HCPCS H0017: Behavioral Health Residential Treatment, Per Diem

Commercial payers pay $201 on average nationally for this procedure.

HCPCS Level II code H0017 describes a per diem behavioral health residential service for treatment provided in a hospital residential treatment program without room and board; the service type is behavioral health residential treatment and the typical site of service is a hospital-based residential treatment program, billed on a per diem basis.

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National Reimbursement Benchmarks

National commercial reimbursement for HCPCS H0017 centers on BUCA’s average commercial rate of $201.000, which serves as a mid-market reference point; individual commercial payers vary substantially around that level. Aetna shows the highest mean and median levels near $701.80 and $774.00 respectively, while Blue Cross Blue Shield averages much lower at $100.00 and Cigna and UnitedHealth Group cluster near the $40–$62 range. This spread highlights a highly segmented market with both premium and low-cost commercial contracting tiers.

Rate dispersion (P75 minus P25) quantifies variability: Blue Cross Blue Shield’s dispersion is $163.30 (P75 $190.90 minus P25 $27.60), UnitedHealth Group’s dispersion is $25.60 (P75 $58.50 minus P25 $32.50), Cigna’s dispersion is $22.40 (P75 $54.40 minus P25 $32.00), BUCA’s dispersion is $87.90 (P75 $253.70 minus P25 $165.80), and Aetna’s dispersion is $0.40 (P75 $774.00 minus P25 $709.00). Aetna displays the tightest distribution by this measure and Blue Cross Blue Shield the widest.

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HCPCS H0017: Behavioral Health Residential Treatment, Per Diem

Commercial payers pay $201 on average nationally for this procedure.

Customize your policy alerts

Sign up for hcpcs H0017 policy alerts

Get alerted when payer policies referencing H0017 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 32-year-old patient with a primary diagnosis of F11.20 (opioid dependence, uncomplicated) is admitted to a hospital-based residential treatment program for intensive behavioral health care without room and board billed separately. The patient presents after repeated outpatient relapse attempts and requires structured daily programming including individual psychotherapy, group therapy, medical monitoring, medication management, and discharge planning. Admission is initiated by the hospital's addiction psychiatry team; an initial assessment (H0001) documents substance use history, medical comorbidities, and psychosocial needs. The multidisciplinary team (addiction psychiatrist, addiction counselor, and addiction psychologist) provides daily therapeutic services billed per diem under H0017. Typical workflow includes admission assessment, daily individualized and group interventions, periodic medication management, progress documentation, and a formal discharge plan with outpatient referrals. Prior authorization and payer-specific documentation (medical necessity, level-of-care justification, and treatment plan) are obtained from payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare when required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`H0018`	Alcohol and/or drug services; short-term residential (non-hospital residential treatment program), without room and board, per diem	Alternative per diem code for non-hospital short-term residential settings; contrasted with `H0017` which denotes hospital residential treatment.
`H0019`	Alcohol and/or drug services; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	Used when length of stay typically exceeds 30 days in a non-medical residential program; differentiates level and expected duration of care.
`H2036`	Alcohol and/or other drug treatment program, per diem	General per diem alcohol/drug treatment program code; may be used for certain non-residential or mixed-level programs as appropriate.
`H0001`	Alcohol and/or drug assessment	Initial assessment and evaluation code commonly performed at admission and used to document medical necessity for per diem residential services.

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…
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
2084B0002X	Obesity Medicine (Psychiatry & Neurology) Physician	A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the ge…
364SP0813X	Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
208C00000X	Colon & Rectal Surgery Physician	A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…
2471C1101X	Cardiovascular-Interventional Technology Radiologic Technologist	A radiologic technologist who specializes in cardiovascular interventional technology.
207XS0117X	Orthopaedic Surgery of the Spine Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with th…

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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`H0018`	Alcohol and/or drug services; short-term residential (non-hospital residential treatment program), without room and board, per diem	Alternative per diem code for non-hospital short-term residential settings; contrasted with `H0017` which denotes hospital residential treatment.
`H0019`	Alcohol and/or drug services; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	Used when length of stay typically exceeds 30 days in a non-medical residential program; differentiates level and expected duration of care.
`H2036`	Alcohol and/or other drug treatment program, per diem	General per diem alcohol/drug treatment program code; may be used for certain non-residential or mixed-level programs as appropriate.
`H0001`	Alcohol and/or drug assessment	Initial assessment and evaluation code commonly performed at admission and used to document medical necessity for per diem residential services.

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…
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
2084B0002X	Obesity Medicine (Psychiatry & Neurology) Physician	A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the ge…
364SP0813X	Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
208C00000X	Colon & Rectal Surgery Physician	A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…
2471C1101X	Cardiovascular-Interventional Technology Radiologic Technologist	A radiologic technologist who specializes in cardiovascular interventional technology.
207XS0117X	Orthopaedic Surgery of the Spine Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with th…

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.

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HCPCS H0017: Behavioral Health Residential Treatment, Per Diem

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National Reimbursement Benchmarks

OpenPayer

HCPCS H0017: Behavioral Health Residential Treatment, Per Diem

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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 H0017: Behavioral Health Residential Treatment, Per Diem

Sign up for hcpcs H0017 policy alerts

National Reimbursement Benchmarks

HCPCS H0017: Behavioral Health Residential Treatment, Per Diem

Sign up for hcpcs H0017 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS H0017 represent and in what setting is it used?

For which clinical situations is H0017 typically billed?

What does the reimbursement benchmark data show for H0017?

Which modifiers are applicable to H0017 and when should they be used?

What related HCPCS/CPT codes should be considered alongside H0017?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS H0017 represent and in what setting is it used?

For which clinical situations is H0017 typically billed?

What does the reimbursement benchmark data show for H0017?

Which modifiers are applicable to H0017 and when should they be used?

What related HCPCS/CPT codes should be considered alongside H0017?

References