What is HCPCS code T1005?
T1005 is the HCPCS code for respite care services billed in units of up to 15 minutes. The CMS descriptor, who pays, real state rates and billing tips.
T1005 is the HCPCS code for respite care services, billed in units of up to 15 minutes. It is a Medicaid code: Medicare does not pay it. States use it for in-home respite in HCBS waivers, often in place of S5150. Each state sets the rate, modifiers, provider type and yearly limit.
What does the T1005 descriptor say?
The CMS long descriptor reads: “Respite care services, up to 15 minutes” (CMS HCPCS quarterly update, October 2026 file). Its Medicare coverage code is “I,” not payable by Medicare.
| Field | Value |
|---|---|
| Unit | Up to 15 minutes |
| Units per hour | 4 |
| Medicare | Not payable |
| Typical payers | Medicaid HCBS waivers, state-funded respite programs |
| Close relatives | S5150 (unskilled respite, 15 min), S5151 (per diem) |
Unlike S5150, the T1005 descriptor doesn’t say “unskilled” or “not hospice.” That’s why some states use T1005 with modifiers to cover several levels of respite, from companion-level to nurse-level.
Who pays for T1005?
Medicaid waivers that include respite for family caregivers: aged and disabled waivers, brain injury waivers, intellectual and developmental disability waivers and children’s waivers. The person must be enrolled in a waiver that covers respite, and the hours must be in the plan. Look up your state’s waivers in the Medicaid waiver lookup.
How do states differ on T1005?
The rate and the modifiers that split T1005 into tiers are set by each state.
| State and program | Code and modifier | Rate per 15 minutes | Effective |
|---|---|---|---|
| South Dakota, HOPE waiver | T1005, in-home respite care | $10.81 | July 1, 2026 |
| South Dakota, Assisted Daily Living Services waiver | T1005, respite | $10.81 | July 1, 2026 |
| Kentucky, Home and Community Based (HCB) waiver | T1005, specialized respite Level I | $5.92 | January 1, 2025 |
| Kentucky, HCB waiver | T1005 U1, specialized respite Level II | $12.10 | January 1, 2025 |
| Kentucky, several waivers | T1005 U9, respite in a congregate setting | $5.92 | January 1, 2025 |
Sources: South Dakota’s HOPE Waiver Fee Schedule and Assisted Daily Living Services Waiver Fee Schedule, and Kentucky DMS’s 1915(c) HCBS rate summary.
Kentucky shows how modifiers carry the meaning. U1 marks the higher respite level and U9 marks a congregate setting. Those are Kentucky’s definitions, not national ones. See home care billing modifiers.
What are the billing tips for T1005?
- Use the code on the authorization. If your state lists respite under S5150, a T1005 claim will deny, and the reverse is also true.
- Match the modifier to the level. A Level II modifier needs the staff qualifications the state requires for Level II.
- Track the annual limit. Respite usually has its own cap in the plan year, apart from personal care hours.
- Round per state rules. “Up to 15 minutes” does not settle how partial units round. Your state’s manual and EVV rules do. Convert hours with the units calculator.
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 the actual visit times behind every unit. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.
FAQ
Is T1005 the same as S5150? No. Both are 15-minute respite codes, but the descriptors differ and each state picks which one it uses, sometimes both for different waivers.
Does Medicare cover T1005? No. CMS lists it as not payable by Medicare. It is billed to Medicaid and state programs.
What does “up to 15 minutes” mean for billing? One unit covers a period of up to 15 minutes. How a partial unit rounds is set by your state, so check the provider manual.
General information, not billing or legal advice. Check your state Medicaid agency’s current fee schedule and provider manual.