MedicaidCoverageMedium impact
MAB2023021701
Pennsylvania Medicaid (DHS)·PA · Pediatrics·Provider Bulletin
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will now cover shadow nursing services for beneficiaries under 21 years old receiving private duty/shift nursing care. Shadow nursing allows a second nurse to receive case-specific training alongside the assigned nurse and can be billed using HCPCS code S5116 at $50 per hour, limited to 34 hours per 90 days.
Action Required
Immediately: Billing teams serving Pennsylvania Medicaid patients under 21 with private duty/shift nursing should update billing systems to include HCPCS code S5116 for shadow nursing services. Bill shadow nursing and private duty nursing on the same claim by individual date of service (do not use span-date billing when both services occur). Ensure shadow nursing is limited to 34 hours per 90-day period and billed in one-hour increments at $50 per hour. Shadow nursing can only be billed when private duty/shift nursing services are rendered simultaneously.