HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

Commercial payers pay $282 on average nationally for this procedure.

HCPCS Level II code H0013 describes acute detoxification services provided in a residential addiction program on an outpatient basis, representing medically supervised management of withdrawal from alcohol and/or drugs; the service is classified as acute detoxification and is typically delivered in a residential outpatient setting where patients receive intensive medical and nursing monitoring during early withdrawal.

Customize your policy alerts

Sign up for hcpcs H0013 policy alerts

Get alerted when payer policies referencing H0013 are released or updated.

Monitor payer policy activity

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

National Reimbursement Benchmarks

Across national commercial payers, BUCA’s average commercial rate of $281.80 sits near the middle of the observed spectrum, offering a useful benchmark for national commercial reimbursement for H0013. Blue Cross Blue Shield shows substantial skew with an extreme maximum but a modest median, while Aetna and Cigna display higher median and mean levels respectively. UnitedHealth Group’s central tendency is lower than BUCA’s average but relatively consistent.

Dispersion (P75 minus P25) highlights contrasts in rate variability: Blue Cross Blue Shield has the widest interquartile spread at $124.40 ($275.50 − $135.10), indicating substantial variability among commercial contracts, followed by Aetna with a spread of $136.40 ($501.00 − $364.00) which is also wide. The tightest dispersion is UnitedHealth Group at $32.50 ($58.50 − $32.50), with Cigna ($83.50 − $25.00 = $58.50) and BUCA ($252.60 − $137.10 = $115.50) in between, reflecting differing levels of rate consistency across payers.

Explore openpayer tools

View all tools

HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

Commercial payers pay $282 on average nationally for this procedure.

Customize your policy alerts

Sign up for hcpcs H0013 policy alerts

Get alerted when payer policies referencing H0013 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 Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 38-year-old patient presents to a residential addiction treatment program for acute detoxification from alcohol after 48 hours of escalating tremor, diaphoresis, nausea, and early hallucinations. The patient is assessed by an addiction medicine physician and addiction psychiatry consult, triaged to an acute residential detox pathway, and admitted under the service described by H0013. Initial evaluation includes medical history, vital signs, CIWA-Ar monitoring, medication management (e.g., benzodiazepine taper or alternative agents per facility protocol), nursing observation, and psychosocial assessment. Daily interdisciplinary rounds include physicians, nursing, and behavioral health staff; documentation captures withdrawal severity, medications administered, response to treatment, and readiness for step-down to sub-acute outpatient services or referral to intensive outpatient H0015.

A typical workflow: upon arrival the patient receives triage and medical clearance; stabilizing medications and symptom-triggered protocols are started; nursing documents frequent observations; periodic physician evaluations are completed and billed under H0013; social work arranges continued care and insurance authorization if required. Common billing scenarios include billing H0013 for each day of medically supervised acute residential detoxification when the primary focus is acute withdrawal management rather than ongoing rehabilitation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`H0012`	Alcohol and/or drug services: Sub-acute detox (residential addiction program outpatient)	Used for less intensive residential detox services when withdrawal risk is lower; may follow or precede `H0013` depending on clinical progress.
`H0011`	Alcohol and/or drug services: acute detox (residential addiction program inpatient)	Represents inpatient acute detox; used when level of care is higher than outpatient residential `H0013` or if patient requires inpatient admission.
`H0010`	Alcohol and/or drug services: Sub‑acute detox (residential addiction program inpatient)	For inpatient sub-acute detoxification; relates to step-down/up decisions in the continuum of detox care.
`H0014`	Alcohol and/or drug services: ambulatory detox	Outpatient clinic-based detox services; appropriate for patients not needing residential supervision and may be an alternative to `H0013`.
`H0015`	Alcohol and/or drug services: intensive outpatient	Intensive outpatient programming for stabilization and continued treatment after resolution of acute withdrawal managed by `H0013`.
`H0050`	Alcohol and/or drug services: brief Intervention, per 15 minutes	Short counseling interventions that can be provided during or after detox; often billed in conjunction with detox services for motivational interviewing.
`99408`	Alcohol and substance (other than tobacco) abuse structured screening and brief intervention: 15–30 minutes	Screening and brief intervention that may occur during intake or follow-up; documents structured counseling related to substance use.
`99409`	Alcohol and substance (other than tobacco) abuse structured screening and brief intervention: greater than 30 minutes	Longer SBI sessions provided as part of comprehensive detox and discharge planning.

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…
54	Modifier ‑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…
55	Modifier –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…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101YA0400X	Addiction (Substance Use Disorder) Counselor	Behavioral Health & Social Service Providers · Counselor
103TP2701X	Group Psychotherapy Psychologist	A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identif…
207QA0401X	Addiction Medicine (Family Medicine) Physician	A family medicine physician who specializes in the diagnosis and treatment of addictions.
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
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,…
2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or …
225XE1200X	Ergonomics Occupational Therapist	Respiratory, Developmental, Rehabilitative and Restorative Service Providers · Occupational Therapist
246XC2903X	Vascular Specialist/Technologist Cardiovascular	A vascular technologist, also known as a vascular sonographer, creates images of blood vessels and collects data that help physicians diagnose disorde…

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

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`H0012`	Alcohol and/or drug services: Sub-acute detox (residential addiction program outpatient)	Used for less intensive residential detox services when withdrawal risk is lower; may follow or precede `H0013` depending on clinical progress.
`H0011`	Alcohol and/or drug services: acute detox (residential addiction program inpatient)	Represents inpatient acute detox; used when level of care is higher than outpatient residential `H0013` or if patient requires inpatient admission.
`H0010`	Alcohol and/or drug services: Sub‑acute detox (residential addiction program inpatient)	For inpatient sub-acute detoxification; relates to step-down/up decisions in the continuum of detox care.
`H0014`	Alcohol and/or drug services: ambulatory detox	Outpatient clinic-based detox services; appropriate for patients not needing residential supervision and may be an alternative to `H0013`.
`H0015`	Alcohol and/or drug services: intensive outpatient	Intensive outpatient programming for stabilization and continued treatment after resolution of acute withdrawal managed by `H0013`.
`H0050`	Alcohol and/or drug services: brief Intervention, per 15 minutes	Short counseling interventions that can be provided during or after detox; often billed in conjunction with detox services for motivational interviewing.
`99408`	Alcohol and substance (other than tobacco) abuse structured screening and brief intervention: 15–30 minutes	Screening and brief intervention that may occur during intake or follow-up; documents structured counseling related to substance use.
`99409`	Alcohol and substance (other than tobacco) abuse structured screening and brief intervention: greater than 30 minutes	Longer SBI sessions provided as part of comprehensive detox and discharge planning.

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…
54	Modifier ‑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…
55	Modifier –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…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101YA0400X	Addiction (Substance Use Disorder) Counselor	Behavioral Health & Social Service Providers · Counselor
103TP2701X	Group Psychotherapy Psychologist	A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identif…
207QA0401X	Addiction Medicine (Family Medicine) Physician	A family medicine physician who specializes in the diagnosis and treatment of addictions.
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
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,…
2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or …
225XE1200X	Ergonomics Occupational Therapist	Respiratory, Developmental, Rehabilitative and Restorative Service Providers · Occupational Therapist
246XC2903X	Vascular Specialist/Technologist Cardiovascular	A vascular technologist, also known as a vascular sonographer, creates images of blood vessels and collects data that help physicians diagnose disorde…

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.

OpenPayer

HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

Sign up for hcpcs H0013 policy alerts

National Reimbursement Benchmarks

OpenPayer

HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

Sign up for hcpcs H0013 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

Sign up for hcpcs H0013 policy alerts

National Reimbursement Benchmarks

HCPCS H0013: Acute Detoxification, Residential Addiction Program Outpatient

Sign up for hcpcs H0013 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code H0013 represent?

When is it appropriate to bill H0013 versus other detox or rehabilitation codes?

What other codes are commonly associated with H0013 and how do they relate?

Which diagnoses are commonly billed with H0013?

What documentation and workflow elements support billing H0013?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code H0013 represent?

When is it appropriate to bill H0013 versus other detox or rehabilitation codes?

What other codes are commonly associated with H0013 and how do they relate?

Which diagnoses are commonly billed with H0013?

What documentation and workflow elements support billing H0013?

References