Summary & Overview
HCPCS S5105: Day Care Center Services, Per Diem
HCPCS Level II code S5105 denotes center-based day care services billed on a per diem basis for services not included in the program fee. This code captures supplemental or add-on day services delivered in a day care center where certain items or activities are billed separately from bundled program payments. Nationally, accurate use of S5105 matters for proper claims classification, benefit design, and facility reimbursement for non-fee-included services.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what S5105 represents, typical sites of service, and the service type. The publication also summarizes common billing contexts and what to expect in payer coverage approaches. Where specific payer policy details or utilization benchmarks are needed, readers will be directed to payer policy documents or claims data sources for definitive guidance. Data not available in the input.
Billing Code Overview
HCPCS Level II code S5105 describes day care services, center-based; services not included in program fee, per diem. The service type is day care center services provided on a per diem basis for items or activities that are not covered within the standard program fee. The typical site of service is a center-based day care setting where patients or participants attend for scheduled daytime care, supervision, and ancillary services that may be billed separately from any bundled program fee.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric participant enrolled in a licensed day care or adult day health program who requires intermittent, center-based services beyond the program’s bundled per-diem fee. For example, a frail older adult with dementia and mobility impairment attends an adult day center for socialization and supervision; during a day visit the participant requires a one-time wound dressing change, specialized medication administration, or an extended nursing observation not included in the program fee. The center documents registration and arrival, identifies the specific additional service (for example, wound care), documents clinical findings, interventions, and time or units, and bills S5105 per diem for the itemized service not covered by the base program fee. Typical workflow: intake and assessment at arrival, identification of additional non-bundled service, provision by licensed staff (nurse, licensed practical nurse, or therapist as appropriate), documentation of clinical need and service rendered, application of an appropriate modifier when required, and submission of claim to the participant’s payor (for example, Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, BUCA, or Medicare) with supporting clinical notes and authorization if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | When no special modifier applies; use for standard reporting if payer requires a placeholder |