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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0010-sub-acute-residential-detoxification
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    HCPCS H0010: Sub-Acute Detoxification, Residential Inpatient

    Commercial payers pay $199 on average nationally for this procedure.

    HCPCS Level II code H0010 describes alcohol and/or drug services for sub-acute detoxification provided in a residential addiction program (inpatient) setting, encompassing medically monitored withdrawal care and supportive services to manage substance withdrawal symptoms during a short-term residential stay.

    For related coverage guidance, see recent payer policy updates: Home Health, Skilled, and Custodial Care Services (for Idaho Only), Private Duty Nursing Services, Private Duty Nursing Services (for Florida Only).

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    National Reimbursement Benchmarks

    National commercial benchmark (BUCA) centers near $199.30 for HCPCS H0010, placing it in the mid-range of payer distributions. Among named commercial plans, Cigna shows a high central tendency with a median of $516.60 and a concentrated upper distribution; Blue Cross Blue Shield (BCBS) and Aetna display broader spreads and lower medians compared with Cigna. UnitedHealth Group sits at the low end with a median of $48.50 and a tighter low-rate cluster.

    Examining dispersion (P75 minus P25) highlights who is tightest and widest: Cigna’s P75–P25 spread is $372.30 (from $144.30 to $516.60), BCBS’s spread is $145.80 (from $134.10 to $279.90), BUCA’s spread is $149.40 (from $116.50 to $265.90), Aetna’s spread is $63.60 (from $120.00 to $183.60), and UnitedHealth Group has the tightest spread at $22.80 (from $32.50 to $55.30). These differences indicate notable variability in upper-tail pricing across payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old male with a five-year history of heavy alcohol use presents to a residential addiction program with escalating tremor, nausea, diaphoresis, and early signs of withdrawal after abrupt cessation. The admitting clinician documents symptoms consistent with alcohol withdrawal requiring medically supervised, sub-acute detoxification in a residential setting. Admission orders include daily nursing assessments, symptom-triggered benzodiazepine protocol, monitoring of vital signs and CIWA-Ar scores, psychosocial evaluation, group counseling, and coordination with an addiction psychiatrist for medication-assisted therapy when indicated. The typical clinical workflow for H0010 begins with intake triage and medical screening, documentation of withdrawal severity, placement in a residential bed for sub-acute detoxification, ongoing nursing and counseling services, multidisciplinary team reviews, and discharge planning with referrals to outpatient treatment or sober living. Observation and treatment generally continue until withdrawal symptoms are controlled and stabilization is achieved but do not meet criteria for acute inpatient medical detoxification.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    H0011Alcohol and/or drug services; acute detoxification (residential addiction program inpatient)Represents a higher-acuity inpatient detoxification service for patients requiring intensive medical monitoring beyond sub-acute scope.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    101YA0400XAddiction (Substance Use Disorder) CounselorBehavioral Health & Social Service Providers · Counselor
    103TP2701XGroup Psychotherapy PsychologistA psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identif…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    261QM1200XMagnetic Resonance Imaging (MRI) Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    2082S0105XSurgery of the Hand (Plastic Surgery) PhysicianA plastic surgeon with additional training in the investigation, preservation, and restoration by medical, surgical and rehabilitative means of all st…
    242T00000XPerfusionistA perfusionist operates extracorporeal circulation and autotransfusion equipment during any medical situation where it is necessary to support or temp…
    125K00000XAdvanced Practice Dental TherapistAn Advanced Practice Dental Therapist is:<br/>(1) A dental therapist who has completed additional training beyond basic dental therapy education and p…
    1041C0700XClinical Social WorkerA social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of p…

    Related Payer Policy Updates

    Specialty: Home Health & Hospice1 / 3

    10 rows

    PolicyPayerEffective Date
    Home Health, Skilled, and Custodial Care Services (for Idaho Only)UnitedHealthcare2026-08-01
    Private Duty Nursing ServicesColorado Rocky Mountain Health Plans2026-08-01
    Private Duty Nursing Services (for Florida Only)Colorado Rocky Mountain Health Plans2026-08-01
    Private Duty Nursing Services (for New Jersey Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for Kentucky Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for Kansas Only)UnitedHealthcare2026-08-01
    Private Duty Nursing ServicesColorado Rocky Mountain Health Plans2026-08-01
    Home Health, Skilled, and Custodial Care Services (for Ohio Only)UnitedHealthcare2026-08-01
    Home Health, Skilled, and Custodial Care ServicesColorado Rocky Mountain Health Plans2026-07-01

    Related Codes

    HCPCS-H0001-ALCOHOL-DRUG-ASSESSMENT-OUTPATIENT

    HCPCS H0001: Alcohol and/or Drug Assessment

    HCPCS-H0002-BEHAVIORAL-HEALTH-SCREENING-ADMISSION-ELIGIBILITY

    HCPCS H0002: Behavioral Health Screening for Treatment Admission

    HCPCS-H0003-ALCOHOL-DRUG-SCREENING-LAB-ANALYSIS

    HCPCS Level II H0003: Alcohol and/or Drug Screening Laboratory Analysis

    HCPCS-H0004-BEHAVIORAL-HEALTH-COUNSELING-15-MINUTE

    HCPCS H0004: Behavioral Health Counseling and Therapy, per 15 Minutes

    HCPCS-H0005-GROUP-COUNSELING-SUBSTANCE-USE-CLINICIAN

    HCPCS H0005: Alcohol and/or Drug Group Counseling by Clinician

    HCPCS-H0006-ALCOHOL-DRUG-CASE-MANAGEMENT

    HCPCS H0006: Alcohol and/or Drug Services, Case Management

    HCPCS-H0007-ALCOHOL-DRUG-CRISIS-INTERVENTION-OUTPATIENT

    HCPCS H0007: Alcohol and/or Drug Crisis Intervention (Outpatient)

    HCPCS-H0008-SUB-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

    HCPCS H0008: Alcohol and/or Drug Sub-Acute Detoxification (Inpatient)

    HCPCS-H0009-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

    HCPCS Level II H0009: Acute Detoxification, Hospital Inpatient

    HCPCS-H0011-ACUTE-DETOXIFICATION-RESIDENTIAL-INPATIENT

    HCPCS H0011: Acute Detoxification, Residential Addiction Inpatient

    Showing 1–10 of 93

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    H0012Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient)Outpatient-equivalent of H0010; used when sub-acute detoxification is delivered in an outpatient/residential ambulatory setting rather than inpatient residential.
    H0014Alcohol and/or drug services; ambulatory detoxificationUsed for ambulatory detox services provided in clinic or outpatient settings; may follow or precede residential H0010 care.
    H2036Alcohol and/or drug treatment program, per diemBilled for per diem comprehensive treatment day services in addiction programs and may be used in conjunction with or as an alternative billing structure to H0010 depending on program billing policies.