Standard Rate Schedule
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This document provides the standard reimbursement rates and taxonomy permissions for state-funded (non-Medicaid) behavioral health services administered by CHOC Children's Hospital Orange County Health Alliance; it affects providers billing state-funded behavioral health services to this payer.
New Site ID 684 LPA was added with effective date 9/1/26.
Rates for H0013, H2034, and H2035 were increased with effective date 1/1/2026.
Several HCPCS/CPT-like service codes (H0012 variants, H0013 HA, and H0047) were added effective 1/1/2026.
All State-funded GT modifiers were end-dated as of 4/30/2025.
Coverage criteria and operational billing rules
Operational criteria — billing and funding notes applicable to rate use
Billing and funding notes applicable to rate use.
Coverage stance and billing rules — rates apply to state‑funded services and are clinician‑based
Rates apply to state-funded (non‑Medicaid) services and are clinician‑based; providers must bill with the clinician as the attending provider. Provider taxonomy determines applicable rates per service.
Service codes, descriptors, and example rates
| H0013 | Medically Monitored Intensive Inpatient Services (Adult/Adolescent variants) — rates updated |
| H2034 | Clinically Managed Low Intensity Residential Treatment Services |
| H2035 | SA Comprehensive Outpatient Treatment |
| H0012 | ACUTE DTOX RES PROG OP / Clinically Managed Residential Services (preg/parenting) variants |
| H0047 | Clinically Managed Population Specific High Intensity Residential Program |
| YP820 | Inpatient Hospital (nonMedicaid) |
| YP821 | Inpatient Hospital (Three Way contract) |
| 90785 | Interactive Complexity; rates vary by taxonomy (examples listed) |
| 90791 | Psychiatric Diagnostic Evaluation (No Medical Services) |
| 90792 | Psychiatric Diagnostic Evaluation (With Medical Services) |
| 90832 | Psychotherapy - 30 Minutes |
| 90833 | Psychotherapy - 30 Minutes Add on to E&M |
| 90834 | Psychotherapy - 45 Minutes |
| 90836 | Psychotherapy - 45 Minutes Add on to E&M |
| 90837 | Psychotherapy - 60 Minutes |
| 90838 | Psychotherapy - 53+ Minutes Add on to E&M |
| 90839 | Psychotherapy for Crisis - 53+ minutes Add on to E&M |
Required billing actions and highlights for providers
Bill services with clinician as attending provider
All state-funded services in this schedule are clinician‑based and must be billed with the clinician listed as the attending provider. Ensure claims show the clinician taxonomy and attending provider information exactly as required by the payer.
Include clinician taxonomy and attending provider on claims
All state-funded services in this schedule are clinician‑based and must be billed with the clinician listed as the attending provider. Confirm the attending clinician taxonomy (e.g., 650, 651, 656, etc.) appears on the claim.
- Use the clinician taxonomy codes provided in the schedule (650, 651, 649, 635, 656, 652, 684).
- Do not bill facility or non‑clinician providers as the attending provider for clinician‑based services.
Definitions, contingencies, and taxonomy permissions
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