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See a sample rate comparisonHCPCS T1001 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Nursing assessment / evaluation
| Key Fact | Detail |
|---|---|
| Service Type | National Codes Established for State Medicaid Agencies Nursing Services |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for T1001 |
National average reimbursement for HCPCS T1001 by major payers:
$56.12
$126.47
$21.30
$244.49
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HCPCS T1001
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See a sample payer proposalHCPCS T1001 vs. Other Nursing Services Codes
The HCPCS T1001 code is part of the National Codes Established for State Medicaid Agencies services used for Nursing Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS T1001 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| T1000-HCPCS | Low | Private duty / independent nursing service(s) - licensed, up to 15 minutes |
| T1001-HCPCS | Low | Nursing assessment / evaluation |
| T1002-HCPCS | Low | RN services, up to 15 minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T1001. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T1001 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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