Billing Code Overview

HCPCS Level II code H2036 represents Alcohol and/or other drug treatment program, per diem. This code is used to bill for daily rates associated with structured substance use disorder treatment programs that provide a range of therapeutic, counseling, and support services delivered on a per‑day basis.

Service Type: Other Mental Health and Community Support Services

Typical Site of Service: Community Mental Health Center (POS 53)

Data not available in the input for service line details.

Clinical Context

A 38-year-old patient with a history of alcohol dependence (F10.20) presents to a Community Mental Health Center (Place of Service 53) and is admitted to a residential-style alcohol and/or other drug treatment program billed per diem. The clinical workflow includes initial intake assessment by an addiction counselor or clinical social worker, daily individual and group therapy sessions provided by addiction specialists and licensed behavioral health clinicians, medication management or psychiatric evaluation by a psychiatry physician or psychiatric/mental health nurse practitioner as needed, and ongoing care coordination. Billing uses the per diem HCPCS Level II code H2036 to capture the daily comprehensive program services, with documentation of daily participation, treatment plan updates, and clinical progress notes.

Coding Specifications

• Common Modifiers:

• HF: Use when the service is provided by a certified Substance Abuse Program and payer rules require program identification.

• U1: Use to indicate Medicaid Level of Care 1 when state Medicaid eligibility criteria specify this level for coverage of per diem treatment services.

• Provider Taxonomies (specialties represented):

• 101YA0400X — Addiction (Substance Use Disorder) Counselor

• 103T00000X — Psychologist

• 1041C0700X — Clinical Social Worker

• 2084P0800X — Psychiatry Physician

• 163WP0808X — Psychiatric/Mental Health Nurse Practitioner

Related Codes

• H2035 — Alcohol and/or drug treatment program, per hour

  H2035 is an hourly alternative to the per diem H2036 when services are billed based on documented hours of active treatment rather than a full day.

• H0034 — Alcohol and/or drug abuse halfway house services, per diem

  H0034 represents residential halfway house per diem services and may be used for step‑down or transitional housing as a clinical continuation or alternative to H2036.

• H0047 — Alcohol and/or Drug abuse services, not otherwise specified

  H0047 is used for services that do not fit specific procedure codes and may be billed when program services differ from the structured per diem captured by H2036.

• H0010 — Alcohol and/or drug services; Sub‑acute detox (residential addiction program inpatient)

  H0010 denotes sub‑acute inpatient detoxification services and is clinically distinct from per diem outpatient or community program billing under H2036 but may occur earlier in the care pathway.

• H0011 — Alcohol and/or drug services; acute detox (residential addiction program inpatient)

  H0011 denotes acute inpatient detoxification services and is an alternative inpatient level of care preceding or separate from per diem program services billed with H2036.

• S9475 — Ambulatory Setting substance abuse treatment or detoxification services per diem

  S9475 is a per diem ambulatory setting code and may be used as an alternative to H2036 depending on facility classification and payer requirements.

• H0020 — Alcohol and/or drug services; methadone administration and/or service (provisions of the drug by a licensed program)

  H0020 describes medication administration services (methadone) provided by a licensed program and may be billed in conjunction with or separately from the comprehensive per diem program H2036 depending on payer rules and documentation.

Related Diagnoses

• F10.20 — Alcohol dependence, uncomplicated

  Relevant because alcohol dependence is a primary condition commonly treated in per diem alcohol/drug treatment programs billed with H2036.

• F11.20 — Opioid dependence, uncomplicated

  Relevant because opioid dependence is treated in outpatient or residential substance use treatment programs and may be included in daily program services.

• F12.20 — Cannabis dependence, uncomplicated

  Relevant because cannabis dependence can be a primary diagnosis for participation in structured per diem treatment programs.

• F19.20 — Other psychoactive substance dependence, uncomplicated

  Relevant because dependence on other psychoactive substances is managed within comprehensive per diem treatment programs.

• F10.21 — Alcohol dependence, in remission

  Relevant because patients in remission may still receive per diem continuing care, relapse prevention, or step‑down services within a treatment program.

National mean rates for HCPCS Level II code H2036 show substantial differences between Medicare and the average commercial benchmark (BUCA). The BUCA average commercial mean rate is $273.75, which is higher than the Medicare mean rate reported here ($0.00) based on the provided input values; BUCA therefore exceeds Medicare in mean pricing for this code in the available data. The table and chart below present the full breakdown.

Rate dispersion varies markedly across payers. Blue Cross Blue Shield exhibits the widest spread (P75–P25 = $388.00), indicating high variability, while Cigna Health is the tightest with no dispersion (P75–P25 = $0.00). Aetna and BUCA show moderate dispersion (Aetna P75–P25 = $101.80; BUCA P75–P25 = $263.00). The table and chart below present the full breakdown.