HCPCS H0015: Intensive Outpatient Alcohol and/or Drug Treatment

Commercial payers pay $470 on average nationally for this procedure.

HCPCS Level II code H0015 describes intensive outpatient alcohol and/or drug treatment services provided as a structured program that operates at least three hours per day and at least three days per week, delivered according to an individualized treatment plan and including assessment, counseling, crisis intervention, and activity therapies or education; service type: intensive outpatient substance use disorder treatment; typical site of service: outpatient behavioral health or addiction treatment facility.

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 rates for HCPCS code H0015 center around BUCA's average commercial rate of $470.30, with individual payers showing materially different central tendencies and spreads. Blue Cross Blue Shield (BCBS) and Aetna exhibit higher medians near the BUCA average range, while Cigna and UnitedHealth Group display lower medians; Cigna’s median is $81.80 and UnitedHealth Group’s median is $125.00. BCBS has an extreme max outlier at $66,111.10 but its central 50% sits near typical commercial levels.

Rate dispersion measured by the interquartile range (P75 minus P25) highlights variability: BCBS has the widest IQR at $60.40 (P75 $192.60 minus P25 $132.00), indicating broader mid-range spread, followed by BUCA with an IQR of $52.50 (P75 $170.30 minus P25 $117.80). UnitedHealth Group shows a moderate IQR of $104.50 (P75 $159.50 minus P25 $52.00) driven by a low P25, while Aetna and Cigna have the tightest interquartile spreads at $4.30 and $1.10 respectively, signaling relatively concentrated mid-range pricing.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 34-year-old male with a history of heavy alcohol use presents following repeated brief hospital visits for intoxication and withdrawal symptoms. After outpatient screening and an initial substance use assessment, the interdisciplinary team enrolls him in an intensive outpatient program billed with H0015. The program operates three days per week for at least three hours per day and follows an individualized treatment plan incorporating group counseling, individual counseling, psychoeducation, relapse prevention skills, and occasional crisis intervention. A licensed clinical social worker conducts intake assessment and treatment planning; addiction counselor-led groups deliver skills-based sessions; a psychologist provides periodic individual therapy and evaluation for comorbid mood symptoms. Typical workflow: referral and prior authorization; comprehensive intake assessment and documentation of diagnosis (for example, F10.20); development of an individualized treatment plan; delivery of daily program components (group therapy, individual sessions, family education, activity therapies); progress notes and weekly multidisciplinary team reviews; periodic outcome measurement and discharge planning. Services may require coordination with primary care, psychiatry, or medication-assisted treatment programs for opioid dependence. Billing uses H0015 per day of intensive outpatient services, with applicable modifiers appended as needed for reduced services, unusual circumstances, or multiple specialties involved.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure

Related Modifiers

9 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
52	Modifier ‑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…
53	Modifier 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…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 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…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
22	Modifier –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…
99	Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…	- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101YA0400X	Addiction (Substance Use Disorder) Counselor	Behavioral Health & Social Service Providers · Counselor
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
1041C0700X	Clinical Social Worker	A 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…
163WD0400X	Diabetes Educator Registered Nurse	Nursing Service Providers · Registered Nurse
204F00000X	Transplant Surgery Physician	A surgeon who specializes in transplant surgery.
103TM1700X	Deactivated - Psychologist Men & Masculinity
1835P1300X	Psychiatric Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing care of patients with psychiatric illness by assessing and mo…
3418M1120X	Military or U.S. Coast Guard Air Transport Ambulance	Vehicle and staff for patient emergency or non-emergency air transport.

Related Payer Policy Updates

Specialty: Home Health & Hospice1 / 3

10 rows

Policy	Payer	Effective Date
Home Health, Skilled, and Custodial Care Services (for Idaho Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for Florida Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for New Jersey Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Kentucky Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for New Mexico Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Kansas Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Home Health, Skilled, and Custodial Care Services (for Ohio Only)	UnitedHealthcare	2026-08-01
Home Health, Skilled, and Custodial Care Services	Colorado Rocky Mountain Health Plans	2026-07-01

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

Frequently Asked Questions

References

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.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.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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State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure

Related Modifiers

9 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
52	Modifier ‑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…
53	Modifier 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…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 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…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
22	Modifier –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…
99	Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…	- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101YA0400X	Addiction (Substance Use Disorder) Counselor	Behavioral Health & Social Service Providers · Counselor
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
1041C0700X	Clinical Social Worker	A 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…
163WD0400X	Diabetes Educator Registered Nurse	Nursing Service Providers · Registered Nurse
204F00000X	Transplant Surgery Physician	A surgeon who specializes in transplant surgery.
103TM1700X	Deactivated - Psychologist Men & Masculinity
1835P1300X	Psychiatric Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing care of patients with psychiatric illness by assessing and mo…
3418M1120X	Military or U.S. Coast Guard Air Transport Ambulance	Vehicle and staff for patient emergency or non-emergency air transport.

Related Payer Policy Updates

Specialty: Home Health & Hospice1 / 3

10 rows

Policy	Payer	Effective Date
Home Health, Skilled, and Custodial Care Services (for Idaho Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for Florida Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for New Jersey Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Kentucky Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for New Mexico Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Kansas Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Home Health, Skilled, and Custodial Care Services (for Ohio Only)	UnitedHealthcare	2026-08-01
Home Health, Skilled, and Custodial Care Services	Colorado Rocky Mountain Health Plans	2026-07-01

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

Frequently Asked Questions

References

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.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.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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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

`S9480`	Intensive outpatient psychiatric services, per diem	Alternate per-diem code used by some payers for psychiatric-intensive outpatient services similar in structure to `H0015`.
`H2019`	Therapeutic behavioral services, per 15 minutes	Used for targeted therapeutic behavioral interventions that may be delivered within or alongside the IOP program on a time-based basis.
`H2020`	Therapeutic behavioral services, per diem	Per-diem reporting for behavioral therapeutic services that may overlap operationally with IOP programming.
`H2035`	Alcohol and/or other drug treatment program, per hour	An hourly reporting option for substance use treatment services, used in workflows where hourly billing is required instead of per-diem IOP billing.
`H2036`	Alcohol and/or other drug treatment program, per diem	Another per-diem code for AOD treatment programs; may be used by providers or payers as an alternative to `H0015` depending on contractual guidance.

HCPCS H0015: Intensive Outpatient Alcohol and/or Drug Treatment

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National Reimbursement Benchmarks

HCPCS H0015: Intensive Outpatient Alcohol and/or Drug Treatment

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National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

HCPCS H0015: Intensive Outpatient Alcohol and/or Drug Treatment

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National Reimbursement Benchmarks

HCPCS H0015: Intensive Outpatient Alcohol and/or Drug Treatment

Sign up for hcpcs H0015 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What services and session structure does HCPCS H0015 describe?

Which other CPT/HCPCS codes are commonly referenced alongside H0015?

What documentation and workflow steps support billing H0015?

Which diagnoses and care coordination needs are associated with H0015?

Is H0015 billed per day and are there payer alternatives or variations?

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What services and session structure does HCPCS H0015 describe?

Which other CPT/HCPCS codes are commonly referenced alongside H0015?

What documentation and workflow steps support billing H0015?

Which diagnoses and care coordination needs are associated with H0015?

Is H0015 billed per day and are there payer alternatives or variations?

References