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See a sample rate comparisonHealthcare 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.
| Key Fact | Detail |
|---|---|
| Service Type | Alcohol and Drug Abuse Treatment Drug, Alcohol, and Behavioral Health Services |
| Common Place of Service | None 53 - Community Mental Health Center |
| Complexity Level | Low |
| ASAM Level | Level 3.7 - Medically Managed Residential |
| Care Type | Withdrawal Mgmt |
| Setting | Residential |
| Revenue Code | |
| Medicaid Fee Schedule | View Medicaid rates for H0011 |
National average reimbursement for HCPCS H0011 by major payers:

$69.95

$124.87

$295.03

$228.02
Choose a payer to see a sample of rates for HCPCS H0011.
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalHCPCS H0011 vs. Other Drug, Alcohol, and Behavioral Health Services Codes
The HCPCS H0011 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 H0011 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 |
|---|---|---|
| H0010-HCPCS | Low | Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) |
| H0011-HCPCS | Low | Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) |
| H0012-HCPCS | Low | Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS H0011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the H0011 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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