What is HCPCS code S5126?
S5126 is the HCPCS code for attendant care services billed per diem. The CMS descriptor, how it differs from S5125, and what to check before you bill.
S5126 is the HCPCS code for attendant care services billed per diem, one unit per day. It is the daily version of S5125, which is billed in 15-minute units. Medicaid waiver programs that pay attendant care by the day use it. Medicare does not pay it.
What does the S5126 descriptor say?
The CMS long descriptor reads: “Attendant care services; per diem” (CMS HCPCS quarterly update, October 2026 file). Like S5125, it names no tasks. The state’s waiver defines what the service includes and what a billable day requires.
| Field | S5125 | S5126 |
|---|---|---|
| Unit | 15 minutes | Per diem (1 day) |
| Code added | January 1, 2003 | January 1, 2003 |
| Medicare coverage code | I (not payable by Medicare) | I (not payable by Medicare) |
When does a state use S5126?
Only when a waiver service is priced by the day. The state schedules we checked pay in-home attendant care by the 15-minute unit. South Dakota’s Assisted Daily Living Services Waiver fee schedule and Utah’s Waiver for Individuals 65 and Older rate sheet, both effective July 1, 2026, list S5125 per 15 minutes and have no S5126 line.
A state that uses a daily code ties it to a specific waiver service, and a modifier may separate one daily service from another. That makes the service definition more important than the code. Before you bill, find in the waiver:
- the service name tied to S5126 and any required modifier
- who can provide it (agency, family caregiver, participant-employed worker)
- what must happen for a day to count
- whether hourly codes can be billed the same day
Search your state’s programs in the Medicaid waiver lookup.
How do you bill S5126 correctly?
Bill 1 unit per calendar day that meets the state’s definition, inside the authorized date range.
- Match the authorization. It should name S5126, the modifier and a number of days.
- Document every day. A daily rate still needs daily proof of service, such as care notes and, where the state requires it, EVV records.
- Watch the date range. Days after the authorization end date usually can’t be billed. See authorization tracking.
- Use the right modifier. See home care billing modifiers.
For setting your own private-pay daily price, see live-in care daily rates.
FAQ
Can I switch a client from S5125 to S5126 to bill a long day? No. The code has to match the service and unit on the authorization. A long hourly visit is still billed in S5125 units.
How many S5126 units is one week? Seven, if the client received a qualifying day of service each day.
Is S5126 a Medicare code? No. CMS lists it with coverage code I, not payable by Medicare. It is used by Medicaid and other payers that adopt it.
General information, not billing or legal advice. Check your state Medicaid provider manual and fee schedule.