2025 HCPCS code S5100
(Active) Effective Date: N/A Revision Date: N/A Home Healthcare - Various Home Care Services Temporary National Codes (Non-Medicare) Feed
Adult day care services for each 15 minutes of time spent.
Modifiers may be applicable depending on payer requirements and specific circumstances of service delivery.
Medical necessity is supported by the patient's need for assistance with activities of daily living (ADLs), cognitive stimulation, social interaction, or respite care for caregivers.The services should be reasonable and necessary based on the patient's medical condition and functional limitations.
The clinical responsibility includes providing a structured program of activities designed to enhance the patient's physical, cognitive, social, and emotional well-being. This requires skilled staff capable of assessing individual needs, developing personalized care plans, and monitoring patient progress.Supervision and coordination with other healthcare professionals may also be necessary.
In simple words: This code covers adult day care services.It's billed for every 15 minutes of care that helps adults be more independent and supports their health and daily living.The day care is in a safe place during the day, and helps caregivers have some time to themselves.
This HCPCS code represents adult day care services provided to an adult patient.The services aim to promote self-independence and support the patient's health, nutrition, and daily living needs.The code is used for each 15-minute interval of service provided in a non-residential, secure environment.These services may include assistance with short-term recovery after hospital discharge, recreational and educational activities, and social interaction.The services offer respite for the patient's caregivers.
Example 1: A 70-year-old patient with mild cognitive impairment attends adult day care three times a week for social interaction, cognitive stimulation exercises, and assistance with meals.The patient is transported to and from the facility by family members., A 65-year-old patient recovering from a stroke participates in a rehabilitation program at an adult day care center.The program includes physical therapy, occupational therapy, and speech therapy. This helps her regain independence and function in her daily life. , An 80-year-old patient with Alzheimer's disease attends adult day care for respite care.This allows the primary family caregiver to take a break from their caregiving duties and attend to other personal needs. The day care provides a safe, structured environment, and specialized support to meet the patient's needs.
Documentation should include the patient's diagnosis, the type and frequency of services provided, the duration of each session, and a record of the patient's participation and progress.Any specific interventions or therapies provided should also be documented. Caregiver input on outcomes is valuable.
** This code is specifically for adult day care services and should not be used for other types of care or services.It is billed in 15-minute increments.Always check payer guidelines for specific requirements and coverage criteria.
- Payment Status: Not payable by Medicare
- Specialties:Geriatric medicine, social work, rehabilitation medicine
- Place of Service:Adult Day Care Center