HCPCS code T1005: Respite care services, up to 4 hours, up to 15 minutes

Properly use and bill for HCPCS code T1005 by meeting the documentation and billing requirements listed in our short guide.

Use Code

## **What is HCPCS code T1005?** HCPCS code T1005 describes respite care services up to 15 minutes or short-term relief care for a primary caregiver, billed in 15-minute increments for up to 4 hours. Services may be provided in the home or community setting by a trained aide or attendant. Respite care ensures the safety and well-being of the patient while the provider or caregiver rests or attends to personal matters. It is often used in home and community-based service programs to prevent caregiver burnout.

## **HCPCS code T1005 documentation requirements** Proper documentation is crucial for T1005 to ensure accurate billing and to demonstrate the medical necessity of the services. Key documentation requirements generally include: - **Medical necessity**: The patient's record must clearly show that the respite care is medically necessary, as determined by a person-centered planning process. It should not be used as a substitute for continuous, long-term care. - **Service plan**: A comprehensive service plan should outline the need for respite care, the frequency, duration, and the specific goals of the service. - **Caregiver information**: Documentation should include details about the primary caregiver and the reason for the need for relief. - **Service log**: A log detailing the date, time, and duration of the respite care provided is essential. Since the code is billed in 15-minute increments, this log must be precise.

## **T1005 billing requirements** To ensure accurate reimbursement, the following requirements when billing T1005 must be met: - **Units**: T1005 is billed in 15-minute increments. For example, if a respite care session lasts one hour, you would bill four units of T1005. - **Modifiers**: Depending on the state and the specific service provided, modifiers may be required to indicate additional information about the service, such as the type of professional providing the care (e.g., an RN, LPN, or aide) or if the service is being provided in a specific setting. - **Billing limitations**: Some states may impose limitations on the total number of hours or days of respite care a beneficiary can receive within a specific period, such as a state fiscal year. Providers should always verify these limits with the specific payer's policies. - **No room and board**: The cost of room and board should not be included in the billing for T1005 unless the service is provided in a licensed facility that is not a private residence.

## **Other related codes** - **T1004**: Services of a qualified nursing aide, up to 15 minutes - **S5150**: Unskilled respite care, not hospice, per 15 minutes - **S5151**: Unskilled respite care, not hospice; per diem - **H0045**: Respite care, out-of-home, per diem