HCPCS H2036: Alcohol and/or Other Drug Treatment Program, Per Diem
HCPCS Level II code H2036 represents an alcohol and/or other drug treatment program, billed per diem, covering daily structured treatment services for individuals with substance use disorders; the service type is per diem residential or outpatient program treatment and the typical site of service is a program-based treatment facility or residential treatment setting where daily therapeutic services, counseling, and program activities are provided.
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 H2036 reimbursement clusters around BUCA’s average commercial benchmark of $165.70, with notablepayer-specific spreads. Blue Cross Blue Shield exhibits the widest interquartile dispersion (P75–P25 = $122.80), reflecting substantial regional or contracting variability, while Aetna and UnitedHealth Group show moderate spreads of $93.00 and $105.80 respectively. Cigna displays the tightest dispersion at $11.20, indicating consistent placement near its median of $143.10.
Maximum and minimum extremes vary by payer: Blue Cross Blue Shield reaches a high of $1,430.70, and Aetna’s minimum is $111.00, which highlights occasional outliers beyond typical commercial averages. Overall, BUCA’s mean of $165.70 sits between Cigna’s concentrated band and Blue Cross Blue Shield’s broad variability, framing the national commercial landscape for H2036.