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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0013-acute-detoxification-residential-outpatient
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    HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

    Commercial payers pay $282 on average nationally for this procedure.

    HCPCS Level II code H0013 describes acute detoxification services provided in a residential addiction program on an outpatient basis, representing medically supervised management of withdrawal from alcohol and/or drugs; the service is classified as acute detoxification and is typically delivered in a residential outpatient setting where patients receive intensive medical and nursing monitoring during early withdrawal.

    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

    Across national commercial payers, BUCA’s average commercial rate of $281.80 sits near the middle of the observed spectrum, offering a useful benchmark for national commercial reimbursement for H0013. Blue Cross Blue Shield shows substantial skew with an extreme maximum but a modest median, while Aetna and Cigna display higher median and mean levels respectively. UnitedHealth Group’s central tendency is lower than BUCA’s average but relatively consistent.

    Dispersion (P75 minus P25) highlights contrasts in rate variability: Blue Cross Blue Shield has the widest interquartile spread at $124.40 ($275.50 − $135.10), indicating substantial variability among commercial contracts, followed by Aetna with a spread of $136.40 ($501.00 − $364.00) which is also wide. The tightest dispersion is UnitedHealth Group at $32.50 ($58.50 − $32.50), with Cigna ($83.50 − $25.00 = $58.50) and BUCA ($252.60 − $137.10 = $115.50) in between, reflecting differing levels of rate consistency 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 38-year-old patient presents to a residential addiction treatment program for acute detoxification from alcohol after 48 hours of escalating tremor, diaphoresis, nausea, and early hallucinations. The patient is assessed by an addiction medicine physician and addiction psychiatry consult, triaged to an acute residential detox pathway, and admitted under the service described by H0013. Initial evaluation includes medical history, vital signs, CIWA-Ar monitoring, medication management (e.g., benzodiazepine taper or alternative agents per facility protocol), nursing observation, and psychosocial assessment. Daily interdisciplinary rounds include physicians, nursing, and behavioral health staff; documentation captures withdrawal severity, medications administered, response to treatment, and readiness for step-down to sub-acute outpatient services or referral to intensive outpatient H0015.

    A typical workflow: upon arrival the patient receives triage and medical clearance; stabilizing medications and symptom-triggered protocols are started; nursing documents frequent observations; periodic physician evaluations are completed and billed under H0013; social work arranges continued care and insurance authorization if required. Common billing scenarios include billing H0013 for each day of medically supervised acute residential detoxification when the primary focus is acute withdrawal management rather than ongoing rehabilitation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    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…
    207QA0401XAddiction Medicine (Family Medicine) PhysicianA family medicine physician who specializes in the diagnosis and treatment of addictions.
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    152WX0102XOccupational Vision OptometristOptometrists who work in Occupational Vision, the branch of environmental optometry, consider all aspects of the relationship between work and vision,…
    2081P2900XPain Medicine (Physical Medicine & Rehabilitation) PhysicianA physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or …
    225XE1200XErgonomics Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Occupational Therapist
    246XC2903XVascular Specialist/Technologist CardiovascularA vascular technologist, also known as a vascular sonographer, creates images of blood vessels and collects data that help physicians diagnose disorde…

    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-H0010-SUB-ACUTE-RESIDENTIAL-DETOXIFICATION

    HCPCS H0010: Sub-Acute Detoxification, Residential 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 detox (residential addiction program outpatient)Used for less intensive residential detox services when withdrawal risk is lower; may follow or precede H0013 depending on clinical progress.
    H0011Alcohol and/or drug services: acute detox (residential addiction program inpatient)Represents inpatient acute detox; used when level of care is higher than outpatient residential H0013 or if patient requires inpatient admission.
    H0010Alcohol and/or drug services: Sub‑acute detox (residential addiction program inpatient)For inpatient sub-acute detoxification; relates to step-down/up decisions in the continuum of detox care.
    H0014Alcohol and/or drug services: ambulatory detoxOutpatient clinic-based detox services; appropriate for patients not needing residential supervision and may be an alternative to H0013.
    H0015Alcohol and/or drug services: intensive outpatientIntensive outpatient programming for stabilization and continued treatment after resolution of acute withdrawal managed by H0013.
    H0050Alcohol and/or drug services: brief Intervention, per 15 minutesShort counseling interventions that can be provided during or after detox; often billed in conjunction with detox services for motivational interviewing.
    99408Alcohol and substance (other than tobacco) abuse structured screening and brief intervention: 15–30 minutesScreening and brief intervention that may occur during intake or follow-up; documents structured counseling related to substance use.
    99409Alcohol and substance (other than tobacco) abuse structured screening and brief intervention: greater than 30 minutesLonger SBI sessions provided as part of comprehensive detox and discharge planning.