Assistance With Self-Care Activities - High Intensity - Sunday

When to use this code

Use this code when a participant receives hands-on personal care on a Sunday. This includes help with showering, dressing, grooming, toileting, or eating. Sunday rates include a higher loading than Saturday, which means this code will use funding faster than standard weekday codes. If the support happens at a different time, check the related items for the correct time-based code. The wrong time code is a common audit flag.

Common billing scenarios

• A participant receives 2 hours of personal care on a Sunday afternoon. The provider claims 2 hours at the Sunday rate of $137.87.
• A support worker assists a participant with a Sunday outing that includes personal care tasks. The personal care portion is billed under this Sunday code, while the community access portion uses the corresponding community participation code at the Sunday rate.

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.