S5115 Nonfamily homecare train/15mHome care training, non-family; per 15 minutes
Status I: not valid for Medicare (Medicare uses another code).
3 of 3 payer prior-auth lists that name S5115 require prior authorization or set conditions: Humana, Molina Healthcare of California, Molina Healthcare of Idaho.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| Molina Healthcare of California | Medicaid | CA | prior auth required | State exception | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth required | State exception; Codes are covered for LTSS plans only | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 |
S5115 appears in 13 coverage policies from Aetna, Anthem, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Skilled Home Health Care Nursing Services (0201) | listed, no stance | Apr 22, 2026 | payer document |
| Anthem | Home Health (CG-MED-23) | covered if criteria are met (range S5115-S5116) | Nov 6, 2025 | payer document |
| Premera Blue Cross | Non-covered Services and Procedures Page | 18 of 30 | ∞ | not covered | Jun 1, 2026 | payer document |
| UnitedHealthcare | Home Health Care Services (for Kentucky Only) (CS137KY.12) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (CS137.X) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (MP.022.28) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Idaho Only) (CS137ID.D) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Kansas Only) (CS137KS.04) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Nebraska Only) (CS137NE.V) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for New Jersey Only) (CS137NJ.X) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for New Mexico Only) (CS137NM.D) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Ohio Only) (CS137OH.E) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Tennessee Only) (CS137TN1.J) | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in IN.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.