Inpatient Facility Coding & Compliance Alert
H Codes for Non-Medicaid Cases
Question: One of our commercial insurers recently denied our claims with HCPCS codes H0035, H0019, and H2036. Our system still lists these as valid codes. What do you think the issue might be?
Delaware Subscriber
Answer: According to CMS, the H code section of HCPCS is to be used by state Medicaid agencies that are mandated by state law to establish separate codes for mental health services (including alcohol and drug treatment). Because of this directive, commercial payers and Medicare will not recognize and reimburse for codes such as H0035 (Mental health partial hospitalization, treatment, less than 24 hours), H0019 (Behavioral health; long-term residential [non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days], without room and board, per diem), and H2036 (Alcohol and/or other drug treatment program, per diem).
Instead: Consult your payer’s reimbursement policies regarding the mental health services represented by the H codes you mention. Then explain the situation to your providers to see which codes best describe the services rendered.
Inpatient Facility Coding & Compliance Alert
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