Assistance with Personal Domestic Activities

When to use this code

Use this code for direct, hands-on personal care support. This covers help with daily self-care tasks like showering, dressing, grooming, toileting, and eating. If the participant needs support at specific times of day (evening, night, weekend), make sure you pick the matching time-based code instead of this one.

Common billing scenarios

• A participant receives 2 hours of personal care support. The provider claims 2 hours at $59.06.
• A support worker provides morning and afternoon assistance. The provider bills the total hours of direct support delivered during the session.

Provider notes

• Non-face-to-face delivery is allowed for this code. This means you can bill for activities like report writing, care coordination calls, or progress notes, provided your service agreement with the participant covers these activities. Keep clear records of what non-face-to-face work was done and how long it took.
• This code allows provider travel claims. Travel time to the participant can be billed, but keep in mind the NDIA expects travel to be reasonable. If you are seeing multiple participants in one area, split the travel cost across their plans.
• Short notice cancellation fees apply. If a participant cancels with less than 7 clear days notice (or 2 clear business days for some supports), you can charge up to 90% of the agreed fee. You must document the cancellation and have the cancellation policy in your service agreement.
• Core supports are the most commonly claimed category. Make sure your service agreements clearly state the code, rate, and cancellation terms. This reduces disputes at claiming time.