New York Commercial reimbursement
Behavioral Health Facilities reimbursement rates in New York
Compare price transparency averages for HCPCS H0015, HCPCS H0035 and HCPCS H2036 across Aetna, Anthem and Cigna. Preview New York medians, rate ranges and named provider rates for free.
Price transparency averages
New York averages by payer
| Service | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
| HCPCS H0015Substance-use intensive outpatient treatment | $226.87 | $197.05 | Not available | $124.84 |
| HCPCS H0035Mental health partial hospitalization, less than 24 hours | $375.67 | Not available | Not available | Not available |
| HCPCS H2036Alcohol or drug treatment program, per diem | $468.52 | Not available | Not available | Not available |
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HCPCS H0015 - Substance-use intensive outpatient treatment
| Payer | New York | National | Difference |
|---|---|---|---|
| Aetna | $226.87 | $155.02 | +46.3% |
| Cigna | $197.05 | $233.80 | -15.7% |
| Anthem | $124.84 | $168.60 | -26.0% |
HCPCS H0035 - Mental health partial hospitalization, less than 24 hours
| Payer | New York | National | Difference |
|---|---|---|---|
| Aetna | $375.67 | $281.65 | +33.4% |
HCPCS H2036 - Alcohol or drug treatment program, per diem
| Payer | New York | National | Difference |
|---|---|---|---|
| Aetna | $468.52 | $357.83 | +30.9% |
Sources and methodology
Averages calculated by PayerPrice from health plan price transparency files.
- Rate source
- The displayed amount is a negotiated facility or program rate published in a payer machine-readable file
- Not a paid claim, billed charge, or utilization-based estimate.
- Rate calculation
- National values summarize eligible published records across available states.
- State views use records associated with the selected state, and averages are not weighted by patient or service volume.
- The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities.
- Tied boundary values stay together, so fewer rates may be removed.
- A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming.
- A missing benchmark does not mean the rate is zero.
- Provider entity
- Named examples use payer-file billing entities and may represent a treatment facility, operating organization, health system, or other contracted entity.
- Each NPI and TIN combination contributes one representative rate: its most frequent normalized value.
- When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Match the level of care, code system, program definition, setting, payment unit, payer product, and network.
- Per-service, per-diem, and inpatient case rates should remain separate.
- Benchmarks keep the payer, service code, geography, reporting period and billing unit separate.
- Different services or payment units are not blended into one rate.
Published negotiated rates are not claim payments or a provider's verified contract.
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