MedicaidBilling CodesMedium impact
Inclusion of Medical Day Care Services in the Brain Injury Waiver Fee Schedule
Maryland Medicaid·MD · Occupational Therapy, Physical Therapy, PM&R (Physical Medicine & Rehab)·Waiver for Adults with Brain Injury (TBI)
Effective date
Sep 1, 2025
We identified it
Jul 17, 2026
Summary
Maryland Medical Assistance Program has added Medical Day Care (MDC) services to the Brain Injury Waiver fee schedule with a per diem reimbursement rate of $116.59 per day. This service was previously offered but lacked a formal fee schedule entry. Billing teams must update their systems to recognize procedure code S5102 for MDC services under this waiver effective September 1, 2025.
Action Required
By September 1, 2025: Billing team must update the practice management system and fee schedules to include HCPCS code S5102 (Medical Day Care) with a reimbursement rate of $116.59 per day for Maryland Brain Injury Waiver claims. Update claim submission logic to recognize S5102 as a valid billable service code under this waiver. Train billing staff and providers that MDC services are now formally reimbursable through the waiver. Ensure claims submitted prior to September 1, 2025 use legacy procedures; claims on or after the effective date must use S5102. Contact Jeronica Baldwin (jeronica.baldwin@maryland.gov) or Elena Janetopoulos (240-761-1344, elena.janetopoulos@maryland.gov) with implementation questions.