2025 HCPCS code T1005
(Active) Effective Date: N/A Revision Date: N/A Nursing Services - Respite Care Nursing Services Feed
Respite care services, up to 15 minutes.
Modifiers may apply depending on the specific service provided and payer requirements. Consult payer-specific guidelines for appropriate modifier use.
Medical necessity for respite care is typically established by demonstrating the need to prevent caregiver burnout, avoid institutionalization, maintain the patient's safety at home, and improve the overall quality of care.Documentation must support the clinical need for this service and the necessity of temporarily relieving the caregiver's burden.
The clinical responsibility for this code would typically fall on a trained caregiver, nurse, or other qualified healthcare professional providing the respite care services. This could include tasks such as monitoring the patient's condition, administering medications (if applicable and permitted), assisting with personal care, and providing companionship.
In simple words: This code is for short breaks caregivers get when someone else takes care of their loved one who needs extra help. The break can be a few hours, overnight, or even a few days. Care can happen at home or at a special facility.Insurance usually doesn't cover this unless there's a long-term care policy.
This HCPCS code represents respite care services provided for a duration of up to 15 minutes.Respite care offers temporary relief to caregivers by providing care for patients for short periods.This can involve care in the patient's home or at a residential respite care facility.Billing is in 15-minute units.
Example 1: A caregiver needs a few hours of respite care for their elderly parent with dementia, allowing them time to attend a medical appointment. The respite care worker provides companionship and assistance with basic needs during this time., A family with a child with significant medical needs requires overnight respite care to allow the parents a break. The service is rendered at home by a qualified nurse. , A hospice patient requires temporary care during the daytime to allow their primary family caregiver to work.A home health aide provides respite care for several hours, assisting with medications, personal hygiene, and monitoring vitals.
Detailed documentation should include the patient's name, date of service, duration of respite care (in 15-minute increments), description of services rendered, caregiver's name (if applicable), and any relevant clinical notes about the patient's condition.Medical necessity documentation might include evidence of the caregiver's need for respite to prevent burnout or compromised care.
** This code's use is largely dependent on state Medicaid programs and private payer policies.Medicare does not reimburse for this code.Always consult the relevant payer's policy and billing guidelines before using this code.The payment amount significantly varies between providers.
- RVU: The relative value units (RVUs) for this HCPCS code will vary depending on the payer and the specific circumstances of the service.It's essential to check the payer's fee schedule for the most up-to-date payment information.
- Payment Status: Active (but coverage may vary by payer and state)
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code as it represents a complete service.
- Fee Schedule: Fee schedules for T1005 vary significantly across state Medicaid programs and private payers.Specific fee data is not available nationally. Refer to the relevant payer's fee schedule for the most accurate reimbursement information.
- Specialties:Home Health, Hospice, Palliative Care, Geriatric Medicine
- Place of Service:Home, Assisted Living Facility, Skilled Nursing Facility, Hospice