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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h0040-assertive-community-treatment-per-diem
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    HCPCS H0040: Assertive Community Treatment Program, Per Diem

    HCPCS Level II code H0040 describes an assertive community treatment program, billed per diem, representing intensive, multidisciplinary outreach and case management services provided daily to individuals with serious mental illness; service type: community-based intensive psychiatric treatment, typical site of service: community or outpatient settings (community residences, patient homes, or clinic-based outreach).

    For related coverage guidance, see recent payer policy updates: Home Health, Skilled, and Custodial Care Services (for Idaho Only), Private Duty Nursing Services, Private Duty Nursing Services (for Florida Only).

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    Table of contents

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    • Billing CodesCPT, HCPCS, DRG & more
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    Clinical & Coding Specifications

    Clinical Context

    An adult with severe, persistent mental illness (for example, schizophrenia or bipolar disorder with frequent relapses and high risk of hospitalization) receives enrollment in an H0040 assertive community treatment (ACT) program. The multidisciplinary ACT team includes psychiatrists, nurse practitioners, licensed clinical social workers, substance use counselors, vocational specialists, and case managers who provide intensive, community-based services. Per diem billing under H0040 covers a day of ACT services and supports: daily medication management, crisis intervention, outreach visits to the patient’s residence or community locations, coordination with primary care, housing stabilization supports, and documentation of team contacts.

    A typical workflow: intake and comprehensive assessment are completed by the ACT team; an individualized recovery plan is developed and updated regularly; daily team staffing reviews each active caseload; staff provide in-person or telephonic contacts, medication administration or monitoring, brief therapy, skill-building, and linkage with social services; each calendar day of active ACT service is documented and billed as one unit of H0040 per the payer’s per diem rules. Clinical documentation includes date and duration of team contact, location of service, interventions provided, participant response, and care coordination activities. Ancillary billable services (e.g., medical evaluation, psychotherapy, laboratory testing) are billed separately using appropriate CPT/HCPCS codes when applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90791Psychiatric diagnostic evaluationUsed during initial intake to document diagnostic assessment that informs ACT individualized recovery planning; billed separately from the H0040 per diem.
    90833Psychotherapy, 30 minutes with evaluation and management (E/M) service, office or other outpatient; with E/MUsed when a psychiatrist or advanced practice clinician provides brief psychotherapy in conjunction with an E/M visit during ACT care; billed separately from per diem when documentation supports both services.
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesUsed for discrete medical or psychiatric follow-up visits (medication checks) that meet E/M criteria and are billed separately from the ACT per diem.
    99484Care management services, behavioral health integration, per 30 minutesUsed when structured behavioral health care management is provided and billed in addition to ACT per diem if payer permits separate care management billing.
    81002Urinalysis without microscopy non-automated dipstickUsed for on-site point-of-care testing related to medication monitoring or substance use screening; billed separately from per diem.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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…
    23Modifier -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…
    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…
    54Modifier ‑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…
    55Modifier –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…
    62Modifier 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 CodeSpecialtyNotes
    101Y00000XCounselorA provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    207SG0205XPh.D. Medical Genetics PhysicianA medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program and serves as a consultant to medi…
    225XP0200XPediatric Occupational TherapistOccupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
    261QC1800XCorporate Health Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    152WP0200XPediatric OptometristOptometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children.

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    F06.8Other specified mental disorders due to known physiological condition
    F10.20Alcohol dependence, uncomplicated
    F11.20Opioid dependence, uncomplicated
    F11.21Opioid dependence, in remission
    F19.20Other psychoactive substance dependence, uncomplicated
    F19.21Other psychoactive substance dependence, in remission
    F20.0Paranoid schizophrenia
    F20.81Schizophreniform disorder
    F20.9Schizophrenia, unspecified
    F25.0Schizoaffective disorder, bipolar type

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Home Health & Hospice1 / 3

    10 rows

    PolicyPayerEffective Date
    Home Health, Skilled, and Custodial Care Services (for Idaho Only)UnitedHealthcare2026-08-01
    Private Duty Nursing ServicesColorado Rocky Mountain Health Plans2026-08-01
    Private Duty Nursing Services (for Florida Only)Colorado Rocky Mountain Health Plans2026-08-01
    Private Duty Nursing Services (for New Jersey Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for Kentucky Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for Kansas Only)UnitedHealthcare2026-08-01
    Private Duty Nursing ServicesColorado Rocky Mountain Health Plans2026-08-01
    Home Health, Skilled, and Custodial Care Services (for Ohio Only)UnitedHealthcare2026-08-01
    Home Health, Skilled, and Custodial Care ServicesColorado Rocky Mountain Health Plans2026-07-01

    Related Codes

    HCPCS-H0001-ALCOHOL-DRUG-ASSESSMENT-OUTPATIENT

    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

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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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