Summary & Overview
HCPCS Level II H2036: Alcohol and/or Other Drug Treatment Program, Per Diem
Headline: HCPCS Level II code H2036: Per‑Diem Coverage for Alcohol and Other Drug Treatment Programs
Lead: HCPCS Level II code H2036 denotes a per‑diem billing code for alcohol and/or other drug treatment programs, covering the daily cost of structured substance use disorder services provided in community settings. This code is a common mechanism for programs to bill for comprehensive, day‑based treatment and support services beyond hourly or procedure‑level encounters.
What the code represents and national relevance
HCPCS Level II code H2036 captures per‑diem reimbursement for programs that deliver intensive, multi‑disciplinary addiction treatment on a daily basis. Nationally, per‑diem codes like H2036 facilitate bundled billing for program days, simplify claims for residential or day‑program care, and are important for payers, behavioral health providers, and program administrators managing service delivery models for substance use disorders.
Key payers covered The analysis addresses major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
What readers will learn
The publication outlines the clinical context for use of H2036, compares it to related service‑level codes (hourly and other program codes), summarizes expected sites of service, and highlights billing considerations and common usage patterns. It identifies where additional data is missing and notes Code relationships important for coding and claims workflows.
Data limitations Specific service line metadata is not available in the input.
Billing Code Overview
HCPCS Level II code H2036 represents Alcohol and/or other drug treatment program, per diem. This code is used to bill for daily rates associated with structured substance use disorder treatment programs that provide a range of therapeutic, counseling, and support services delivered on a per‑day basis.
Service Type: Other Mental Health and Community Support Services
Typical Site of Service: Community Mental Health Center (POS 53)
Data not available in the input for service line details.
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient with a history of alcohol dependence (F10.20) presents to a Community Mental Health Center (Place of Service 53) and is admitted to a residential-style alcohol and/or other drug treatment program billed per diem. The clinical workflow includes initial intake assessment by an addiction counselor or clinical social worker, daily individual and group therapy sessions provided by addiction specialists and licensed behavioral health clinicians, medication management or psychiatric evaluation by a psychiatry physician or psychiatric/mental health nurse practitioner as needed, and ongoing care coordination. Billing uses the per diem HCPCS Level II code H2036 to capture the daily comprehensive program services, with documentation of daily participation, treatment plan updates, and clinical progress notes.
Coding Specifications
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Common Modifiers:
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HF: Use when the service is provided by a certified Substance Abuse Program and payer rules require program identification. -
U1: Use to indicate Medicaid Level of Care 1 when state Medicaid eligibility criteria specify this level for coverage of per diem treatment services. -
Provider Taxonomies (specialties represented):
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101YA0400X—