HCPCS H0016 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Alcohol and Drug Abuse Treatment • Drug, Alcohol, and Behavioral Health Services |
| Common Place of Service | • 11 - Office • None • 10 - Telehealth in Patient's Home |
| Complexity Level | Low |
National average reimbursement for HCPCS H0016 by major payers:
$144.85
$131.28
$39.73
$99.17
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS H0016 | ||||||
United | H0016 | $60.00 | 1558458273 - CONCEPTS IN REHAB INC | 650655320 - CONCEPTS IN REHAB INC | FL | Comprehensive Outpatient Rehabilitation Facility (CORF) (261QR0401X) |
United | H0016 | $60.00 | 1285680660 - SOLEX LLC | 203392467 | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $35.00 | 1821030115 - GENESIS HEALTH DEVELOPMENT INC | 592249372 - GENESIS HEALTH DEVELOPMENT INC | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $40.00 | 1215956479 - PHYSIOTHERAPY ASSOCIATES INC | 382617193 | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $60.00 | 1780964973 - NOKOMIS PHYSICAL THERAPY LLC | 453032106 - NOKOMIS PHYSICAL THERAPY LLC | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $40.00 | 1700819976 - CORA HEALTH SERVICES INC | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $40.00 | 1427614783 - CORA HEALTH SERVICES, INC. | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $55.00 | 1144288986 - FLORIDA THERAPY CENTER OF MELBOURNE LLC | 30453497 - FLORIDA THERAPY CENTER OF MELBOURNE LLC | FL | Comprehensive Outpatient Rehabilitation Facility (CORF) (261QR0401X) |
United | H0016 | $40.00 | 1679517908 - REHAB GV INC | 593408604 - REHAB G. V.. INC. | FL | Comprehensive Outpatient Rehabilitation Facility (CORF) (261QR0401X) |
United | H0016 | $35.00 | 1184795957 - H2 REHABILITATION SERVICES OF FLORIDA LLC | 592504386 | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $55.00 | 1861643132 - TENDER CARE MEDICAL SERVICES, INC. | 30385189 - TENDER CARE MEDICAL SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $35.00 | 1740864164 - GENESIS HEALTH DEVELOPMENT, INC. | 592249372 - GENESIS HEALTH DEVELOPMENT INC | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $40.00 | 1396778577 - CORA HEALTH SERVICES INC | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $40.00 | 1437661683 - CORA HEALTH SERVICES INC | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | H0016 | $40.00 | 1124051305 - CORA HEALTH SERVICES INC | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS H0016 vs. Other Drug, Alcohol, and Behavioral Health Services Codes
The HCPCS H0016 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 H0016 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 |
|---|---|---|
| H0015-HCPCS | Low | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education |
| H0016-HCPCS | Low | Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) |
| H0017-HCPCS | Low | Behavioral health; residential (hospital residential treatment program), without room and board, per diem |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS H0016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the H0016 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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