Summary & Overview
HCPCS Level II H2035: Alcohol and/or Other Drug Treatment Program, Per Hour
HCPCS Level II code H2035 designates an hour-based service for alcohol and/or other drug treatment programs delivered in community behavioral health settings. Nationally, this code is an important billing mechanism for time-based substance use disorder treatment outside of inpatient or facility-per-diem models, supporting continuity of care in community mental health centers and similar programs. Major commercial payers included in coverage considerations are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will gain a concise understanding of what H2035 represents clinically and operationally, how it is used alongside related service codes and per-diem alternatives, common sites of service, and typical clinical contexts where it applies. The publication also summarizes matching diagnosis contexts, associated provider taxonomies, commonly billed modifiers, and related HCPCS and CPT/other codes used in substance use disorder program billing. Where input data is incomplete, the text notes "Data not available in the input." This piece is intended to inform coding, claims review, and benefit design discussions at a national level rather than provide clinical guidance or payer-specific policy rules.
Billing Code Overview
HCPCS Level II code H2035 describes an alcohol and/or other drug treatment program billed per hour. This service falls under Other Mental Health and Community Support Services and is commonly provided in a Community Mental Health Center (POS 53). The code represents time-based, structured treatment services focused on substance use disorder care delivered in a community setting.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a primary diagnosis of F11.20 (opioid dependence, uncomplicated) presents to a Community Mental Health Center (Place of Service 53) for structured outpatient substance use treatment. The patient attends scheduled one-hour individual counseling sessions focused on relapse prevention, medication adherence review, and coordination with a prescribing clinician. Billing is performed per hour using HCPCS Level II code H2035 for the time-based treatment program. Sessions may occur in individual or group formats and are documented with start and stop times, treatment goals, interventions provided, and the treating provider’s taxonomy and credentials.
Coding Specifications
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Common modifiers and use cases:
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HQ: Use when services are provided in a group setting (group-based program hour). -
U1: Use to indicate Medicaid Level of Care 1 when payer policy requires level of care reporting. -
U2: Use to indicate Medicaid Level of Care 2 when payer policy requires level of care reporting. -
U3: Use to indicate Medicaid Level of Care 3 when payer policy requires level of care reporting. -
Associated provider taxonomies and specialties:
| Taxonomy Code | Specialty |
|---|---|
101YA0400X | Addiction (Substance Use Disorder) Counselor |
103T00000X | Psychologist |
1041C0700X | Clinical Social Worker |
101Y00000X | Counselor |
2084P0800X | Psychiatry & Neurology Physician |
Related Diagnoses
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F10.20— Alcohol dependence, uncomplicated- Clinical relevance: Alcohol dependence is a common primary diagnosis for enrollment in an alcohol and/or other drug treatment program billed with HCPCS Level II code
H2035.
- Clinical relevance: Alcohol dependence is a common primary diagnosis for enrollment in an alcohol and/or other drug treatment program billed with HCPCS Level II code
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F11.20— Opioid dependence, uncomplicated- Clinical relevance: Opioid dependence frequently requires structured outpatient treatment hours such as those billed with HCPCS Level II code
H2035for counseling and care coordination.
- Clinical relevance: Opioid dependence frequently requires structured outpatient treatment hours such as those billed with HCPCS Level II code
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F12.20— Cannabis dependence, uncomplicated- Clinical relevance: Cannabis dependence can be managed in outpatient treatment programs where therapeutic hours are billed under HCPCS Level II code
H2035.
- Clinical relevance: Cannabis dependence can be managed in outpatient treatment programs where therapeutic hours are billed under HCPCS Level II code
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F19.20— Other psychoactive substance dependence, uncomplicated- Clinical relevance: Dependence on other psychoactive substances is addressed in multi-substance treatment programs billed per hour with HCPCS Level II code
H2035.
- Clinical relevance: Dependence on other psychoactive substances is addressed in multi-substance treatment programs billed per hour with HCPCS Level II code
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F10.10— Alcohol abuse, uncomplicated- Clinical relevance: Alcohol abuse without dependence may still receive time-based treatment services billed with HCPCS Level II code
H2035when program interventions are provided.
- Clinical relevance: Alcohol abuse without dependence may still receive time-based treatment services billed with HCPCS Level II code
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F11.10— Opioid abuse, uncomplicated- Clinical relevance: Opioid abuse presentations are treated in outpatient program hours that correspond to HCPCS Level II code
H2035for counseling and support services.
- Clinical relevance: Opioid abuse presentations are treated in outpatient program hours that correspond to HCPCS Level II code
Related Codes
| Code | Description |
|---|---|
H2036 | Alcohol and/or other drug treatment program, per diem |
H2034 | Alcohol and/or drug abuse halfway house services, per diem |
H0047 | Alcohol and/or other drug abuse services, not otherwise specified |
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Relationship to HCPCS Level II code
H2035: -
H2036: A per diem alternative to the hourly billed HCPCS Level II codeH2035; used when payers reimburse on a daily program rate rather than by the hour. -
H2034: Used for residential halfway house services and functions as a different level-of-care setting compared with the outpatient/hourly program billed withH2035. -
H0047: A miscellaneous service code for alcohol and/or other drug abuse services; may be used when the service does not fit the specific hourly program definition ofH2035or when documentation supports a non-specific service designation. -
Common usage patterns:
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H2035is commonly billed for discrete hourly outpatient treatment sessions;H2036may be billed instead when the program is structured and reimbursed on a per-diem basis.H2034is used for residential halfway house care and is not typically billed withH2035for the same days of service.H0047can be used as an alternative when the service description aligns more closely with an unspecified treatment service.
National Reimbursement Benchmarks
National mean rates for HCPCS Level II code H2035 show a clear gap between Medicare and the BUCA commercial average: Medicare is represented as $0.00 in the input, while the BUCA (average commercial) mean is $52.55. UnitedHealthcare reports the highest mean at $109.81, well above the BUCA and other commercial payers.
Rate dispersion (P75 minus P25) varies across payers. UnitedHealthcare has the widest dispersion (84.00 - 42.33 = 41.67), indicating greater variability. Blue Cross Blue Shield and Aetna have moderate dispersion (27.8 and 0.5 respectively, with Aetna being the tightest among those listed), while Cigna Health shows no dispersion in the provided percentiles (32 - 32 = 0), indicating the tightest distribution. The table and chart below present the full breakdown.
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