HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours
Commercial payers pay $297 on average nationally for this procedure.
HCPCS Level II code H0035 describes mental health partial hospitalization treatment, less than 24 hours, representing a structured, intensive outpatient behavioral health program that provides day treatment services rather than inpatient admission; typical service type is partial hospitalization/day treatment and the usual site of service is a hospital-based or freestanding behavioral health day program or partial hospitalization program where patients receive multi-disciplinary therapeutic interventions during the day and return home at night.
For related coverage guidance, see recent payer policy updates: Home Health, Skilled, and Custodial Care Services (for Idaho Only), Private Duty Nursing Services (for Florida Only), Private Duty Nursing Services.
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National Reimbursement Benchmarks
National commercial reimbursement for HCPCS H0035 centers around BUCA’s average commercial rate of $297.10, with individual payer means varying substantially. Cigna’s mean is the highest at $457.30 while Blue Cross Blue Shield averages $333.30 and Aetna $190.50; UnitedHealth Group is notably lower with a mean of $98.30. This spread highlights meaningful differences in payer willingness to reimburse for this service across the commercial market.
Examining dispersion using the interquartile range (P75 minus P25) reveals where rates are most and least consistent: Aetna’s IQR is $146.00 (P75 $268.00 minus P25 $122.00), Blue Cross Blue Shield’s IQR is $165.40 (P75 $430.30 minus P25 $264.90), BUCA’s IQR is $121.80 (P75 $356.30 minus P25 $234.50), Cigna’s IQR is $0.00 (P75 $426.90 minus P25 $426.90) indicating a tightly clustered set of values, and UnitedHealth Group’s IQR is $46.50 (P75 $78.00 minus P25 $32.50). Thus Blue Cross Blue Shield shows the widest dispersion while Cigna is the tightest.