Behavioral health HCPCS codes such as H0004, H0031, H0036 and H2019 are how most state Medicaid programs pay for community mental health and substance use services, while CPT codes such as 90834 and 90837 cover psychotherapy billed to Medicare and commercial plans. Many practices bill both sets in the same week, and the two follow different rules for counting time.
This guide replaces an earlier version of the page that described several H codes incorrectly. Every descriptor below follows the current HCPCS Level II and CPT code sets, and the notes cover how each code is typically billed. Agencies and group practices that want this handled for them can see our behavioral health billing services.
Key Takeaways
- H codes are HCPCS Level II codes created for state Medicaid programs. Medicare does not pay them, and commercial plans use them only in some contracts.
- H0004 is behavioral health counseling and therapy billed per 15 minutes, while 90837 is a single unit of psychotherapy lasting 53 minutes or more.
- H0031 is a mental health assessment by a non-physician, and H0032 is service plan development by a non-physician.
- H0036 is community psychiatric supportive treatment per 15 minutes, H2019 is therapeutic behavioral services per 15 minutes and H2036 is a per diem alcohol and drug treatment program.
- Units, modifiers and allowed provider types for H codes are set state by state, so the state Medicaid manual decides how each one is billed.
How H Codes and CPT Codes Divide Behavioral Health Billing
Behavioral health claims draw on two code sets that were built for different payers.
HCPCS Level II H Codes
HCPCS Level II H CodesH codes were added to HCPCS Level II for state Medicaid agencies that needed codes for mental health and substance use services with no CPT equivalent. They describe community-based work such as peer support and residential treatment. Most are time-based in 15-minute units or billed per diem.
CPT Psychotherapy and Evaluation Codes
CPT codes in the 90785 to 90899 range describe psychiatric evaluations, psychotherapy and related services. Medicare and commercial plans pay behavioral health services through these codes, and many Medicaid programs accept them for licensed clinicians as well.
Which Payer Takes Which
Medicare does not recognize H codes. Commercial plans generally expect CPT codes, though some Medicaid managed care plans and behavioral health carve-outs accept H codes for specific programs. State Medicaid fee schedules often list both, assigning H codes to agency-based services and CPT codes to licensed outpatient therapy.
Counseling and Assessment H Codes
These codes cover the intake and counseling work at the front of most Medicaid treatment episodes.
H0004 Behavioral Health Counseling and Therapy
H0004 is behavioral health counseling and therapy, per 15 minutes. It is used for individual counseling in many state Medicaid programs, often by agency clinicians or counselors whose license level the state allows to bill it. A 45-minute session is reported as three units.
H0031 Mental Health Assessment by a Non-Physician
H0031 is a mental health assessment performed by a non-physician. States use it for intake and periodic reassessments by licensed or qualified clinicians, and many set a limit on how often it can be billed per member per year.
H0032 Mental Health Service Plan Development
H0032 is mental health service plan development by a non-physician. It covers creating or updating the treatment plan, and several states require a current plan billed under H0032 before other H code services are payable.
H0001 and H0002 for Substance Use Intake
H0001 is an alcohol and/or drug assessment. H0002 is a behavioral health screening to determine eligibility for admission to a treatment program, which is usually shorter than a full assessment.
Community Support and Rehabilitation H Codes
Community programs bill most of their services under this group, and these codes see heavy audit attention in many states.
H0036 Community Psychiatric Supportive Treatment
H0036 is community psychiatric supportive treatment, face-to-face, per 15 minutes. Often called CPST, it covers rehabilitative support that helps members manage symptoms and build daily living skills. H0037 is the per diem version of the same program.
H2019 Therapeutic Behavioral Services
H2019 is therapeutic behavioral services, per 15 minutes, and H2020 is the per diem version. States commonly use these codes for behavioral interventions with children and adolescents, including in-home and school-based programs.
H2017 Psychosocial Rehabilitation
H2017 is psychosocial rehabilitation services, per 15 minutes, with H2018 as the per diem code. It is typically billed by community mental health agencies for adults with serious mental illness.
Peer, Skills and Team-Based Codes
- H0038 is self-help/peer services, per 15 minutes, billed for certified peer support specialists.
- H2014 is skills training and development, per 15 minutes.
- H0039 is assertive community treatment, face-to-face, per 15 minutes, and H0040 is the assertive community treatment program per diem.
- H2015 and H2016 are comprehensive community support services, per 15 minutes and per diem.
Substance Use Treatment H Codes
Substance use programs use a separate group of H codes, many of them billed per diem by level of care.
H2036 Alcohol and Other Drug Treatment Program
H2036 Alcohol and Other Drug Treatment ProgramH2036 is an alcohol and/or other drug treatment program, per diem. H2035 is the same program billed per hour. States define which levels of care qualify, so the same code can describe different programs from one state to the next.
Outpatient and Intensive Outpatient Codes
- H0005 is alcohol and/or drug group counseling by a clinician.
- H0015 is alcohol and/or drug intensive outpatient treatment, for programs that operate at least three hours a day for at least three days a week.
- H0050 is an alcohol and/or drug brief intervention, per 15 minutes.
- H0020 is methadone administration and/or service provided by a licensed program.
Residential Codes
H0018 covers short-term residential treatment without room and board, per diem. H0019 covers long-term residential treatment, also without room and board and billed per diem.
Crisis, Day Treatment and Unlisted H Codes
A few codes cover intensive or unlisted services that fall outside the groups above.
Crisis and Day Programs
H2011 is crisis intervention service, per 15 minutes. H2012 is behavioral health day treatment, per hour, and H0035 is mental health partial hospitalization treatment of less than 24 hours.
Specialized Programs
H2033 is multisystemic therapy for juveniles, per 15 minutes. H2040 and H2041 cover team-based coordinated specialty care for first episode psychosis, billed per month or per encounter.
Not Otherwise Specified Codes
H0046 is mental health services, not otherwise specified, and H0047 is the matching code for alcohol and other drug services. Use them only when the state manual directs it for a service with no specific code, since many states deny them without a prior approval.
Units, Modifiers and State Rules for H Codes
The descriptor tells you what the service is, but the state manual decides how it is billed.
Counting 15-Minute Units
Many states count a 15-minute unit once at least eight minutes of service are provided, while others require the full 15 minutes for each unit. Document start and stop times for every timed H code so units can be supported on audit. Most medical billing software can calculate units from those times when the state rule is configured correctly.
Common H Code Modifiers
HCPCS modifiers tell the payer about the program and the clinician. HE marks a mental health program and HF a substance abuse program. HA identifies a child or adolescent program and HB an adult program. HN, HO and HP mark bachelor’s, master’s and doctoral level clinicians, and HQ marks a group setting. U1 through UD are left for each state to define, often for levels of care.
State Manuals and Authorizations
Each state publishes its own code list and decides which provider types can bill each code. Kentucky’s community mental health code and unit schedule is one example of how a state sets these rules. Many H code services also need prior authorization through the state or the member’s managed care plan.
Psychotherapy and Evaluation CPT Codes
The CPT codes below are the core of outpatient behavioral health billing for licensed clinicians.
Diagnostic Evaluations
90791 is a psychiatric diagnostic evaluation without medical services, used by psychologists, social workers and counselors. 90792 is the same evaluation with medical services, billed by physicians and other prescribing clinicians.
Individual Psychotherapy
- 90832 covers 16 to 37 minutes of psychotherapy.
- 90834 covers 38 to 52 minutes.
- 90837 covers 53 minutes or more.
- 90833, 90836 and 90838 are the matching add-on codes when psychotherapy is provided with an E/M visit.
Family, Group and Crisis Codes
90846 is family psychotherapy without the patient present, and 90847 is family psychotherapy with the patient. 90853 is group psychotherapy, and 90849 is multiple-family group psychotherapy. Crisis psychotherapy is billed with 90839 for the first 30 to 74 minutes and 90840 for each additional 30 minutes.
Add-On and Screening Codes
90785 is the interactive complexity add-on, reported when communication factors make the service harder to deliver. 96127 is a brief emotional or behavioral assessment with scoring and documentation, billed per standardized instrument such as a PHQ-9 or GAD-7. For coding strategy and Medicare payment rules on these codes, see our guide to maximizing psychotherapy reimbursement. Codes for conditions outside behavioral health are in our list of common diseases and their CPT codes.
H0004 Versus 90837
These two codes describe similar work, and the payer usually decides which one applies.
How They Differ on the Claim
H0004 is billed in 15-minute units, so a 60-minute session is four units. 90837 is one unit for any psychotherapy session of 53 minutes or more. The payment for each is set separately on the state fee schedule, and four units of H0004 do not always equal one unit of 90837.
Choosing Between Them
Medicare and commercial plans expect 90837 for a licensed clinician’s psychotherapy session. State Medicaid programs may require H0004 for agency-based counseling or for clinicians below a certain license level, and allow 90837 for independently licensed providers. Check the state manual and the provider’s enrollment type before choosing.
Behavioral Health H Code FAQ
What is HCPCS code H0004?
H0004 is behavioral health counseling and therapy, billed per 15 minutes. It is used mainly by state Medicaid programs for individual counseling, with units based on the time of the session.
What is H0031 used for?
H0031 is a mental health assessment by a non-physician. Medicaid programs use it for intake assessments and periodic reassessments by qualified clinicians.
What does H0036 cover?
H0036 covers community psychiatric supportive treatment, face-to-face, per 15 minutes. It is the code for CPST services that help members manage symptoms and daily functioning in the community.
What is H2019?
H2019 is therapeutic behavioral services, per 15 minutes. It is commonly billed for behavioral intervention programs for children and adolescents.
What is H2036?
H2036 is an alcohol and/or other drug treatment program billed per diem. The state defines which levels of substance use treatment qualify for the code.
Does Medicare pay for H codes?
No. H codes were created for state Medicaid agencies, and Medicare pays behavioral health services through CPT codes such as 90791 and 90834.
Should I bill H0004 or 90837?
It depends on the payer and the clinician. Medicare and commercial plans use 90837 for sessions of 53 minutes or more, while some state Medicaid programs require H0004 in 15-minute units for agency-based counseling.
Medwave’s Behavioral Health Billing Team
Agencies that bill H codes and CPT codes side by side carry two rulebooks at once. A unit rule that works for one state’s H0036 can fail for another, and a clinician enrolled under one license type may be paid under only one of the two code sets.
Medwave has supported 15,000+ providers and keeps a 98% clean claim rate across the claims we submit. For behavioral health agencies we map each service to the code and modifier each payer expects. We also track authorizations against scheduled units so nothing is delivered past an approval. Clinician enrollment with Medicaid and commercial plans averages 85 days with our credentialing team. Send us a note below to talk through your H code and psychotherapy claims.
Disclaimer: This article is provided for informational purposes only and does not constitute legal, billing or financial advice. HCPCS and CPT codes and state Medicaid rules change, and providers should verify current requirements with each payer before billing. CPT® is a registered trademark of the American Medical Association.
Co-Founder and COO of Medwave, bringing more than 25 years of hands-on experience in healthcare revenue cycle management, payer contracting, and medical credentialing.