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    v1.0.30
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0001-alcohol-drug-assessment-outpatient
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    HCPCS H0001: Alcohol and/or Drug Assessment

    HCPCS Level II code H0001 represents an alcohol and/or drug assessment, a behavioral health assessment service used to evaluate substance use history, level of care needs, and determine appropriate treatment planning; the service type is a behavioral health assessment typically provided in outpatient behavioral health clinics, community mental health centers, or substance use treatment programs.

    For related coverage guidance, see recent payer policy updates: Home Health Care Services - Medical Policy, Adult Foster Care, Group Adult Foster Care Clinical Coverage Criteria.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 28-year-old adult presenting to an outpatient community behavioral health clinic requesting evaluation for problematic alcohol and/or drug use. The patient reports increasing frequency of binge drinking and occasional nonmedical opioid use, with functional impairment at work. The clinical workflow begins with check-in and brief screening (for example, AUDIT-C or DAST-10). A licensed clinician (licensed clinical social worker, licensed professional counselor, addiction psychiatrist, or certified addiction counselor) conducts a comprehensive H0001 alcohol and/or drug assessment consisting of structured psychosocial history, substance use history (quantity, frequency, route), withdrawal risk assessment, medical and psychiatric comorbidity review, readiness to change assessment, risk behaviors (overdose risk, injection use), and establishment of a preliminary treatment plan and level-of-care recommendation. Documentation includes time spent, assessment instruments used, identified diagnoses, recommended referrals (detox, outpatient therapy, medication-assisted treatment), and consent for treatment. Typical sites of service are outpatient behavioral health clinics, community mental health centers, federally qualified health centers, primary care offices with integrated behavioral health, and substance use disorder treatment programs. The assessment often triggers billing of H0001 for the initial diagnostic evaluation and care planning; follow-up services may include individual therapy, group therapy, or medication management billed under other codes.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90791Psychiatric diagnostic evaluation (no medical services)Often performed alongside H0001 when a comprehensive psychiatric diagnostic assessment is needed to evaluate co-occurring mental health conditions
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesMay be billed on the same day when a separate, medically necessary E/M is provided in addition to the substance use assessment (use modifier 25 when appropriate)
    99408Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; 15 to 30 minutesUsed for brief intervention services that follow an assessment like H0001 when counseling is provided for risky substance use
    99409Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; greater than 30 minutesUsed when a longer SBIRT intervention is delivered after or as part of the assessment process
    96127Brief emotional/behavioral assessment (eg, depression inventory), with scoring and documentation, per standardized instrumentMay be used for brief standardized screening instruments documented as part of the H0001 workflow

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    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…
    59Modifier 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…
    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…
    93Modifier 93 denotes that a billed service was delivered synchronously via audio-only telecommunications (real-time telephone or other audio-only system). The AMA added modifier 93 in CPT Appendix A…- When to use: Apply modifier -93 when a synchronous, real-time, two-way patient–provider encounter is conducted entirely via audio-only (telephone or other real-time interactive audio-only…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    101Y00000X
    1041C0700X
    2084P0800X
    2086S0122X
    101YM0800X
    364SP0808X
    284300000X
    385HR2050X

    Related Payer Policy Updates

    Specialty: Home Health & Hospice1 / 3

    10 rows

    PolicyPayerEffective Date
    Home Health Care Services - Medical PolicyHealth-New-England2027-02-01
    Adult Foster Carefallon_community_health_plan_inc2027-01-27
    Group Adult Foster Care Clinical Coverage Criteriafallon_community_health_plan_inc2027-01-01
    Hospice and Palliative Care- Medical PolicyHealth-New-England2026-12-01
    Home Health Care Payment Policyfallon_community_health_plan_inc2026-12-01
    Private Duty Nursing Services (for Ohio Only)Colorado Rocky Mountain Health Plans2026-11-01
    Personal Care Attendant and Personal Care Management Agency ServicesMass General Brigham Health Plan2026-11-01
    Private Duty Nursing in the Home SettingAnthem2026-10-01
    Home Health, Skilled, and Custodial Care Services (for Nebraska Only)UnitedHealthcare2026-10-01
    Home Health, Skilled, and Custodial Care Services (for Tennessee Only)UnitedHealthcare2026-10-01

    Related Codes

    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

    HCPCS-H0011-ACUTE-DETOXIFICATION-RESIDENTIAL-INPATIENT

    HCPCS H0011: Acute Detoxification, Residential Addiction 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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