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    CFSS-EVV service code crosswalk

    The table below shows how CFSS service codes appear on the DHS-3945 rate sheet and how they appear in EVV systems, noting that the order of the modifiers are not the same. This does not affect service delivery or claims.

    CFSS DHS-3945 Rate Sheet Service Codes: Modifiers ordered by model type (U9 or UB) Mod 1 Mod 2 Mod 3 Mod 4 Service Name EVV Service Codes: Modifiers in alphanumerical order as exported from MMIS Mod 1 Mod 2 Mod 3 Mod 4
    T1019 U8 N/A N/A N/A CFSS, Agency, 45 Day Temporary Start T1019 U8 N/A N/A N/A
    T1019 U8 TG N/A N/A CFSS, Agency, Complex, 45 Day Temporary Start T1019 TG U8 N/A N/A
    T1019 U9 UC N/A N/A CFSS, Agency, Extended, 1:1 T1019 UC U9 N/A N/A
    T1019 U9 UC TG N/A CFSS, Agency, Complex, Extended,1:1 T1019 UC TG U9 N/A
    T1019 U9 U5 N/A N/A CFSS, Agency, Reduction, 1:1 T1019 U5 U9 N/A N/A
    T1019 U9 U5 TG N/A CFSS, Agency, Complex, Reduction, 1:1 T1019 TG U5 U9 N/A
    T1019 U9 N/A N/A N/A CFSS, Agency, 1:1 T1019 U9 N/A N/A N/A
    T1019 U9 TG N/A N/A CFSS, Agency, Complex, 1:1 T1019 TG U9 N/A N/A
    T1019 U9 U6 N/A N/A CFSS, Agency, Temporary Increase, 1:1 T1019 U6 U9 N/A N/A
    T1019 U9 U6 TG N/A CFSS, Agency, Complex, Temporary Increase, 1:1 T1019 TG U6 U9 N/A
    T1019 U9 U4 N/A N/A CFSS, Agency, Continuation of Benefits, 1:1 T1019 U4 U9 N/A N/A
    T1019 U9 U4 TG N/A CFSS, Agency, Complex, Continuation of Benefits, 1:1 T1019 TG U4 U9 N/A
    T1019 U9 UC UN N/A CFSS, Agency, Extended, 1:2 T1019 UC UN U9 N/A
    T1019 U9 UC UN TG CFSS, Agency, Complex, Extended,1:2 T1019 TG UC UN U9
    T1019 U9 U5 UN N/A CFSS, Agency, Reduction, 1:2 T1019 UN U5 U9 N/A
    T1019 U9 U5 UN TG CFSS, Agency, Complex, Reduction, 1:2 T1019 TG UN U5 U9
    T1019 U9 UN N/A N/A CFSS, Agency, 1:2 T1019 UN U9 N/A N/A
    T1019 U9 UN TG N/A CFSS, Agency, Complex, 1:2 T1019 TTG UN U9 N/A
    T1019 U9 UN U6 N/A CFSS, Agency, Temporary Increase, 1:2 T1019 UN U6 U9 N/A
    T1019 U9 U6 UN TG CFSS, Agency, Complex, Temporary Increase, 1:2 T1019 TH UN U6 U9
    T1019 U9 UN U4 N/A CFSS, Agency, Continuation of Benefits, 1:2 T1019 UN U4 U9 N/A
    T1019 U9 UN U4 TG CFSS, Agency, Complex, Continuation of Benefits, 1:2 T1019 TG UN U4 U9
    T1019 U9 UC UP N/A CFSS, Agency, Extended, 1:3 T1019 UC UP U9 N/A
    T1019 U9 UC UP TG CFSS, Agency, Complex, Extended,1:3 T1019 TG UC UP U9
    T1019 U9 U5 UP N/A CFSS, Agency, Reduction, 1:3 T1019 UP U5 U9 N/A
    T1019 U9 U5 UP TG CFSS, Agency, Complex, Reduction, 1:3 T1019 TG UP U5 U9
    T1019 U9 UP N/A N/A CFSS, Agency, 1:3 T1019 UP U9 N/A N/A
    T1019 U9 UP TG N/A CFSS, Agency, Complex, 1:3 T1019 TG UP U9 N/A
    T1019 U9 UP U6 N/A CFSS, Agency, Temporary Increase, 1:3 T1019 UP U6 U9 N/A
    T1019 U9 U6 UP TG CFSS, Agency, Complex, Temporary Increase, 1:3 T1019 TH UP U6 U9
    T1019 U9 UP U4 N/A CFSS, Agency, Continuation of Benefits, 1:3 T1019 UP U4 U9 N/A
    T1019 U9 UP U4 TG CFSS, Agency, Complex, Continuation of Benefits, 1:3 T1019 TG UP U4 U9
    T1019 UB UC N/A N/A CFSS, Budget, Extended, 1:1 T1019 UB UC N/A N/A
    T1019 UB UC TG N/A CFSS, Budget, Complex, Extended,1:1 T1019 TG UB UC N/A
    T1019 UB U5 N/A N/A CFSS, Budget, Reduction, 1:1 T1019 UB U5 N/A N/A
    T1019 UB U5 TG N/A CFSS, Budget, Complex, Reduction, 1:1 T1019 TG UB U5 N/A
    T1019 UB N/A N/A N/A CFSS, Budget, 1:1 T1019 UB N/A N/A N/A
    T1019 UB TG N/A N/A CFSS, Budget, Complex, 1:1 T1019 TG UB N/A N/A
    T1019 UB U6 N/A N/A CFSS, Budget, Temporary Increase, 1:1 T1019 UB U6 N/A N/A
    T1019 UB U6 TG N/A CFSS, Budget, Complex, Temporary Increase, 1:1 T1019 TG UB U6 N/A
    T1019 UB U4 N/A N/A CFSS, Budget, Continuation of Benefits, 1:1 T1019 UB U4 N/A N/A
    T1019 UB U4 TG N/A CFSS, Budget, Complex, Continuation of Benefits, 1:1 T1019 TG UB U4 N/A
    T1019 UB UC UN TG CFSS, Budget, Complex, Extended,1:2 T1019 TG UB UC UN
    T1019 UB U5 UN N/A CFSS, Budget, Reduction, 1:2 T1019 UB UN U5 N/A
    T1019 UB U5 UN TG CFSS, Budget, Complex, Reduction, 1:2 T1019 TG UB UN U5
    T1019 UB UN N/A N/A CFSS, Budget, 1:2 T1019 UB UN N/A N/A
    T1019 UB UN TG N/A CFSS, Budget, Complex, 1:2 T1019 TG UB UN N/A
    T1019 UB UN U6 N/A CFSS, Budget, Temporary Increase, 1:2 T1019 UB UN U6 N/A
    T1019 UB U6 UN TG CFSS, Budget, Complex, Temporary Increase, 1:2 T1019 TG UB UN U6
    T1019 UB UN U4 N/A CFSS, Budget, Continuation of Benefits, 1:2 T1019 UB UN U4 N/A
    T1019 UB UN U4 TG CFSS, Budget, Complex, Continuation of Benefits, 1:2 T1019 TG UB UN U4
    T1019 UB UC UP N/A CFSS, Budget, Extended, 1:3 T1019 UB UC UP N/A
    T1019 UB UC UP TG CFSS, Budget, Complex, Extended,1:3 T1019 TG UB UC UP
    T1019 UB U5 UP N/A CFSS, Budget, Reduction, 1:3 T1019 UB UP U5 N/A
    T1019 UB U5 UP TG CFSS, Budget, Complex, Reduction, 1:3 T1019 TG UB UP U5
    T1019 UB UP N/A N/A CFSS, Budget, 1:3 T1019 UB UP N/A N/A
    T1019 UB UP TG N/A CFSS, Budget, Complex, 1:3 T1019 TG UB UP N/A
    T1019 UB UP U6 N/A CFSS, Budget, Temporary Increase, 1:3 T1019 UB UP U6 N/A
    T1019 UB U6 UP TG CFSS, Budget, Complex, Temporary Increase, 1:3 T1019 TG UB UP U6
    T1019 UB UP U4 N/A CFSS, Budget, Continuation of Benefits, 1:3 T1019 UB UP U4 N/A
    T1019 UB UP U4 TG CFSS, Budget, Complex, Continuation of Benefits, 1:3 T1019 TG UB UP U4
    T1019 UB UC UN N/A CFSS, Budget, Extended, 1:2 T1019 UB UC UN N/A
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