device.
  • Removed language "that originally requested the device".

Reason Code 300 – Phone Lines Not Working – Attendant or Assigned Staff Not Able to Call – Verified Services Were Delivered

  • Selected when a call-in or a call-out is not possible due to technical problems with the landline phone (e.g., individual's/member's phone not working, phone line is disconnected or EVV vendor system issues). Continuous vendor system issues must be reported to the EVV vendor. Please notify payor(s) within 48 hours or unresolved vendor system issues.

Reason Code 305 – Malfunctioning Small Alternative Device or Invalid Small Alternative Device Value – Verified Services Were Delivered

  • Selected when a SAD malfunctions or provides invalid values.

Reason Code 310 – Malfunctioning Mobile Application

  • Selected when the EVV mobile application malfunctions and prevents an attendant or assigned staff from documenting the time service delivery begins and/or ends.

Reason Code 400 – Individual or Member Does Not Have Home Phone – Verified Services Were Delivered

  • Selected when an individual/member does not have a home landline phone and requires the use of a small alternative device but one has not yet been requested by the individual/member.

Reason Code 500 – In-Home Respite Services

  • Selected when unscheduled in-home respite services are provided.

Reason Code 700 – Downward Adjustment to Billed Hours

  • Selected when the timed billed is adjusted downward to offset rounding. The EVV system applies rounding rules to the total actual hours for each visit.
  • Each visit is rounded to the nearest quarter hour (0, 15, 30, 45 minutes past the hour) based on the total actual hours.
  • Misuse of this preferred reason code may result in contract action(s)

Read More About Reason Codes