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2025 HCPCS code H0045

Respite care services provided outside the home on a per diem basis.

Use this code to report respite care services provided outside the home. The code is billed per diem, and the U6 modifier can indicate Community Supports Respite Care.

Modifier U6 can be used with H0045 to indicate Community Supports Respite Services.

Medical necessity for respite care is established by demonstrating the patient's need for continuous caregiving and the temporary inability of the primary caregiver to provide that care. Documentation should support the caregiver's need for temporary relief to prevent burnout or address other urgent matters.

Care providers such as Certified Nursing Assistants (CNAs), Registered Nurses (RNs), trained caregivers, and physicians (if medical oversight is necessary) are responsible for delivering respite care services. This involves reviewing medical and personal information, understanding the patient's routine, providing assistance with daily living activities, engaging the patient in activities, and monitoring their medical condition as required.

IMPORTANT:S5151 (Unskilled respite care, not hospice; per diem), S9125 (Respite care, in the home; per diem), T2033 (Residential care, not otherwise specified, waiver; per diem)

In simple words: Temporary care provided outside the home, for a person who needs regular care, giving their usual caregiver a break. This service is billed by the day and may include help with daily tasks, activities, and medical attention if necessary.

This code covers temporary care and supervision provided to an individual in an approved out-of-home location, giving primary caregivers relief from their duties. Services are provided on a daily basis (per diem) and can include assistance with daily activities like bathing, feeding, and medication administration, as well as social and recreational activities. Medical monitoring is provided as needed.

Example 1: A caregiver of a parent with Alzheimer's disease needs a week-long break to attend to a family emergency. The parent is admitted to a respite care facility for the week, where they receive daily care and supervision., A child with a developmental disability attends an adult day care center on a daily basis while their primary caregiver works. The center provides respite care services, including assistance with meals, activities, and medication administration., An elderly individual recovering from surgery requires temporary assistance with daily living activities. They receive respite care services in a nursing home for a few days before returning home.

Documentation should include the patient's medical history, care needs, the reason for respite care, the duration of the service, and the type of facility providing care. Details about the services provided, such as assistance with daily activities and medical monitoring, should also be recorded.

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