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2025 HCPCS code S9125

HCPCS code S9125 represents respite care services provided in the patient's home on a per diem basis.

This is a temporary HCPCS code; follow payer-specific guidelines for submission.

Modifiers may apply depending on payer requirements.

Medical necessity is established by demonstrating the need for temporary relief of the primary caregiver due to the patient's significant care needs or the caregiver's exhaustion or health concerns.

The clinical responsibility rests with the healthcare professional providing the respite care services, which may include nurses, home health aides, or other qualified personnel.

IMPORTANT:None specified.Note that this is a temporary code and may not have direct equivalents.

In simple words: This code is for short-term care provided in someone's home to give their caregiver a break.It's billed for each day of care given.

HCPCS code S9125, Respite care, in the home, per diem, is a temporary code used for billing respite care services provided in a patient's home.This code is reported for each day of service provided. Respite care offers temporary relief to caregivers of elderly or chronically ill individuals, allowing them time for their own health and well-being. The code is specifically for services delivered within the patient's residence.

Example 1: A family caregiver of an Alzheimer's patient needs a day off. A certified nursing assistant provides respite care at the patient's home for eight hours, allowing the caregiver to attend to personal matters. Code S9125 is reported for that day of service., A patient recovering from a stroke requires assistance with activities of daily living.A home health agency provides respite care for several hours each week to help relieve the family's burden. Code S9125 is reported for each day of respite care services provided., A hospice patient's family requests respite care for a few days to allow for a family vacation. A qualified hospice worker provides care during their absence.Code S9125 is reported for each day of service provided.

* Daily record of services provided.* Documentation of patient's need for respite care.* Caregiver's identification and contact information.* Verification of the caregiver's need for respite.* The type and duration of the respite care provided.* Proof of the patient's residence.

** This code is not recognized by Medicare.Always confirm payer-specific billing requirements and reimbursement policies before using this code.

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

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