Cigna Behavioral Health
Last Updated: April 2025
Cigna's Behavioral Health fee schedules provides essential insights for behavioral health providers looking to optimize billing, streamline claims, and maximize reimbursement. Understanding these rates allows you to click-to-compare, negotiate better contracts, and ensure your practice remains financially sustainable.
Introduction
The Affordable Care Act (ACA) expanded upon the Mental Health Parity and Addiction Equity Act to strengthen behavioral health parity requirements. These parity rules are designed to ensure that mental health and substance use disorder benefits are covered at levels comparable to medical/surgical benefits. As a result, health plans are required to cover services related to Mental and Behavioral Health and Addiction Treatment.
Most services are categorized into different levels of care, as defined by The American Society for Addiction Medicine and are billed to insurance using a combination of HCPCS and Revenue Codes.
ASAM Levels with Billing Codes and Descriptions
Level 1.0 - Outpatient Services
Consists of treatment for substance use that is less than 9 hours a week. Level 1 is appropriate for people with less severe disorders, or as a step-down from more intensive services.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0001 | Alcohol and/or drug assessment | 0919 | Other behavioral health treatments | $82.99 |
| H0002 | Behavioral health screening to determine eligibility for admission to treatment program | 0919 | Other behavioral health treatments | $77.54 |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 0914 | Individual therapy | $14.98 |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | 0915 | Group therapy | $19.92 |
Level 2.1 - Intensive Outpatient Program (IOP)
Intensive outpatient services consisting of at least 9 and no more than 20 hours per week of treatment. These programs typically offer medical care 24 hours a day by phone or within 72 hours in person.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0015 | 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 | 0906 | Intensive outpatient services - chemical dependency | Click to see more |
| H2012 | Behavioral health day treatment, per hour | 0906 | Intensive outpatient services - chemical dependency | $50.68 |
| S9480 | Intensive outpatient psychiatric services, per diem | 0905 | Intensive outpatient services - psychiatric | Click to see more |
Level 2.5 - Partial Hospitalization Program (PHP)
Partial hospitalization provides at least 20 hours a week but is less than 24-hour care. This level of care provides structure, and daily oversight for people who need daily monitoring, but not 24/7 care.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0035 | Mental health partial hospitalization, treatment, less than 24 hours | 0912 | Partial hospitalization - less intensive | Click to see more |
| S0201 | Partial hospitalization services, less than 24 hours, per diem | 0913 | Partial hospitalization - intensive | Click to see more |
Level 3.1 - Clinically Managed Low-Intensity Residential Treatment
Residential services at this level consist of a setting, such as a group home, where people live. However, treatment is only required to be 5 hours per week, which helps people with such topics as relapse management.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0018 | Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem | 1002 | Residential treatment - chemical dependency | Click to see more |
| H0019 | Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 1002 | Residential treatment - chemical dependency | Click to see more |
| H2034 | Alcohol and/or drug abuse halfway house services, per diem | 1002 | Residential treatment - chemical dependency | Click to see more |
Level 3.3/3.5 - Clinically Managed Residential Services
Clinically managed high-intensity and population-specific services. These programs are targeted for providing treatment designed to move at a slower pace, for people with cognitive functioning issues, including people with traumatic brain injuries, the elderly, or people with developmental disabilities.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0010 | Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) | 1002 | Residential treatment - chemical dependency | Click to see more |
| H0011 | Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) | 1002 | Residential treatment - chemical dependency | Click to see more |
| H0047 | Alcohol and/or other drug abuse services, not otherwise specified | 1002 | Residential treatment - chemical dependency | $21.00 |
Level 3.7 - Medically Monitored High-Intensity Inpatient Treatment
These services are for people who need intensive medical or psychological monitoring in a 24-hour setting but do not need daily physician interaction.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H2036 | Alcohol and/or other drug treatment program, per diem | 0944 | Drug rehabilitation | Click to see more |
| S9976 | Lodging, per diem, not otherwise classified | 1002 | Residential treatment - chemical dependency | $127.21 |
Level 4.0 - Medically Managed Intensive Inpatient Services
Provides 24-hour nursing care and daily physician visits. People in this level of care need daily physician monitoring, along with 24-hour oversight.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 0944 | Drug rehabilitation | $12.22 |
| H2037 | Developmental delay prevention activities, dependent child of client, per 15 minutes | 0944 | Drug rehabilitation | $159.00 |
Other service categories
Case Management
Support services for coordinating care and treatment plans
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| H0038 | Self-help/peer services, per 15 minutes | 0919 | Other behavioral health treatments | $62.82 |
| T1023 | Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter | 0919 | Other behavioral health treatments | $1,846.67 |
MAT (Medication-Assisted Treatment) Services
Medication-assisted treatment services for substance use disorders
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| J0571 | Buprenorphine, oral, 1 mg | 0636 | Drugs requiring detailed coding | $0.70 |
| J0572 | Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine | 0636 | Drugs requiring detailed coding | $4.79 |
| J0573 | Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine | 0636 | Drugs requiring detailed coding | $9.36 |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | 0636 | Drugs requiring detailed coding | $9.37 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99214. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99214 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.
View behavioral health fee schedules for other major payers
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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