26-377m Respite Services Authorization Form Updated

Date: 03/24/26

Billing codes are now included on the form to support accurate and timely processing

The Respite Services (For Caregivers) Authorization Form has been updated to include required billing codes. Adding these codes helps streamline authorization and billing, improving processing accuracy and reducing potential delays.

Select the correct billing code when requesting respite services

When submitting a request, choose the code that best reflects the type and location of respite care:

• S9125: Respite care, in home, U6 (no prior authorization required)
• H0045: Respite care, not in the home, U6
• S5151: Unskilled respite care, not hospice, U6

Access the latest Respite Authorization Form on the CalAIM Resources for Providers.

Questions?

If you have any questions about the form or respite services, please email the long-term services and supports liaison.

 

This information applies to Community Supports (CS) Providers.

This information applies to Medi-Cal in Imperial County.