HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours

Commercial payers pay $297 on average nationally for this procedure.

HCPCS Level II code H0035 describes mental health partial hospitalization treatment, less than 24 hours, representing a structured, intensive outpatient behavioral health program that provides day treatment services rather than inpatient admission; typical service type is partial hospitalization/day treatment and the usual site of service is a hospital-based or freestanding behavioral health day program or partial hospitalization program where patients receive multi-disciplinary therapeutic interventions during the day and return home at night.

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).

Customize your policy alerts

Sign up for hcpcs H0035 policy alerts

Get alerted when payer policies referencing H0035 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National commercial reimbursement for HCPCS H0035 centers around BUCA’s average commercial rate of $297.10, with individual payer means varying substantially. Cigna’s mean is the highest at $457.30 while Blue Cross Blue Shield averages $333.30 and Aetna $190.50; UnitedHealth Group is notably lower with a mean of $98.30. This spread highlights meaningful differences in payer willingness to reimburse for this service across the commercial market.

Examining dispersion using the interquartile range (P75 minus P25) reveals where rates are most and least consistent: Aetna’s IQR is $146.00 (P75 $268.00 minus P25 $122.00), Blue Cross Blue Shield’s IQR is $165.40 (P75 $430.30 minus P25 $264.90), BUCA’s IQR is $121.80 (P75 $356.30 minus P25 $234.50), Cigna’s IQR is $0.00 (P75 $426.90 minus P25 $426.90) indicating a tightly clustered set of values, and UnitedHealth Group’s IQR is $46.50 (P75 $78.00 minus P25 $32.50). Thus Blue Cross Blue Shield shows the widest dispersion while Cigna is the tightest.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 46-year-old patient with an alcohol-related mood disorder (F10.14) and recent alcohol withdrawal with perceptual disturbance (F10.132) is referred for intensive structured daytime treatment. The patient requires multi-disciplinary therapeutic modalities for stabilization but does not require 24-hour inpatient admission. The typical clinical workflow begins with an intake assessment by a psychiatry physician (2084P0800X) or clinical social worker (1041C0700X) who documents current symptoms, medical history, and safety risk. A multidisciplinary treatment plan is developed, including daily group psychotherapy, individual psychotherapy, medication management, nursing observation for withdrawal symptoms, and psychoeducation. Services are delivered in a partial hospitalization program during daytime hours (<24 hours) at an outpatient behavioral health facility or hospital-affiliated day program. Progress is reviewed daily with adjustment of individual goals; formal discharge planning begins when the patient demonstrates clinical improvement, with transition to outpatient psychotherapy (90834/90837) or community supports. This service aligns with billing code H0035 for mental health partial hospitalization, treatment, less than 24 hours.

Related CPT Codes

CPT Code	Description

Related Modifiers

8 rows

Modifier	Description	When to Use
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…
23	Modifier -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…
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…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101YM0800X	Mental Health 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…
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	An allergy and immunology physician who specializes in clinical and laboratory immunology disease management..
152WX0102X	Occupational Vision Optometrist	Optometrists who work in Occupational Vision, the branch of environmental optometry, consider all aspects of the relationship between work and vision,…
2085R0202X	Diagnostic Radiology Physician	A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
1041S0200X	School Social Worker	Behavioral Health & Social Service Providers · Social Worker

Related ICD-10-CM Codes

37 rows

ICD-10-CM Code	Description
F06.0	Psychotic disorder with hallucinations due to known physiological condition
F06.2	Psychotic disorder with delusions due to known physiological condition
F06.30	Mood disorder due to known physiological condition, unspecified
F06.31	Mood disorder due to known physiological condition with depressive features
F06.32	Mood disorder due to known physiological condition with major depressive-like episode
F06.33	Mood disorder due to known physiological condition with manic features
F06.34	Mood disorder due to known physiological condition with mixed features
F06.4	Anxiety disorder due to known physiological condition
F10.132	Alcohol abuse with withdrawal with perceptual disturbance
F10.14	Alcohol abuse with alcohol-induced mood disorder

Showing 1–10 of 37

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.

Published by

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

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.

Explore openpayer tools

View all tools

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description

Related Modifiers

8 rows

Modifier	Description	When to Use
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…
23	Modifier -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…
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…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101YM0800X	Mental Health 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…
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	An allergy and immunology physician who specializes in clinical and laboratory immunology disease management..
152WX0102X	Occupational Vision Optometrist	Optometrists who work in Occupational Vision, the branch of environmental optometry, consider all aspects of the relationship between work and vision,…
2085R0202X	Diagnostic Radiology Physician	A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
1041S0200X	School Social Worker	Behavioral Health & Social Service Providers · Social Worker

Related ICD-10-CM Codes

37 rows

ICD-10-CM Code	Description
F06.0	Psychotic disorder with hallucinations due to known physiological condition
F06.2	Psychotic disorder with delusions due to known physiological condition
F06.30	Mood disorder due to known physiological condition, unspecified
F06.31	Mood disorder due to known physiological condition with depressive features
F06.32	Mood disorder due to known physiological condition with major depressive-like episode
F06.33	Mood disorder due to known physiological condition with manic features
F06.34	Mood disorder due to known physiological condition with mixed features
F06.4	Anxiety disorder due to known physiological condition
F10.132	Alcohol abuse with withdrawal with perceptual disturbance
F10.14	Alcohol abuse with alcohol-induced mood disorder

Showing 1–10 of 37

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.

Published by

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

`90834`	Psychotherapy, 45 minutes with patient	Used for individual psychotherapy sessions before or after partial hospitalization enrollment or as an outpatient continuation following `H0035`.
`90837`	Psychotherapy, 60 minutes with patient	Used for longer individual psychotherapy sessions as part of ongoing outpatient care transitioning from partial hospitalization.
`90853`	Group psychotherapy	Represents the group therapy component commonly delivered daily within a partial hospitalization program billed under `H0035`.
`H2012`	Behavioral health day treatment, per hour	Alternative or complementary code for hourly day treatment services; used when programs bill hour-based day treatment instead of the partial hospitalization bundle.

HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours

Sign up for hcpcs H0035 policy alerts

National Reimbursement Benchmarks

HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours

Sign up for hcpcs H0035 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours

Sign up for hcpcs H0035 policy alerts

National Reimbursement Benchmarks

HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours

Sign up for hcpcs H0035 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code H0035 represent and where is it typically provided?

How do commercial reimbursement rates for H0035 compare across major payers?

Which related CPT or HCPCS codes are relevant when billing services associated with a partial hospitalization program billed under H0035?

What clinical services and provider types are typically involved in care billed under H0035?

Which modifiers are commonly associated with H0035 and in what situations are they used?

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code H0035 represent and where is it typically provided?

How do commercial reimbursement rates for H0035 compare across major payers?

Which related CPT or HCPCS codes are relevant when billing services associated with a partial hospitalization program billed under H0035?

What clinical services and provider types are typically involved in care billed under H0035?

Which modifiers are commonly associated with H0035 and in what situations are they used?

References