2025 HCPCS code S5101
(Active) Effective Date: N/A Revision Date: N/A Home Healthcare - Adult Day Care Services Various Home Care Services Feed
Adult day care services; per half day.
Modifiers may apply depending on the specific services rendered and payer requirements.
Medical necessity for adult day care services is established based on the patient's need for supervision, assistance with daily living, and structured activities to prevent deterioration and maintain functional abilities.The services must be deemed appropriate and reasonable given the patient’s condition and prognosis.
The clinical responsibility for this service falls under the purview of healthcare professionals managing adult day care programs. This might encompass nurses, social workers, occupational therapists, and other allied health professionals involved in patient care, assessment, and program supervision within the day care setting. The specific tasks performed vary depending on individual patient needs and the program's scope.
In simple words: This code covers half a day of adult day care.It's a program with activities to help adults be more independent and improve their health.The care happens during the day in a safe place, giving family members a break.
This HCPCS code represents adult day care services provided for half a day.These services aim to promote independence, support health, nutrition, and daily living needs in a non-residential, secure environment.Services may include recreational and educational activities, assistance with daily tasks, and social interaction, offering respite for caregivers.
Example 1: A 70-year-old patient with mild cognitive impairment attends an adult day care program for four hours, receiving assistance with daily living activities, engaging in social interaction, and participating in structured cognitive stimulation exercises., A 65-year-old patient recovering from a stroke attends a four-hour session of adult day care to improve mobility and regain upper extremity function through supervised activities and therapy., An 80-year-old patient with dementia attends an adult day care facility for four hours, benefiting from a secure and stimulating environment that helps maintain their cognitive function and reduces caregiver burden.
Documentation should include the patient's diagnosis, the type and duration of services provided, the patient's functional status, and the care plan goals.Detailed records should be maintained of the patient’s participation in various activities, progress notes, and any interventions administered.Physician orders should be present and the clinical notes of the staff involved in direct patient care should also be maintained and documented.
** This code is not reimbursable under Medicare.Specific billing and reimbursement policies may vary according to individual payer contracts.
- Payment Status: Active (Non-Medicare)
- Specialties:Geriatric Medicine, Rehabilitation Medicine, Social Work
- Place of Service:Adult Day Care Facility