What is HCPCS code S5151?
S5151 is the HCPCS code for unskilled respite care billed per diem. The CMS descriptor, who pays, a real 2026 state daily rate and tips for billing it.
S5151 is the HCPCS code for unskilled respite care, not hospice, billed as one unit per day. It is the daily version of S5150. Medicaid HCBS waivers pay for it for longer respite, such as a full day or overnight. Medicare does not. Each state sets the daily rate, what counts as a day and any yearly limit.
What does the S5151 descriptor say?
The CMS long descriptor reads: “Unskilled respite care, not hospice; per diem” (CMS HCPCS quarterly update, October 2026 file). Its Medicare coverage code is “I,” not payable by Medicare.
| Field | Value |
|---|---|
| Unit | 1 day (per diem) |
| Medicare | Not payable |
| Typical payers | Medicaid HCBS waivers |
| 15-minute version | S5150 |
When is S5151 used instead of S5150?
States use the per diem code for longer respite, such as a full day or night, for example a caregiver staying while the family travels. Shorter visits go under the 15-minute code. The descriptor doesn’t define how many hours make a “day,” so the state sets that in its waiver or provider manual. Some states require a minimum number of hours before the daily rate applies. Others pay a daily rate only in a facility or residential setting.
How do states differ on S5151?
Daily rates vary widely, and so does the code a state picks for daily respite.
| State | Code and modifier | Rate | Effective |
|---|---|---|---|
| Alaska | S5151, respite | $470.29 per day | July 1, 2026 |
| Alaska | S5151 U2, family-directed respite | $470.29 per day | July 1, 2026 |
| Alaska | S5150, respite (for comparison) | $9.09 per 15 minutes | July 1, 2026 |
| South Dakota (HOPE waiver) | S5150, residential respite care | $302.16 per day | July 1, 2026 |
Sources: Alaska Department of Health, 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).
At Alaska’s rates, one day of S5151 equals about 52 units of S5150 ($470.29 divided by $9.09), or roughly 13 hours. So a 24-hour respite stay pays far less per hour than hourly respite would. South Dakota doesn’t use S5151 in that waiver at all: it pays daily residential respite under S5150. Check which code and unit the authorization lists before you staff a long shift.
What are the billing tips for S5151?
- Bill 1 unit per day. Don’t convert the day into hours or 15-minute units.
- Know the day definition. Find the state’s minimum hours and whether the day runs midnight to midnight.
- Track the yearly limit. Respite days may count against an annual cap in the person-centered plan.
- Pay the caregiver correctly. A per diem bill rate does not change wage and hour rules. Sleep time and overtime still apply. Compare costs with the live-in vs. hourly calculator.
Find which waivers in your state cover respite with the Medicaid waiver lookup.
FAQ
Is S5151 a 24-hour code? The CMS descriptor only says “per diem.” Your state defines how many hours of care a billable day requires.
Can I bill S5151 and S5150 on the same day? It depends on the state, and some don’t allow both for the same client on the same day. Check the waiver’s billing rules before mixing them.
Does Medicare pay S5151? No. CMS lists it as not payable by Medicare, and the descriptor excludes hospice respite.
General information, not billing or legal advice. Check your state Medicaid agency’s current fee schedule and waiver rules.