1. Chapter 538 School-Based Health Services
Personal Care Services
2019

2. August 1, 2019 Personal Care is billable in 15- minute units
Maximum of 28 units per instructional day.
Units must be documented with start and stop times.
Extra minutes can be carried over to the next instructional day with a month.
A new billing form is required per student per day.

3. Demographics Medicaid Number Last Name First Name County School
Procedure Code  
 Johnson
Kelley
Clay
Clay High School
T1019 SE
WVEIS #
Diagnosis Code(s)
Date of Birth
Date of Service
Provider Name (Printed)  
 F72
 05/31/2003
 09/06/2019
 Joseph Riley

4. Student Demographic Section
On the top row, enter the information as requested. County and school as the code numbers.
On the second row enter data as requested.
Print the name of the employee providing the personal care services.
If two employees split the tasks with one student, each employee would complete a separate billing form for the services they provided.
A global diagnosis is acceptable.

5. Who can be a Personal Care Provider
Aide I
Aide II
Aide III
Aide IV
Paraprofessional
Autism Mentor
Early Childhood Classroom Assistant teacher (ECCAT) 1
Early Childhood Classroom Assistant teacher (ECCAT) II
Early Childhood Classroom Assistant teacher (ECCAT) III
Braille Specialist
Sign Support Specialist
Educational Sign Language Interpreter I
Educational Sign Language Interpreter II
Licensed Practical Nurse (LPN)
** Parents are NOT to be counted as personal care aides.

6. What is Personal Care
Services are related to a child’s physical and behavioral health requirements, including assistance with:
Grooming
Bathing
Toileting
Dressing
Laundry (employee)
Brushing Teeth
Hand Washing
Repositioning/Transfer
Walking
Adaptive Medical equipment
Assistance with Medication
Range of motion (Per Physician Orders)

7. What is Personal Care Continued….
Vitals (Per Physician Orders)
Catheterization
Communication
Meal preparation
Feeding
Special Dietary Needs
Housecleaning
Laundry/Ironing Student
Making/Changing bed
Dishwashing
Supervision/Non-educational
Redirection
Positive behavioral Support

8. Personal Care Tasks on the Billing Form
1. Grooming
6. Brushing Teeth
11. Assistance with Medication
16. Meal Preparation
21. Making/Changing Bed
2. Bathing
7. Hand Washing
12. Range of Motion Per Physician Orders
17. Feeding
22. Dishwashing
3. Toileting
8. Repositioning/Transfer
13. Vitals Per Physician Orders
18. Special Dietary Needs
23. Supervision/Non-Educational
4. Dressing
9. Walking
14. Catheterization
19. Housecleaning
24. Redirection
5. Laundry (Employee)
10. Adaptive Medical Equipment
15. Communication
20. Laundry/Ironing Student
25. Positive Behavior Support

9. Documenting the tasks on the Billing Form
List Number of Activity
Start Time
End Time  1
 9:00
9:20
 17
 12:00
12:30  3
10:00 
10:15
1:00
1:15 7
10:15 
10:20  4
1:40  6
10:45
TOTAL MINUTES PER COLUMN
65 
70 

10. Final Unit Count and Signature
Carryover Minutes from Previous Instructional Day 0 TOTAL MINUTES: TOTAL UNITS: 9
Carryover for next instructional day: 0
No carryover if maximum units reached for the day.
PROVIDER SIGNATURE/CREDENTIAL: JosephRiley Paraprofessional
DATE: 9/6/2019

11. Contact Information
Kelley Johnson – Coordinator Office of Special Education ext WVDE Medicaid Website: