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2025 HCPCS code S5151

Unskilled respite care, not hospice; per diem.

Follow payer-specific guidelines.Ensure the services billed are truly unskilled and that proper documentation is included.

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.

IMPORTANT:S5150 (Unskilled respite care, not hospice; per 15 minutes) can be used for unskilled respite care provided in 15-minute increments.H0045 and T1005 are alternative codes for respite care, but their specific applications may vary.

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.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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