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See a sample rate comparisonHCPCS T2040 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.
Financial management, self-directed, waiver; per 15 minutes
| Key Fact | Detail |
|---|---|
| Service Type | National Codes Established for State Medicaid Agencies Waiver Services |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for T2040 |
National average reimbursement for HCPCS T2040 by major payers:
$68.06
$51.64
$1.00
$39.50
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HCPCS T2040
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See a sample payer proposalHCPCS T2040 vs. Other Waiver Services Codes
The HCPCS T2040 code is part of the National Codes Established for State Medicaid Agencies services used for Waiver 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 T2040 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 |
|---|---|---|
| T2039-HCPCS | High | Vehicle modifications, waiver; per service |
| T2040-HCPCS | Low | Financial management, self-directed, waiver; per 15 minutes |
| T2041-HCPCS | Low | Supports brokerage, self-directed, waiver; per 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 T2040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T2040 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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