Claims billed with S5111 not payable after Jan. 1, 2019, new code required
Effective Jan. 1, 2019, CPT S5111 (home care family training per session) is not a payable code. Instead, you must bill CPT S5110 (home care family training per 15 minutes) and provide the quantity of time in 15-minute increments on the claim.
As part of our annual code review, Priority Health reviewed behavioral health provider codes and determined S5110 was a better way to gather information on autism home care family training than S5111. We also want to ensure we're reimbursing you in the most appropriate way for the services provided.