Summary & Overview
HCPCS Level II H0031: Mental Health Assessment by Non-Physician
Headline: HCPCS Level II code H0031: Mental Health Assessment by Non-Physician
Lead: HCPCS Level II code H0031 denotes a mental health assessment performed by a non-physician clinician, a foundational service in community-based behavioral health care. This code captures the assessment encounter used to evaluate psychiatric symptoms, functioning, and care needs when delivered outside physician-led settings.
What the code represents and why it matters: H0031 documents non-physician-led mental health assessments that inform treatment planning, care coordination, and access to behavioral health services. Nationally, clear use of this code supports tracking of outpatient behavioral health capacity and ensures appropriate service classification in community mental health and similar settings.
Key payers covered: Analysis and guidance address major national commercial payers: Aetna; Blue Cross Blue Shield (BCBS) plans; Cigna Health; and UnitedHealthcare. Coverage policies and billing rules among these payers influence utilization and claims processing for non-physician assessment services.
Overview of reader takeaways: Readers will learn the clinical and billing context for H0031, typical sites of service, common documentation expectations, common associated diagnoses, and how this code relates to closely associated services used in behavioral health workflows. The publication clarifies which encounter this code represents, highlights payor coverage considerations, and presents relevant clinical scenarios where the assessment code is commonly applied.
Data gaps: Service-line metadata is not provided. Data not available in the input.
Billing Code Overview
HCPCS Level II code H0031 describes a mental health assessment provided by a non-physician. The service is classified under Behavioral Health and is typically delivered in a Community Mental Health Center (POS 53). This code documents the assessment encounter itself and is used to record the professional activity of a qualified non-physician clinician conducting an initial or follow-up mental health evaluation.
Clinical & Coding Specifications
Clinical Context
A 29-year-old patient presents to a Community Mental Health Center (POS 53) requesting evaluation for worsening mood and anxiety after recent job loss. The intake is scheduled with a non-physician behavioral health clinician (master's-level mental health counselor) who completes a comprehensive mental health assessment lasting 45–60 minutes. The assessment includes standardized screening instruments, clinical interview covering history of present illness, psychiatric history, substance use, risk assessment, functional status, and summary recommendations for treatment planning. The clinician documents findings, assigns provisional diagnoses, and communicates results to the treatment team for service planning. Telehealth may be used when appropriate with interactive audio and video systems.
Coding Specifications
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HCPCS Level II code
H0031: Mental health assessment, by non-physician. -
Common Modifiers
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GT— Via interactive audio and video telecommunication systems: Use when the assessment is delivered synchronously by interactive audio and video technology. -
HO— Master's degree level: Use to indicate the service was provided by a clinician whose highest qualifying credential is a master’s degree. -
Associated Provider Taxonomies
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101YM0800X— Mental Health Counselor: Providers with this taxonomy typically perform psychotherapy, assessments, and counseling services in behavioral health settings. -
1041C0700X— Clinical Social Worker: Providers with this taxonomy perform psychosocial assessments, case management, and psychotherapy in clinical and community settings. -
103T00000X— Psychologist: Providers with this taxonomy perform psychological testing, diagnostic assessment, and therapeutic interventions.
Related Diagnoses
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F32.9— Major depressive disorder, single episode, unspecifiedRelevance: Depression is a common presenting problem evaluated during a mental health assessment; symptoms inform severity assessment and treatment planning.
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F41.1— Generalized anxiety disorderRelevance: Anxiety symptoms are assessed for impact on functioning and to guide therapeutic recommendations.
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F43.23— Adjustment disorder with mixed anxiety and depressed moodRelevance: Adjustment disorders are identified during assessment when symptoms follow a psychosocial stressor and influence the recommended level of care.
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F84.0— Autistic disorderRelevance: Developmental disorders are considered during assessment to capture baseline functioning, communication needs, and tailored interventions.
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F90.9— Attention-deficit hyperactivity disorder, unspecified typeRelevance: ADHD symptoms are evaluated for attentional and behavioral patterns that affect treatment choices and support needs.
Related Codes
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H0032— Mental health service plan development by non‑physician: Typically follows an assessment coded withH0031and documents the individualized service plan derived from the assessment findings. Often used together in the same episode of care. -
H0033— Oral medication administration, direct observation: May be used in workflow when the assessment identifies a need for observed medication administration; serves a different service purpose but can be part of the overall treatment plan derived fromH0031.
National Reimbursement Benchmarks
National mean rates for HCPCS Level II code H0031 show that BUCA (average commercial) mean ($127.03) is substantially higher than Medicare (no Medicare mean provided in the input). Cigna Health reports the highest reported mean ($256.78), while Aetna reports the lowest mean ($36.81). The table and chart below present the full breakdown of national mean rates and percentiles.
Rate dispersion (P75 minus P25) varies notably by payer. Cigna Health has zero dispersion in the input (P75−P25 = 0), indicating the tightest reported distribution among provided values. Blue Cross Blue Shield and BUCA show wide dispersion (BCBS P75−P25 = 121.5; BUCA P75−P25 = 157), indicating broader variability. Aetna and UnitedHealthcare have relatively tighter spreads (Aetna P75−P25 = 6; UnitedHealthcare P75−P25 = 13.5). The table and chart below present the full breakdown.
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