Summary & Overview
HCPCS S5102: Adult Day Care Services, Per Diem
HCPCS Level II code S5102 denotes a per diem rate for adult day care services, covering daytime supervision, social support, and basic health monitoring for adults needing assistance outside a residential setting. This code is relevant nationally as adult day services are an integral component of long-term care and community-based support, influencing care access, service coordination, and payer coverage decisions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how S5102 maps to service delivery (per diem adult day care), typical sites of service (adult day care centers and community-based programs), and the payer landscape. The publication also summarizes common billing modifiers and ancillary documentation practices when available, presents national benchmarking considerations for per diem adult day services, and outlines relevant policy and reimbursement trends that affect coverage and utilization.
This resource is intended for revenue cycle professionals, policy analysts, and program administrators seeking a compact, national-level briefing on HCPCS Level II code S5102, its clinical context, and payer relevance. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code S5102 describes day care services, adult; per diem. This code represents a bundled daily rate for non-residential adult day care services provided to support supervision, socialization, and basic health monitoring for adults who require daytime assistance.
Service type: Adult day care, per diem
Typical site of service: Adult day care centers or community-based day programs (non-residential)
Clinical & Coding Specifications
Clinical Context
Day care adult per diem services billed with S5102 typically apply to adult patients who require medically supervised, non-residential daytime care for ongoing medical, nursing, or rehabilitation needs that do not require inpatient admission. A realistic scenario: a 72-year-old patient with post-stroke hemiparesis and moderate cognitive impairment attends a licensed adult day health center for daily skilled nursing oversight, medication administration, therapeutic activities, and monitoring of vital signs. The clinical workflow begins with a referring primary care physician or neurologist completing an order and clinical evaluation. On arrival, nursing staff perform an admission assessment, document baseline vitals and functional status, and create a per diem care plan that includes therapy sessions (physical, occupational, or speech as indicated), medication administration, wound checks if present, and monitoring for acute changes. The center documents attendance, services rendered during the day (nursing interventions, therapeutic activities, social services), and any physician or advanced practice clinician contacts. Billing uses S5102 as the per diem rate for the day-care service; additional billable professional services (e.g., separate therapy codes or physician visits) are documented and billed as applicable. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare following each payer’s coverage rules for adult day health services and per diem reimbursement.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|