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See a sample rate comparisonHCPCS H0004 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Behavioral health counseling and therapy, per 15 minutes
| Key Fact | Detail |
|---|---|
| Service Type | Alcohol and Drug Abuse Treatment Drug, Alcohol, and Behavioral Health Services |
| Common Place of Service | 11 - Office 53 - Community Mental Health Center 99 - Other POS |
| Complexity Level | Low |
| ASAM Level | Level 1 - Outpatient Services |
| Care Type | Treatment |
| Setting | Outpatient |
| Revenue Code | |
| Medicaid Fee Schedule | View Medicaid rates for H0004 |
National average reimbursement for HCPCS H0004 by major payers:
$30.63
$20.01
$14.98
$14.98
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HCPCS H0004
5 of 25 sample ratesHigher to lower in this preview
Maria Emma Francisco Solon
$23.14Published rateRamneesh Baweja
Main Line Healthcare
$21.87Published rateKashif Malik
Alamance Regional Medical Center
$17.00Published rateLindsey Hayes
Folium Inc
$15.00Published rateAngela Jacobs
$15.00Published rate
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See a sample payer proposalHCPCS H0004 vs. Other Drug, Alcohol, and Behavioral Health Services Codes
The HCPCS H0004 code is part of the Alcohol and Drug Abuse Treatment services used for Drug, Alcohol, and Behavioral Health Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS H0004 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| H0003-HCPCS | Low | Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs |
| H0004-HCPCS | Low | Behavioral health counseling and therapy, per 15 minutes |
| H0005-HCPCS | Low | Alcohol and/or drug services; group counseling by a clinician |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS H0004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the H0004 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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