HomeMy WebLinkAboutAdult Developmental Disabilities Waiver ServicesDate Effective: 06/10/2025 Page 1 of 4 Last Reviewed: 06/04/2025
Adult Developmental Disabilities Waiver – Idaho Medicaid
ADULT DD WAIVER
Procedure
Code Modifier Description 1 Unit
Equiv.
Allowed
Amount
A0080 Non-Medical Transportation by Agency 1 Mile $.44
A0080 Non-Medical Transportation by Individual 1 Mile $.10
A0080
Non-Medical Transportation
Commercial Provider
First mile of the first trip of the day
1 Mile $4.20
A0080 76
Non-Medical Transportation
Commercial Provider
Additional miles per day
1 Mile $1.17
A0110 Non-Medical Transportation
Commercial Bus Pass 1 Pass Manual
Price
E1399 Specialized Medical Equipment (75% of
manufacturer’s suggested retail price) Manual
Price
H2015 Individual Supported Living 15 Mins $7.88
H2015 HQ Group Supported Living 15 Mins $4.02
H2016 Daily Supported Living Services-Intense
Support Reduction of Services Due to School 1 Day $598.88
H2016 Daily Supported Living Services-Intense
Support 1 Day $756.48
H2016 Daily Supported Living Services-High Support
Reduction of Services Due to School 1 Day $325.28
H2022 Daily Supported Living Services-High Support 1 Day $410.88
H2019 Behavioral Consultation by a QIDP/Clinician 15 Mins $6.42
H2019 Behavioral Consultation by a Psychiatrist 15 Mins $10.02
H2019 HM Behavioral Consultation Emergency
Intervention Technician 15 Mins $2.90
H2023 Supported Employment 15 Mins $11.92
S5100 Adult Day Health 15 Mins $2.79
S5121 Chore Services (Skilled) Manual
Price
S5140 Residential Habilitation-CFH 1 Day $69.41
S5160 Personal Emergency Response System
Install and First Month’s Rent
1 Time
Only $67.13
S5161 Personal Emergency Response System
Monthly Rent 1 Month $39.92
Date Effective: 06/10/2025 Page 2 of 4 Last Reviewed: 06/04/2025
ADULT DD WAIVER
Procedure
Code Modifier Description 1 Unit
Equiv.
Allowed
Amount
S5165 Environmental Accessibility Adaptations Manual
Price
S5170 Home Delivered Meals 1 Meal $7.06
S9125 Respite Care Daily 1 Day $53.39
T1000 Skilled Nursing Services-Independent RN 15 Mins $15.29
T1000 TE Skilled Nursing Services-Agency LPN 15 Mins $14.62
T1000 TD Skilled Nursing Services-Agency RN 15 Mins $20.38
T1001 Nursing Oversight Services-LPN 1 Visit $54.00
T1001 TD Nursing Oversight Services-Agency RN 1 Visit $101.90
T1001 TD Nursing Oversight Services-Independent RN 1 Visit $76.43
T1005 Respite Care 15 Mins $5.77
T2038 Transition Services
Goods and services;
not to exceed
$2,000
ADULT DD STATE PLAN HCBS
Procedure
Code Modifier Description 1 Unit
Equiv.
Allowed
Amount
97537 Home/Community Individual and/or Group
Developmental Therapy for Adults
15
Mins $6.26
H2000 Developmental Therapy Evaluation 15
Mins $16.95
H2011 Community Crisis Supports 15
Mins $11.35
H2032 Center Based Individual and/or Group
Developmental Therapy for Adults
15
Mins $4.17
DD SERVICE COORDINATION
Procedure
Code Modifier Description 1 Unit
Equiv.
Allowed
Amount
G9002 DD Service Coordination 15
Mins $21.84
G9002 HM DD Service Coordination (Paraprofessional) 15
Mins $14.02
G9007 DD Plan Development 15
Mins $21.84
H2011 DD Crisis Assistance 15
Mins $21.84
Date Effective: 06/10/2025 Page 3 of 4 Last Reviewed: 06/04/2025
DD SERVICE COORDINATION
Procedure
Code Modifier Description 1 Unit
Equiv.
Allowed
Amount
H2011 HM DD Crisis Assistance (Paraprofessional) 15
Mins $14.02
SELF DIRECTED SERVICES
Procedure
Code Modifier Description 1 Unit
Equiv.
Allowed
Amount
T2025 Community Support Services TBD Manual
Price
T2025 Non-Medical Transportation TBD Manual
Price
T2025 Skilled Nursing Services TBD Manual
Price
T2025 Specialized Medical Equipment and Supplies TBD Manual
Price
T2041 Support Broker Services 15
Mins
Manual
Price
T2025 Transition Services TBD Manual
Price
T2040 Financial Management Services - Agency PMPM Manual
Price
For services billed under the self-direction model, participants set rates based on their
specific needs and approved budget through negotiation with the Department.
OTHER SERVICES
Procedure
Code
Modifier Description 1 Unit
Equiv.
Allowed
Amount
T1013 Interpretive Services-oral 15
Mins $3.72
T1013 CG Interpretive Services-sign language 15
Mins $15.30
T2022 UD Transition Management (Community
Integration)
15
Mins $12.09
Coverage and criteria information is communicated in the Provider Handbook, MedicAide
Newsletters and Information Releases at IDMedicaid.com.
For questions related to billing and claims, please contact the appropriate resource:
Fee-For-Service Medicaid Participants:
o Gainwell Technologies – (866) 686-4272
Date Effective: 06/10/2025 Page 4 of 4 Last Reviewed: 06/04/2025
Questions about pricing should be directed to the Office of Reimbursement, Idaho Division
of Medicaid, at (208) 287-1180 or email MedicaidReimTeam@dhw.idaho.gov
Requests for a reimbursement rate review should be directed to the Provider Rate Review
team at MedicaidRateReview@dhw.idaho.gov
Thank you for your continued participation in the Idaho Medicaid Program.