Question 1

What is HCPCS code S5105?

Accepted Answer

HCPCS code S5105 is "Centerbased day care perdiem". Day care services, center-based; services not included in program fee, per diem

Question 2

What category is S5105 in?

Accepted Answer

S5105 belongs to HCPCS Category S (Temporary National Codes (Non-Medicare)).

Question 3

When should I use HCPCS code S5105?

Accepted Answer

Use S5105 when billing for centerbased day care perdiem. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is S5105 covered by Medicare?

Accepted Answer

Coverage for S5105 (Centerbased day care perdiem) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for S5105?

Accepted Answer

Documentation for S5105 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).