Summary & Overview
HCPCS S5126: Attendant Care Services, Per Diem
HCPCS Level II code S5126 denotes attendant care services billed on a per diem basis for patients needing continuous assistance with activities of daily living. Nationally, this code identifies non-medical attendant support delivered in home or community-based residential settings and is used across commercial and public payers to classify day-long personal care services. Its proper use affects coverage determinations, benefit design, and program monitoring for long-duration personal care needs.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, how it maps to service settings, and which payers commonly process it. The publication provides benchmarks for utilization and reimbursement patterns where available, notes on billing practice considerations, and summaries of policy updates affecting attendant care reimbursement and coverage criteria. Clinical context outlines the typical patient needs driving use of attendant care per diem billing and implications for care coordination and benefit administration. Data gaps or missing fields from source inputs are noted as "Data not available in the input."
Billing Code Overview
HCPCS Level II code S5126 describes attendant care services; per diem. This code represents full-day, non-medical personal care and attendant support provided to patients who require continuous assistance with activities of daily living. The service type is attendant care delivered on a per diem basis. The typical site of service is the patient's home or other community-based residential setting where attendants provide ongoing, day-long support.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
Attendant care services (S5126) provide per diem non-skilled personal care and assistance with activities of daily living (ADLs) for patients who require supervision or hands-on help but do not need licensed skilled nursing. A typical patient is an older adult recently discharged from an acute hospital following hip fracture repair who demonstrates safe mobility with assistance but requires ongoing help with bathing, toileting, meal preparation, medication reminders, and transfers. The clinical workflow begins with a physician or authorized clinician documenting the need for attendant care in the discharge plan or a home health/long-term services assessment. A care coordinator or case manager arranges a daily attendant schedule and communicates care tasks, safety risks, and goals to the attendant caregiver. Documentation includes the start and end date of per diem services, daily service logs of ADL assistance, any changes in condition prompting skilled referral, and periodic reassessments by the supervising clinician. Billing uses S5126 as a per diem rate for each calendar day of attendant care provided, with appropriate modifiers appended as required by payer policy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/no modifier | Use when no specific modifier applies to the per diem attendant service. |