Summary & Overview
HCPCS H0045: Respite Care Services, Non-Home, Per Diem
HCPCS Level II code H0045 covers per diem respite care services delivered outside the patient’s home. Respite care provides temporary relief for unpaid caregivers by offering supervised short-term care in settings such as residential facilities or licensed respite centers. Nationally, this code is relevant for behavioral health, disability services, and long-term services and supports programs where intermittent out-of-home caregiving is needed.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of who typically covers this service, how the code is used in non-home respite contexts, and the clinical and operational implications for facilities that bill on a per diem basis. The publication addresses benchmarks and policy considerations relevant to reimbursement and program design, summarizes clinical contexts in which out-of-home respite is deployed, and highlights documentation and billing elements commonly associated with per diem social-support services.
This analysis is written for a national audience and is intended to inform payers, provider administrators, and policy analysts about the role and application of H0045 in outpatient residential and facility-based respite programs. Data not available in the input.
Billing Code Overview
HCPCS Level II code H0045 represents respite care services, not in the home, per diem. The service type is respite care, provided on a per diem basis to support temporary relief for primary caregivers. The typical site of service is a non-home setting, such as a residential facility, group home, or licensed respite center where beneficiaries receive short-term supervised care outside their usual residence.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old woman with advanced Alzheimer disease residing in an assisted living facility requires temporary placement in a facility-based adult day or residential respite program to give her primary caregiver a planned rest period. The patient has baseline difficulty with activities of daily living, supervision needs, and intermittent behavioral agitation related to dementia. The clinical workflow begins with a referral from the primary care physician or geriatrician documenting the need for short-term respite care. The respite provider conducts an intake assessment reviewing medical history, current medications, mobility and toileting needs, fall risk, and advance directives. An individualized care plan is created, including activity schedule, medication administration instructions, and emergency contact information. The patient is admitted to the respite program for one or more full days; staff provide supervision, meals, activities, and basic assistance with ADLs. Nursing documents daily status, any medication administration, and incidents. At discharge back to the caregiver, the respite provider communicates a summary of care and any clinical changes to the referring clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional documentation supports significantly greater service intensity or complexity for the respite admission beyond typical care requirements |