What is HCPCS code S5150?

S5150 is the HCPCS code for unskilled respite care, not hospice, billed in 15-minute units. Four units equal 1 hour. Medicaid HCBS waivers are the main payer. Medicare does not pay it. Each state sets its own rate, modifiers and limits, and some states use a different code for the same service.

What does the S5150 descriptor say?

The CMS long descriptor reads: “Unskilled respite care, not hospice; per 15 minutes” (CMS HCPCS quarterly update, October 2026 file). The same file gives it Medicare coverage code “I,” which means not payable by Medicare.

“Unskilled” means the respite worker gives the same kind of non-medical support as a personal care aide or companion: supervision, help with daily activities, meals. It gives the family caregiver a break. “Not hospice” means hospice respite is billed separately under the hospice benefit.

Who pays for S5150?

Mostly Medicaid HCBS waivers for older adults, people with physical disabilities and people with intellectual or developmental disabilities. Respite is usually a waiver service, so the person has to be enrolled in a waiver that includes it. Find your state’s programs in the Medicaid waiver lookup.

How do states differ on S5150?

Rates, modifiers and even the code itself change from state to state.

Sources: Alaska’s Chart of Waiver Services Rates and South Dakota’s HOPE Waiver Fee Schedule. Alaska’s chart lists base rates, which it adjusts by region (up to 1.5 times in the Aleutian Region).

South Dakota shows how far states can drift from the national descriptor. Its HOPE waiver bills in-home respite under T1005 and uses S5150 as a daily rate for residential respite. Alaska uses S5150 as written and adds U2 for the family-directed version. Always bill the code, modifier and unit on the authorization, not the one you’d guess from the national descriptor.

What are the billing tips for S5150?

• Check the annual cap. Some waivers limit respite to a set number of hours or days per plan year, separate from personal care hours.
• Don’t overlap. Some states won’t pay respite and personal care for the same client at the same time. Check your waiver’s rules.
• Watch the rounding rule. Partial units follow your state’s rounding policy, and EVV times have to support the units billed. Convert hours with the units calculator.
• Confirm EVV. CMS says respite that includes personal care is subject to EVV, even under a different service name (CMS EVV FAQ). Check whether your state lists respite in its EVV program in the EVV state directory.

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 start and end times to back up the units you bill. $199/month for up to 10 caregivers or $299/month for up to 50, with a 30-day free trial.

FAQ

Is S5150 billed per hour? No. The CMS descriptor says per 15 minutes, so 1 hour is 4 units, unless your state’s fee schedule defines a different unit.

Can a family member bill S5150? Only if the state’s waiver allows paid family caregivers for respite.

What is the difference between S5150 and T1005? S5150 is “unskilled respite care, not hospice,” while T1005 is the broader “respite care services, up to 15 minutes.” Each state chooses which one to use.

General information, not billing or legal advice. Check your state Medicaid agency’s current fee schedule and provider manual.