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See a sample rate comparisonHCPCS T1040 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.
Medicaid certified community behavioral health clinic services, per diem
| Key Fact | Detail |
|---|---|
| Service Type | National Codes Established for State Medicaid Agencies Behavioral Health Services |
| Common Place of Service | 11 - Office None 53 - Community Mental Health Center |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for T1040 |
National average reimbursement for HCPCS T1040 by major payers:
$75.95
$140.00
$115.54
$128.52
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HCPCS T1040
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See a sample payer proposalHCPCS T1040 vs. Other Behavioral Health Services Codes
The HCPCS T1040 code is part of the National Codes Established for State Medicaid Agencies services used for 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 T1040 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 |
|---|---|---|
| T1033-HCPCS | Low | Services performed by a doula birth worker, per diem |
| T1040-HCPCS | Low | Medicaid certified community behavioral health clinic services, per diem |
| T1041-HCPCS | Moderate | Medicaid certified community behavioral health clinic services, per month |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T1040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T1040 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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