Summary & Overview
HCPCS S5140: Foster Care, Adult; Per Diem
HCPCS Level II code S5140 covers daily per diem billing for adult foster care, capturing the costs of room, board, and supportive supervision in community-based foster residences or group homes. This code matters nationally as Medicaid programs, Medicare Advantage plans, and commercial insurers increasingly coordinate payment for nonmedical residential supports that affect health outcomes and service utilization. Coverage and payment approaches for adult foster care per diem services vary across major payers, influencing access to community-based long-term supports and the integration of social care with clinical services.
Key payers discussed include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what S5140 represents, common billing practices associated with per diem residential care, and guidance on the kinds of benchmarks and policy developments that typically affect reimbursement and utilization for adult foster care. The publication highlights national policy context, payer coverage patterns, and areas where updates to benefit design or coding guidance can change how these services are billed and authorized.
The report provides operationally useful details for revenue cycle, care management, and policy teams: definition and service setting, payer coverage landscape, common modifiers (listed separately), and notes on missing or variable data. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code S5140 describes foster care, adult; per diem. The code represents daily per diem billing for adult foster care services, reflecting the routine provision of room, board, and supportive care in a non-institutional setting. Service type: Adult foster care per diem services. Typical site of service: Community-based foster care residence or group home where adults receive daily care and supervision.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
Atypical adult foster care per diem services billed under S5140 cover daily room, board, supervision, and nonmedical support provided to an adult in a foster care placement. Typical patients are adults with chronic mental health conditions, intellectual or developmental disabilities, or functional impairments who require a supervised living environment but not continuous skilled nursing. A realistic scenario: a 45-year-old adult with schizophrenia and serious functional deficits is discharged from an inpatient psychiatric facility to an adult foster home. The foster care provider documents daily supervision, medication reminders, meal provision, transportation to outpatient appointments, and assistance with activities of daily living. The clinical workflow includes placement authorization, establishment of a care plan by a case manager, daily care delivery by the foster provider, routine progress notes, monthly care plan reviews, and per diem billing submitted by the foster agency using S5140 for each day of service provided. Payer authorization, documentation of level of need, and coordination with behavioral health clinicians are typical administrative steps before ongoing per diem billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no modifier applies to the per diem claim |