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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0023-behavioral-health-outreach-service
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    HCPCS H0023: Behavioral Health Outreach Service

    Commercial payers pay $91 on average nationally for this procedure.

    HCPCS Level II code H0023 describes a behavioral health outreach service, a planned approach to engage and reach a targeted population for mental health support; the service is typically delivered as community-based outreach or field-based behavioral health engagement rather than in-office psychotherapy, and focuses on outreach activities such as engagement, referral linkage, and brief supportive contacts to connect individuals to ongoing behavioral health care.

    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 benchmark sits at $91, representing a mid-market reference for H0023. Cigna and Aetna occupy higher average positions with Cigna’s mean at $125 and Aetna’s mean at $190.80, while UnitedHealth Group and Blue Cross Blue Shield cluster substantially lower with means of $84.4 and $27.30 respectively. These differences indicate a multi-tiered commercial pricing environment where BUCA aligns closer to UnitedHealth Group than to the higher-paying Cigna and Aetna.

    Dispersion measured as the interquartile spread (P75 minus P25) highlights variability by payer: Aetna’s IQR is $84.00 (P75 $243.00 minus P25 $160.00), Blue Cross Blue Shield’s IQR is $32.50, BUCA’s IQR is $30.10, while UnitedHealth Group and Cigna show the tightest spreads at $0.00 each. Thus Aetna exhibits the widest payer-level dispersion and Cigna and UnitedHealth Group the tightest.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A community behavioral health outreach team is notified that a cluster of patients with severe mood and psychotic disorders has disengaged from outpatient services following recent clinic closures. A licensed clinical social worker (1041C0700X) and a mental health counselor (101YM0800X) coordinate a planned outreach campaign to re-engage a targeted population of adults known to have diagnoses such as F32.9 (major depressive disorder, single episode, unspecified), F41.1 (generalized anxiety disorder), F43.23 (adjustment disorder with mixed anxiety and depressed mood), F31.9 (bipolar disorder, unspecified), and F20.9 (schizophrenia, unspecified). The outreach team schedules home and community visits, telephonic engagement, and coordination with primary care and crisis services to assess current symptoms, safety, medication adherence, and barriers to care.

    Typical workflow: the outreach clinician reviews the patient registry and recent crisis encounters, tailors outreach materials and contacts, conducts in-person or telehealth engagement, documents outreach attempts and clinical findings, updates the mental health service plan as needed, and refers to urgent care or crisis intervention (H2011) or comprehensive community supports (H2015) when indicated. Outreach activities emphasize engagement rather than billable psychotherapy content and are billed under H0023 when the service is a planned approach targeting a defined population rather than an individual psychotherapy session.

    Related Modifiers

    7 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…
    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
    101YM0800XMental Health CounselorBehavioral Health & Social Service Providers · Counselor
    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…
    103T00000XPsychologistA psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    101Y00000XCounselorA provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
    2081P0004XSpinal Cord Injury Medicine PhysicianA physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal c…
    2251S0007XSports Physical TherapistA licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Sports Physical Therapy, who has demo…
    103TS0200XSchool PsychologistA psychologist whose specialty is concerned with the science and practice of psychology with children, youth, families; learners of all ages; and the …

    Related ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    F31.9Bipolar disorder, unspecified
    F41.1Generalized anxiety disorder
    F43.23Adjustment disorder with mixed anxiety and depressed mood
    F32.9Major depressive disorder, single episode, unspecified
    F20.9Schizophrenia, unspecified

    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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    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    H0031Mental health assessment, by non-physicianUsed when an outreach encounter includes a formal non-physician assessment that documents symptoms, functioning, and immediate needs; may precede or accompany outreach activities billed as H0023.
    H0032Mental health service plan development by non-physicianUsed when outreach leads to creation or revision of an individualized service plan following assessment or engagement.
    H2011Crisis intervention service, per 15 minutesApplied when outreach identifies acute safety concerns requiring crisis-level intervention; used for short-term stabilization.
    H2015Comprehensive community support services, per 15 minutesUsed when outreach transitions into ongoing community support services addressing daily living, skills, and sustained recovery supports.