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See a sample rate comparisonHCPCS T1012 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.
Alcohol and/or substance abuse services, skills development
| Key Fact | Detail |
|---|---|
| Service Type | National Codes Established for State Medicaid Agencies Alcohol and Substance Abuse Services |
| Common Place of Service | None 53 - Community Mental Health Center 11 - Office |
| Complexity Level | Low |
| ASAM Level | Level 1 - Outpatient Services |
| Care Type | Treatment |
| Setting | Outpatient |
| Medicaid Fee Schedule | View Medicaid rates for T1012 |
National average reimbursement for HCPCS T1012 by major payers:
$68.72
$51.64
$4.64
$4.86
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HCPCS T1012
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See a sample payer proposalHCPCS T1012 vs. Other Alcohol and Substance Abuse Services Codes
The HCPCS T1012 code is part of the National Codes Established for State Medicaid Agencies services used for Alcohol and Substance Abuse 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 T1012 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 |
|---|---|---|
| T1010-HCPCS | Low | Meals for individuals receiving alcohol and/or substance abuse services (when meals not included in the program) |
| T1012-HCPCS | Low | Alcohol and/or substance abuse services, skills development |
| T1013-HCPCS | Low | Sign language or oral interpretive services, per 15 minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T1012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T1012 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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