Appendix XVI, Long Term Services and Supports Codes and Modifiers

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Revision 25-3; Effective Sept. 1, 2025

The LTSS Codes and Modifiers billing matrix is a table that provides the codes and modifiers for State Plan services utilized in STAR+PLUS as well as services specific to STAR+PLUS Home and Community Based Services (HCBS).

MCOs and providers must use the link below for services provided on or after Sept. 1, 2025.

Long Term Services and Supports Codes and Modifiers (Excel)