If a nurse does home visits beyond the 10 billable maternity case management visits – can this time be claimed in MAC as code C1?
The answer to this question is yes, provided that the MCM status for the client has been closed out and all billing for the MCM case visits has ended. This is a good opportunity to expand upon the nature and interrelationships of Targeted Case Management (TCM), Maternity Case Management (MCM), and “direct services” with Medicaid Administrative Claiming (MAC). For purposes of MAC, there are essentially two different sets of activities which are called “direct services”. The first set are those activities included under Code “E” on the time survey. The second set is actually a specific subset of the first set – they are those activities included and classified as part of the services provided under a TCM plan or under MCM. TCM/MCM Services: Let’s first look at the TCM/MCM subset. TCM services are services which assist a Medicaid eligible individual gain access to needed medical, social, educational, and other services. TCM services are optional services which the state has elected to pro
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