Summary & Overview
HCPCS Level II H0035: Mental Health Partial Hospitalization, <24 Hours
HCPCS Level II code H0035 represents mental health partial hospitalization services provided for periods shorter than 24 hours. As an ambulatory, program-based psychiatric treatment option, the code captures day-treatment models that deliver intensive, multidisciplinary care without inpatient admission. Nationally, partial hospitalization occupies a key role in the continuum of behavioral health services by offering a higher level of support than outpatient therapy while avoiding inpatient hospitalization.
Major commercial payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of coverage implications under those payers, common clinical contexts for use, and how H0035 relates to other behavioral health service codes used in ambulatory and day-treatment settings. The publication outlines coding considerations, typical sites of service, and associated service lines to help clarify documentation and billing workflows. It also highlights where input data is missing and flags items requiring payer-specific policy review.
Content is oriented to national stakeholders including billing professionals, behavioral health clinicians, and policy analysts seeking concise guidance on code definition, service setting, and practical coding relationships. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code H0035 describes mental health partial hospitalization, treatment, less than 24 hours. This service type is psychiatric partial hospitalization, providing structured, intensive mental health treatment during the day without an overnight stay. Typical sites of service include hospital outpatient departments (POS 19) and community mental health centers (POS 53). This code denotes a programmatic level of care designed to deliver multidisciplinary psychiatric services in a concentrated, non-residential setting.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a mood disorder due to a known physiological condition (F06.31) is referred to a psychiatric partial hospitalization program for intensive daytime treatment when symptoms escalate but inpatient admission is not required. The patient presents to the hospital outpatient department (POS 19) for intake evaluation in the morning, receives structured therapeutic activities, medication management, and group psychotherapy over several hours, then returns home the same day. The interdisciplinary team includes a psychiatry physician, clinical social worker, psychologist, and mental health counselor who document daily treatment, coordinate care with the referring provider, and monitor progress for possible transition to outpatient psychotherapy or higher level of care.
Coding Specifications
HCPCS Level II code H0035 represents mental health partial hospitalization, treatment, less than 24 hours. Common modifiers listed and their usage:
-
59- Distinct Procedural Service -
Use when two procedures/services not normally reported together are performed on the same day and are distinct or independent from each other.
-
76- Repeat Procedure by Same Physician -
Use when the same service is repeated by the same provider on the same day.
Associated provider taxonomies and specialties:
| Taxonomy Code | Specialty |
|---|---|
101YM0800X | Mental Health Counselor |
103T00000X | Psychologist |
1041C0700X | Clinical Social Worker |
2084P0800X | Psychiatry Physician |
Related Diagnoses
-
F06.0— Psychotic disorder with hallucinations due to known physiological condition- Clinical relevance: Psychotic symptoms such as hallucinations may prompt enrollment in partial hospitalization for stabilization and intensive day treatment under
H0035.
- Clinical relevance: Psychotic symptoms such as hallucinations may prompt enrollment in partial hospitalization for stabilization and intensive day treatment under
-
F06.2— Psychotic disorder with delusions due to known physiological condition- Clinical relevance: Delusional symptoms may require structured therapeutic programming and medication management provided in a partial hospitalization setting billed with
H0035.
- Clinical relevance: Delusional symptoms may require structured therapeutic programming and medication management provided in a partial hospitalization setting billed with
-
F06.30— Mood disorder due to known physiological condition, unspecified- Clinical relevance: Unspecified mood disorder with functional impairment can be managed with partial hospitalization services when outpatient care is insufficient.
-
F06.31— Mood disorder due to known physiological condition with depressive features- Clinical relevance: Depressive features associated with a physiological condition can be treated in a partial hospitalization program for intensive therapy and monitoring.
-
F06.32— Mood disorder due to known physiological condition with major depressive-like episode- Clinical relevance: Major depressive-like episodes often require structured, multidisciplinary day treatment available under
H0035.
- Clinical relevance: Major depressive-like episodes often require structured, multidisciplinary day treatment available under
-
F06.33— Mood disorder due to known physiological condition with manic features- Clinical relevance: Manic features may necessitate close monitoring and day-treatment interventions available through partial hospitalization.
-
F06.34— Mood disorder due to known physiological condition with mixed features- Clinical relevance: Mixed mood features can require comprehensive partial hospitalization services for stabilization and coordinated care.
-
F10.132— Alcohol abuse with withdrawal with perceptual disturbance- Clinical relevance: Withdrawal with perceptual disturbances may be managed in a partial hospitalization setting when inpatient care is not indicated, with services billed under
H0035.
- Clinical relevance: Withdrawal with perceptual disturbances may be managed in a partial hospitalization setting when inpatient care is not indicated, with services billed under
-
F10.14— Alcohol abuse with alcohol-induced mood disorder- Clinical relevance: Alcohol-induced mood disorder may be an indication for intensive day treatment and psychosocial interventions provided in partial hospitalization billed as
H0035.
- Clinical relevance: Alcohol-induced mood disorder may be an indication for intensive day treatment and psychosocial interventions provided in partial hospitalization billed as
Related Codes
| Code | Description |
|---|---|
90834 | Psychotherapy, 45 minutes with patient |
90837 | Psychotherapy, 60 minutes with patient |
90853 | Group psychotherapy |
H2012 | Behavioral health day treatment, per hour |
90834, 90837, and 90853 are psychotherapy codes used for individual or group psychotherapy sessions that may occur as components of a partial hospitalization program represented by HCPCS Level II code H0035. H2012 describes behavioral health day treatment billed per hour and can be an alternative or complementary code for hourly day treatment services. These codes are commonly used together when specific psychotherapy encounters or hourly behavioral day-treatment billing need separate reporting from the overall partial hospitalization service. Common pairings include H0035 with 90853 for documented group psychotherapy sessions during the program, or with 90834/90837 when individual psychotherapy sessions are separately documented and billed where payer policy allows.
National Reimbursement Benchmarks
National mean rates for HCPCS Level II code H0035 show that Medicare is not represented in the provided input, while BUCA (the average commercial benchmark) has a mean rate of $277.12 compared with Medicare data not available. Among commercial payers, Cigna Health reports the highest mean at $429.56, followed by UnitedHealthcare at $349.32, BUCA at $277.12, Aetna at $221.82, and Blue Cross Blue Shield at $140.27.
Rate dispersion (P75 minus P25) varies significantly by payer: Blue Cross Blue Shield shows a wide spread (231.75 - 20 = $211.75), UnitedHealthcare also shows substantial dispersion (500 - 42.33 = $457.67), while Cigna Health is the tightest with no dispersion (427 - 427 = $0.00). Aetna has moderate dispersion (268 - 151 = $117.00) and BUCA shows notable dispersion (427 - 156 = $271.00). 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.