HCPCS H0031: Mental Health Assessment by Non-Physician
HCPCS Level II code H0031 denotes a mental health assessment performed by a non-physician clinician. This code captures a structured clinical evaluation used to establish presenting problems, assess symptom severity, and support care planning in outpatient and ambulatory behavioral health settings. Nationally, accurate use of H0031 matters for care coordination, treatment planning, and payer documentation across public and private plans.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise explanation of the code’s clinical scope, common clinical diagnoses associated with these assessments, related service codes used for follow-up care, and the payer landscape relevant to coverage and billing practice. The publication outlines typical care settings and the non-physician provider types who commonly perform these assessments.
This resource provides benchmarks and policy context relevant to claim adjudication and service coding, summarizes common clinical indications tied to the assessment, and highlights related codes used in care planning and medication administration. It is written for national audiences involved in behavioral health billing, clinical management, and payer contracting.
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Billing Code Overview
HCPCS Level II code H0031 represents mental health assessment performed by a non-physician provider. The service typically involves systematic evaluation of a patient’s mental health status, symptom severity, functional impairments, and psychosocial needs conducted by qualified non-physician clinicians.
Service type: Mental health assessment by non-physician
Typical site of service: Outpatient behavioral health clinics, community mental health centers, school-based health settings, or other ambulatory care locations where non-physician mental health clinicians deliver assessments
National Reimbursement Benchmarks
National commercial rates for HCPCS H0031 cluster around BUCA’s average commercial benchmark of $121.4, but individual payers diverge notably. Blue Cross Blue Shield shows the largest spread with a P75–P25 range of $66.0 ($155.4 − $88.4), reflecting substantial variability above BUCA’s mean. Cigna and Aetna both show tighter high-end concentrations; Cigna’s P75–P25 is $146.3 ($283 − $123.7) driven by a high median, while Aetna’s interquartile range is $19.3 ($33.1 − $13.8), indicating relatively concentrated commercial rates near its median.
UnitedHealth Group presents the tightest dispersion with a P75–P25 of $3.75 ($125.0 − $87.5), suggesting consistent contracted amounts, while BUCA’s published percentiles ($81.7, $127.5, $151.2) imply a moderate interquartile range of $69.5. These contrasts highlight where commercial pricing for H0031 is most consistent versus most variable across payers.