CurrentOptumPolicy N/A

Behavioral health reimbursement — HCPCS/CPT code exclusions

Defines reimbursement policy for behavioral health services billed on CMS 1500, UB-04 and electronic claims for Optum-administered commercial products; specifies HCPCS/other procedure codes that are not eligible for reimbursement and related billing notes.

Policy Summary

PayerOptum

PolicyBehavioral health reimbursement — HCPCS/CPT code exclusions

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionH2020 and H2036 may only be used for contracted providers and require prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~60+representative HCPCS/CPT/H codes listed as not eligible for reimbursement

Prior authH2020 and H2036 for contracted providers

Applies toCommercial products, network and non-network physicians and other qualified health care professionals

CMS 1500/UB-04Claims forms

AnnualRevision history

Non-Reimbursable Services and Billing Guidance

Non-reimbursable codes and billing guidance

The listed HCPCS/CPT/H/T/S codes are not considered for reimbursement under Commercial benefit plans unless otherwise stated (contracted provider exceptions/prior authorization). Inclusion in code sets does not imply reimbursement.

The inclusion of the code in HCPCS, or ICD-10 does not imply that it is covered or reimbursable; for Commercial benefit plans the HCPCS/CPT/H/T/S codes listed below are not considered for reimbursement.

Representative non-reimbursable codes

G0396 — Alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention, 15–30 minutes.
G0397 — Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention, greater than 30 minutes.
H0001 — Alcohol and/or drug assessment.

Policy Summary

PayerOptum

PolicyBehavioral health reimbursement — HCPCS/CPT code exclusions

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionH2020 and H2036 may only be used for contracted providers and require prior authorization.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

H0002 — Behavioral health screening to determine eligibility for admission to treatment program.

H0004 — Behavioral health counseling and therapy, per 15 minutes.

H0005 — Alcohol and/or drug services; group counseling by a clinician.

H0007 — Alcohol and/or drug services; crisis intervention (outpatient).

H0008 — Alcohol and/or drug services; sub-acute detoxification (hospital inpatient).

H0009 — Alcohol and/or drug services; acute detoxification (hospital inpatient).

H0010 — Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient).

H0011 — Alcohol and/or drug services; acute detoxification (residential addiction program inpatient).

H0012 — Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient).

H0013 — Alcohol and/or drug services; acute detoxification (residential addiction program outpatient).

H0014 — Alcohol and/or drug services; ambulatory detoxification.

H0017 — Behavioral health; residential (hospital residential treatment program), without room and board, per diem.

H0032 — Mental health service plan development by non-physician.

H0034 — Medication training and support, per 15 minutes.

H0035 — Mental health partial hospitalization, treatment, less than 24 hours.

H0046 — Mental health services, not otherwise specified.

H0049 — Alcohol and/or drug screening.

H0050 — Alcohol and/or drug services, brief intervention, per 15 minutes.

H2010 — Comprehensive medication services, per 15 minutes.

H2011 — Crisis intervention service, per 15 minutes.

H2012 — Behavioral health day treatment, per hour.

H2013 — Psychiatric health facility service, per diem.

H2014 — Skills training and development, per 15 minutes.

H2035 — Therapeutic behavioral services, per diem / Alcohol and/or other drug treatment program, per hour.

H2036 — Therapeutic behavioral services, per diem / Alcohol and/or other drug treatment program, per diem.

S0201 — Partial hospitalization services, less than 24 hours, per diem.

S9123 — Nursing care in home registered nurse.

S9127 — Social work visit, in the home.

S9480 — Intensive outpatient psychiatric.

S9482 — Family stabilization, 15 minutes.

T1006 — Alcohol and/or substance abuse services, family/couple counseling.

T1012 — Alcohol and/or substance abuse services, skills development (contract only).

T1021 — Home health aide or certified nurse assistant per visit.

T1024 — Team evaluation & management.

T1027 — Family training and counseling for child development, per 15 minutes.

T1030 — Registered nurse home care per diem.

Claims submitted for reimbursement must be submitted with the appropriate revenue or CPT code for services to be considered for reimbursement.

Operational exception: H2020 and H2036 may only be used for contracted providers and require prior authorization.

Codes Not Eligible for Reimbursement (Representative List)

Codes not eligible for reimbursement (representative list)mixedNot Covered

G0396	Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes
G0397	Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and intervention, greater than 30 minutes
H0001	Alcohol and/or drug assessment
H0002	Behavioral health screening to determine eligibility for admission to treatment program
H0004	Behavioral health counseling and therapy, per 15 minutes
H0005	Alcohol and/or drug services; group counseling by a clinician
H0007	Alcohol and/or drug services; crisis intervention (outpatient)
H0008	Alcohol and/or drug services; sub-acute detoxification (hospital inpatient)
H0009	Alcohol and/or drug services; acute detoxification (hospital inpatient)
H0010	Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient)

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Provider Billing Requirements and Prior Authorization

Prior Authorization

Prior authorization required for H2020 and H2036

H2020 and H2036 may only be billed for contracted providers and require prior authorization before submission.

H2020
H2036

Scope and Coding References

Coding and code references

Primary procedure coding systemsHealthcare Common Procedure Coding System (HCPCS) and ICD-10-CM are used to identify professional services and enable accurate identification of the service or procedure.

References to CPT/CMSPolicy may use CPT, CMS or other procedure coding guidelines; references are definitional only and do not imply entitlement to reimbursement.

Claims forms and submissionApplies to services billed on CMS-1500 and, when specified, UB-04, and electronic claim submissions (837p/837i) and provider portals.

Coding guides consideredCoding methodology, industry-standard reimbursement logic and regulatory requirements are considered when developing reimbursement policy.

Inclusion in code setsInclusion of a code in HCPCS or ICD-10 does not guarantee coverage or reimbursement under Commercial benefit plans.

Population covered

Applies toBehavioral health benefit plans administered by Optum, including but not limited to UnitedHealthcare members.

Additional applicable planAlso applicable to behavioral health benefit plans administered by UTHealth Behavioral Solutions of California when specified.

Provider responsibilityProviders are responsible for submission of accurate claims that correctly describe services provided to covered individuals.

Scope of servicesPolicy covers behavioral health services billed to the identified plans on CMS-1500, UB-04 (when specified), and electronic claim formats.