HCPCS Level II › S codes S5116 Nonfamily hc train/sessionHome care training, non-family; per session
Medicare coverage: Not payable by Medicare Status: active (October 2026 file) Medicare pricing for S5116 Physician Fee Schedule (CY 2026, RVU26D) Status I: not valid for Medicare (Medicare uses another code).
Payer policies and prior authorization for S5116 21 of 22 payer prior-auth lists that name S5116 require prior authorization or set conditions: Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky).
Payer Plan State Prior auth Conditions Since Source Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana LTSS (Healthy Horizons) VA prior auth under conditions Beyond limit: 10 visits per year Jul 1, 2025 Humana Healthy Horizons® in Virginia Long-Term Services and Supports (LTSS) Prior Authorization and Notification List Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Molina Complete Care (Virginia) Virginia state exceptions to the national Medicaid grid (exceptions only) VA prior auth under conditions State exception; PA after 4 visits Apr 1, 2025 Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 Molina Complete Care (Virginia) Medicaid VA prior auth under conditions State exception; PA after 4 visits Apr 1, 2025 Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 Molina Healthcare of California Medicaid CA prior auth required Apr 1, 2026 Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 Molina Healthcare of Idaho Medicaid ID prior auth required Jan 1, 2025 Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 Molina Healthcare of Illinois Medicaid IL prior auth required Apr 1, 2024 Molina Healthcare of Illinois Codification Grid Q3 2026 Molina Healthcare of Iowa Medicaid IA prior auth required Jul 1, 2023 IA Prior Authorization Matrix, effective Q3 2023 Molina Healthcare of Michigan Exchange MI prior auth required Jul 1, 2021 Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 Molina Healthcare of Mississippi Medicaid MS prior auth required Jan 1, 2025 Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 Molina Healthcare of Nevada Medicaid NV prior auth required Oct 1, 2022 Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 Molina Healthcare of New Mexico Medicaid NM prior auth required Prior authorization is required for all home health services Jul 1, 2026 New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 Molina Healthcare of Ohio Medicaid and MyCare Ohio (MMP) Medicaid OH prior auth required Oct 1, 2023 Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 Molina Healthcare of Ohio Exchange OH prior auth required Oct 1, 2023 Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 Molina Healthcare of Texas STAR TX prior auth required Feb 19, 2025 Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 Molina Healthcare of Texas STAR+PLUS TX prior auth required Feb 19, 2025 Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 Molina Healthcare of Texas STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) TX prior auth required Jul 1, 2026 Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 Molina Healthcare of Utah Medicaid UT prior auth required Jan 1, 2025 Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 Passport by Molina Healthcare (Kentucky) Medicaid KY prior auth under conditions PA after 6 snv Jul 1, 2026 Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Payer coverage policies that name S5116 S5116 appears in 12 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 ProceduresPage | 19 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 (MP.022.28) 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 (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 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
Recent prior-auth changes Jan 1, 2027: PA added, Humana Jul 1, 2026: conditions changed, Passport by Molina Healthcare (Kentucky) Apr 1, 2024: PA added, Molina Healthcare of Illinois Jan 1, 2024: PA removed, humana:pa:commercial Medicaid fee-for-service Prior authorization required or conditional in IN.
IN: $1700.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2012 VA: $90.14 (medical), effective Jul 1, 2024 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.