Summary & Overview
HCPCS Level II H2035: Alcohol and/or Other Drug Treatment Program, Per Hour
HCPCS Level II code H2035 designates an hour-based service for alcohol and/or other drug treatment programs delivered in community behavioral health settings. Nationally, this code is an important billing mechanism for time-based substance use disorder treatment outside of inpatient or facility-per-diem models, supporting continuity of care in community mental health centers and similar programs. Major commercial payers included in coverage considerations are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will gain a concise understanding of what H2035 represents clinically and operationally, how it is used alongside related service codes and per-diem alternatives, common sites of service, and typical clinical contexts where it applies. The publication also summarizes matching diagnosis contexts, associated provider taxonomies, commonly billed modifiers, and related HCPCS and CPT/other codes used in substance use disorder program billing. Where input data is incomplete, the text notes "Data not available in the input." This piece is intended to inform coding, claims review, and benefit design discussions at a national level rather than provide clinical guidance or payer-specific policy rules.
Billing Code Overview
HCPCS Level II code H2035 describes an alcohol and/or other drug treatment program billed per hour. This service falls under Other Mental Health and Community Support Services and is commonly provided in a Community Mental Health Center (POS 53). The code represents time-based, structured treatment services focused on substance use disorder care delivered in a community setting.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a primary diagnosis of F11.20 (opioid dependence, uncomplicated) presents to a Community Mental Health Center (Place of Service 53) for structured outpatient substance use treatment. The patient attends scheduled one-hour individual counseling sessions focused on relapse prevention, medication adherence review, and coordination with a prescribing clinician. Billing is performed per hour using HCPCS Level II code H2035 for the time-based treatment program. Sessions may occur in individual or group formats and are documented with start and stop times, treatment goals, interventions provided, and the treating provider’s taxonomy and credentials.
Coding Specifications
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Common modifiers and use cases:
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HQ: Use when services are provided in a group setting (group-based program hour). -
U1: Use to indicate Medicaid Level of Care 1 when payer policy requires level of care reporting. -
U2: Use to indicate Medicaid Level of Care 2 when payer policy requires level of care reporting. -
U3: Use to indicate Medicaid Level of Care 3 when payer policy requires level of care reporting. -
Associated provider taxonomies and specialties: