Summary & Overview
HCPCS Level II H0017: Behavioral Health Residential Treatment, Per Diem
HCPCS Level II code H0017 denotes per diem behavioral health services delivered in a hospital residential treatment program, excluding room and board. Nationally, this code captures a core category of inpatient-style, structured care for individuals with substance use disorders and related behavioral health needs. Clarity about its scope matters for coverage determinations, benefit design, and utilization monitoring across commercial and managed care plans.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication outlines how H0017 is used in practice, common clinical contexts where it applies, and its relationship to other residential treatment codes. Readers will find benchmarks for service type and site of care, a concise clinical context for typical diagnoses associated with residential treatment, and crosswalks to related service codes for care pathway mapping.
The analysis is intended for a national audience of payers, provider billing staff, and policy analysts. It highlights where H0017 fits within the continuum of substance use disorder treatment, summarizes typical use cases, and identifies areas where additional documentation or coding clarity is often needed. Data not provided in the input are noted explicitly.
Billing Code Overview
HCPCS Level II code H0017 describes behavioral health residential treatment services provided on a per diem basis, specifically for a hospital residential treatment program without room and board. The service type is behavioral health / substance abuse residential treatment, and the typical site of service is a Residential Substance Abuse Treatment Facility (Place of Service 55).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient with a primary diagnosis of F11.20 (opioid dependence, uncomplicated) is admitted to a residential substance abuse treatment facility (Place of Service 55) for per diem behavioral health services. The patient requires structured daily therapeutic programming, group and individual counseling, medication management oversight, and monitoring for withdrawal or relapse risk. Admissions are typically initiated after an emergency department referral, outpatient assessment (e.g., using H0001), or through coordinating community providers; the clinical workflow includes initial intake and assessment, individualized treatment planning, daily therapeutic sessions, periodic multidisciplinary team reviews, and discharge planning with community referrals and aftercare.
Coding Specifications
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HCPCS Level II code
H0017: Behavioral health; residential (hospital residential treatment program), without room and board, per diem. -
Common Modifiers:
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HF- Substance Abuse Program: Used to indicate services provided within a recognized substance abuse program when payer-specific rules require program identification. -
U1- Medicaid Level of Care 1: Used to indicate the Medicaid-specified level of care for the patient when required by the payer for authorization or payment determination.