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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0017-residential-behavioral-health-per-diem-without-room-board
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    HCPCS H0017: Behavioral Health Residential Treatment, Per Diem

    Commercial payers pay $201 on average nationally for this procedure.

    HCPCS Level II code H0017 describes a per diem behavioral health residential service for treatment provided in a hospital residential treatment program without room and board; the service type is behavioral health residential treatment and the typical site of service is a hospital-based residential treatment program, billed on a per diem basis.

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

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    National Reimbursement Benchmarks

    National commercial reimbursement for HCPCS H0017 centers on BUCA’s average commercial rate of $201.000, which serves as a mid-market reference point; individual commercial payers vary substantially around that level. Aetna shows the highest mean and median levels near $701.80 and $774.00 respectively, while Blue Cross Blue Shield averages much lower at $100.00 and Cigna and UnitedHealth Group cluster near the $40–$62 range. This spread highlights a highly segmented market with both premium and low-cost commercial contracting tiers.

    Rate dispersion (P75 minus P25) quantifies variability: Blue Cross Blue Shield’s dispersion is $163.30 (P75 $190.90 minus P25 $27.60), UnitedHealth Group’s dispersion is $25.60 (P75 $58.50 minus P25 $32.50), Cigna’s dispersion is $22.40 (P75 $54.40 minus P25 $32.00), BUCA’s dispersion is $87.90 (P75 $253.70 minus P25 $165.80), and Aetna’s dispersion is $0.40 (P75 $774.00 minus P25 $709.00). Aetna displays the tightest distribution by this measure and Blue Cross Blue Shield the widest.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 32-year-old patient with a primary diagnosis of F11.20 (opioid dependence, uncomplicated) is admitted to a hospital-based residential treatment program for intensive behavioral health care without room and board billed separately. The patient presents after repeated outpatient relapse attempts and requires structured daily programming including individual psychotherapy, group therapy, medical monitoring, medication management, and discharge planning. Admission is initiated by the hospital's addiction psychiatry team; an initial assessment (H0001) documents substance use history, medical comorbidities, and psychosocial needs. The multidisciplinary team (addiction psychiatrist, addiction counselor, and addiction psychologist) provides daily therapeutic services billed per diem under H0017. Typical workflow includes admission assessment, daily individualized and group interventions, periodic medication management, progress documentation, and a formal discharge plan with outpatient referrals. Prior authorization and payer-specific documentation (medical necessity, level-of-care justification, and treatment plan) are obtained from payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare when required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    H0018

    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, …
    2084B0002XObesity Medicine (Psychiatry & Neurology) PhysicianA physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the ge…
    364SP0813XGeropsychiatric Psychiatric/Mental Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    208C00000XColon & Rectal Surgery PhysicianA colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…
    2471C1101XCardiovascular-Interventional Technology Radiologic TechnologistA radiologic technologist who specializes in cardiovascular interventional technology.
    207XS0117XOrthopaedic Surgery of the Spine PhysicianRecognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with th…

    Related Payer Policy Updates

    Specialty: Home Health & Hospice1 / 3

    9 rows

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

    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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    Alcohol and/or drug services; short-term residential (non-hospital residential treatment program), without room and board, per diem
    Alternative per diem code for non-hospital short-term residential settings; contrasted with H0017 which denotes hospital residential treatment.
    H0019Alcohol and/or drug services; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diemUsed when length of stay typically exceeds 30 days in a non-medical residential program; differentiates level and expected duration of care.
    H2036Alcohol and/or other drug treatment program, per diemGeneral per diem alcohol/drug treatment program code; may be used for certain non-residential or mixed-level programs as appropriate.
    H0001Alcohol and/or drug assessmentInitial assessment and evaluation code commonly performed at admission and used to document medical necessity for per diem residential services.