Summary & Overview
HCPCS Level II H0017: Behavioral Health Residential Treatment, Per Diem
HCPCS Level II code H0017 denotes per diem behavioral health services delivered in a hospital residential treatment program, excluding room and board. Nationally, this code captures a core category of inpatient-style, structured care for individuals with substance use disorders and related behavioral health needs. Clarity about its scope matters for coverage determinations, benefit design, and utilization monitoring across commercial and managed care plans.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication outlines how H0017 is used in practice, common clinical contexts where it applies, and its relationship to other residential treatment codes. Readers will find benchmarks for service type and site of care, a concise clinical context for typical diagnoses associated with residential treatment, and crosswalks to related service codes for care pathway mapping.
The analysis is intended for a national audience of payers, provider billing staff, and policy analysts. It highlights where H0017 fits within the continuum of substance use disorder treatment, summarizes typical use cases, and identifies areas where additional documentation or coding clarity is often needed. Data not provided in the input are noted explicitly.
Billing Code Overview
HCPCS Level II code H0017 describes behavioral health residential treatment services provided on a per diem basis, specifically for a hospital residential treatment program without room and board. The service type is behavioral health / substance abuse residential treatment, and the typical site of service is a Residential Substance Abuse Treatment Facility (Place of Service 55).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient with a primary diagnosis of F11.20 (opioid dependence, uncomplicated) is admitted to a residential substance abuse treatment facility (Place of Service 55) for per diem behavioral health services. The patient requires structured daily therapeutic programming, group and individual counseling, medication management oversight, and monitoring for withdrawal or relapse risk. Admissions are typically initiated after an emergency department referral, outpatient assessment (e.g., using H0001), or through coordinating community providers; the clinical workflow includes initial intake and assessment, individualized treatment planning, daily therapeutic sessions, periodic multidisciplinary team reviews, and discharge planning with community referrals and aftercare.
Coding Specifications
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HCPCS Level II code
H0017: Behavioral health; residential (hospital residential treatment program), without room and board, per diem. -
Common Modifiers:
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HF- Substance Abuse Program: Used to indicate services provided within a recognized substance abuse program when payer-specific rules require program identification. -
U1- Medicaid Level of Care 1: Used to indicate the Medicaid-specified level of care for the patient when required by the payer for authorization or payment determination. -
Provider Taxonomies and Specialties:
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101YA0400X- Addiction Counselor: Represents licensed professionals providing addiction counseling and psychosocial interventions in residential settings. -
103TP2701X- Psychologist, Addiction (Substance Use Disorder): Represents psychologists specializing in assessment and psychotherapy for substance use disorders. -
2084P0800X- Psychiatry & Neurology, Addiction Psychiatry: Represents psychiatrists with addiction psychiatry training who provide medication management and complex psychiatric care.
Related Diagnoses
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F10.20- Alcohol dependence, uncomplicated- Clinical relevance: Alcohol dependence is a primary substance use disorder diagnosis that commonly justifies admission to a residential treatment program billed with
H0017for daily therapeutic services.
- Clinical relevance: Alcohol dependence is a primary substance use disorder diagnosis that commonly justifies admission to a residential treatment program billed with
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F11.20- Opioid dependence, uncomplicated- Clinical relevance: Opioid dependence often requires structured residential care for stabilization, counseling, and medication-assisted treatment oversight in a residential program billed as
H0017.
- Clinical relevance: Opioid dependence often requires structured residential care for stabilization, counseling, and medication-assisted treatment oversight in a residential program billed as
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F12.20- Cannabis dependence, uncomplicated- Clinical relevance: Cannabis dependence may be managed in residential treatment when outpatient care is insufficient;
H0017covers the per diem behavioral health services in a hospital residential program.
- Clinical relevance: Cannabis dependence may be managed in residential treatment when outpatient care is insufficient;
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F13.20- Sedative, hypnotic or anxiolytic dependence, uncomplicated- Clinical relevance: Dependence on sedatives or anxiolytics can require monitored residential care for safe tapering and counseling, aligning with services billed under
H0017.
- Clinical relevance: Dependence on sedatives or anxiolytics can require monitored residential care for safe tapering and counseling, aligning with services billed under
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F14.20- Cocaine dependence, uncomplicated- Clinical relevance: Cocaine dependence may necessitate residential behavioral interventions and monitoring provided under a hospital residential treatment program billed with
H0017.
- Clinical relevance: Cocaine dependence may necessitate residential behavioral interventions and monitoring provided under a hospital residential treatment program billed with
Related Codes
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H0018- Alcohol and/or drug services; short-term residential (non-hospital residential treatment program), without room and board, per diem- Relationship:
H0018describes short-term non-hospital residential care and is an alternative toH0017when services are provided in a non-hospital residential program with shorter expected stays.
- Relationship:
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H0019- Alcohol and/or drug services; 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- Relationship:
H0019applies when the residential stay is typically longer than 30 days and serves as an alternative toH0017for non-hospital long-term programs.
- Relationship:
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H2036- Alcohol and/or other drug treatment program, per diem- Relationship:
H2036may be used for per diem alcohol and other drug treatment programs and can be used in different programmatic settings; it may be an alternative per-diem billing code depending on program type and payer instructions.
- Relationship:
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H0001- Alcohol and/or drug assessment- Relationship:
H0001is commonly used at intake to document assessment and helps determine appropriate placement (e.g., hospital residentialH0017) and level of care prior to per diem residential billing.
- Relationship:
National Reimbursement Benchmarks
National commercial averages for HCPCS Level II code H0017 show substantial separation between Medicare and average commercial (BUCA). BUCA's mean rate of $476.41 is markedly higher than Medicare (Medicare value not provided in the input, shown as $0.00 here for reference), while Aetna's mean of $683.11 exceeds BUCA, indicating variability across commercial payers.
Dispersion measured as the difference between the 75th and 25th percentiles varies by payer. Aetna and BUCA exhibit wide dispersion (both with P75–P25 = $221.57 and $562.50 respectively), Blue Cross Blue Shield shows a moderate spread (P75–P25 = $42.00), and Cigna Health and UnitedHealthcare are comparatively tighter (P75–P25 = $26.50 and $55.99 respectively). The table and chart below present the full breakdown.
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.