Virginia Medicaid S5102 Hourly Billing for Adult Day Health Care
Bill Virginia Medicaid Adult Day Health Care as hourly S5102: $11.55 NOVA and $10.70 rest of state. Cap reimbursement at six hours per day, document attendance hours, and bill A0120 trips separately.
Virginia Medicaid bills Adult Day Health Care (ADHC) under procedure code S5102 by the hour. The Department of Medical Assistance Services (DMAS) posts two regional rates on the Commonwealth Coordinated Care Plus (CCC Plus) Waiver rate sheet: $11.55 an hour in Northern Virginia (NOVA) and $10.70 an hour in the Rest of State (ROS). The billed unit is Hour. An ADHC provider that bills S5102 correctly records the hours the member attended, stays within the General Assembly's six-hour daily reimbursement cap, bills Adult Day Health Care transportation (A0120) separately, and confirms the unit and dollars against the live DMAS rate sheet before the claim goes out.
ElderSuite serves adult day care centers nationwide. This resource is Virginia-specific.
What S5102 is now
On the State Fiscal Year (SFY) 2027 CCC Plus Waiver rate sheet, Rate Effective 7/1/2026, DMAS lists:
Chapter V of the CCC Plus Waiver billing instructions still lists the Northern Virginia localities used for CCC Plus Waiver billing rates: Alexandria City, Arlington County, Clarke County, Culpeper County, Fairfax County, Fairfax City, Falls Church City, Fauquier County, Fredericksburg City, Loudon County, Manassas City, Manassas Park City, Prince William County, Rappahannock County, Spotsylvania County, Stafford County, and Warren County. Localities that are not on that list use the ROS rate.
What changed on July 1, 2026
S5102 used to be a daily (per diem) code. The SFY 2027 rate-sheet change log, Date Entered 6/29/2026, states: "Adult Day Health Care (procedure code S5102) transitioned from a daily rate to an hourly rate," Effective Date 7/1/2026.
The prior SFY 2026 sheet, Rate Effective 7/1/2025, listed S5102 as Per Diem at $69.30 NOVA and $64.17 ROS. Those are historical, not current, S5102 rates.
The Waiver Rate Updates Effective July 1, 2025 bulletin said DMAS would update the unit billed for Adult Day Healthcare effective July 1, 2025, in accordance with Item 288.HHHHH of the 2025 Appropriation Act, budget-neutral, and implemented upon Centers for Medicare & Medicaid Services (CMS) approval. The live hourly unit then appears on the SFY 2027 sheet. The Waiver Rate Updates Effective July 1, 2026 bulletin is the later notice: DMAS "has updated the unit billed for Adult Day Healthcare effective July 1, 2026" in accordance with Item 291. ZZZZ of the 2026 Appropriation Act.
The six-hour daily reimbursement cap
The Virginia General Assembly capped hourly ADHC reimbursement when it converted the daily rate. Conference amendment 288#6c inserts, after "hourly rate," the clause ", however, such reimbursement is limited to no more than six hours per day." The amendment explanation says that in the conversion from a daily rate to an hourly rate, reimbursement is limited to no more than six hours per day.
That six-hour figure is a reimbursement cap in the Appropriation Act language. The sources opened for this article do not publish a DMAS claim-edit, rounding rule, or required documentation field that implements the cap.
Managed care and fee-for-service timing
The 2026 bulletin is addressed to all providers and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program. DMAS wrote that MCOs may need 30–60 days after the rates are posted to finish updating their systems with the new Fiscal Year 2027 rates, and that MCOs will automatically reprocess any claims that paid using old rates within approximately 30 days after they finish those updates. DMAS will automatically reprocess fee-for-service (FFS) claims once the system is updated with the new rates. Providers have the option to bill MCOs immediately under old rates or delay billing until FY2027 rates are updated by the MCOs.
For questions on rates, the bulletin points to the provider helpline at 800-552-8627.
Where to check the current rate sheet
The operational check is the live CCC Plus Waiver file on the DMAS Rates and Rate Setting page. The SFY 2027 file is the current hourly S5102 sheet as of the 6/29/2026 change log. If DMAS later posts a newer CCC Plus Waiver file, use that file. The 2026 bulletin says corrections or revisions will be noted at the bottom of the official rate sheet.
ElderSuite is adult day care software for attendance, Medicaid billing, nursing documentation, and CACFP. You can try it free for 30 days.
Start a Free Trial
