2025 HCPCS code S5102
(Active) Effective Date: N/A Revision Date: N/A Home Healthcare - Adult Day Care Services Various Home Care Services Feed
HCPCS code S5102 represents adult day care services billed per diem.
Modifiers may apply depending on payer requirements and specific circumstances of service delivery; consult payer-specific guidelines.
Medical necessity for adult day care services is generally established by the individual's needs, such as cognitive or physical impairment requiring supervision, assistance with activities of daily living (ADLs), or the need for respite care for family caregivers.Specific documentation requirements and medical necessity criteria may vary by payer.
Adult day care services are typically provided by trained personnel under the supervision of a qualified healthcare professional, but billing responsibility varies by state and payer regulations. The specific clinical responsibilities will include monitoring the health and well-being of participants, implementing individualized care plans, providing activities and therapies, administering medication when necessary, and documentation of the services provided.
In simple words: This code is for adult day care services.It's used to bill for each full day of care that helps adults stay healthy, eat well, and live more independently.Medicare doesn't pay for this type of care.
HCPCS code S5102, "Day care services, adult; per diem," is used to bill for adult day care services provided for a full day.These services aim to promote independence, support health and nutritional needs, and assist with daily living activities for adults. The code is applied for each full day of service provided and is not payable by Medicare.Services may include assistance with short-term recovery post-hospital discharge or respite care for family caregivers.A secure and comfortable environment is offered, along with recreational, educational, and social interaction opportunities to increase independence and support physically impaired adults.
Example 1: A 70-year-old woman with mild dementia attends adult day care five days a week.Code S5102 is billed for each day of attendance., A 65-year-old man recovering from a stroke attends adult day care for rehabilitation and socialization. Code S5102 is billed for each full day of the program., A caregiver utilizes adult day care for respite care, enabling them to attend to personal matters while their adult child with cerebral palsy receives care. Code S5102 is billed for each day used for respite.
Detailed daily records should be maintained, including the individual's participation in activities, medications administered (if any), and any changes in health status.Attendance records are essential. Documentation may need to meet specific requirements outlined by the payer.
** Code S5102 is not reimbursable by Medicare. Reimbursement varies greatly depending on state and payer regulations and contract agreements. Always confirm payer policies before billing.
- Payment Status: Active (non-Medicare)
- Modifier TC rule: Not applicable.
- Specialties:Geriatric medicine, rehabilitation medicine, social work
- Place of Service:Adult Day Health Care Facility