What is HCPCS code S5135?
S5135 is the HCPCS code for adult companion care billed per 15 minutes. The CMS descriptor, which Medicaid programs pay it, 2026 rates and billing tips.
S5135 is the HCPCS code for adult companion care, billed in 15-minute units. Medicaid HCBS waivers use it for supervision, socialization and light help at home, as each state defines the service. Medicare does not pay it. Rates, modifiers and allowed tasks come from your state’s waiver.
What does the S5135 descriptor say?
The CMS long descriptor reads: “Companion care, adult (e.g., iadl/adl); per 15 minutes” (CMS HCPCS quarterly update, October 2026 file). IADL means instrumental activities of daily living, such as meal preparation and errands. ADL means activities of daily living, such as dressing and eating. The descriptor names both as examples, but the state’s service definition decides what companion staff may actually do.
| Field | Value |
|---|---|
| Unit | 15 minutes |
| Code added | January 1, 2003 |
| Medicare coverage code | I (not payable by Medicare) |
| Daily version | S5136 (per diem) |
How is companion care different from personal care?
Companion care centers on company, supervision and light tasks. Personal care is hands-on help with bathing, toileting and transfers and is usually billed under T1019 or S5125. A companion who starts giving baths may be outside the companion service definition. See companion care vs. personal care.
How do S5135 rates vary by state?
Companion care pays less than personal care in some programs, and some states use S5135 under a different service name.
| State and program | S5135 rate | Personal care on same schedule | Effective |
|---|---|---|---|
| Utah, Waiver for Individuals 65 and Older | $8.25 per 15 minutes (U3 required) | T1019 $9.30 | July 1, 2026 |
| North Carolina, CAP/CD waiver, listed as Personal Assistance Services | $7.03 per 15 minutes (up from $5.96) | S5125 $7.03, T1019 $8.66 | August 1, 2026 |
Utah’s sheet also lists an optional TN rate for S5135 at 175% of base, $14.44.
What should you check before billing S5135?
Make sure the authorization, the caregiver’s notes and the EVV record all describe companion work.
- Tasks. Notes should show companion activities that match the service plan, not hands-on personal care.
- Modifiers. Use the program modifiers your state lists. See home care billing modifiers.
- EVV. The Cures Act requires EVV for Medicaid personal care, and CMS says that covers any service that includes personal care, whatever it’s called (CMS EVV FAQ). Whether companion-only visits need EVV depends on how your state defines the service. Check the EVV state directory.
- Units. Convert minutes with the units calculator and apply your state’s rounding rule.
- Authorization. Track units used each week so you don’t provide unbillable hours.
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 times, and AI visit notes help caregivers record the companion tasks they did. $199/month for up to 10 caregivers or $299/month for up to 50, with a 30-day free trial.
FAQ
Is S5135 only for adults? Yes. The descriptor says “companion care, adult.”
How many units is a 3-hour companion visit? 12 units, since each unit is 15 minutes.
Does Medicare pay for companion care? No. CMS lists S5135 with coverage code I, not payable by Medicare.
General information, not billing or legal advice. Check your state Medicaid provider manual and fee schedule.