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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0031-mental-health-assessment-non-physician
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    HCPCS H0031: Mental Health Assessment by Non-Physician

    Commercial payers pay $121 on average nationally for this procedure.

    HCPCS Level II code H0031 represents a mental health assessment performed by a non-physician provider, typically delivered as an evaluation/assessment service in outpatient behavioral health clinics, community mental health centers, school-based settings, or other ambulatory care locations where licensed counselors, social workers, or psychologists conduct initial and follow-up diagnostic interviews and psychosocial assessments to inform treatment planning.

    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 H0031 cluster around BUCA’s average commercial benchmark of $121.4, but individual payers diverge notably. Blue Cross Blue Shield shows the largest spread with a P75–P25 range of $66.0 ($155.4 − $88.4), reflecting substantial variability above BUCA’s mean. Cigna and Aetna both show tighter high-end concentrations; Cigna’s P75–P25 is $146.3 ($283 − $123.7) driven by a high median, while Aetna’s interquartile range is $19.3 ($33.1 − $13.8), indicating relatively concentrated commercial rates near its median.

    UnitedHealth Group presents the tightest dispersion with a P75–P25 of $3.75 ($125.0 − $87.5), suggesting consistent contracted amounts, while BUCA’s published percentiles ($81.7, $127.5, $151.2) imply a moderate interquartile range of $69.5. These contrasts highlight where commercial pricing for H0031 is most consistent versus most variable 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 28-year-old adult presents to a community mental health clinic seeking evaluation for several months of low mood, poor sleep, worry about work performance, and difficulty concentrating. The patient has no prior psychiatric diagnosis documented. A licensed clinical social worker performs a comprehensive H0031 mental health assessment during a 60-minute face-to-face visit. The workflow includes: initial presentation and history of present illness, past psychiatric and medical history, medication review, substance use screening, risk assessment for self-harm, standardized symptom rating scales for depression and anxiety, mental status examination, formulation of diagnostic impressions, and recommendations for a treatment plan. The clinician documents findings, assigns appropriate ICD-10 diagnoses (for example F32.9 and F41.1), and either completes or coordinates referral for psychotherapy, care management, or psychiatric medication evaluation as indicated.

    Typical site of service is an outpatient behavioral health clinic, community mental health center, or primary care behavioral health integration setting. The service is commonly provided by a non-physician behavioral health clinician such as a licensed mental health counselor, clinical social worker, or psychologist working under organizational billing rules for H0031. The visit may be delivered in person or via an approved telehealth modality when payer rules permit (use telehealth modifier as required).

    Related CPT Codes

    CPT CodeDescription

    Related Modifiers

    6 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…
    95Modifier 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…
    99Modifier 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 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…
    163WX0003XInpatient Obstetric Registered NurseNursing Service Providers · Registered Nurse
    207YS0123XFacial Plastic Surgery PhysicianAn otolaryngologist who specializes in facial plastic surgery.
    364SP2800XPerioperative Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    224ZE0001XEnvironmental Modification Occupational Therapy AssistantOccupational therapy assistants provide environmental modifications under the supervision of an occupational therapist. OTAs develop and implement an…
    170100000XPh.D. Medical GeneticsA medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to med…

    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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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Relationship to This Procedure
    H0032Mental health service plan development by non‑physicianOften follows H0031 when the assessment identifies treatment needs requiring a documented service plan.
    H0033Oral medication administration, direct observationMay be billed when medication is administered under observation during or after the assessment visit in applicable settings.