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See a sample rate comparisonHCPCS H1003 Fee Schedule
Last Verified: September 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.
Prenatal care, at-risk enhanced service; education
| Key Fact | Detail |
|---|---|
| Service Type | Alcohol and Drug Abuse Treatment Prenatal Care and Family Planning Assessment |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for H1003 |
National average reimbursement for HCPCS H1003 by major payers:
$53.88
$44.22
$18.34
$22.21
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HCPCS H1003
5 of 12 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateRehabcare Group East, LLC, Rehabcare
$60.00Published rateRehabcare Group East, LLC, Rehabcare
$40.00Published rateRehabcare Group East, LLC, Rehabcare
$35.00Published ratePremise Health Of Texas Medical, P.A, Ross Avenue Health Center
$8.00Published rate
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See a sample payer proposalHCPCS H1003 vs. Other Prenatal Care and Family Planning Assessment Codes
The HCPCS H1003 code is part of the Alcohol and Drug Abuse Treatment services used for Prenatal Care and Family Planning Assessment. 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 H1003 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 |
|---|---|---|
| H1002-HCPCS | Low | Prenatal care, at risk enhanced service; care coordination |
| H1003-HCPCS | Low | Prenatal care, at-risk enhanced service; education |
| H1004-HCPCS | Low | Prenatal care, at-risk enhanced service; follow-up home visit |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS H1003. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the H1003 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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