2025 HCPCS code S5151
(Active) Effective Date: N/A Revision Date: N/A Home Healthcare - Respite Care Various Home Care Services Feed
Unskilled respite care, not hospice; per diem.
Modifiers may apply depending on payer requirements.Consult payer guidelines for specific modifier usage.
Medical necessity is determined by the payer and is typically based on the patient's need for respite care, the caregiver's need for relief, and the impact of respite care on preventing caregiver burnout or improving patient well-being.
The clinical responsibility falls on the provider delivering the unskilled respite care.This does not require a licensed medical professional.
In simple words: This code is for short-term, daily help given to someone who cares for a patient at home, allowing the caregiver a break.This help is not medical care and might include things like bathing, feeding, and light housework. This is not covered by Medicare.
HCPCS code S5151 represents unskilled respite care provided per diem to relieve a caregiver or family member for a short period.This non-medical care may involve assistance with activities of daily living such as bathing, feeding, grooming, housekeeping, shopping, and meal preparation.It excludes respite care in hospitals, clinics, or nursing homes and is not payable by Medicare.
Example 1: A family caregiver of a patient with Alzheimer's disease uses code S5151 to bill for 8 hours of daily respite care services from a home health aide to provide relief during the day, allowing the caregiver to attend to personal needs and appointments., A patient recovering from a stroke receives 6 hours of per diem respite care from a family friend who is not medically trained. The family uses code S5151 to bill the insurance company for the services rendered., A single parent utilizes S5151 to bill for a full day of respite care assistance for their child with Autism, allowing for some personal time and a break from the demanding nature of the child’s care.
Detailed documentation should include the date of service, the total duration of respite care, the type of unskilled services provided (e.g., bathing, feeding, grooming, light housekeeping), caregiver's name, and patient's condition (if relevant).Documentation should support medical necessity.
** This code is primarily used by private payers and Medicaid.Medicare does not cover this service.Always refer to payer-specific guidelines for billing and coding requirements.
- RVU: Not separately priced by Medicare Part B. Payment varies by payer.
- Global Days: Per diem billing; no global period.
- Payment Status: Active, but not payable by Medicare.
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedules vary by payer and are not consistently available publicly. Contact the specific payer for rate information.
- Specialties:Home healthcare agencies, social work, case management.
- Place of Service:Home