What is HCPCS code S5125?
S5125 is the HCPCS code for attendant care services per 15 minutes. The CMS descriptor, how states use it for self-directed care, and 2026 sample rates.
S5125 is the HCPCS code for attendant care services, billed in 15-minute units. Medicaid HCBS waivers use it, and some states use it for self-directed or participant-employed attendant care. Medicare does not pay it. The service definition, rate and modifiers come from your state’s waiver.
What does the S5125 descriptor say?
The CMS long descriptor is short: “Attendant care services; per 15 minutes” (CMS HCPCS quarterly update, October 2026 file). It doesn’t list tasks. Each state defines what attendant care covers, usually hands-on help with activities of daily living plus some household tasks.
| Field | Value |
|---|---|
| Unit | 15 minutes |
| Code added | January 1, 2003 |
| Medicare coverage code | I (not payable by Medicare) |
| Daily version | S5126 (per diem) |
How is S5125 different from T1019?
Both cover hands-on help at home, and the state decides which code goes with which program. T1019 is “personal care services.” S5125 is “attendant care services.” In the schedules below, S5125 is the self-directed or participant-employed version and T1019 is the agency version:
| State and program | Code | Service name on schedule | Rate per 15 minutes | Effective |
|---|---|---|---|---|
| South Dakota, Assisted Daily Living Services Waiver | T1019 | Personal Care Services, Provider Managed | $11.17 | July 1, 2026 |
| South Dakota, same schedule | S5125 | Personal Care Services, Self Directed | $11.17 | July 1, 2026 |
| Utah, Waiver for Individuals 65 and Older | T1019 | Personal Attendant Service, Agency Based | $9.30 | July 1, 2026 |
| Utah, same sheet | S5125 | Personal Attendant Service, Participant Employed | $7.44 | July 1, 2026 |
North Carolina pays S5125 in its CAP/C, CAP/CD and CAP/DA waivers. It raised the rate from $5.96 to $7.03 per unit effective August 1, 2026 (CAP fee schedules).
Don’t assume your state follows the same split. Check the waiver’s service definitions in the Medicaid waiver lookup.
What should you check before billing S5125?
Confirm that your agency is enrolled for the waiver service that maps to S5125, then match every claim to the authorization and the EVV record.
- Provider type. If your state reserves S5125 for self-directed care, an agency may only bill it in a specific role, or not at all.
- Required modifiers. Utah’s sheet requires the U3 program modifier. See home care billing modifiers.
- EVV. The Cures Act requires EVV for Medicaid personal care services, and CMS counts attendant care services as personal care for EVV (CMS EVV FAQ). Check how your state handles S5125 in the EVV state directory.
- Units. Convert minutes with the units calculator and apply your state’s rounding rule.
- Authorization. Units over the authorized amount usually can’t be billed.
How Caregiver Scheduling handles this
Caregiver Scheduling warns you when a week goes over a client’s authorized hours (Growth and up). GPS check-in records actual visit times to back up the units on each claim. $199/month for up to 10 caregivers or $299/month for up to 50, with a 30-day free trial.
FAQ
Is S5125 the same as personal care? The tasks overlap, but the code is separate. Your state’s waiver decides whether a service is billed as S5125 or T1019.
How many units is a 2-hour attendant care visit? 8 units, since each unit is 15 minutes.
Does Medicare cover S5125? No. CMS lists it with coverage code I, not payable by Medicare.
General information, not billing or legal advice. Check your state Medicaid provider manual and fee schedule.