Virginia DD Waiver Service Codes and Rates (SFY 2027)
Last verified
, against the DMAS “My Life, My Community” rate file dated 6/26/2026, rates effective July 1, 2026.
Every procedure code, modifier, unit, and rate for the Building Independence (BI), Family and Individual Supports (FIS), and Community Living (CL) waivers, in one place. Bookmark this page. We update it within a week of every DMAS rate change and log what moved at the bottom.
Source: DMAS SFY 2027 DD Waiver Rates. Regulatory authority: 12VAC30-122.
How to read this page
- NOVA vs ROS
- Every rate has two values. NOVA is the Northern Virginia rate. ROS is Rest of State. Which one you bill depends on the locality where the service is delivered, not where your office is.
- Tiers
- Residential, day support, and community engagement rates vary by the individual's SIS-based tier (1 through 4). The tier comes from the individual's record, not from the provider.
- Modifiers
- Several codes reuse the same HCPCS code with a modifier to distinguish group size, staffing ratio, or partial month. Bill the wrong modifier and the claim pays at the wrong rate or denies.
- 344 billing days
- Residential per diems (group home, sponsored residential, supported living) are paid on a 344-day year, not 365. The difference is the built-in allowance for hospitalizations, visits home, and vacancies.
- IC = Individual Consideration
- Paid at approved cost up to a cap, based on the service authorization. No fixed rate.
- EVV
- Only three agency-directed codes on this list require Electronic Visit Verification data on the claim: T1019, T1005, and S5135. Everything else does not. See the EVV section below for setting-based exemptions.
Employment and day options
Available in BI, FIS, and CL unless noted.
| Service | Code | Modifier | Unit | NOVA | ROS |
|---|---|---|---|---|---|
| Individual Supported Employment | H2023 | N/A | Hour | DARS rate | DARS rate |
| Group Supported Employment, 2 or fewer per staff | H2024 | UA | Hour | $32.96 | $28.91 |
| Group Supported Employment, more than 2 up to 4 per staff | H2024 | U2 | Hour | $23.08 | $20.29 |
| Group Supported Employment, more than 4 per staff | H2024 | U3 | Hour | $19.11 | $16.86 |
| Workplace Assistance Services (FIS and CL only) | H2025 | N/A | Hour | $57.06 | $48.87 |
| Community Engagement, Tier 1 | T2021 | N/A | Hour | $30.22 | $25.88 |
| Community Engagement, Tier 2 | T2021 | N/A | Hour | $34.50 | $29.55 |
| Community Engagement, Tier 3 | T2021 | N/A | Hour | $41.05 | $35.16 |
| Community Engagement, Tier 4 | T2021 | N/A | Hour | $52.12 | $44.64 |
| Community Coaching | T2013 | N/A | Hour | $56.71 | $48.57 |
| Group Day Support, Tier 1 | 97150 | N/A | Hour | $16.48 | $14.10 |
| Group Day Support, Tier 2 | 97150 | N/A | Hour | $21.22 | $18.32 |
| Group Day Support, Tier 3 | 97150 | N/A | Hour | $25.08 | $21.74 |
| Group Day Support, Tier 4 | 97150 | N/A | Hour | $32.22 | $28.07 |
| Peer Mentoring | H0038 | N/A | Hour | $38.24 | $35.00 |
| Community Guide | H2015 | N/A | Hour | $67.45 | $58.45 |
- H2023 Individual Supported Employment is paid at the DARS-established rate. Look it up at the DARS Public Rate Source. DMAS pays that rate as the Medicaid fee schedule rate.
- T2013 Community Coaching replaced 97127 on 1/1/2020. Claims still going out under 97127 will deny.
- T2013, T2021, and H2025 were rebased on 7/1/2026 using the 2025 DD Waiver Rate Study. If you built a budget on the SFY 2026 rates, recheck these three first.
Personal care and related services
Available in FIS and CL. Not available in BI.
| Service | Code | Modifier | Unit | NOVA | ROS | EVV |
|---|---|---|---|---|---|---|
| Personal Assistance (agency-directed) | T1019 | N/A | Hour | $23.81 | $20.23 | Yes |
| Respite Care (agency-directed) | T1005 | N/A | Hour | $23.81 | $20.23 | Yes |
| Companion Care (agency-directed) | S5135 | N/A | Hour | $23.81 | $20.23 | Yes |
| CD Personal Assistance | S5126 | N/A | Hour | $17.97 | $13.88 | Via F/EA |
| CD Respite Care | S5150 | N/A | Hour | $17.97 | $13.88 | Via F/EA |
| CD Companion Care | S5136 | N/A | Hour | $17.97 | $13.88 | Via F/EA |
| CD Routine Visit (Services Facilitation) | 99509 | N/A | Hour | $112.67 | $101.14 | No |
| CD Initial Comprehensive Visit | H2000 | N/A | Hour | $360.54 | $323.64 | No |
| CD Employee Management / Consumer Training | S5109 | N/A | Hour | $260.63 | $200.49 | No |
| CD Management Training | S5116 | N/A | Hour | $90.14 | $80.91 | No |
| CD Reassessment Visit | T1028 | N/A | Hour | $180.27 | $161.82 | No |
| Individual and Family Caregiver Training (FIS only) | S5111 | N/A | Year | IC | IC | No |
- S5111 caregiver training is FIS only, IC up to $4,000 per ISP year.
- Personal care codes did not get an increase on 7/1/2026. The last increase was 2% on 7/1/2025.
- Agency-directed personal care, respite, and companion are billed in whole-hour units. Partial hours accrue across visits within the month and round once at month end. See the EVV section for the DMAS rule.
Residential options
| Service | Code | Modifier | Unit | Waiver | NOVA | ROS |
|---|---|---|---|---|---|---|
| Independent Living Supports, Tier 1 | T2032 | N/A | Month | BI | $2,865.14 | $2,454.04 |
| Independent Living Supports, Tiers 2 to 4 | T2032 | N/A | Month | BI | $4,297.70 | $3,681.06 |
| Independent Living Supports, Partial Month, Tier 1 | T2032 | U1 | Partial month | BI | $1,432.57 | $1,227.02 |
| Independent Living Supports, Partial Month, Tiers 2 to 4 | T2032 | U1 | Partial month | BI | $2,148.85 | $1,840.53 |
| Shared Living | T1020 | N/A | Month or partial month | BI, FIS, CL | IC | IC |
| Supported Living Residential, Tier 1 | H0043 | N/A | Per diem (344 days) | FIS, CL | $369.06 | $327.54 |
| Supported Living Residential, Tier 2 | H0043 | N/A | Per diem (344 days) | FIS, CL | $414.42 | $367.81 |
| Supported Living Residential, Tier 3 | H0043 | N/A | Per diem (344 days) | FIS, CL | $459.80 | $408.05 |
| Supported Living Residential, Tier 4 | H0043 | N/A | Per diem (344 days) | FIS, CL | $541.45 | $480.52 |
| In-Home Support Services, Size 1 | H2014 | UA | Hour | FIS, CL | $54.73 | $46.88 |
| In-Home Support Services, Size 2 | H2014 | U2 | Hour | FIS, CL | $29.53 | $25.29 |
| In-Home Support Services, Size 3 | H2014 | U3 | Hour | FIS, CL | $21.29 | $18.23 |
| Sponsored Residential, Tier 1 | T2033 | N/A | Per diem (344 days) | CL | $253.74 | $205.08 |
| Sponsored Residential, Tier 2 | T2033 | N/A | Per diem (344 days) | CL | $347.48 | $279.08 |
| Sponsored Residential, Tier 3 | T2033 | N/A | Per diem (344 days) | CL | $446.12 | $357.32 |
| Sponsored Residential, Tier 4 | T2033 | N/A | Per diem (344 days) | CL | $579.35 | $460.92 |
- H2014 In-Home Support Services was rebased on 7/1/2026. The size modifier is the number of individuals served at the same time by the same staff. Size 1 is one-to-one.
- In-Home Support Services does not require EVV. It is not on the DMAS EVV code list.
- Sponsored Residential is CL only. Group Home Residential is CL only.
Group Home Residential (H2022), CL waiver
Rate depends on home size (modifier) and the individual's tier. Per diem, 344 billing days.
| Home size | Modifier | Tier | NOVA | ROS |
|---|---|---|---|---|
| 4 or fewer | UA | 1 | $391.16 | $347.17 |
| 4 or fewer | UA | 2 | $467.16 | $414.60 |
| 4 or fewer | UA | 3 | $515.37 | $457.37 |
| 4 or fewer | UA | 4 | $616.89 | $547.46 |
| 5 | U2 | 1 | $369.73 | $327.54 |
| 5 | U2 | 2 | $415.08 | $367.81 |
| 5 | U2 | 3 | $460.46 | $408.05 |
| 5 | U2 | 4 | $542.12 | $480.52 |
| 6 | U3 | 1 | $358.39 | $317.49 |
| 6 | U3 | 2 | $398.08 | $352.71 |
| 6 | U3 | 3 | $443.45 | $392.96 |
| 6 | U3 | 4 | $527.95 | $467.96 |
| 7 | U4 | 1 | $329.15 | $291.69 |
| 7 | U4 | 2 | $362.52 | $321.13 |
| 7 | U4 | 3 | $406.11 | $359.59 |
| 7 | U4 | 4 | $491.55 | $434.96 |
| 8 | U5 | 1 | $318.03 | $281.88 |
| 8 | U5 | 2 | $345.84 | $306.40 |
| 8 | U5 | 3 | $390.32 | $345.65 |
| 8 | U5 | 4 | $478.74 | $423.66 |
| 9 | U6 | 1 | $306.92 | $272.05 |
| 9 | U6 | 2 | $329.15 | $291.69 |
| 9 | U6 | 3 | $373.65 | $330.92 |
| 9 | U6 | 4 | $464.82 | $411.38 |
| 10 | U7 | 1 | $295.79 | $262.26 |
| 10 | U7 | 2 | $312.47 | $276.98 |
| 10 | U7 | 3 | $356.95 | $316.21 |
| 10 | U7 | 4 | $450.94 | $399.12 |
| 11 | U8 | 1 | $284.67 | $252.44 |
| 11 | U8 | 2 | $295.79 | $262.26 |
| 11 | U8 | 3 | $340.28 | $301.50 |
| 11 | U8 | 4 | $437.03 | $386.85 |
| 12 | U9 | 1 | $273.53 | $242.64 |
| 12 | U9 | 2 | $279.12 | $247.53 |
| 12 | U9 | 3 | $323.60 | $286.78 |
| 12 | U9 | 4 | $423.13 | $374.58 |
Group home and sponsored residential rates got a 2% increase on 7/1/2026.
Crisis support options
Available in BI, FIS, and CL.
| Service | Code | Modifier | Unit | NOVA | ROS |
|---|---|---|---|---|---|
| Community-Based Crisis Supports, professional | S9484 | U1 | Hour | $114.38 | $99.46 |
| Community-Based Crisis Supports, non-professional | S9484 | N/A | Hour | $31.06 | $27.02 |
| Center-Based Crisis Supports, professional | H2019 | U1 | Hour | $114.38 | $99.46 |
| Center-Based Crisis Supports, non-professional | H2019 | UA | Hour | $31.06 | $27.02 |
| Crisis Support Services, professional | T2034 | U1 | Hour | $114.38 | $99.46 |
| Crisis Support Services, non-professional | T2034 | N/A | Hour | $31.06 | $27.02 |
- S9484 replaced H0040 for community-based crisis on 7/1/2021. H2019 replaced H2011 for center-based crisis on 12/1/2021.
Medical and behavioral support options
| Service | Code | Modifier | Unit | Waiver | NOVA | ROS |
|---|---|---|---|---|---|---|
| Skilled Nursing, RN | S9123 | N/A | 15 min | FIS, CL | $25.86 | $23.43 |
| Skilled Nursing, LPN | S9124 | N/A | 15 min | FIS, CL | $20.46 | $17.49 |
| Private Duty Nursing, RN | T1002 | N/A | 15 min | FIS, CL | $22.73 | $19.85 |
| Private Duty Nursing, LPN | T1003 | N/A | 15 min | FIS, CL | $17.67 | $14.58 |
| Therapeutic Consultation, Therapist / BCBA / Rehab Engineer | 97139 | N/A | Hour | FIS, CL | $171.71 | $147.07 |
| Therapeutic Consultation, Psychologist / Psychiatrist | H2017 | N/A | Hour | FIS, CL | $123.28 | $111.73 |
| Therapeutic Consultation, Other Professionals | 97530 | N/A | Hour | FIS, CL | $168.92 | $144.68 |
| PERS, RN | H2021 | TD | 30 min | BI, FIS, CL | $14.85 | $12.13 |
| PERS, LPN | H2021 | TE | 30 min | BI, FIS, CL | $12.87 | $10.15 |
| PERS Installation | S5160 | N/A | One-time | BI, FIS, CL | $58.41 | $49.50 |
| PERS Installation and Medication Monitoring | S5160 | U1 | One-time | BI, FIS, CL | $87.62 | $74.25 |
| PERS Monitoring | S5161 | N/A | Month | BI, FIS, CL | $35.05 | $29.70 |
| PERS Medication Monitoring | S5185 | N/A | Month | BI, FIS, CL | $58.41 | $49.50 |
- 97139 and 97530 therapeutic consultation were rebased on 7/1/2026. H2017 was not.
- Nursing increases on 7/1/2026: S9123 up 3.8%, S9124 up 4.5%, T1002 and T1003 up 5%.
Employment and community transportation
Available in BI, FIS, and CL. Billed per mile per passenger (A0090) or per trip (A0110, A0120).
| Trip | Passengers | Code | NOVA | ROS |
|---|---|---|---|---|
| Under 10 miles, one way | 1 | A0090 | $10.25 | $8.91 |
| Under 10 miles, one way | 2 | A0090 | $5.64 | $4.90 |
| Under 10 miles, one way | 3 | A0090 | $4.10 | $3.56 |
| 10 to 20 miles, one way | 1 | A0090 | $20.49 | $17.82 |
| 10 to 20 miles, one way | 2 | A0090 | $11.27 | $9.80 |
| 10 to 20 miles, one way | 3 | A0090 | $8.20 | $7.13 |
| Over 20 miles, one way | 1 | A0090 | $34.15 | $29.70 |
| Over 20 miles, one way | 2 | A0090 | $18.79 | $16.34 |
| Over 20 miles, one way | 3 | A0090 | $13.66 | $11.88 |
| Public transit, non-emergency and bus | per trip | A0110 | $0.94 | $0.94 |
| Public transit, para-transit | per trip | A0120 | $3.89 | $3.89 |
Additional options
Available in BI, FIS, and CL.
| Service | Code | Modifier | Unit | Rate | Cap |
|---|---|---|---|---|---|
| Assistive Technology | T1999 | N/A | Per item | IC | $5,000 per year |
| Assistive Technology, maintenance cost only | T1999 | U5 | Per item | IC | $5,000 per year |
| Electronic-Based Home Supports | A9279 | N/A | Per item | IC | $5,000 per year |
| Environmental Modifications | S5165 | N/A | Per item | IC | $5,000 per year |
| Environmental Modifications, maintenance cost only | 99199 | U4 | Per item | IC | $5,000 per year |
| Transition Services | T2038 | N/A | Per item | IC | $5,000 lifetime |
| Benefits Planning | T1023 | N/A | Hour | $69.89 NOVA / $62.30 ROS | — |
The $5,000 annual cap for AT, EBHS, and environmental modifications can be spent on one item or spread across several within the year. Transition Services is a lifetime cap.
EVV: which codes need it and which don't
Virginia requires Electronic Visit Verification data on the claim for exactly three agency-directed DD waiver codes:
- T1019 Personal Assistance
- T1005 Respite Care
- S5135 Companion Care
Consumer-directed equivalents (S5126, S5150, S5136) go through the Fiscal/Employer Agent's EVV system, not yours.
No other code on this page requires EVV. That includes In-Home Support Services (H2014), Community Engagement (T2021), Community Coaching (T2013), Group Day Support (97150), and all residential per diems.
The exemption is about the setting, not the provider. DMAS's own language: “The important part of the exemption is where the service is provided, not who is providing it.” Even T1019, T1005, and S5135 are exempt when delivered in a DBHDS-licensed group home, sponsored residential home, supervised living, supported living, a REACH program, or in a school under an IEP. Bill exempt-setting claims with the UB modifier. Using UB outside those settings is not allowed.
Live-in exemption ends October 1, 2026. All agency-directed aides and consumer-directed attendants, regardless of live-in status, must use an approved EVV method for every shift from that date.
How Virginia collects it. Virginia is a provider-choice state with no state aggregator. The six EVV data elements ride the 837P claim itself, submitted through Conduent (fee-for-service) or the MCO's clearinghouse. There is no separate portal upload.
Billing rules that trip people up
- Each HCPCS code is a separate clock-in and clock-out, even if the same aide provides two services in one visit.
- A shift that crosses midnight must be split into two services: one ending at 2359, one starting at 0000.
- A second claim for the same code, same member, same day needs modifier 76.
- Only whole hours can be billed. Extra minutes accrue per member across the month and round once at month end. Rounding per visit is not allowed.
- Manual adjustments must be made by someone with authority over the aide's pay (RN, supervisor, owner, or designee). Coworkers may not adjust each other's time.
- EVV records must be retained six years from the last date of service, longer for minors.
Source: DMAS EVV FAQ, revised November 16, 2023 and the DMAS EVV page.
Frequently asked questions
Which DD waiver codes changed on July 1, 2026?
Rebased from the 2025 DD Waiver Rate Study: T2013, T2021, T2032, H2014, 97139, 97530, H2025. Up 2%: 97150, H2015, H0038, H2023, H2024, H2022, T2033, H0043, T1023. Nursing: S9123 up 3.8%, S9124 up 4.5%, T1002 and T1003 up 5%. Personal care codes (T1019, T1005, S5135, S5126, S5150, S5136) did not change.
How do I know whether to bill NOVA or ROS?
By the locality where the service is delivered. A provider based in Richmond serving an individual in Fairfax bills NOVA for that individual.
What does "344 billing days" mean?
Residential per diems are paid on 344 days per year rather than 365. The 21-day difference covers hospital stays, home visits, and other absences. You do not bill for days the individual is not in the home; the rate is already built to absorb typical absences.
What is the difference between Community Engagement and Community Coaching?
Community Engagement (T2021) is group-based community access, up to three individuals per staff, tiered by SIS level. Community Coaching (T2013) is one-to-one, time-limited, skill-building toward a specific community goal, and requires a DBHDS license for the service. The rate difference reflects the staffing ratio.
Does In-Home Support Services require EVV?
No. H2014 is not on the DMAS EVV code list. Only T1019, T1005, and S5135 require EVV, and only when delivered outside an exempt setting.
Which waivers cover group home and sponsored residential?
Community Living only. FIS and BI do not include H2022 or T2033.
Where is the Individual Supported Employment rate?
DMAS pays the DARS rate for H2023. It is not in the DMAS file. See the DARS Public Rate Source.
Will the MCOs pay the new rates?
Yes. Rates set by the Appropriation Act are incorporated into the Cardinal Care Managed Care capitation, and MCOs are required to update to the same percentage as fee-for-service. MCOs may take 30 to 60 days to update their systems, then automatically reprocess claims paid at old rates.
Change log for this page
| Date | Change |
|---|---|
| Page created from the SFY 2027 rate file (DMAS update dated 6/26/2026). |
DMAS change history for the rate file itself is on the last two pages of the SFY 2027 PDF.