Summary & Overview
HCPCS H2013: Psychiatric Health Facility Service, Per Diem
HCPCS Level II code H2013 denotes a per diem psychiatric health facility service, covering daily facility-based psychiatric care for patients requiring structured treatment. This code matters nationally because it standardizes billing for inpatient and residential psychiatric stays that bundle room, board, and therapeutic services into a single daily rate, impacting access to behavioral health treatment and facility payment models.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks and context for use of H2013, updates on policy and coding considerations, and the clinical settings where the code applies. The publication outlines payer coverage patterns, documentation expectations, and typical service lines associated with per diem psychiatric facility billing.
The analysis provides clinicians, billing professionals, and policy stakeholders with an overview of where H2013 fits in the behavioral health billing landscape, how major payers approach per diem psychiatric facility services, and what clinical contexts commonly generate use of the code. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code H2013 describes psychiatric health facility service, per diem. This code represents a daily, facility-level psychiatric care service provided to patients requiring structured mental health treatment. The service type is inpatient or residential psychiatric care delivered on a per diem basis. The typical site of service is a psychiatric health facility or psychiatric residential treatment setting where daily rates cover room, board, and facility-based therapeutic services.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult admitted to a psychiatric health facility for an acute exacerbation of a serious mental health condition such as major depressive disorder with suicidal ideation, acute psychosis, or severe mood instability requiring 24-hour inpatient psychiatric care. The patient is evaluated in the emergency department or by outpatient psychiatry, meets criteria for inpatient psychiatric admission due to safety concerns or inability to maintain self-care, and is admitted to a licensed psychiatric hospital or psychiatric unit under attending psychiatric physician oversight. The facility documents a per diem stay that includes room and board, nursing care, ongoing psychiatric assessment, medication management, group and individual therapeutic activities, and discharge planning. Daily multidisciplinary rounds occur with psychiatrists, psychiatric nurses, social workers, and therapists; progress notes document clinical status, medication adjustments, risk assessments, and treatment goals. The hospital bills the per diem psychiatric facility service using H2013 for each calendar day of inpatient-level psychiatric care, applying appropriate modifiers when necessary to indicate unusual circumstances (for example, increased complexity, concurrent services, or atypical payment scenarios).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the per diem service required substantially greater resources or work due to documented complexity beyond typical inpatient psychiatric care. |
23 | Unusual anesthesia | Rarely used; may apply if general anesthesia was medically necessary and linked to a psychiatric procedure during the inpatient stay. |
52 | Reduced services | Use when the facility provided a reduced level of service for the day (partial-day stays or early discharge without full per diem services). |
53 | Discontinued procedure | Use if the planned facility-level service was initiated but discontinued for clinical reasons before completion of expected care for that day. |
54 | Surgical care only | Use if the facility claim needs to indicate only the surgical portion of care, when surgical services occur during an inpatient psychiatric stay and billing separation is required. |
55 | Postoperative management only | Use if only postoperative management services are being billed by the facility separate from other services during the psychiatric admission. |
56 | Preoperative management only | Use if only preoperative management services are being reported on a given day during the psychiatric stay. |
62 | Two surgeons | Use in rare instances where two distinct surgical specialties provided operative services during the psychiatric admission and the facility must reflect shared operative care. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use if midlevel practitioners assisted in procedures during the inpatient stay and billing requires the AS modifier. |
CO | Clinic or outpatient visit | Use when the facility per diem overlaps with outpatient clinic services that need separation for billing. |
CQ | Service furnished by a CAH to an EP who is not a physician | Use in critical access hospital scenarios when reporting facility services related to eligible professional encounters. |
FX | Unusual anesthesia — patients with high risk | Use when anesthesia during the inpatient psychiatric admission carried unusually high risk and must be identified for reimbursement adjustments. |
FY | Anesthesia complicated by emergency conditions | Use to denote emergency anesthesia circumstances occurring during the psychiatric inpatient stay. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when medical direction of concurrent anesthesia procedures occurred during the admission and must be reported. |
QX | CRNA service: when performed with medical direction by a physician | Use when a certified registered nurse anesthetist provided anesthesia services under physician direction during the inpatient stay. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207R00000X | Psychiatry & Neurology - Adult Psychiatry | Attending psychiatrists who admit and manage inpatient psychiatric care. |
2084P0800X | Behavioral Health & Social Service Providers - Clinical Social Worker | Clinical social workers who coordinate discharge planning and therapy. |
2084N0400X | Behavioral Health & Social Service Providers - Mental Health Counselor | Therapists providing group and individual psychotherapy during the inpatient stay. |
363L00000X | Nursing - Registered Nurse (RN) | Psychiatric registered nurses delivering 24-hour care and medication administration. |
208D00000X | Behavioral Health & Social Service Providers - Psychologist | Psychologists performing assessments, psychotherapy, and testing as part of the treatment plan. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
F32.2 | Major depressive disorder, single episode, severe without psychotic features | Common primary diagnosis requiring inpatient psychiatric admission for safety, medication initiation, and intensive therapy. |
F33.2 | Major depressive disorder, recurrent severe without psychotic features | Recurrent severe depression often necessitating a per diem inpatient psychiatric admission for stabilization. |
F31.4 | Bipolar disorder, current episode manic severe | Severe manic episodes with safety risks or inability to care for self frequently require inpatient psychiatric per diem services. |
F20.0 | Schizophrenia, paranoid type | Acute psychotic exacerbations with safety concerns commonly lead to psychiatric inpatient admission billed by per diem. |
F41.2 | Mixed anxiety and depressive disorder | Severe presentations with functional impairment may require short-term inpatient psychiatric care for stabilization. |
F43.10 | Post-traumatic stress disorder, unspecified | Severe PTSD with acute symptom escalation or safety risk may be managed in a psychiatric facility under per diem billing. |
R45.851 | Suicidal ideation | A symptom code frequently present in patients admitted to psychiatric facilities; drives need for 24-hour observation and inpatient care. |
Z63.5 | Disruption of family by separation or divorce | Social determinant often documented during inpatient psychiatric care influencing discharge planning and treatment focus. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99223 | Initial hospital care, typically 70 minutes or more | Used by the admitting psychiatrist for the initial inpatient psychiatric evaluation and medical decision-making on admission day prior to per diem billing. |
90791 | Psychiatric diagnostic evaluation (no medical services) | Used for a comprehensive psychiatric diagnostic evaluation performed on admission to establish diagnosis and treatment plan complementary to the facility per diem. |
90833 | Psychotherapy, 30 minutes with evaluation and management (E/M) | Used when psychotherapy is provided by the psychiatrist in conjunction with E/M services during the inpatient stay; may be reported alongside appropriate physician services. |
99324 | Domiciliary or rest home visit for care plan oversight (initial) — placeholder for extended care coordination | Represents multidisciplinary care coordination services that may occur in extended inpatient psychiatric settings; billed by clinicians overseeing ongoing care. |
G0463 | Hospital outpatient clinic visit for assessment and management of a patient | Used in hospital billing contexts when outpatient clinic services are rendered adjacent to or overlapping with inpatient psychiatric care and need distinction in workflow. |