HCPCS code T1026 – Intensive multidisciplinary services

Key takeaways

HCPCS Code T1026 bills intensive, multidisciplinary clinic services for children with complex medical needs, with one unit per hour.

State Medicaid programs use it for partial-day care at Prescribed Pediatric Extended Care (PPEC) centers, while T1025 bills a full day.

CMS lists T1026 as not payable by Medicare, so the claim goes to the state Medicaid program or its managed care plan.

The partial-day ceiling depends on the state: four hours in Florida and Texas STAR Kids, and six hours in Mississippi.

Prior authorization, a current plan of care and a parent-signed daily attendance log are what keep a T1026 claim payable.

What is HCPCS code T1026?

HCPCS code T1026 bills intensive, extended multidisciplinary care delivered in a clinic setting, counted by the hour. Specifically, the patients are children with complex medical, physical, mental and psychosocial impairments. State Medicaid programs use it for partial-day care at Prescribed Pediatric Extended Care (PPEC) centers. For example, Florida, Mississippi and Texas all list it this way in their PPEC policies.

Moreover, T1026 sits in the HCPCS Level II T-code section, which CMS reserves for state Medicaid agencies. Consequently, the CMS HCPCS quarterly file gives it Medicare coverage code I, which means not payable by Medicare. In addition, it was added on January 1, 2003, and has no termination date in the October 2026 file.

T1026 is not a personal care code. Instead, paraprofessional personal care is billed with T1019 (per 15 minutes) or T1020 (per diem), and a home health aide visit is T1021.

What T1026 covers in a PPEC center

T1026 pays for the hours a medically fragile child spends in a licensed PPEC center under nursing supervision. For instance, the Florida PPEC coverage policy describes the service as skilled nursing supervision and therapeutic interventions in a non-residential setting. In particular, it lists the services a PPEC day must include at a minimum:

• Nursing services
• Medical services
• Personal care services
• Respiratory therapy services
• Developmental therapies
• Psychosocial services
• Caregiver training
• An escort for travel to and from the center when Medicaid non-emergency transportation is used

First, Florida covers children under 21 who need continuous therapeutic interventions or skilled nursing supervision. A physician must also judge the child medically stable and not a threat to self or others. Similarly, Mississippi’s fee schedule covers ages 0 to 20 and requires prior authorization for every PPEC code.

The PPEC day starts when the child arrives at the center, or is picked up for escorted transportation. It ends when the child leaves the center or is returned home. However, a full day of the same service is billed as T1025 instead.

What T1026 does not cover

The hourly rate pays for the center’s own package of care, so several services sit outside it.

• Medicare and commercial claims: CMS lists T1026 as not payable by Medicare, and the code exists for state Medicaid agencies.
• A full day and a partial day on one date: Florida does not pay T1025 and T1026 for one child on the same date.
• Transportation: Florida excludes it from the PPEC benefit, while Texas and Mississippi pay a daily PPEC transport fee under T2002.
• Separately billed therapy and hospice: Texas’s CSHCN Services Program leaves PT, OT, speech, respiratory care and hospice out of the T1026 rate. In addition, each needs its own prior authorization.
• Food, formula and early intervention: Florida excludes food and formulas, and early intervention services billed separately.
• Overnight or inpatient care: PPEC is a non-residential day service, so residential and inpatient stays fall outside it.

Likewise, transport time stays out of the hour count. For example, the Texas CSHCN Services Program manual (August 2021) says transit time does not count toward its 400-hour annual limit.

T1026 vs T1025 and related T-codes

Because T1026 and T1025 share the same descriptor, they differ only in the billing unit. Thus, T1026 counts the hours of a partial day, and T1025 pays one flat rate for a full day. Therefore, choose the code from the hours the child attended that day.

Units and daily limits for HCPCS code T1026

First, one unit of T1026 equals one hour of PPEC care. However, the partial-day ceiling, the rounding rule and any annual cap all come from the state, not from CMS.

In fact, the rounding rules change what the same visit is worth. For example, a child who attends for 3 hours and 20 minutes bills three units in Mississippi, which pays completed hours only. By contrast, under the Florida and Texas CSHCN 15-minute rule, the same visit bills four units.

Modifiers used with T1026

CMS sets no modifier requirement for T1026, so modifier rules come from each state fee schedule and plan contract. These are the ones the published PPEC schedules show:

• U6 (Texas STAR Kids): marks PPECC hours for members in the Medically Dependent Children Program (MDCP). Moreover, the Superior HealthPlan STAR Kids rate guide pays them at the same hourly rate.
• UC (Mississippi, retired): Mississippi discontinued UC for PPEC transport on July 1, 2021, because T2002 replaced it.
• Florida: providers report the current billing code, modifier and unit from the fee schedule adopted under Rule 59G-4.002.

U modifiers are defined by each state, so U6 can mean something different in another Medicaid program. Consequently, check the modifier against the current fee schedule for the state and plan you bill.

Prior authorization for T1026

In fact, every state program reviewed for this guide requires prior authorization before T1026 hours begin.

• Florida: the center obtains authorization from AHCA or its designee every 180 days, or sooner if a change in condition alters the services. Finally, to end services, it files a discharge request with the last service date and the units used.
• Texas CSHCN Services Program: requests go on the program PPECC form, signed and dated by the ordering physician. Additionally, verbal orders are not accepted, and an initial authorization lasts up to 90 days.
• Mississippi: the Mississippi PPEC fee schedule (July 2026) flags T1025, T1026 and T2002 as requiring prior authorization.

Texas requires the authorization before the start of care, so hours delivered earlier fall outside it. Therefore, track the start date, end date and approved hours for each child, and renew before the period runs out.

Documentation requirements for a T1026 claim

The records behind T1026 need to show two facts: the child needed PPEC care, and attended for the hours billed.

• Plan of care: Florida requires an update every 180 days, signed, dated and credentialed by the PPEC registered nurse and the physician.
• Daily attendance log: a parent, guardian or authorized representative signs it each day, with arrival and departure times.
• Transport times: when the center escorts the child, the log records pickup and return-home times instead.
• Authorization request: Texas expects the signed plan of care with the request, including scheduled days and hours of attendance.
• Diagnosis codes: Florida asks for the most specific diagnosis code that supports medical necessity.
• Therapy records: where therapies are billed separately, keep their notes and authorizations apart from the PPEC hours.

Finally, the hour count on the claim should match the arrival and departure times in the signed log. Besides, sound medical billing compliance habits keep those records ready for a Medicaid review.

T1026 reimbursement rates

First, there is no federal fee for T1026, and each state Medicaid program sets its own hourly rate. The figures below come from published state and plan schedules, so check the current file before you rely on them.

Specifically, Mississippi updated its PPEC rate calculation to the 2023 average small nursing facility rate, effective May 1, 2025. In addition, the July 2026 schedule carries the current rates. The Texas STAR Kids figures are the HHSC rates from June 2023, so check the current HHSC PPECC rate before you bill. Meanwhile, Florida publishes its PPEC rates in a separate fee schedule on the AHCA website.

Therefore, the partial-day ceiling decides how far apart the two codes sit. For example, six Mississippi hours of T1026 pay $316.38, two cents under the T1025 day rate. By contrast, four Texas STAR Kids hours pay $129.84, about a third of the $389.49 full-day rate.

Common T1026 denial reasons and how to avoid them

Most T1026 problems trace back to the payer, the authorization or the hour count. In addition, knowing the common claim denial codes helps your team read each remittance quickly.

First, payer and code errors can usually be corrected and resubmitted. In contrast, authorization denials tend to need the plan reconsideration or appeal route, with the signed plan of care attached. As a result, a clear denial management workflow keeps those two tracks apart.

How Pabau supports T1026 documentation and claims

Overall, a T1026 claim depends on three records: the plan of care, the authorization and the signed daily log. When they live in separate binders and spreadsheets, hours get billed that the log cannot support.

Instead, Pabau, the practice management platform we build, keeps those records on one patient file. For instance, digital forms capture the parent’s signature and the day’s arrival and departure times. Furthermore, the calendar shows each child’s scheduled days, so staff can compare attendance with the authorized hours.

When a claim is ready, Pabau’s cleaner claim submission sends it through Claim.MD using data already on the record. It then tracks the claim status for you. However, it does not choose codes, add modifiers or audit documentation, so your team still applies the state rules above.

Keep PPEC records and T1026 claims together

Pabau keeps signed daily logs, plans of care and appointments on one patient record. Claims go out through Claim.MD from that data, and you track their status in one place.

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Conclusion

T1026 is simple to describe and easy to bill wrongly, because the rules that matter sit in each state’s PPEC policy. Before the first claim, write down your state’s partial-day ceiling, rounding rule, caps and modifiers. Finally, bill each day from the signed log, not from the planned schedule.

As a result, that habit keeps corrected claims and appeals rare, and it holds up when Medicaid reviews the file. Book a demo to see how Pabau keeps PPEC logs, plans of care and claims on one record.

Continue your research

Billing a full PPEC day? HCPCS code T1025 covers the per diem version of the same service.

New to the revenue cycle? What is medical billing explains the end-to-end process and where Medicaid T-codes fit within it.

Want a systematic approach to reducing Medicaid rejections? Denial management in healthcare covers the workflows and appeal strategies that recover revenue faster.

Looking for compliance standards for Medicaid billing? Medical billing compliance outlines the documentation and audit-readiness practices that protect centers billing Medicaid codes.

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