Summary & Overview
HCPCS Level II S5145: Foster Care, Therapeutic, Child; Per Diem
HCPCS Level II code S5145 denotes therapeutic foster care for children billed on a per diem basis. The code captures structured, family-based placements that provide daily support and clinical oversight for children with behavioral, emotional, or other treatment needs. Nationally, per diem therapeutic foster care is a key component of community-based behavioral health systems that aim to reduce residential placements and support family-style treatment settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing context, payer coverage considerations, typical sites of service, and common modifier usage where available. The report highlights national relevance for payers and providers engaged in child behavioral health, including reimbursement structure (per diem), care setting implications, and administrative considerations.
This publication provides benchmarks and policy-oriented context for payers and administrators, summarizes clinical implications of per diem therapeutic foster care placements, and identifies areas where coding clarity and coverage policy affect access and billing. Data not available in the input will be noted where applicable in specific sections.
Billing Code Overview
HCPCS Level II code S5145 describes foster care, therapeutic, child; per diem services. This code represents day-to-day placement and care for a child in a therapeutic foster care setting, with services typically focused on behavioral, emotional, or other treatment needs that require a structured family-based environment. Service type: Therapeutic foster care (child-focused), per diem. Typical site of service: therapeutic foster family home or community-based foster care placement.
Clinical & Coding Specifications
Clinical Context
A child placed in a therapeutic foster care program requires 24-hour supervised care with integrated behavioral health supports provided in a licensed foster home. Typical patients are children and adolescents with complex behavioral, emotional, or psychiatric needs such as disruptive behavior disorders, post-traumatic stress disorder, mood disorders, or severe attachment issues that impair functioning at home or school. Services coded as S5145 are billed on a per diem basis to cover room, board, supervision, and treatment-focused caregiving delivered by trained foster parents and program staff.
A typical workflow: upon referral from child protective services, juvenile court, or a behavioral health provider, the child undergoes an intake and clinical assessment by a multidisciplinary team (social worker, psychiatrist/psychologist, and care coordinator). A treatment plan is developed with goals for stabilization, skill-building, medication management if indicated, family engagement, and discharge planning. The foster parent documents daily progress and participates in team meetings and therapeutic interventions. Clinical oversight is provided by a licensed clinician who delivers psychotherapy, medication management, and supervision of behavior plans. The per diem S5145 covers the therapeutic foster care stay; ancillary billable services (psychotherapy, medication management, targeted case management) are billed separately using standard CPT codes when applicable and documented.
Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare; authorization requirements, medical necessity criteria, and documentation standards vary by payor and must be met for reimbursement.
Coding Specifications
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